Video by Amy Wolf and Pat Slattery
“The way you think about health and the way you think about medicine has a direct effect on how you understand disease, and as a result, how you treat it,” says Jeffrey Bennett, associate professor of communication studies. “For example, we use a lot of war metaphors when we talk about cancer, but we find that kind of language can make patients depressed because there’s this idea that if you just try hard enough, you can beat this disease, and we know that’s not always the case.”
Bennett studies the rhetoric of medicine-literally, what we talk about when we talk about health. And by “we,” he means everyone, everywhere. He’s analyzed pop culture, Senate hearings, public health ad campaigns, social media and more. “I’ve always loved studying the ways that messages steer how we think about things,” he said.
His first book, Banning Queer Blood: Rhetorics of Citizenship, Contagion, and Resistance, examined the politics driving the ban on blood donations by men who have sex with men, and how unfairly framing an entire category of men as a contagious vector for HIV excludes this population from fully participating and contributing to society.
A diagnosis of Type 1 diabetes shortly after he finished graduate school was the seed for his latest book, Managing Diabetes: The Cultural Politics of Disease, analyzing the public conversation around the disease. “My nurse educator told me I need to be really careful about the advice I took from people because everybody thinks they know something about diabetes,” he said.
Misleading narratives blame and shame patients
He discovered that there were two very common, contradictory narratives about diabetes: That on the one hand, it’s highly manageable with diet and medication, while on the other hand it’s a lethal illness that inevitably leads to an early death. But at the root of both these narratives is the idea of self-control-that given enough self-discipline, anyone can stave off the effects of the disease.
“One of the problems with a narrative of self-control, though, is it only tells part of the story of what’s happening for most people with diabetes,” Bennett said. He noted that successful diabetes management depends on a multitude of factors-biological, environmental, social, and financial-that individual patients may have little control over.
The focus on self-control can warp our understanding of diabetes management in damaging ways, Bennett said. “One of the things you hear over and over again is the phrase, ‘They just didn’t take care of themselves,'” he said, when in fact many are doing the very best they can with what they have. “I think anytime we invoke the idea that diabetes is simply a disease of self-control, it’s inevitably going to lead to us to blaming and shaming people with diabetes for their own disease.”
“Anytime we invoke the idea that diabetes is simply a disease of self-control, it’s inevitably going to lead to us to blaming and shaming people with diabetes for their own disease.”
Redefining ‘management’ opens doors to new solutions
The focus on self-control can also keep us from seeing broader opportunities for change, he said. Rather than framing diabetes as a problem of individual management, he said, diabetes should be discussed as a public health issue-one that requires systemic intervention across a number of public domains.
“Twenty-nine million people, or just over 9 percent of the population, have some form of diabetes. That’s about the same number of people that live in the state of Texas. Another 8 million people are said to be undiagnosed, and that’s about the population of Virginia,” he said. “So we need to be talking about things like access to care. We need to be talking about affordable insulin. We need to be talking about community support. We need to be talking about specific populations that are living with something like diabetes.”
Bennett said his hope is that people-especially those who know someone with diabetes-educate themselves more about the disease and strive to use more nuanced language when discussing it.
“Even shortly after diagnosis, a lot of people already have internalized shame about what, perhaps, they did to give themselves diabetes, and that is productive for nobody,” he said. “And so trying to move away from that language is really important, because we don’t want people with diabetes to feel shame, we don’t want them to internalize blame-we want them to be well.”