Classifying Diabetes; or, Commensurating Bodies of Unequal Experience
It is a commonly known fact that there are two types of diabetes, type 1 (also called juvenile diabetes) and type 2 (also called adult onset diabetes). This medical classification is not without functional value both for diabetes prevention programs and for clinical treatments of the disease and the wide range of symptoms that often ensue, including loss of limb use, internal organ failure, sensory and vision loss, and—for male diabetics—erectile dysfunction. The classification establishes a formal commensurability among diabetics—both type 1 and type 2 diabetics are, precisely, diabetics—that at times serves to efface profound social and economic inequalities underlying incidence of the disease. Indeed, contemporary efforts to treat and prevent diabetes may actually deepen social inequalities because of how they use this classification. Given the rising prevalence of diabetes, a critical analysis of its socioeconomic contexts and the organization of medical knowledge about it is needed.
This essay picks apart the “typing” of people entailed in diabetes classification.1 I contend that diabetes classification establishes the semblance of equality, in the sense of sameness in kind and worth, but actually reproduces inequality. The application of biomedical expertise and technologies renders diabetic bodies commensurate, even as individual diabetics face profoundly different circumstances of life and death. In the aggregate, the very different prospects of different diabetics hinge on the organization of material resources along with cultural knowledge. If “the power of a particular form of communication to commensurate morally and epistemologically divergent social groups lies at the heart of liberal hopes for a non-violent democratic form of governmentality,”2 then medicine is surely as significant as the law in the modern-day politics by which inequality is acknowledged, obscured, or contested.3 The case of diabetes suggests that inequality is reproduced through dynamic interchanges between biomedical and broader social logics, including the espousal of equality as a social ideal. The concluding section of the essay outlines what a progressive politics that engaged these inequalities might look like.
Typing Diabetes: A Historical Overview
Diabetes comes from a Greek word meaning “to run through” or “to siphon.” The ancient Greeks understood diabetes as a condition in which food runs through the body instead of fueling it, eventually causing the flesh to melt down into urine.4 In the early 1700s, a physician noted the sweet taste of the urine produced by most, but not all, people classified as having diabetes, giving rise to the distinction between diabetes mellitus and diabetes insipidus.5 In Latin, mellitus means “honey” and insipidus means “lacking flavor.” Today it is known that the hormone involved in diabetes insipidus is not insulin, but rather ADH (antidiruetic hormone), which regulates the production of urine. In current popular as well medical usage, “diabetes” on its own refers to diabetes mellitus. Still, the very existence of the category “diabetes insipidus” underscores both how diabetes classificatory schemas have grouped together people with very different bodily conditions and how the grounds for defining diabetes as a disease in the Western medical tradition have shifted over time.
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Notes
I would like to thank John Clarke, Spencer Moore, reviewers for Public Culture, and especially Beth Povinelli for their feedback on previous versions of this essay. I also owe a special word of thanks to James Rizzo for editing the manuscript. This essay is based on research conducted while I was a doctoral student in anthropology at McGill University and a postdoctoral researcher with the Groupe de recherche interdisciplinaire en santé at the Université de Montréal. My studies were supported by a doctoral fellowship from the Social Sciences and Humanities Research Council of Canada and a postdoctoral fellowship jointly funded by the Canadian Health Services Research Foundation and the Canadian Institutes for Health Research.
- Ian Hacking, “Making up People,” in Reconstructing Individualism: Autonomy, Individuality, and the Self in Western Thought, ed. Thomas C. Heller and Christine Brooke-Rose (Stanford, Calif.: Stanford University Press, 1986), provides inspirational guidance in this regard.
- Elizabeth A. Povinelli, “Radical Worlds: The Anthropology of Incommensurability and Inconceivability,” Annual Review of Anthropology 30 (2001): 319–34.
- For a superb analysis of legal arguments that partly hinge on knowledge from biomedicine and epidemiology, see Sarah S. Lochlann Jain, “ ‘Come up to the Kool Taste’: African American Upward Mobility and the Semiotics of Smoking Menthols,” Public Culture 15 (2003): 295–322.
- Michael Bliss, The Discovery of Insulin, 2nd ed. (Toronto: University of Toronto Press, 2000).
- Sidney Mintz, Sweetness and Power: The Place of Sugar in Modern History (New York: Viking, 1985).