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    The 2016 annual meeting featured a conversation between Darren Walker, president of the Ford Foundation, and Pauline Yu.

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    William Adams, chairman of the National Endowment for the Humanities, was the 2016 annual meeting luncheon speaker. 

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    Search ACLS fellows' publications online. 

ACLS News

Focus on Research: Arleen Marcia Tuchman F'07 on the Cultural History of Diabetes

9/4/2012

ACLS asked its fellows to describe their research: the knowledge it creates and how this knowledge benefits our understanding of the world. We are pleased to present this response from Arleen Marcia Tuchman, professor of History at Vanderbilt University.

Tuchman_Arleen_lgI have always been interested in the history of disease, but I had no intention of publishing in this area until my father moved to Nashville in 2002. When he was diagnosed with diabetes in 1985, I was living a thousand miles from home and only seeing him a few times a year. It was only when he moved closer to me and I saw him on a regular basis that I got an inkling of what it meant to live with a disease that plays havoc with your blood sugar levels. When my father’s sugar levels were high (hyperglycemia), I did not notice anything, although the longterm effects can be devastating. However, when they dropped (hypoglycemia), he became giddy, unsteady on his feet, and risked lapsing into a coma. A glass of orange juice or a glucose tablet would help him regain his full faculties, but the few times no one was there to help him, he ended up in the ER. My father hadn’t been in Nashville more than a year when I realized that I wanted my next book to be about the history of diabetes

Personal stories are often the inspiration for history projects. (A friend of mine decided to write a book on the history of childbirth while she was delivering her first child!) I also had to find the questions that would drive my research. I knew of two excellent histories of diabetes: Michael Bliss’s account of the discovery of insulin, the hormone that regulates blood sugar, and Chris Feudtner’s study of how insulin transformed diabetes from an acute disease into a chronic condition. Both books included riveting accounts of the impact of this hormone on the lives of individuals who needed insulin to survive, but they had little to say about the vast majority of individuals with the milder form of diabetes, what we currently call type 2 diabetes. I thought I had found my niche.

Today, type 1 diabetes is considered an autoimmune disease that attacks the beta cells of the pancreas, rendering the body incapable of producing insulin. Type 2 has a more obscure pathology but is marked by the tissues' resistance to the insulin produced by the pancreas. Type 2 diabetes is the form we hear about constantly today. We read that it is reaching epidemic proportions; that it is associated with increasing rates of obesity; that Native Americans, African Americans, and Hispanics are at greater risk of developing it; that it is appearing more frequently among the young; and that it is placing an enormous financial burden upon health care systems around the world. The urgency surrounding these pronouncements reinforced my decision to write a history of type 2 diabetes. 

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Research in the humanities and in the sciences share this in common: The questions that we, as scholars, begin with are often not the questions we answer. Something happens in the archive, as in the laboratory, that takes us down a path we had not imagined when we began our research.

 
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And so I began scouring and collecting sources. I turned to medical journals and textbooks, popular magazines, clinical records, public health reports and films, TV news archives, and letters. One of the first things I learned was that the populations considered most at risk of developing diabetes today were not on anyone’s radar in the past. On the contrary, at the turn of the twentieth century diabetes was believed to be “a disease of the higher classes,” and to be especially prevalent among Jews. African Americans, in contrast, were believed to have “some measure of immunity to the disease.”

This surprised me and led immediately to an obvious question: Did the populations most at risk for developing diabetes actually change over time? My research soon suggested that past statistics were too unreliable to accurately answer this question. Prevalence rates were usually drawn from select patient populations who visited a particular physician or hospital. There were also (and still are) “invisible” populations with little contact with the formal medical community. But while I lacked reliable data, I had uncovered a host of assumptions and stereotypes about race and class that purported to explain perceived prevalence rates. Convinced, for example, that diabetes afflicted “civilized” individuals with more advanced nervous systems, early twentieth-century popular and professional writers alike explained the alleged low rate among African Americans with racist beliefs about their "primitive" nature and lack of "nervous strain." In contrast, Jews, stereotypically cast as “civilized” yet “neurotic” city dwellers, overweight, and highly ambitious, were widely believed to experience rates up to six times greater than any other "race." My book thus became a study of the way cultural assumptions and stereotypes about age, race, and class shaped perceptions, explanations, and approaches to the management and eradication of diabetes.

It also became an examination of the cultural work performed in the very act of labeling the different “types” of the disease. I had known since an early stage of the project that the dominant etiological theory had been, until recently, that all diabetic symptoms stemmed from the same fundamental pathology. To be sure, physicians had long recognized that diabetes had different forms, the two most dominant of which they described variously as severe vs. mild, acute vs. chronic, or juvenile vs. adult. I thought that by focusing on what doctors described as the mild, chronic, and adult forms, I could write the history of what we now call type 2 diabetes. But my anachronistic use of this distinction troubled me, and I became increasingly troubled as I learned about other designations, such as latent autoimmune diabetes of adults (or type 1.5) and maturity onset diabetes of the young, which were necessary to account for symptoms that did not fit neatly into type 1 or type 2. I also began hearing about research that was suggesting once again that the same underlying mechanism may be at play in both type 1 and type 2.

What had previously been a discomfort now became a research question: Why, in 1979, did the medical community decide it was time to create an official distinction between these forms of the disease? Some of the answer, as other scholars have shown, rests with the professional and bureaucratic changes that accompanied the U.S. government’s increased investment in the “fight” against diabetes. But my interest in diabetes, race, and class led me to focus on the cultural images that began coalescing around these two forms: young, usually thin white children and adolescents, who are cast asinnocent victims of a pathological process over which they have no control vs. middle-aged and elderly individuals, disproportionately poor and from minority populations, who are often obese and responsible for their disease. Working with written, visual, and media sources, I am bringing my analysis up to the present, convinced that ideas of race and class shape our understanding and our judgments of diabetes every bit as much today as they did in the past. These judgments, I argue, also affect the allocation of resources and efforts to control the disease.

Research in the humanities and in the sciences share this in common: The questions that we, as scholars, begin with are often not the questions we answer. Something happens in the archive, as in the laboratory, that takes us down a path we had not imagined when we began our research. I had begun with my dad’s experiences and an interest in type 2 diabetes. I have ended up studying the cultural history of a disease, questioning the very designation that had allegedly provided me with my niche. My dad, who has been insulin dependent since he was diagnosed 27 years ago, will be 92 years old this year. With any luck, he’ll be around to read my book.

Arleen Marcia Tuchman F'07 received an ACLS Fellowship for her project "Diabetes: A Cultural History." The complete series is available here.

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