Diabetes and Its Discontents
This concluding chapter summarized the central argument of the book: Biomedicalization does not flatten out differences so much as it proliferates them. As the biomedical paradigm has become central to lay systems of meaning, the language and ideas of biomedicine are imbued with cultural meanings. In this way, medicine shapes and reorganizes cultural meanings. But the reverse also occurs: the cultural meanings that arise from lay systems shape the patient-provider encounters and narratives that lie at the heart of the practice of medicine. These meetings of lay and medical systems of meaning are sense-making events in which patients and providers “practice culture.” In the United States, biomedicalization and a capitalist ethic of productivity and individual responsibility become mutually reinforcing: the individual is continually reinscribed as the primary category of being and the object of medicine. In Japan, biomedicalization intertwines with discourses of nationhood, membership in a purportedly unique racial-cultural community, and gendered domestic labor. While biomedicalization does not flatten, its targets are reshaped in traceable ways by the cultural repertoires that inform it. As biomedicalization renders interactions between providers and patients more uncertain and more collaborative, the cultural resources that they bring to those encounters become more—not less—relevant.
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