Insulin restriction, medicalisation and the Internet: A corpus-assisted study of diabulimia discourse in online support groups
Issue: Vol 15 No. 1 (2018)
Journal: Communication & Medicine
Subject Areas: Healthcare Communication Linguistics
DOI: 10.1558/cam.33067
Abstract:
Diabulimia is a contested eating disorder characterised by the deliberate restriction of insulin by people with type 1 diabetes in order to lose and control body weight. This article reports the first discourse-based study of diabulimia. It employs a combination of quantitative and qualitative techniques afforded by corpus linguistics, a methodology for examining extensive collections of digitised language data, to interrogate the discourse surrounding diabulimia in an approx. 120,000-word collection of messages posted to three English-speaking online diabetes support groups. The analysis shows how, despite lacking official disease status, diabulimia was nonetheless linguistically constructed by the support group contributors as if it were a medically legitimate mental illness. This article explores some of the consequences that such medicalising conceptions are likely to have for people experiencing diabulimia, as well as their implications for health professionals caring for people presenting with this emerging health concern in the future.
Open Access: CC BY
This research was supported by the Economic and Social Research Council (ESRC) (grant number: ES/J500100/1). Open Access funding was provided by the ESRC Centre for Corpus Approaches to Social Science (grant number ES/K002155/1).
Author: Gavin Brookes
References :
Affenito, S. and Adams, C. (2001) Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered? Nutrition Reviews 59 (6): 179–182.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5). Washington, DC: American Psychiatric Association.
Armstrong, N., Koteyko N. and Powell, J. (2012) ‘Oh dear, should I really be saying that on here?’ Issues of identity and authority in an online diabetes community. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 16 (4): 347–365. https://doi.org/10.1177/1363459311425514
Baker, P. (2006) Using Corpora in Discourse Analysis. London: Continuum.
Barker, K. K. (2008) Electronic support groups, patient-consumers, and medicalization: The case of contested illness. Journal of Health and Social Behavior 49 (1): 20–36. https://doi.org/10.1177/002214650804900103
Bordo, S. (1993) Unbearable Weight: Weight, Feminism, Western Culture, and the Body. Los Angeles: University of California Press.
Brown, B., Crawford, P. and Carter, R. (2006) Evidence-Based Health Communication. Buckingham, UK: Open University Press.
Cassel, E. (1976) Disease as an ‘it’: Concepts of disease revealed by patients’ presentation of symptoms. Social Science & Medicine 10 (3–4): 143–146. https://doi.org/10.1016/0037-7856(76)90040-8
Colton, P., Rodin, G., Bergenstal, R. and Parkin, C. (2009) Eating disorders and diabetes: Introduction and overview. Diabetes Spectrum 22 (3): 138–142. https://doi.org/10.2337/diaspect.22.3.138
Conrad, P. (1992) Medicalization and social control. Annual Review of Sociology 18: 209–232. https://doi.org/10.1146/annurev.so.18.080192.001233
Conrad, P. (2007) The Medicalization of Society: On the Transformation of Health Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press.
Eysenbach, G. and Till, J. (2001) Ethical issues in qualitative research on internet communities. BMJ 323: 1103–1105. https://doi.org/10.1136/bmj.323.7321.1103
Ferzacca, S. (2012) Diabetes and culture. Annual Review of Anthropology 41: 411–426. https://doi.org/10.1146/annurev-anthro-081309-145806
Fleischman, S. (1999) I am…, I have…, I suffer from…: A linguist reflects on the language of illness and disease. Journal of Medical Humanities and Cultural Studies 20 (1): 3–32. https://doi.org/10.1023/A:1022918132461
Fleischman, S. (2001) Language and medicine. In D. Schiffrin, D. Tannen and H. Hamilton (eds) The Handbook of Discourse Analysis, 470–502. Oxford: Blackwell.
Fox, N., Ward, K. and O’Rourke, A. (2005) ‘Expert patients’, pharmaceuticals and the medical model of disease: The case of weight loss drugs and the Internet. Social Science & Medicine 16 (6): 1299–1309. https://doi.org/10.1016/j.socscimed.2004.07.005
Gabe, J. (2013) Medicalization. In J. Gabe and L. Monaghan (eds) Key Concepts in Medical Sociology (2nd edition), 49–52. London: Sage. https://doi.org/10.4135/9781526401687.n11
Galasiński, D. (2008) Men’s Discourses of Depression. Basingstoke, UK: Palgrave Macmillan. https://doi.org/10.1057/9780230227620
Goebel-Fabbri, A., Fikkan, J., Franko, D., Pearson, K., Anderson, B. and Weinger, K. (2008) Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 31 (3): 415–419. https://doi.org/10.2337/dc07-2026
Gwyn, R. (2002) Communicating Health and Illness. London: Sage.
Harvey, K. (2012) Disclosures of depression: Using corpus linguistics methods to interrogate young people’s online health concerns. International Journal of Corpus Linguistics 17 (3): 349–379. https://doi.org/10.1075/ijcl.17.3.03har
Harvey, K. (2013) Investigating Adolescent Health Communication: A Corpus Linguistics Approach. London: Bloomsbury.
Hughes, J. (2010) Addressing the new teen trend of ‘diabulimia’: Moral quandaries of a pediatric endocrinologist. University of Western Ontario Medical Journal 79 (1): 11–13.
Hunt, D. (2013) Anorexia nervosa, depression and medicalisation: A corpus-based study of patients and professionals. Unpublished doctoral dissertation, University of Nottingham, Nottingham, UK.
Jones, R. (2013) Health and Risk Communication: An Applied Linguistic Perspective. London: Routledge. https://doi.org/10.4324/9780203521410
Mathieu, J. (2008) What Is Diabulimia? Journal of the Academy of Nutrition and Dietetics 108 (5): 769–770.
McEnery, T. and Hardie, A. (2012), Corpus Linguistics: Method, Theory and Practice. Cambridge: Cambridge University Press.
McEnery, A., Xiao, R. and Tono, Y. (2006) Corpus-Based Language Studies: An Advanced Resource Book. London: Routledge.
Miah, A. and Rich, E. (2008) The Medicalization of Cyberspace. London: Routledge. https://doi.org/10.4324/9780203931134
Mintz, D. (1992) What’s in a word: The distancing function of language in medicine. Journal of Medical Humanities 13 (4): 223–233. https://doi.org/10.1007/BF01137420
Paterson, B., Thorne, S. and Dewis, M. (1998) Adapting to and managing diabetes. Journal of Nursing Scholarship 30 (1): 57–62. https://doi.org/10.1111/j.1547-5069.1998.tb01237.x
Reintges, C. H. and Lipták A. K. (2006) ‘Have’ = ‘be’ + prep(position): New evidence for the preposition incorporation analysis of clausal possession. In M. Frascarelli (ed.) Phases of Interpretation, 107–132. Berlin: Mouton de Gruyter.
Rich, E. (2006) Anorexic dis(connection): Managing anorexia as an illness and an identity. Sociology of Health and Illness 28 (3): 284–305. https://doi.org/10.1111/j.1467-9566.2006.00493.x
Ridgway, P. (2001) ReStorying psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal 24 (4): 335–343. https://doi.org/10.1037/h0095071
Scott, M. (2016) WordSmith Tools version 7. Stroud, UK: Lexical Analysis Software.
Semino, E. (2008) Metaphor in Discourse. Cambridge: Cambridge University Press.
Sharma, A. (2013) Diabulimia: Towards Understanding, Recognition, and Healing. Columbia, SC: CreateSpace.
Shih, G. (2011) Diabulimia: Diabetes + Eating Disorders. What It Is and How to Treat It. Lexington, KY: Grace Huifeng Shih.
Sinclair, J. (2003) Reading Concordances: An Introduction. London: Pearson.
Staiano, K. (1986) Interpreting Signs of Illness: A Case Study in Medical Semiotics. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9783110855654
Wykes, M. and Gunther, B. (2005) The Media & Body Image: If Looks Could Kill. London: Sage.