Managing Diabetes. Jeffrey A. Bennett
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stigmas that should be addressed honestly?”1 By ending the query with a call for more “honest” deliberation about HIV management, the site indicated to readers that the analogy deserved further scrutiny, if not outright dismissal.
TPAN and Queerty are not the first to incite spirited public discussions that engage the role of analogy in the production of medical knowledge. Just as physicians, researchers, and public health officials come to know diseases in comparative fashion, publics generally become acquainted with disease through already sanctioned medical epistemologies. Articulating scientific understandings of disease to accepted cultural frames directs interpretations of communal threats and stimulates possibilities for contemplating treatment and containment. AIDS was famously, if incorrectly, labeled both “gay cancer” and “gay pneumonia.” Yellow fever and malaria were frequently studied in tandem because mosquitoes transmit both, even though their causal agents are etiologically distinct. Depending on the literature one reads, fibromyalgia, chronic fatigue syndrome, and depression are variations on a theme or unambiguously dissimilar. More recently, debates rage over analogies likening alcoholism to a disease when it may more accurately correspond to an allergy and be addressed with medication. How we come to know a disease is dependent on a complicated interplay of sociopolitical practices, medical parlance, and the lived proximity of populations to the condition being assessed. Resituating a disease such as HIV from fatal to chronic is accomplished not solely through medicine and technology, then, but by analogically reimagining it alongside conditions that are widely acknowledged as manageable.
The politics of intelligibility underlying comparisons between HIV and diabetes illustrate a conspicuous, though not unprecedented, historical moment for those invested in the shifting logics of conceptualizing chronic conditions. Rhetorically, the analogy works to stabilize the crisis of signification that once marked AIDS, reestablishing life with HIV as habitual rather than volatile. In opposition to the disquieting urgency that once underwrote the incalculability of HIV, the analogy relinquishes the precariousness of AIDS and relocates life with HIV to more secure rhetorical groundings in health and wellness.2 This movement from a tenuous embodiment to one that renders HIV dormant offers, in the words of Lauren Berlant, a lateral agency that focuses on the maintenance of the body in everyday life.3 This agency is marked not by the ongoing social trauma that once characterized AIDS narratives, but by a slow and deliberate care of the self. Technological developments for attending to HIV have been as transformative as the virus itself once was, with life expectancy rates for people living with HIV now being roughly equivalent to people who are seronegative. While stigma, depression, and economic disparities remain significant obstacles for many who are living with HIV, advances in medical treatment and prevention have been nothing short of astounding. The comparison to diabetes is not only plausible, but in many cases warranted.
In this chapter I argue that comparisons between HIV and diabetes affect the rhetorical architecture of each disease. The analogy is perhaps most potent because it can be utilized to disrupt the notion that diabetes can be unreflectively managed. Those who believe that HIV emulates features of diabetes tend to focus almost exclusively on the dynamic nature of HIV. Diabetes, conversely, is envisioned as static in the analogy, viewed as treatable with a single pill or with unmindful regimens. A statement such as “HIV is the new diabetes” might be rich with potential but often reduces diabetes to a condition that is effortlessly mastered and in doing so imparts presumptions about the ease of regulating HIV. Not surprisingly, critics sensitive to AIDS’s ruinous past assail analogies to diabetes as trivializing the perils of HIV. Those suspicious of the association rehearse familiar scripts about the precarity of HIV even as they cement torpid meanings tied to diabetes, in some cases going as far as to dismiss the reparative promise of actual medical advancements.4 The alarmist outcry exhibited by platforms such as Queerty tell us much about attitudes toward both conditions, accentuating public sentiments about the mutability of HIV and the enigmatic sedimentation of diabetes.
Analogies are complex rhetorical configurations that suggest relations of similitude and difference. The power of analogies lies not in their ability to bestow uncompromising truth claims, but to act as sites of invention for judging something anew. Chaïm Perelman reminds us that etymologically, analogies indicate proportionality, a relation that contributes to the logic (the logos implied in the second half of analogy) of argumentative form.5 The degree to which affinities are accepted depends on a number of factors that are not reducible to discrete variables. As Isaac West has noted, analogies are not best understood as quasi-mathematical formulations; rather, they are dependent on a rich network of contexts, contingencies, and articulations that actualize the potential for knowledge creation in figurative manners apart from encoded meanings.6 It is the innovative power of analogy that I am most invested in here—looking not to a priori conclusions about one set of experiences at the expense of another, but to the productive possibilities that might be cultivated from the analogy’s circulation. In short, if diabetes functions as a stabilizing mechanism for those living with HIV, the latter might also constructively destabilize the sedentary connotations associated with diabetes, reformulating troubling perceptions that glucose irregularities are controlled through sheer force of will. What might the analogy tell us if we asked not how HIV resembles diabetes, but how diabetes—culturally, discursively, and politically—is similar to HIV? I approach this question by scrutinizing the entanglements of the analogy to unsettle the tropes of convenience and placidity that underwrite oversimplified management scripts. In what follows I contemplate how vernacular exchanges about HIV reproduce narrowed understandings of chronic conditions in an era of ongoing endemics. Although the imperative to manage diabetes is at times clarified by the exaggerated nature of HIV, the analogy tends to conceal the former’s protean character.
Working from the premise established in the introduction that diabetes is made intelligible in diverse contexts, and that understandings of diabetes are often contradictory, incompatible, and asymmetrical, this chapter looks to the trope of diabetes as a mechanistically governed disease. This figuration stands in sharp contrast to fatalistic rhetorics that personify diabetes as essentially unstable, which is explored in chapter 3. Challenging the credo that diabetes is fundamentally languid, I first examine the ways that HIV has been represented as erratic, immedicable, and destructive. I concoct a rhetorical genealogy of HIV/AIDS from queer theory that imagines HIV’s character as cataclysmic, a quality that is captured through the reoccurring figures of apocalypse, paranoia, and precarity. This calamitous narrative delineates shifting interpretations of HIV over time and ultimately provides the grounds for detractors to reject comparisons to diabetes. Next, I turn to the curious case of diabetes being an iterate referent in the emergence of HIV as a manageable condition through the oft-recited refrain that “HIV is the new diabetes.” The allusions between HIV and diabetes are increasingly prevalent, shaping the ways each is brought into discourse, even as residual notions of HIV hold tight. I then invert the pair to untidy conventions about signification, stigma, and agency, asking how we might reimagine the ways diabetes is personified. This inversion is not meant to suggest an equivocation of the two diseases or an artificial supplanting of the public health strategies related to one condition onto another. Rather, I contend that the discursive features of HIV/AIDS and its storied history can shape the rhetorical texture of diabetes to complicate the nomenclature of personal sovereignty and medical determinism.
Analogical Parallels? Apocalypse, Paranoia, and Precarity
The evolution of diabetes from a fatal disease to a proxy for surmountable conditions like HIV has been centuries in the making. Diabetes was first observed in ancient times, and situating it as a nominally stable illness is itself a relatively new phenomenon.7 The “siphoning” of the body suggested in diabetes’s etymological root indicates a rapidly deteriorating subject, one who did not have the benefit of time on their side. The mercurial nature of the disease was presumed until the discovery of insulin in the early 1920s, when treatment modalities began to resituate it as a manageable condition. Since that time diabetes, especially type 2, has become associated with passive bodies and states of decay. That typification has had tremendous implications, as it is often falsely assumed that diabetes is easily corralled with medicine and diet changes. Although diabetes has been depicted as both fervently precarious and markedly static, HIV has been couched almost exclusively in the former category. Indeed, HIV’s haphazardness has generally