Date of Award
Doctor of Philosophy (PhD)
The impetus for this project grew out of my experience working as a pharmacist in a federally-funded ambulatory-care clinic In Tacoma, WA. Many people seen at the clinic struggled with type-2 diabetes (T2DM) and over time, I began to see this condition not only as a biological disorder, but also as a complex symptom of both macro-level social history and micro-level daily activities. I also began to see how the emphasis on medical abstraction in the form of measuring, monitoring and scheduling into daily routines, while necessary to control T2DM, created a gap between lived experience and the broader social contexts that gave rise to the condition. I have used the theoretical work of Henri Lefebvre to build on my clinical background and on previous anthropological examinations of T2DM, to examine the body as social space and, through this perspective, show how the political, economic and cultural forces involved in the production of social space also shape relationships between body and self. In other words, how the spatiotemporal world we imagine internally corresponds to the world we face outwardly.
Interviewees for diabetes life-histories were recruited from ambulatory-care clinics serving lower-income Tacoma residents, and reflected the city residents most affected by T2DM. Through analysis of 58 histories, three patterns emerged, showing the different ways individuals grappled with scientific abstraction in constructing T2DM self-care practices. For many people, bodily self-care contradicted the high value given to employment and pushing one's body as a strategy to maintain social autonomy. More significantly, medical instructions to make rational decisions based on scientifically defined facts only increased stress and created further alienation between body and self. However, the success of those individuals able to maintain long-term control of diabetes, did not translate into resistance to medical abstraction. Rather, it was the ability to attach meaning to mechanical, uniform practices that de-alienated body and self. Instead of a well-delineated dichotomy between lived experience and medical abstraction, sustained T2DM self-care emerged through an individual's creative capacity to disable the neutrality of biological abstraction and give meaning to medical facts, reflecting the key importance of creativity as a life-skill.
The findings of this project show how examining spatiotemporal structures provide medical anthropological research a unique methodology to connect social context to practices of self-care. Rather than being a neutral backdrop for things that happen, conceiving of bodies as social space illuminates forms of power that shape how subjectivities change (or not) over time.
Chair and Committee
Pete Benson, John Bowen, Brad Stoner, Corinna Treitel
Epstein, Jenny, "The Violence of Abstraction: Learning to Live With Type-2 Diabetes in Everyday Life" (2016). Arts & Sciences Electronic Theses and Dissertations. 986.