Biographical Disruption Theory and Dallas Buyers Club

Introduction to Dallas Buyers Club and HIV/AIDS

Dallas Buyers Club is a 2013 biographical drama film that tells the story of Ron Woodroof, an AIDS patient diagnosed in 1985 (Ford, 2017). During this period there were no effective treatments for HIV/AIDS, and the field was highly under-researched. The disease was not well understood, and in most cases patients diagnosed with it were stigmatized. HIV/AIDS was widely associated with homosexuality. After his diagnosis, Ron was given only 30 days to live (Singleton, Lau, & Nissen, 2016); however, he lived for seven more years before dying from the disease (Vallée, 2013).

The film centers on Ron's life after his diagnosis and the struggles he faced in trying to access treatment. His life changed dramatically: he lost friends, and his family ostracized him because they believed he had contracted the disease through homosexual relations (Vallée, 2013). He was also fired from his job and evicted from his home. Although he was enrolled in a drug trial for zidovudine (AZT), Ron soon discovered the drug was negatively affecting his health. He eventually sought treatment in Mexico, and having found that the drugs available there were effective, he decided to import them into the United States as a means of generating income (Ribon, 2020; Vallée, 2013).

Human immunodeficiency virus (HIV) is a virus that damages the immune system of an infected individual (Eisinger & Fauci, 2018). It is mainly transmitted through contact with infected blood, vaginal fluids, or semen (Worobey et al., 2016). Within a few weeks of infection, a person typically develops flu-like symptoms such as sore throat, fever, and fatigue. The disease then becomes asymptomatic until it progresses to acquired immune deficiency syndrome (AIDS), whose symptoms include fever, weight loss, night sweats, recurrent infections, and fatigue (Rueda et al., 2016). There is no cure, but strict adherence to antiretroviral regimens (ARVs) can dramatically slow disease progression and prevent secondary infections.

HIV was first reported in 1981 and was initially associated with homosexual men, as the earliest cases comprised a cluster of gay men. To this day, it is estimated that 39 million people are living with HIV, and there have been over 32 million deaths associated with the disease since its discovery (Gökengin, Doroudi, Tohme, Collins, & Madani, 2016). More than half of all infected people are considered to be living in Africa.

Biographical Disruption Theory

The biographical disruption theory describes the influence a chronic disease has on an individual's life (Engman, 2019). The disease causes changes in a person's life, and their plans are disrupted. The theory holds that significant changes affecting the individual will be experienced both objectively and explained, and will be interpreted subjectively by the individual. Bury (1982) described how chronic disease breaks an individual's social and cultural experience, threatening his or her self-identity. Bury (1982) stated that chronic disease changes a person's habits and perception of life, alters relationships between the ill person and those around them, and leads to the mobilization of resources such as time, energy, finances, and family support (Wouters & De Wet, 2016). Biographical disruption arises from a major life event, and the onset of a chronic disease is considered to be one such event.

Changes in Habits and Life Perception

Biographical disruption theory has three key elements: (1) the perception and habits of life will change; (2) relationships between the sick person and those in his or her social network will change (Dean et al., 2019); and (3) resources will be mobilized. These three elements can be directly linked to the film, as it is clear that significant changes took place in Ron's life.

Ron was a real-life Texas cowboy who had lived a free-wheeling life. His world was overturned when he was diagnosed with HIV and given only 30 days to live. However, Ron did not accept the life expectancy he had been given and was compelled to make changes in his habits and outlook. While he continued using cocaine even after being enrolled in the AZT drug trial, Ron had a deep desire to live and was not prepared to simply accept the diagnosis and the timeline he had been given (Ribon, 2020). He began actively seeking alternatives.

While undergoing treatment with AZT, Ron noticed that his health was deteriorating further and began looking for other options to slow the disease's progression. This search led him to a clinic in Mexico, where he learned about the side effects of AZT and was told the drug was damaging his cells — a finding that made sense to him given how his health had worsened. The doctor at the clinic, Dr. Vass, had had his medical license revoked in the United States because aspects of his practice had violated US regulations (Ribon, 2020). Nevertheless, Vass prescribed a cocktail of drugs and nutritional supplements centered on the protein peptide T and ddC (Ford, 2016). These drugs had not been approved by the US Food and Drug Administration (FDA). After only three months, Ron found that his health had improved considerably.

Conclusion

Due to stigmatization, Ron's life was changed for the better in unexpected ways. While living with a chronic condition, his life's purpose changed and he became more invested in helping people gain access to HIV drugs. The theoretical perspective of biographical disruption resonates clearly with the life changes Ron experienced. He became more focused on others than he had ever been — a transformation that can be attributed directly to his contracting the disease. The film ultimately portrays Ron as a person who shifted public perception of HIV/AIDS and made a tangible contribution to the development and distribution of drugs for the disease.

The three elements of Bury's (1982) biographical disruption theory — changes in habits and perception, shifts in social relationships, and the mobilization of resources — are all evident in Ron's story. His journey from a self-interested, stigmatizing cowboy to a patient advocate illustrates how a chronic illness diagnosis can fundamentally reorder a person's priorities, identity, and social world. The film stands as both a historical account of the 1980s AIDS crisis and a compelling case study in the lived experience of chronic illness.

References

Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health & Illness, 4(2), 167–182.

Dean, L., Tolhurst, R., Nallo, G., Kollie, K., Bettee, A., & Theobald, S. (2019). Neglected tropical disease as a 'biographical disruption': Listening to the narratives of affected persons to develop integrated people-centred care in Liberia. PLoS Neglected Tropical Diseases, 13(9), e0007710.

Eisinger, R. W., & Fauci, A. S. (2018). Ending the HIV/AIDS pandemic. Emerging Infectious Diseases, 24(3), 413.

Engman, A. (2019). Embodiment and the foundation of biographical disruption. Social Science & Medicine, 225, 120–127.

Ford, A. (2016). Whose club is it anyway? The problematic of trans representation in mainstream films — "Rayon" and Dallas Buyers Club. Screen Bodies, 1(2), 64–86.

Ford, A. (2017). The Dallas Buyers Club: Who's buying it? Transgender Studies Quarterly, 4(1), 135–140.

Gandara, R. (2018). An "AIDS memory story": The desexualization of gay men's relationships during the marriage equality movement. American Papers, 47.

Gökengin, D., Doroudi, F., Tohme, J., Collins, B., & Madani, N. (2016). HIV/AIDS: Trends in the Middle East and North Africa region. International Journal of Infectious Diseases, 44, 66–73.

Morgan, D. J., & Burholt, V. (2020). Loneliness as a biographical disruption: Theoretical implications for understanding changes in loneliness. The Journals of Gerontology: Series B.

Ribon, R. (2020). The 1980s AIDS crisis in contemporary American cinema. Università Ca' Foscari Venezia.

Rueda, S., Mitra, S., Chen, S., Gogolishvili, D., Globerman, J., Chambers, L., … Morassaei, S. (2016). Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open, 6(7), e011453.

Singleton, J., Lau, E., & Nissen, L. (2016). Online 'Dallas Buyers Club' promises medications, fast. The Conversation.

Vallée, J.-M. (Writer). (2013). Dallas Buyers Club. Focus Features.

Worobey, M., Watts, T. D., McKay, R. A., Suchard, M. A., Granade, T., Teuwen, D. E., … Jaffe, H. W. (2016). 1970s and 'Patient 0' HIV-1 genomes illuminate early HIV/AIDS history in North America. Nature, 539(7627), 98–101.

Wouters, E., & De Wet, K. (2016). Women's experience of HIV as a chronic illness in South Africa: Hard-earned lives, biographical disruption and moral career. Sociology of Health & Illness, 38(4), 521–542.