Bittersweet: Diabetes, Insulin, and the Transformation of Illness (Studies in Social Medicine)

One of medicine's most remarkable therapeutic triumphs was the discovery of insulin in 1921. The drug produced astonishing results, rescuing children and adults from the deadly grip of diabetes. But as Chris Feudtner demonstrates, the subsequent transformation of the disease from a fatal condition into a chronic illness is a story of success tinged with irony, a revealing saga that illuminates the complex human consequences of medical intervention. Bittersweet chronicles this history of diabetes through the compelling perspectives of people who lived with this disease. Drawing on a remarkable body of letters exchanged between patients or their parents and Dr. Elliot P. Joslin and the staff of physicians at his famed Boston clinic, Feudtner examines the experience of living with diabetes across the twentieth century, highlighting changes in treatment and their profound effects on patients' lives. Although focused on juvenile-onset, or Type 1, diabetes, the themes explored in Bittersweet have implications for our understanding of adult-onset, or Type 2, diabetes, as well as a host of other diseases that, thanks to drugs or medical advances, are being transformed from acute to chronic conditions. Indeed, the tale of diabetes in the post-insulin era provides an ideal opportunity for exploring the larger questions of how medicine changes our lives. Contents......Page 8 Illustrations......Page 9 Figures......Page 12 Tables......Page 13 Looking Back as a Means to Look Forward......Page 14 Notes......Page 248 A Currebt View of Diabetes Mellitus......Page 19 Part I. Disease and Medicine Today......Page 26 1. Irony in an Era of Medical Marvels: Diabetes History as a Study of Health and Hope......Page 28 Diabetes and the Technology Ethos......Page 29 Dr. Joslin's Records and Letters......Page 37 The Paradigm of Disease Transmutation......Page 42 The Phenomenon of Transformed Illness......Page 50 Overview......Page 53 Part II. The Bittersweet Transformation of Diabetes......Page 56 2. A Disease in Motion: The Cycles of Diabetic Transmutation......Page 58 Diabetes and the Transmutation of Disease......Page 61 From Transmuted Disease to Transformed Experience......Page 68 Diabetes at the Turn of the Century......Page 69 The Cycles of Rigorous Diet......Page 73 Breaking the Cycle of Insulin Therapy......Page 75 Managing New Regimes......Page 79 New Expectations and Social Change......Page 81 The Human Consequences of Intervened Disease......Page 85 Notes......Page 252 3. Illness Unfolding: The Transformed Experience of Diabetic Patients......Page 87 The Language of Living with Diabetes......Page 88 Learning the Language of Diabetic Life......Page 93 The Punctuating of Crises and Transitions......Page 99 The Grammar of Routine......Page 102 "Complications" and the Denouement of Diabetic Life......Page 106 Narrations and Creating Meaning in Life......Page 111 Notes......Page 255 4. Getting the Point: The Daily Work of Diabetes......Page 114 Daily Life and work in the Diabetic World......Page 117 Monitoring Work......Page 120 Diet Work......Page 122 Insulin Work......Page 125 Symptom Work......Page 129 Identity Work......Page 139 "Work Shortens the Day, but Lengthens the Life"......Page 143 Notes......Page 259 5. The Want of Control: Ideas and Ideals in the Management of Diabetes......Page 146 Ideal Control before Insulin......Page 148 Ideal Control Intensified......Page 156 Insulin and Control "Among the Erstwhile Dead"......Page 157 Striving for Control of Life and Death......Page 162 The Want of Control......Page 168 Notes......Page 261 6. Pregnant Longings: Mounting Medical Intensity in the Pursuit of Motherhood......Page 171 Migrating Focus of Clinical Control......Page 175 Mounting Intensity of Care......Page 179 Expanding Horizon of Medical Management......Page 183 Reconfiguring Relationships and Responsibilities......Page 186 Life after Pregnancy......Page 189 Cultural Logic, Social Constraints, and Medical Innovation......Page 191 Notes......Page 265 7. Predicaments of Dangerous Safety: Identity, Responsibility, and Life with a Chronic Illness......Page 194 The Arrangement of Responsibility before Insulin......Page 195 The Arrangement of Responsibility after Insulin......Page 199 Establishing One's Self in a Diabetic World......Page 201 Tracy Pike Villars......Page 202 John Hansen......Page 204 Tracy......Page 207 John......Page 209 Coping with Therapeutic "Failure"......Page 212 Tracy......Page 213 John......Page 215 Responsibilities and the Sequela of "Success"......Page 217 Elliott P. Joslin, M.D.......Page 218 Each Day as a sort of Bonus......Page 220 Notes......Page 267 Part III. Illness and People Care Tomorrow......Page 222 8. Medcine and the Marshaling of Hope: Confronting the Increasingly Complicated Choices of Incomplete Control......Page 224 Reckoning with Imperfect Miracles......Page 225 A Life of Managed Hope and Sorrow......Page 229 History, Medicine, and Forms of Imagination......Page 233 The Constant Presence of the Past......Page 234 Inextinguishable Tensions......Page 237 Confronting the Choices of Incomplete Control......Page 239 Marshaling Hope......Page 245 Notes......Page 270 Bibliography......Page 274 Acknowledgments......Page 300 A-B......Page 302 C-D......Page 303 E-H......Page 306 I......Page 307 J......Page 308 K-M......Page 309 N......Page 310 O-P......Page 311 R......Page 312 S......Page 313 T-V......Page 314 W-Z......Page 315 9780807827918 Contents 8 Illustrations 9 Figures 12 Tables 13 Preface 14 Notes 248 Looking Back as a Means to Look Forward 14 A Currebt View of Diabetes Mellitus 19 Part I. Disease and Medicine Today 26 1. Irony in an Era of Medical Marvels: Diabetes History as a Study of Health and Hope 28 Diabetes and the Technology Ethos 29 Dr. Joslin's Records and Letters 37 The Paradigm of Disease Transmutation 42 The Phenomenon of Transformed Illness 50 Overview 53 Notes 248 Part II. The Bittersweet Transformation of Diabetes 56 2. A Disease in Motion: The Cycles of Diabetic Transmutation 58 Diabetes and the Transmutation of Disease 61 From Transmuted Disease to Transformed Experience 68 Diabetes at the Turn of the Century 69 The Cycles of Rigorous Diet 73 Breaking the Cycle of Insulin Therapy 75 Managing New Regimes 79 New Expectations and Social Change 81 The Human Consequences of Intervened Disease 85 Notes 252 3. Illness Unfolding: The Transformed Experience of Diabetic Patients 87 The Language of Living with Diabetes 88 Learning the Language of Diabetic Life 93 The Punctuating of Crises and Transitions 99 The Grammar of Routine 102 "Complications" and the Denouement of Diabetic Life 106 Narrations and Creating Meaning in Life 111 Notes 255 4. Getting the Point: The Daily Work of Diabetes 114 Daily Life and work in the Diabetic World 117 Monitoring Work 120 Diet Work 122 Insulin Work 125 Symptom Work 129 Identity Work 139 "Work Shortens the Day, but Lengthens the Life" 143 Notes 259 5. The Want of Control: Ideas and Ideals in the Management of Diabetes 146 Ideal Control before Insulin 148 Ideal Control Intensified 156 Insulin and Control "Among the Erstwhile Dead" 157 Striving for Control of Life and Death 162 The Want of Control 168 Notes 261 6. Pregnant Longings: Mounting Medical Intensity in the Pursuit of Motherhood 171 Migrating Focus of Clinical Control 175 Mounting Intensity of Care 179 Expanding Horizon of Medical Management 183 Reconfiguring Relationships and Responsibilities 186 Life after Pregnancy 189 Cultural Logic, Social Constraints, and Medical Innovation 191 Notes 265 7. Predicaments of Dangerous Safety: Identity, Responsibility, and Life with a Chronic Illness 194 The Arrangement of Responsibility before Insulin 195 The Arrangement of Responsibility after Insulin 199 Establishing One's Self in a Diabetic World 201 Tracy Pike Villars 202 John Hansen 204 Maturing in the Diabetic World 207 Tracy 207 John 209 Coping with Therapeutic "Failure" 212 Tracy 213 John 215 Responsibilities and the Sequela of "Success" 217 Elliott P. Joslin, M.D. 218 Each Day as a sort of Bonus 220 Notes 267 Part III. Illness and People Care Tomorrow 222 8. Medcine and the Marshaling of Hope: Confronting the Increasingly Complicated Choices of Incomplete Control 224 Reckoning with Imperfect Miracles 225 A Life of Managed Hope and Sorrow 229 History, Medicine, and Forms of Imagination 233 The Constant Presence of the Past 234 Inextinguishable Tensions 237 Confronting the Choices of Incomplete Control 239 Marshaling Hope 245 Notes 270 Notes 248 Bibliography 274 Acknowledgments 300 Index 302 A-B 302 C-D 303 E-H 306 I 307 J 308 K-M 309 N 310 O-P 311 R 312 S 313 T-V 314 W-Z 315 One Of Medicine's Most Remarkable Therapeutic Triumphs Was The Discovery Of Insulin In 1921. The Drug Produced Astonishing Results, Rescuing Children And Adults From The Deadly Grip Of Diabetes. But As Chris Feudtner Demonstrates, The Subsequent Transformation Of The Disease From A Fatal Condition Into A Chronic Illness Is A Story Of Success Tinged With Irony, A Revealing Saga That Illuminates The Complex Human Consequences Of Medical Intervention. Bittersweet Chronicles This History Of Diabetes Through The Compelling Perspectives Of People Who Lived With This Disease. Drawing On A Remarkable Body Of Letters Exchanged Between Patients Or Their Parents And Elliot P. Joslin And The Staff Of Physicians At His Famed Boston Clinic, Feudtner Examines The Experience Of Living With Diabetes Across The Twentieth Century, Highlighting Changes In Treatment And Their Profound Effects On Patients' Lives. Although Focused On Juvenile-onset, Or Type 1, Diabetes, The Themes Explored In Bittersweet Have Implications For Our Understanding Of Adult-onset, Or Type 2, Diabetes, As Well As A Host Of Other Diseases That Are Being Transformed By Drugs Or Medical Devices From Acute To Chronic Conditions. Indeed, The Tale Of Diabetes In The Post-insulin Era Provides An Ideal Opportunity For Exploring The Larger Questions Of How Medicine Changes Our Lives.--jacket. Irony In An Era Of Medical Marvels : Diabetes History As A Study Of Health And Hope -- A Disease In Motion : The Cycles Of Diabetic Transmutation -- Illness Unfolding : The Transformed Experience Of Diabetic Patients -- Getting The Point : The Daily Work Of Diabetes -- The Want Of Control : Ideas And Ideals In The Management Of Diabetes -- Pregnant Longings : Mounting Medical Intensity In The Pursuit Of Motherhood -- Predicaments Of Dangerous Safety : Identity, Responsibility, And Life With A Chronic Illness -- Medicine And The Marshaling Of Hope : Confronting The Increasingly Complicated Choices Of Incomplete Control. Chris Feudtner. Includes Bibliographical References (p. [223]-273) And Index. One of medicine's most remarkable therapeutic triumphs was the discovery of insulin in 1921. But the author demonstrates that the transformation of the disease from fatal condition into a chronic illness is tinged with irony and one which illuminates the human consequences of medical intervention If today is like most days, approximately two dozen children across America will develop diabetes mellitus, joining a million other Americans who have so-called insulin-dependent, juvenile-onset, or Type 1, diabetes mellitus. A fascinating portrayal of a medical miracle traces the influence of insulin on the world, from its discovery in 1921 through its widespread dissemination as a treatment for diabetes. (Health & Fitness)