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36 chapter two Cavemen ­Didn’t Get Diabetes American Narratives about the Origins of Type 2 Diabetes Sofie Loftis, an athletic blonde in her midthirties, told me she ­ doesn’t look the part. Though a publicist for a professional sports team sponsored by a phar­ma­ceu­ti­cal com­pany known for its oral and injectable antidiabetics, she avoids mentioning her polycystic ovary syndrome (PCOS)-­related type 2 diabetes to strangers. Most ­ people, she has learned, do not take the news gracefully. Surprised, they blurt out objections: “But ­ you’re so fit!” A slim, overachieving endurance athlete who once walked for most of a day with an excruciating knee injury rather than permit a brace to ruin the line of her dress, Sofie’s social identity revolves around extraordinary discipline. She is not the sort of person Americans think is supposed to get diabetes. This chapter introduces American discourse on the origins of the diabetes epidemic. I argue that this discourse emphasizes universal risk and rests on pervasive perceptions that illness arises when one treats the body in ways that are “unnatural.” Popu­lar accounts portray the road to health as a life disciplined by natu­ral rhythms, in contrast to the stress-­and temptation-­filled lives that are pos­si­ble in modern Amer­i­ca. Popu­lar understanding of diabetes risk rests largely on what anthropologist Leslie Aiello and biologist Marlene Zuk have memorably labeled “paleofantasy,” the widely accepted but empirically suspect just-so stories of evolutionary history that pervade American popu­ lar culture. This power­ ful narrative on the origins of the type 2 diabetes epidemic emphasizes universality of diabetes risk to all citizens of modernity, alongside the idea that groups associated with certain lifestyles put themselves at higher risk by behaving in evolutionarily unpre­ce­dented or unwise ways. Americans strongly associate diabetes with obesity, and this association is burdened with moralistic overtones that overshadow the socioeconomic and ge­ ne­ tic patterning of diabetes risk. Even health care providers draw on this narrative, speaking in interviews of “my-­fault diabetes,” informally observed correlations between “type B personalities” and diabetes , and the emotional work of fairly treating patients with illness that arose at least in part from their “own” be­hav­ior. In this chapter, I synthesize findings from the vari­ ous lit­ er­ a­ tures on patient models of type 2 diabetes, analy­sis of popu­lar discourse in the popu­ Cavemen ­Didn’t Get Diabetes 37 lar lit­ er­ a­ ture on diabetes, and interviews with American health providers and members of the general public. I conclude with a discussion of the alternative narratives to paleofantasy and blame that can be found in African American guides to diabetes management. In ­ these materials, choice is situated within a broader social context that is understood to powerfully shape the lifestyle that puts African Americans at higher risk for illness. This narrative is closer to pervasive Japa­nese explanations of the type 2 diabetes epidemic covered in the next chapter than to the narratives that dominate other American health materials. This chapter deals only peripherally with individual patients’ ideas about what in their personal experience precipitated the onset of type 2 diabetes. Much excellent work has already been done on the personal explanatory models of American patients with type 2 diabetes (Borovoy & Hine 2008; Chesla et al. 2000, 2009; Ferzacca 2000; Lange & Piette 2006; Loewe & Freeman 2000; Hampson et al. 1990, 1995, 1997; Glasgow et al. 1997; Poss & Jezew­ ski 2002; Schoenberg et al. 2005; Mercado-­ Martinez & Ramos-­ Herrera 2002). However, defining the materials from which American providers and patients piece together their approach to diabetes requires examination of widerunderstandingsandstoriesaboutwhythetype2diabetesepidemicisgrowing in the United States. Answers to the questions “Why do you think you got diabetes at the time that you did?” and “Why do you think diabetes rates are rising in this country?” can be very dif­fer­ ent. The wider context in which patients creatively construct their explanatory models is key to understanding ­ those models ­ because explanatory models exist and are only interpretable within the context of a complex social system of healing. Explanatory models are constructed by individuals in response to a specific disease or illness episode, but they are patterned in impor­tant ways by the wider sociocultural context. Modernity and Risk Anthropologists have found that patients tend to identify social, economic, or relational ­ factors when describing the origins of their own diabetes (Schoenberg et al. 2005; Mercado-­ Martinez & Ramos-­ Herrera 2002). While lay articulations of the origins...


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