Date of Award

Winter 2021

Author's School

College of Arts & Sciences

Author's Program


Degree Name

Bachelor of Arts (A.B.)




In this thesis, I explore physicians’ conceptions of culture in the management of chronic diseases like diabetes and hypertension. Physicians whom I interviewed deconstructed the challenges of compliance into coded components of knowing, wanting, and doing. This pattern creates a new form of adherent autonomy, which offers the freedom to choose as much as it surveils, expects, and moralizes “good” choices in the pursuit of good care. Consequently, adherent autonomy deprives patients of practical sovereignty and continues to objectify individuals in more indirect and ostensibly acceptable forms. While physicians’ definitions for culture ranged in scope and content, they prominently framed culture as one’s beliefs on normalcy. These conceptions become salient in the clinical encounter through characteristics presumably creating resistance to successful chronic disease management. Both “culture” and “cultures” become explanatory and exculpatory linguistic devices used to mask structural violence. The most frequently offered stand-in for culture, race, is reified by biomedicine, compounding assumptions that may become tied to race in clinics given physicians’ conceptions of culture. Culture-qua-race functions as an especially effective necropolitical tool that legitimizes socially constructed categories and inequities while normalizing the slow death of groups on this basis and insulating perpetrators from acknowledging this violence.


Dr. Anna Jacobsen