Kieran Fionn Murphy writes: In Old God’s Time Sebastian Barry writes that his protagonist, Tom Kettle, a retired detective, ‘never took sugar because he had a touch of diabetes’. What is a ‘touch of diabetes’? One might assume, given Tom’s age, that it is type 2. Or is it type 1 and he’s had it from youth? Alternatively, is it pre-diabetes or impaired glucose, being only ‘a touch’? What is the significance of it to him, besides not eating sugar? Barry never clarifies and readers learn nothing further about the disease or its impact on Tom’s life. The book is typical of Barry’s nimble prose and deft, light touch; his touch with diabetes is so ephemeral as to hardly exist.
This is not surprising. Depictions of type 2 diabetes remain virtually absent from English-language novels, even though 589 million people worldwide have the disease and the number of cases continues to grow. Whether drugs such as Ozempic, low-carb diets and increased awareness of remission as a therapeutic target can reverse this trend remains to be seen. One in nine adults and one in five people over the age of sixty-five have type 2 diabetes. As such, it likely affects 11 per cent of adult novelists and 20 per cent of novelists sixty-five or older. However, they rarely write about it.
As part of a PhD thesis, I searched for depictions of type 2 diabetes in novels and identified none before 1998 and seven characters with the disease (in eight books) after that year (Old God’s Time isn’t included due to ambiguity about the type of diabetes). To put the finding in perspective, the Stanford Literary Lab estimates that approximately 222,000 English-language novels are published yearly, totalling roughly 5.5 million since 1998. That’s a type 2 diabetes mention rate of 0.00000145. I’ve certainly missed mentions, given the number of novels printed, but the representation is still minimal.
This omission is not due to avoidance of illness in the novel form, where maladies proliferate. Cancer, heart disease and mental illness show up regularly. Type 1 diabetes is easy to find (though type 2 is 67 times its population size). Huntington’s disease, which affects a mere 0.003 per cent of the world’s population, appears in a score of books, including Jacqueline Susann’s Valley of the Dolls and Saturday by Ian McEwan. Instead, the literary gap reflects a pattern of stigmatisation and marginalisation.
A study in the British Journal of Medicine calls type 2 the ‘blame and shame disease’. The Lancet Diabetes & Endocrinology journal found that individuals with type 2 diabetes internalise representations such as ‘weak, inferior, a burden’ and view themselves as unworthy of cultural attention. That the disease disproportionately affects older populations, racial minorities and people experiencing poverty doesn’t help. A correlation with obesity further compounds the stigmatisation and perception of diabetes sufferers as negligent, selfish, lazy and deserving their plight. Given this, perhaps the lack of published diabetic voices is unsurprising.
Even so, more than a trillion people are diabetic or pre-diabetic. Why is it not used in novels as a character trait? Reasons could include the diffuse nature of the illness, with a range of symptoms that tend to progress slowly and thus lack dramatic appeal. Many, such as neuropathy, are invisible. Dialysis is hidden away. Patients may develop blindness or need an amputation, but an author might choose a more compelling and sympathetic back story for a character with such a disability. A further issue is the belief that type 2 diabetes is progressive and incurable, which leaves few plotting possibilities. Finally, if an author depicts familiar symbols such as insulin injections or a hypoglycaemic episode, they would have to clarify whether it is type 1 (generally blameless young people, as in the film Panic Room) or type 2 (as in the violent, ageing reprobate in The Godfather, parts II and III). Confusingly, the two types have almost opposite cultural meanings and exposition is tedious.
If type 2 diabetes is too stigmatised, perplexing and diffuse to comfortably inhabit the literary world, what representations exist? In a subplot in Sandhya Menon’s When Dimple Met Rishi, a sheepish, diabetic father with no impulse control needs his daughter to save him from himself. The Frederick Sisters are Living the Dream, by Jeannie Zusy, features a character with diabetes, intellectual disabilities and no impulse control who cannot be saved from herself. Two violent, diabetic men named Ray abuse the next generation in Big Ray by Michael Kimball and I Know This Much Is True by Wally Lamb. Ageing, alcoholic detectives with uncontrolled diabetes deteriorate and die in The Remorseful Day by Colin Dexter and The Troubled Man by Henning Mankell (the previous Morse book, Death is Now My Neighbour, also mentions type 2 diabetes). Chocolat by Joanne Harris features a shunned grandmother who chooses death over diabetic control (but gains a grandson along the way) when a chocolate maker opens an establishment in her village.
Amidst these negative portrayals there is no representation of diabetes reversal, which is a shame, for literature has contributed societally by offering counter-narratives to diseases such as cancer, mental illness and HIV/AIDS. Fictional characters who put their diabetes into remission could offer hope and map an alternate real-world path that circumvents the worst effects of the disease. Naturally, novelists wishing to tackle the subject would need to avoid a simplistic restitution model that reduced the lived experience of type 2 diabetes to a binary success/failure outcome. Otherwise, they’d risk perpetuating the blame-based frameworks that need to be obliterated. At the very least, a simple mention of a character with type 2 diabetes who isn’t feckless, gluttonous, evil or dissolute, even as an aside, could help a vast, marginalised population feel recognised.