Control, compliance, and common sense: power relations in diabetes care for Mexican Americans

This dissertation examines power relations in diabetes care among working class Mexican Americans in San Antonio, Texas. The concepts of hegemony and common sense as a model are used to examine biomedical and popular knowledge and practices. An analysis of the discourse in physiology textbooks and diabetes care manuals shows that metaphors of "control" are pervasive in biomedical constructions of the body and diabetes. Thus, I argue that “control” operates at the level of “common sense” for many health care providers. Notions of "control" extend from the cellular level to the functioning of insulin and glucose to patients and patient care. Clinicians ranked patients as having "good" or “poor” control. Patients with “poor control” were often presumed to be “non-compliant” with recommended treatments. Doctors attributed “non-compliance” to lack of knowledge and/or motivation. These assumptions dovetail with and can help reproduce stereotypes about “ignorance” and "fatalism" among Mexican Americans. Likewise, epidemiological statistics that focus on (“biological”) categories of race/ethnicity can obscure the effects of poverty and discrimination on health and health care. In the dissertation, I discuss how the construction of diabetes care in terms of control and compliance affected interactions between doctors and patients and the diabetes education classes. I also highlight practices based on respect for the patients’ knowledge and their lifeworld concerns. The working class Mexican Americans we interviewed were contending with low pay, periods of un- and under-employment, and inconsistent or no access to private or public health insurance. They gathered and evaluated information about diabetes from various sources in the United States and Mexico. Power differences related to class, race/ethnicity, and gender affected their approaches to medications, diet, exercise, drinking, smoking, and other forms of selfcare. Financial constraints, caring for family members, and desires to act and feel “normal” were important themes. I discuss how working class Mexican Americans talked about diabetes and biomedical conceptions of “pathologized life,” treatment “regimens,” “normalcy,” "control," "compliance," and “risk.” In the conclusion, I readdress the themes of power and knowledge.