Studying Unformed Objects: Integration

In the final post of this series, I begin by circling back through the rich questions that prompted this conversation: How do we define the objects of our study, or attend to “people’s efforts (successful or not)” to define and engage emerging forms and lived problems?  In probing these queries, the authors in this series have worked through a range of perspectives and genres: a sensory anthropologist’s poetic explorations of affective layers unleashed in landscape histories, a young scholar whose painterly meditations are part of her work to dwell with ethnographic materials in “curious not-knowing,” a technoscience "historian of yesterday" observing the emerging ontological animals of our age.  Taken together, their texts remind us of the productive frictions and blurred edges between “still life objects” and moving frames, between what is formed and what is unfinished, and what ethnography helps us do by using thinkable things (scenes, taxonomies, maps, houses) to get at murky realities or unformed objects and back.  

Here, I play with these notions to offer a “still life object” from my own ethnographic work, one I had not previously written about or tracked as a topic onto itself. But once I began thinking with this series’ unformed objects, it seemed that my larger object of study—a worldwide epidemic of diabetes that continues to shape-shift as it grows—might be interestingly refracted through the “compositional node” of the glucometer.

Inline_dextrosix
Image courtesy of Il Museo del Diabete (Turin, Italy) [1]

Anthropologist Sherry Turkle reminds us how instruments of science become “things we think with,” containing "inner histories" and inflecting futures [2]—objects akin to those Kathleen Stewart describes as “compositional nodes” in her opening provocation. Reconsidered from this angle, glucose meters become dense nodes in the material culture of an undefined epidemic, key artifacts that offer an entry point for ethnographic observation and writing.  They trace stories of real people and systems that (to borrow a phrase from Stewart) “gave up, or faltered, wore out, or started up again because of something.”  

The meanings, causes, and therapeutic itineraries of diabetes are now being re-imagined and diversely narrated by various actors. [3]  Yet there are still gaping holes in our basic knowledge of the epidemic’s global profile, such as how many people actually die from the disease each year.  Institutional counts of global mortality range wildly, estimating that anywhere between one and four million people die of diabetes annually—meaning that somewhere between these two credible tallies is a phantom population of some three million people displaced in our accounting, a population of dead either being erased by one estimate or conjured by the other.   

By including this uncertainty within my ethnographic scope, I am trying to understand how people fall in and out of such populations— what it’s like to live today in emerging flux or plateaued knowledges, and how people inhabit or rework these chronic diagnoses.  Inevitably, the counting involved in defining an epidemic is enmeshed in deeper politics and bureaucracies that may shape or foreclose entry points for public action.  Yet counting also has an aesthetics, as the glucometer reminds us—people’s concrete engagements with technoscience that may render otherwise-elusive politics visible for observation on an ethnographic scale.  

If viewing glucose meters as a barometer of epidemic, it might seem self-evident to interpret this measurement device through the received frameworks of medicalization or biopolitical theory.  Yet additional meanings and ethical layers are pulled into ethnographic range by viewing glucometers instead through the observational stance that Britt Dahlberg suggests: “to continue to look closely, to wonder what the angle really does, rather than stopping short under the assumption that we already know.” 

Intimate histories gather around glucometers.  These little computerized machines—whether painstakingly curated by a caregiver or sitting long broken-down on a kitchen shelf—are relics of care and intentions over time.  They trace investments and microeconomies of kin and neighbors; or, arriving from overseas in cardboard boxes, make visible new constellations of family support and diasporic medicine.  Observing their circulation pulls into view social ecologies (as when a glucometer was shared by a village in Ghana), generosity and debt (as when glucometers were pawned for groceries in Belize), scarcities and grey markets (in 2012, diabetic testing supplies became the most commonly stolen item in the United States).  Glucometers have a memory (most models today record up to 100 past readings of strangers and screenings, stasis or lost control); their assemblages are messy (lancets to draw blood from fingertips, calibrating fluid, lithium ion batteries, log books, computer chips, costly brandname tests strips often painfully mismatched with their machines or expiring uselessly in a jar).  Even when broken, they archive brittle ties: humanitarian interventions that passed through a place and did not return, care that dried up, savings that ended, people now gone.  In contexts of scarcity, at times people invent diagnostic registers of their own making in order to live within ruptured systems (for example, learning to read the movement of ants and other insects toward their urine as a sign of hyperglycemia when glucometers were unavailable).  For those living within such gaps and absences, breakdowns in the circulation of these devices trace the micropolitics of exclusion.  From this vantage, glucometers shed light on uneven processes of medicalization in the margins—precarious realities that show biopolitics as “an insecure enterprise indeed,” in the words of João Biehl, “more a symptom of the limits of governance than a marker of its presence and control.” [4]  

For people living with chronic disease, treatment is always an unfinished object.  I struggle to convey this in writing about an epidemic still in formation (though what epidemic isn't?), and in trying to engage with questions that are beyond my own toolkit to actually answer (was it one million dead, or four?).  But there are still granular moments that might show these processes of lost diagnosis in one person’s life.  Much of my description begins as a series of small writing experiments around some particular kernel, like these provisional notes here on the glucometer—trying to find objects and characters that storytelling might stick to, or some way to hold a narrative lens steady for a while through what remains unknown.

Ongoing histories and potentialities might be found in seemingly settled or gone-by things, as Kathleen Stewart has evoked here. Or unfinishedness might itself be part of new consistencies in emerging eco-scientific problems people face and changing ways that we understand ourselves on a planetary scale, as Michelle Murphy’s field guide suggests.  It is a work of close observation over time, Britt Dahlberg reminds us, hesitation as a cultivated practice.

Notes

[1] Many thanks to Il Museo del Diabete for their kind permission to use this image of the Reflectance Meter, which hit US markets circa 1970. It worked by reflecting light from a photo-electric cell to read the glucose levels in blood droplets, smeared on paper reagent strips called Dextrostix.  The word “glucometer” here is also an interesting anachronism—although now used to refer to such devices in general, it was originally the brand name for a model marketed by Ames (today Bayer).  For a techno-history of how these corporate objects became interwoven into the fabric of self-care, see S.F. Clarke and J.R. Foster, 2012. “A History of Blood Glucose Meters and Their Role in Self-Monitoring of Diabetes Mellitus.”  British Journal of Biomedical Science 69(2): 83-93.

[2] Turkle, Sherry (ed).  2007.  Evocative Objects: Things We Think With.  Cambridge: MIT Press.  

[3] Here I’m thinking of the multiplicities examined in the vast and important literature on diabetes in anthropology and technoscience studies, including the work of Michael Montoya, Annemarie Mol, Ian Whitmarsh, Carolyn Smith-Morris, Harris Solomon, Juliet McMullin, Chris Feudtner, Cornelia Guell, Melanie Rock, Steve McGarvey, Jessica Hardin, Leandris Liburd, Dennis Wiedman, Aaron Mauck, Hannah Landecker, Emily Mendenhall, Daniel Benyshek, Susan Reynolds Whyte, Mariana Ferreira, Gretchen Lang, Steve Ferzacca, Rebecca Seligman, Donna Leonetti, and the late Diane Weiner. 

[4] Biehl, João.  2011   “Homo Economicus and Life Markets.” Medical Anthropology Quarterly 25(2): 280.