Doctoral Dissertation Research: Chronically Normal: How Biomedical Knowledge is Used in Everyday Life
This project investigates how people create new kinds of health knowledges and identities as a result of living with type-2 diabetes. This illness is often attributed to combinations of social, environmental, biological, and political causes that are often deeply intertwined with conceptions of individual and group identity. Understanding how people come to treat illness such as type-2 diabetes as normal is important because worldwide, chronic disease conditions, such as cancer, heart disease, obesity, depression, and asthma are prevalent. Intergovernmental organizations as well as local and national public health organizations across the world are scrambling to stem the tide, yet interventions often draw on either individual or community-level interventions, which do not take into account the meanings that people with chronic illness attribute to these diseases, nor integrate individual and larger-scale attributions of causality. By studying everyday settings, such as at support groups and free health screenings, or watching public service announcements, this research investigates how illness binds people together who would otherwise be strangers. In these social interactions, chronic illness sufferers produce new kinds of knowledge -both about their illnesses and about their identities- as well as develop sociality based around illness. In doing so, they form what can be called a chronic public.
The theoretical significance of this project is that it integrates medical anthropology, science and technology studies, and cultural anthropology to analyze how people make sense of biomedical knowledge about chronic illnesses in everyday life in the United States. In contrast to studies of illness and biomedicine that focus on intense moments of individual decision-making in clinic settings to discover how people take on illness identities, this research examines how social ties, expert and non-expert knowledge, and material culture mediate and shape illness identities among the ill, the non- and pre-ill. Moreover, it contributes to theories about how micro- and macro-level social processes coexist and are refashioned through everyday life.
Chronic illnesses are major local, state, and federal public health concerns, leading to predictions of catastrophe for individuals, for the insurance industry, and for nations. Chronic illnesses, however, are also sites that gather people; at health fairs or while watching public service announcements, they form momentary connections with people who would otherwise be strangers. In these social interactions, chronic illness sufferers produce new kinds of knowledge—both about their illnesses and about their identities—as well as beginning to develop a stranger sociality based around illness, forming a chronic public. People living with type-2 diabetes, along with friends and families, institutions, professionals, and public media, produce knowledge about themselves and about this illness. These new kinds of knowledge attribute type-2 diabetes to various combinations of social, environmental, biological, and political causes that are often deeply intertwined with conceptions of individual and group identity. This project investigated the concepts of a chronic public, knowledge production, and processes of identification in the Rio Grande Valley (also known as "The Valley") of south Texas. "The Valley" is a region of the United States described in popular media and in academic literature as poor, as "the fattest in the nation," and as having a diabetes rate three times higher than the rest of the country. Through ethnographic research, I have found that these common descriptions exclude key factors the aid in understanding how diabetes (and chronic illnesses, in general) are becoming part of everyday life, knowledge production, and the formation of publics. The regional context of the Rio Grande Valley is more complex than poverty, obesity, and diabetes. There is extreme wealth, vibrant physical fitness and extreme sports cultures, as well as numerous industries that profit financially from diabetes care. Through participant observation, in-depth interviews, and media analysis it has emerged that diabetes and obesity are not primarily individual or biological concerns. Rather, they are key sites for developing social and political capital as well being central nodes in numerous highly profitable industries. Additionally, this project has traced trace the intense local politics surrounding the analysis and presentation of scientific claims about diabetes and obesity.
