African-Americans in Louisiana Term Paper

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[. . .] She dominated her children and husband, the Sambo, with her temper. This image of the Mammy as the controller of the African-American male, was used as further evidence of his inferiority to whites (

The second is the "Sapphire" stereotype, a demanding woman who refuses to take moral responsibility either for her own actions or for the actions that she demands of others.

Sapphire was a stereotype solidified through the hit show "Amos 'n' Andy" (Jewell, 1993). This profoundly popular series began on the radio in 1926 and developed into a television series, ending in the 1950s (Boskin, 1986). This cartoon show depicted the Sapphire character as a bossy, headstrong woman who was engaged in an ongoing verbal battle with her husband, Kingfish (Jewell, 1993). Sapphire possessed the emotional makeup of the Mammy and Aunt Jemimah combined. Her fierce independence and cantankerous nature placed her in the role of matriarch. She dominated her foolish husband by emasculating him with verbal put-downs (

African-American women are often put in the position of having to care for both themselves and their extended families without realistically being able to do so. Because of this many strike out, seeking to find others to take over some of the responsibility - or at least someone else to blame. This combination of roles (and stereotypes) can be deadly and may well explain at least a large part of the very high degree of Type 2 diabetes in African-American women.

Purnell Transcultural Health Model

This research also draws on the Purnell Transcultural Health Model, which argues that we can neither understand nor treat disease without considering the cultural context in which the subject herself or himself understands the disease (Camphinha-Bacote 1996, Camphinha-Bacote 1998). Purnell argues that there are cultural bases to both disease and health and that these often interfere with biomedicine as a culture that is as rule-governed as other systems of belief. This refutes the commonsense attitude of many people - both lay and health professionals - that dictates that the concepts of health and illness seem at first glance to be entirely biological constructs. After all, a person contracts tuberculosis not because she belongs to a certain religion or because he is a certain ethnicity but because a particular type of bacillus enters into her or his body and infects its human host. People get epilepsy because of a particular mis-wiring in their brains. Diabetes is caused through a failure of the endocrine system. Nothing could seem more straightforwardly objective and clear-cut and scientific. But in fact the picture is more complicated than this.

Purnell argues that health (and the absence of health, or sickness) is culturally constructed. Both concepts of sickness and perhaps to an even degree ideas about health are in fact deeply culturally rooted in the specific belief systems of a given role and society. We get sick for a number of reasons - and through the invasion of our bodies by a number of parasites. This is as close to an objective Truth as any of us is likely to get. But health, and sickness (and what to do about either) is not only a matter of objective truth; belief matters at least as much as truth.

It is often the case that health-care workers and African-Americans fail to share cultural assumptions about diabetes. But perhaps even more damningly what they often fail to share is an understanding that culture limits the way in which we can understand the world. This is actually a good thing about culture: If every time that we had to do something or decide anything we had to consider every possible alternative then we should all be paralyzed by the possibilities always before us. One of the functions of culture is that it limits the range of possible ways of seeing (and acting in the world). Culture simplifies the world so that we do not go mad.

But each culture simplifies the world in different ways, blotting out different details, erasing different bits of "reality." This results all too often in the fact that people from different cultures find it almost impossible to communicate with each other. Members of different cultures are in fact living in different worlds because their cognitive maps (formed by their languages and customs and material culture) highlight different elements of the "real" world. This often prevents health-care professionals and African-Americans at risk of diabetes or those who already have diabetes from communicating with each other.

Chapter Two: Pathopsychology of Diabetes Mellitus

Although diabetes is a very common ailment among Americans, most of those who are not directly affected by it remain relatively ignorant of what exactly causes the disease, the different types of diabetes, and the forms of treatment. It may be helpful to begin with a basic definition of this disease. Diabetes is a metabolic disorder of carbohydrate metabolism that results from an insufficient production of (or a reduced sensitivity) to insulin (American Diabetes Association, 1996, p. 8).

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose. It results from defects in insulin secretion, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take measures to reduce the likelihood of such occurrences (

Insulin itself is a hormone that regulates the level of glucose (a form of sugar) in the bloodstream. Insulin is produced in the pancreas, specifically by the beta cells of the islets of Langerhans. In a person who is not suffering from one of the forms of diabetes, the normally functioning pancreas secretes insulin whenever the level of blood glucose rises - most commonly after an individual eats. When the level of blood glucose falls in a person without diabetes (as it normally does after a meal is digested) the pancreas stops secreting insulin; this is accompanied by a release of glucose by the liver into the bloodstream. This allows a non-diabetic individual to maintain sufficient ready energy stores.

However, the metabolic picture is quite different for people with diabetes. In diabetics, the normal ability of body cells to use glucose as the basic source of energy is inhibited: Because cells cannot use glucose the way that they should there is a rise in blood sugar levels - the condition called hyperglycemia. More and more glucose accumulates in the bloodstream, which triggers the body to release high levels of sugar in the urine (which is called glycosuria). Sugar in the urine is one of the key ways in which diabetes is usually diagnosed, along with other common symptoms such as urinary volume and frequency, high levels thirst, itching across the body, disproportionate feelings of hunger, disproportionate weight loss, and overall weakness and fatigue. These symptoms can be extremely debilitating to the person with uncontrolled diabetes preventing him or her from attending school or going to work or otherwise participating in daily activities (Hanas, 1998, p. 61).

There are two basic types of diabetes and it is important to distinguish between the two of them. Insulin-dependent diabetes usually starts in younger people (and so is often referred to as juvenile-onset diabetes) when their islets of Langerhans begin to secrete too little insulin and sometimes cease to secrete insulin at all. People with this form of the disease must inject insulin at least once each day to control their blood glucose. Development of this type of diabetes is not related to diet - which is often a surprise to people who consider all diabetes to result from poor diet and obesity (Hanas, 1998, p. 78). In fact the cause of insulin-dependent diabetes is entirely perfectly understood; scientists believe that it may result either from some form of viral infection or from damage to the islets of Langerhans caused by an autoimmune response (American Diabetes Association, 1996, p. 42).

Type Two diabetes, which is also called non-insulin-dependent diabetes (sometimes abbreviated to NID) is far more common amongst African-Americans (and indeed among all Americans and all citizens of the developed world). Non-insulin-dependent diabetes usually begins in middle age. In this form of the disease, an individual's islets of Langerhans secrete normal amounts of insulin, but that individual's body has become resistant to insulin. The result is that the blood glucose levels respond weakly to the insulin. This type of diabetes is very closely linked to obesity and accounts for 90% of all diabetes (Hanas, 1998, p. 11).

Incidence of Diabetes in Rural African-Americans

Most African-Americans who suffer from diabetes suffer from Type II diabetes.

The proportion of the African-American population that has diabetes rises from less than 1% for those aged younger than 20 years to as high as 32% for women age 65-74 years. Overall, among those age 20 years or older, the rate is 11.8% for women and… [END OF PREVIEW]

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