Diabetes and “Race Betterment”

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“During the late 1920s and 1930s, a time considered to be the ‘high water mark of eugenic sterilization in the United States,’ roughly twenty-five thousand individuals underwent surgical operations to ensure that they would never reproduce. Diabetics were not among them.”[1] This was despite the fact that medical experts agreed that newly-discovered insulin was a blessing for the individual and a disaster for the human gene pool. So, why were diabetics excluded from sterilization campaigns?

Vanderbilt Professor of History Arleen Tuchman poses this question in a 2013 article for Journal of the History of Medicine and Allied Sciences; and her answer highlights some disturbing rhetorical trends that continue to shape discussions of diabetes today.

According to Tuchman, diabetics evaded the knife for one simple reason: their race and class conferred protection. No diabetes expert argued that diabetics did not have “defective genes” that could be passed on to future generations. Rather, these experts argued that diabetics possessed laudable traits such as intelligence, discipline, and self-control, and that these individuals contributed to society. These factors outweighed defective genes, they argued. More plainly, most diabetics under clinical care were middle class whites—“exactly the kind of people eugenicists wished to see reproduce.”[2]

“Most diabetics under clinical care were middle class whites—exactly the kind of people eugenicists wished to see reproduce.”

The crusade to protect diabetics from eugenics campaigns was heralded by “Diabetes Doctor” Elliott P. Joslin. In his lectures and in an article for Medical Clinics of North America that was later published in the 1937 edition of his famous manual, The Treatment of Diabetes Mellitus, the physician urged that it was the “people in the streets” about whom public health experts needed to worry. By this, he meant the usual targets of eugenics campaigns—immigrants, prostitutes, criminals, the poor, the disabled, and the “feebleminded” (anyone determined to be cognitively unfit). In contrast to these individuals, Joslin maintained, diabetics did not pose an economic risk to the state.

To support his case, the physician shared the story of a hypothetical woman who presented at his office to seek his blessing for marriage. (He expected patients to consult with him prior to wedding, and, in some cases, required patients’ prospective spouses to present at his office to be physically examined.) Joslin shares:

An attractive woman comes to your office and asks you if she can get married. A moment’s conversation suffices to disclose that she is unusually intelligent; she is evidently physically strong, because she is a champion tennis player, often rides to hounds for six hours at a time, has driven an automobile recently 300 miles a day, and repeatedly dances all night. In the midst of city gaieties she has learned stenography and typewriting, and what is more, secured a job.[3]

Joslin adds that this woman weighed 117 pounds and was never “so careless as to develop a coma.” He also explains that her fiancé was “a good boy,” the couple’s parents approved of the marriage, and there was enough money to cover hospitalization, if needed. Joslin’s response to this hypothetical woman was simple: “get married and God bless you.”[4]

Tuchman suggests that this patient might have been a composite of the women Joslin was used to seeing in his clinic, adding that the authenticity of this woman matters less than her symbolic value. “In choosing an intelligent, strong, tennis-playing, horseback riding, young (presumably) white woman for his ‘concrete’ case, he wanted to make sure his readers understood what might be lost if diabetics were denied the right to reproduce.” Here and elsewhere in his writings about sterilization, it becomes clear that Joslin “fully embraced the eugenic language of his day” while simultaneously defending an entire community from its effects.

It is not difficult for Tuchman to trace the trajectory of eugenics rhetoric from the 1930s to the present. She discusses mid-century American Diabetes Association (ADA)-sponsored ad campaigns encouraging “wholesome” white females to reproduce, and she acknowledges the striking differences between current representations of “good” and “bad” diabetes (Type 1 and Type 2 diabetes, respectively). Type 1 diabetes “is usually associated with young, thin, white children, who are cast as innocent victims of a pathological process over which they have no control,” whereas type 2 diabetes “is usually associated with middle-aged and elderly individuals, disproportionately obese, poor, and either Native American, African American, or Hispanic, … who are held responsible for their disease.”[5]

Those of us who are active in the Type 1 diabetes online community can easily identify examples of this thinking: the frequency with which we defend ourselves and our loved ones on the grounds that we/they “didn’t ask for” the disease; our over-circulation of images of sports-playing, mountain-climbing diabetics; and our dogged efforts to demonstrate that individuals can live “beyond” diabetes. I will be the first to admit that I have supported some of these efforts and that it has only been over time that I have realized just how implicitly harmful they can be. Much like Joslin’s hypothetical patient, these efforts are purposed with portraying a discrete profile of the condition—one that legitimates only the privileged few.

However, I believe that the epistemic whiteness of Type 1 diabetes is becoming less of a dirty secret. More and more community members are challenging appeals to race, class, and ableism when and where those appeals occur. Community members are increasingly collaborating with Type 2 diabetics on shared initiatives, and they are defending Type 2 diabetics from public attacks. A recent instance occurred when the U.S. Surgeon General compared diabetics to addicts, implying that their health problems resulted from poor choices. (The purpose of the tweet was to emphasize the need to provide resources for addicts, though the gesture failed for obvious reasons.) Countless Type 1 diabetics intervened, including Quinn Nystrom, who secured a meeting with the official to discuss the impact of stigmas on the diabetes community at large, among other topics.

Remarkably, these socially conscious initiatives are not happening amidst a prosperous moment for diabetics. Rather, they coincide with a serious crisis within the community that is not unlike the eugenics era of decades past. In the United States, more Type 1 diabetics than ever are frightened for their lives, thanks primarily to the unaffordability of the drug that they need to survive. But instead of appealing to deeply entrenched prejudices against minorities, disabled persons, and those living in poverty, many advocates are amplifying the voices of other vulnerable groups so that they can collectively undermine the institutions that do harm. For instance, diabetes advocates are supporting the HIV/AIDS community in their own fight against drug prices; advocating for the Affordable Care Act, Medicare, and welfare rights; and standing in solidarity with those affected by stigmatizing policies such as Straw Bans.

Many but not all of these advocates operate under the banner of #insulin4all, and their efforts cannot be overstated. Fran Quigley, director of the Health and Human Rights Clinic at Indiana University McKinney School of Law and coordinator of the nonprofit People of Faith for Access to Medicine, recently told a member of this group: “I’m convinced you will not only win #insulin4all, you will take down the whole meds profiteering model in the process.”

The work of all socially-minded activists within the diabetes community, regardless of their affiliation, suggests to me that Joslin was right about one point: Type 1 diabetics meaningfully contribute to society. Not by virtue of their station or personal traits, but by virtue of their relentless fight to improve the lives of those whom the rest of society has deemed disposable.

The author recently became a volunteer for the PA chapter of #insulin4all advocacy, which is supported by T1International.
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[1] Tuchman, Arleen. “Diabetes and ‘Defective Genes’ in the Twentieth-Century United States.” Journal of the History of Medicine and Allied Sciences, Vol. 70, Issue 1, p. 1.
[2] Tuchman, 3.
[3] As quoted in Tuchman, 22.
[4] Tuchman, 22.
[5] Tuchman, 32.

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About Author

Audrey Farley is the Editor in Chief of Pens and Needles. She recently earned a PhD in English from University of Maryland, College Park, where she studied contemporary American fiction, popular culture, and the medical humanities. She has written for various peer-reviewed journals in the literary fields, as well as outlets such as Public Books, ASAP/J, and Insulin Nation. She lives with chronic migraine and is the parent of a child with Type 1 diabetes. Follow her on Twitter @AudreyCFarley.

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