“This disease is hell. I wouldn't wish it on my worst enemy.”
--Vince, maybe 50 years old, diagnosed at 13
History is shaped by the worthy victim, or, better stated, those who would shape history use the worthy victim for their own political advantage. We relate to that victim; we sympathize with their plight. Jamal Khashoggi, Saudi journalist, murdered in Istanbul by a Saudi government hit squad. Worthy. Western educated and employed, in love and just wanting the proper documentation to get married, he entered the Saudi embassy and, after being tortured, was dismembered, carried off in pieces, possibly dissolved in acid, then disposed of in a yard a few hundred meters away.
Meanwhile, over the border in Yemen, over fifty thousand dead—mostly children—millions of others suffering starvation and cholera: alien, Islamic, Arabic-speaking, desert-dwelling friends of Iran. All also victims of Saudi Arabia. Individually, they might be decent people, but they are unfathomably distant from our lives, thus unworthy, eminently forgettable. Not valuable as agents of change. Examples abound. The assaulted woman drunk at a party, or wearing a short skirt: she deserved it. Unworthy. Dead Syrians: worthy—Syrian rebels are our allies, the regime who killed them our enemy.
The world of diabetes is also shaped by this dichotomy. As I recount elsewhere, my general practitioner told me that he was not in the business of diagnosing people who look like me with diabetes. This comment only makes sense when informed by the belief that type 1 is inherited, while type 2 is a lifestyle disease. People like me with 'good' lifestyles don't get it. If your immune system attacks your pancreas, leaving you unable to produce the very hormone you most need to survive, you did nothing to deserve it. If, on the other hand, your lifestyle—primarily your diet and your lack of exercise—leaves your cell walls impermeable to that same hormone, it is definitely your fault. You asked for it and you got it.
I have spent a number of years dwelling on this distinction. It always annoyed me when I'd read, “...diabetics have a ten percent chance of developing....” “Another study has documented an association between diabetes and adipose fat....” “India is the country with highest increase in rate of diabetes.... Which diabetes were they talking about? Which diabetics? Why can't they be more specific? We're not the ones who did it to ourselves. We have type 1, of the confused immune system. But what if we find out in a couple years that we've got all it wrong? What if it turns out that it was something in the Snickers Bars we snacked on? Maybe it was all that movie popcorn butter. How about the hydrox cream-filled cookies. I liked those things too.
I've argued many times that type 1 and type 2 really should be considered completely different diseases. Those around me would concur. I can't count the number of times I've heard, “You have diabetes? But you don't look....” Then, if they were trying to be tactful, they would use their hands to indicate round, rotund, obese. It is quite predictable. “You're in great shape.” Understandably, most people have no real understanding of any form of the disease. Why should they? I'm only beginning to understand it myself.
Media discussion of health also reinforces this, and does little for the empowerment necessary for people to change their habits and turn their lives around. It is pretty well understood by all who follow it that the chronic diseases afflicting the Western world (increasingly the whole world) are ones of 'lifestyle.' The blame may not be explicit, but it is there, undeniable. If your doctor tells you you have something that will most likely kill you (and perhaps even steal your eyesight and feet on the way), and you know it's because of what you do and have always done nearly every day of your life, it doesn't make you feel all so positive about yourself.
Something that costs our country billions and causes untold suffering is your fault. Every time you eat more starch than vegetables, it's your fault. Every time you drink a big gulp instead of a 1960s-size soda, it's your fault. Every time you sit on the couch and watch Breaking Bad instead of going to the gym, it's your fault. Don't forget it. Lost in the mix is that your world is your world and moving to another world is one of the most challenging things in the entire human experience. Neglected: you don't just inherit your genes, you inherit your lifestyle as well. (Oh... and don't forget all those hormone-whacking industrial pollutants floating around as well....)
A worthy note of caution: the first step towards creating a blood bath is the branding of those worthy and unworthy, the framing of scapegoats for the intractable problems of the modern age. Citizens of important countries around the world—America included—are increasingly and willingly lining up rank and file in easily labeled groups. Blame is tossed around like a Nerf football. Terms like 'evil,' 'despicable,' and 'deplorable' are used daily to describe those who you don't agree with. Have we forgotten Rwanda, Cambodia, Bosnia, Nazi Germany? Who's unworthy enough to be next?
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