Traveling with Sugar. Amy Moran-Thomas

      “That’s not mine,” Cresencia said of the prayer. It was labeled with the names of two collectives that shared materials, the Philippine Diabetes Association and a nongovernmental organization (NGO) in Tobago.

      She shrugged. “But we could talk a little.”

      I joined Cresencia along some of her travels as she sought care in the following year, usually wherever she invited me. In addition to kitchens, temples, and clinics, Cresencia kept collapsing on the roads and on the beach. Some events were attributed to spirit possession and others to coma caused by either low blood sugar or by diabetic ketoacidosis (a state linked to high blood sugar and missing doses of insulin). The similarity of these semiconscious states confused the local Kriol nurse, who had to send for someone who spoke Garifuna to distinguish between trance and diabetes crisis each time Cresencia was carried again to her clinic.

      How does expertise get constructed in different ways around death and survival? The crucial thresholds in this story all relate to that question. Caregivers presented these threshold definitions as “natural” facts, using them as tools to navigate uncertain biology. The specific ways they were defined often took on a meaningful life of their own, “healing despite sickness”¹¹ along the borders between religion and medicine.¹²

      One of anthropologist Victor Turner’s famous theories described the betwixt-and-between threshold states that he called “liminality,” building on the work of Arnold van Gennep. He wrote: “The attributes of liminality or of liminal personae (‘threshold people’) are necessarily ambiguous, since this condition and these persons elude or slip through the network of classifications that normally locate states and positions in cultural space.”¹³

      Many anthropologists have since reflected on these ideas of liminality and thresholds—spaces of transformation, open on both ends. For Turner the way out of the liminal state was through ritual. But in situations of chronic conditions, it was not always possible to find a ritual that worked. Getting caught in its betwixt-and-between, neither-nor state can recall what it’s like for patients to live with chronic diagnoses, Jean Jackson argues, classified by biomedicine as “ambiguous beings.”¹⁴ Yet a “liminal figure—one that haunts the very field of power that excludes her”—at times also sheds light on those fields’ definitions in turn, Angela Garcia offers.¹⁵ “Such a liminal position can animate a critically different reflection on medicine and society, a reflection that need not accept things as they are,” Arthur Kleinman once reflected.¹⁶ Ieva Jusionyte adds that certain thresholds of states may look like peripheries but in fact act as the core, consolidating political power along their borders.¹⁷