Lora Arduser's Living Chronic: Agency and Expertise in the Rhetoric of Diabetes is the author's response to her "nagging suspicion that…a singular view of people with diabetes does not tell the whole story" (3). Drawing on rhetorical theories of health and medicine, technical communication studies, and interviews with diabetics, their nurses, physicians, and other medical professionals, the project speaks back to "the biomedical definition of patient agency" (4). This definition presumes that people with diabetes are perpetually cared for, that they remain unequivocally tethered to a medical team who is responsible for managing their disease (4). Arduser instead argues for a model of agency that understands diabetics "as people doing work" and as patients who often know more about their disease, their symptoms, and their bodies than medical professionals (7). While the book admittedly does not draw heavily from disability studies scholarship and lacks attention to the diversity among disabled people, it should nevertheless be of interest to scholars invested in conversations about chronic illness and to those interested in the intersection of disability and rhetoric.

Central to Arduser's argument is the figure of the "worker," who is meant to contrast the "subjectivity of patient and consumer" (19). The term worker helps to emphasize how "[t]here is no vacation from managing a chronic illness," that people with diabetes are constantly managing themselves in ways that the medical model of disability tends to overlook or downplay (19). Indeed, most medical professionals structure their relationships with their diabetic patients along paternalistic lines, where the patients are granted agency over their bodies only so long as they are compliant with a treatment plan. Arduser points out, however, that most diabetes treatment plans are not only made without consulting the patient themself but also are evaluated based on a series of quantitative measures that ignore "that the disease is experienced differently by different individuals" (28). If a patient fails to meet their blood sugar target numbers, the medical model presumes that it is their own fault, that they are "noncompliant"—a word Arduser concludes is merely code for "bad patient" (37). Such swift judgement denies patient agency, both by ignoring the particularities of the individual patient and dismissing the amount of labor people with diabetes are expected to do outside of the clinical space. Emphasizing the work involved in diabetes management is, for Arduser, an effective way of "[r]e-mapping the articulations of agency" to empower patients with more control over their bodyminds (61).

Following the first body chapter, which problematizes the medical model of diabetes, the remaining body chapters explore various settings where "diabetes work occurs" (24). For instance, the second chapter, "Liminal Spaces: Counter Narratives and Writing as Social Action," investigates online forums and group appointment sessions for diabetics. Referring to these contexts as "liminal spaces," Arduser argues that the agency of a diabetic person is not predetermined but made possible only through "temporary articulations" that offer agency in a particular moment (66). Writing, the author adds, is a uniquely effective way "to enact agency" because it constructs a relationship between "the writer and the audience," identifying both parties as agents who can produce and receive knowledge (71).

Chapter 3, "Rhetorical Plasticity: Negotiating Types of Knowledge," documents the multiple knowledges people with diabetes use to talk about their disease. While the medical model of diabetes imagines a linear transfer of information from medical professional to patient, Arduser reveals that this approach does not account for how a person might "use his or her own lived experience to draw conclusions" (81). Outside of clinical settings, diabetics employ a variety of knowledges for self-management, including medical information, skills to manage one's symptoms, and bodily awareness to oscillate across knowledges. "[P]atients perform agency" Arduser writes, "through the act of situational meaning making" (99).

The fourth chapter extends the previous discussion of agency into the realm of expertise, where people are not only agents over their own diabetic bodyminds but also providers of knowledge to others about the disease. In "Shifting Subjectivities: Attributed and Interactional Expertise," Arduser argues that diabetics become experts through a dynamic process, where they "do not just shift from one subjectivity to another. They are in fact at once teacher and student, expert and novice" (116). When participating in intra-group discussions, people with diabetes ask questions in the same breath as they share knowledge and personal experiences. Arduser links this fluid subjectivity to rhetorical plasticity, noting that there is a "perpetual state of liminality in which agency is enacted in diabetes, a state in which roles are not static, immobile subjectivities but rather temporary articulations and performances" (123).

Chapter five, "Mimesis and Identification: The Patient as Professional," considers how these performances might contribute to the formation of a professional identity. Arduser suggests that mimesis, or "imitating the words or actions of another," allows diabetic patients to build credibility (124). By echoing the language that dietitians, nurses, and doctors use to talk about diabetes, patients "create a similarly real definition of themselves as professionals," thereby boosting their ethos among other patients and with their medical teams (147).

Disability scholars may note that this mimetic approach to navigating the medical system is not in line with most disability activism, which seeks not to adopt the diagnostic rhetoric used to medicalize non-normative bodyminds but to undermine it by elevating the value of disability experience. Unfortunately, Living Chronic does not engage much disability studies scholarship, citing only a handful of disability scholars. The most robust discussion of disability activism appears in the conclusion, where Arduser rejects its relevance to diabetes because, according to her, it "is counterproductive and reinforces the problematic view of people with diabetes as a singular patient set" (150). It seems the author misunderstands that among the fundamental purposes of disability studies and activism is to reject the "patient and consumer" discourse that she herself critiques (19). Disability advocacy does not erase nuance among disabled bodyminds but, in the words of Simi Linton, is "used to identify us as a constituency, to serve our needs for unity and identity, and to function as a basis for political activism" (225).

Coincidentally, Arduser's critique of disability activism for being reductionist mirrors my own concern that her book does not address the multiple or intersecting identities held by diabetics. Throughout the project, there is no mention of race, gender, class, or any other axis of social identity that a person might hold in addition to being diabetic (150). It is not merely that queer folks can have diabetes or that brown folks can have diabetes but that, as Alison Kafer points out, "disability is figured in and through these other categories of difference" (17). Given that poor folks and people of color are disproportionately diagnosed with diabetes (see Beckles and Chou), it seems necessary that any critical investigation of the disease should take these axes of power and identity into account. Had the author attended more closely to the range of embodiments that constitute the diabetic community, her project would have been able to offer a more nuanced and insightful analysis.

This shortcoming aside, the book serves as an important addition to literature on chronic illness and the rhetorics of disability. The project's specific focus on diabetes addresses Susan Wendell's concern that "people with chronic illnesses inhabit a category not easily understood or accepted" (21). And the interviews guiding each chapter usefully foreground the perspectives of diabetics themselves, fielding off the "suspicion" that people with chronic illness are "mismanaging our lives, minds, or souls" (Wendell 28). Regarding rhetorics of disability, the piece takes up Jay Dolmage's claim that "rhetoric is indivisible from embodiment" (194). By critiquing the medical model, Arduser demonstrates how "a foundation in rhetorical theory can drive changes in the discourse and practices of health and medicine" by "re-articulat[ing] [patient agency] to new relationships that are more empowering for people living with chronic disease" (165). Rhetoric thus carries real, material consequences for disabled people. Ultimately, Living Chronic gestures toward a future of exciting, interdisciplinary work that uses rhetoric for disability justice, and it is perhaps this gesture that most clearly marks the piece's importance.

Works Cited

  • Beckles, Gloria L. and Chiu-Fang Chou. "Disparities in the Prevalence of Diagnosed Diabetes — United States, 1999-2002 and 2011-2014. Morbidity and Mortality Weekly Report, vol. 65, no. 45, 2016, pp. 1265-1269. https://doi.org/10.15585/mmwr.mm6545a4
  • Dolmage, Jay. Disability Rhetoric. Syracuse UP, 2014.
  • Linton, Simi. "Reassigning Meaning." Disability Studies Reader, edited by Lennard J Davis, 3rd ed., Routledge, 2010, pp. 223–236.
  • Kafer, Alison. Feminist Queer Crip. Indiana UP, 2013.
  • Wendell, Susan. "Unhealthy Disabled: Treating Chronic Illnesses as Disabilities." Hypatia, vol. 16, no. 4, 2001, pp. 17-33. https://doi.org/10.1353/hyp.2001.0062
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