Last week, I wrote about the response of the online food allergy community to an article written by a mom who told strangers her vegan son had food allergies. Her reasoning seemed to be that this was an easier way to receive accommodations for his diet than explaining his actual dietary choices. Many parents of food allergic kids were shocked that she would “fake” having a kid with food allergies.
One of the themes I saw in reactions to that article in the article comments and on Twitter was that living with food allergies is a difficult reality, not an identity that someone can choose to claim for convenience. This got me thinking about food allergy “identity.” More specifically, since my academic training has taught me to think about how medical tests and devices affect everyday life, I’ve been considering the role that testing and diagnosis play in giving people access to a food allergic identity.
In order to be able to claim “food allergic” as an identity, it’s my understanding that a person must first go through the process of testing and medical verification. After an unexpected reaction and a visit to the emergency room, a person will get referred to an allergist, either by the ER or by their primary care doctor in a follow-up appointment. Testing in an allergist’s office typically includes skin testing and/or blood testing. To verify that test results correspond to the patient’s symptoms, the allergist will also take a detailed medical history, focusing on any history of allergic reactions. These two pieces are necessary to confirm the diagnosis in the eyes of most allopathic (that is, mainstream Western) physicians.
Going through this diagnostic process looks like what STS scholars call an obligatory passage point. According to French sociologist Michel Callon, an obligatory passage point is a scientific process or activity through which individuals must go through in order to be considered credible by other people with an interest in the issue at hand. The actors involved become “interested,” which, in this case, means that they’re now “in this together,” whether they mean to be or not. Their future actions will work in tandem toward a solution or resolution of the issue at hand. The canonical case for this is a field research project in which fishermen, scientists, scallops, and fishing tools all end up in the right place at the right time. Their combined activities and interactions present a solution to an overfishing problem off the coast of France. But it presents a new problem: who has the authority to speak for the many people and things that played important roles in this project?
The question of food allergic identity has so many features of an obligatory passage points. Different people (doctor, patient, nurse) and things (medical needles, lab equipment, allergen extracts) have different roles in this process. As the testing process wraps up, the “fact” of food allergies emerges from a mess of previous uncertainty. Solutions and management strategies come into view and people, especially those with a new diagnosis, learn to play new roles.
The testing process separates those people who have a scientific basis for claiming the food allergic identity and those who do not. As I discussed in a previous post, getting a positive diagnosis, while it can certainly present new challenges that no one wants to deal with, opens to door to participating in communities of people with food allergies. These communities are places to share tips, network, and exchange news about food allergy science. Physicians, professional advocates, such as the staff of FARE and Kids with Food Allergies, and other allies, like researchers and purveyors of allergen-free foods, also participate. But someone without food allergies or scientific or professional interest in them wouldn’t find much to relate to here.
The question of representation is where this all loops back to identity. “Faking” food allergies short-circuits this whole diagnostic process; it bypasses the obligatory passage point of testing and diagnosis. As such, the faker has no scientific credibility for saying, “I have food allergies.” In the well-informed food allergy community, lacking that scientific credibility means that a person also lacks the social credibility to say, “I have food allergies.” What is more, they are publicly representing food allergies when they tell a server, teacher, or parent about a food allergy diagnosis that doesn’t “exist” according to the accepted diagnostic procedure. The worry is that a bad representative – one who is both dishonest and who has less investment in seeking consistent accommodations than someone who is truly food allergic – will be taken to represent all people with food allergies.
What do you think of this angle on diagnosis, identity, and impostors?