This article suggests that IBS, and its relationship to disability studies, can be better understood by examining the rhetorics surrounding gastrointestinal (GI) disorders. To understand the function of GI rhetorics, I examine three rhetorical sites: (1) communal meal settings and the rhetorical politics of food refusal; (2) historical and contemporary texts that gender gastrointestinal distress; and (3) rhetorics of cure and control in advertising for GI-related products, particularly Zelnorm and Activia. The article concludes that changing attitudes about gastrointestinal disorders is not so much about controlling our bodies, but reclaiming the rhetorics of these disorders.
I was chagrined when Novartis began direct-to-consumer advertising for an Irritable Bowel Syndrome (IBS) medication in 2003. Not because the product wasn't needed, but because I was hoping that name wouldn't stick: Irritable Bowel Syndrome. As a person with a 15-year history of IBS, I have been leading a one-woman movement to honor the disorder's previous name — "spastic colon" — which I believe more aptly describes the experience of having IBS. I want people to know that my bowels aren't like someone who hasn't had their coffee, a teething toddler, or an abrasive salesperson. The reality is that my colon prefers to restrict and block, expand and expunge: it's spastic. I've also found that saying "spastic colon" and jumping a bit in my chair — as if the spasms are taking over — is typically an effective, if humorously inappropriate, conversation-ender.
Gastrointestinal disorders are a rhetorical paradox. People typically do not want to know or talk about such disorders, but rhetorical situations commonly arise that invite, or demand, gastrointestinal chit-chat. In fact, while nearly everything I've read about gastrointestinal disorders claims that they are little discussed, I've found that these disorders are rhetorically quite productive. IBS invites consideration of how chronic and episodic disorders fit in disability studies, especially in cases where the disorder impacts life, but is not debilitating, as is the case with my IBS (though not everyone's). The meaning of IBS, and its relationship to disability studies, can be explored by assessing how rhetorics of GI disorders circulate in private and public spheres, and I examine three rhetorical sites of GI disorders and distress. First, I explore how IBS functions in communal meal settings common in mainstream U.S. cultures, and how food intolerance is read as cultural aversion. Next, I examine gendered rhetorics of GI disorders, with attention to "hysterical" representations of GI distress in historical documents and hypermasculine representations in modern-day fiction. Finally, I investigate the representation of IBS in advertising, particularly for the now off-the-market Zelnorm (Tegaserod maleate), and for Dannon's Activia yogurt, a non-prescription product. I read these sites using rhetorical theory, disability studies, and personal experience.
In examining these rhetorical sites of GI disorders, I focus on the dominant desire to control IBS. I claim that we must redefine rhetorics of control — and in a way, take control of — the rhetorics that surround GI disorders. By claiming that GI disorders are rhetorically prolific, rather than courteously silent, I make an argument similar to Foucault's repressive hypothesis regarding discourses of sex. Foucault notes these discourses result in "[a] policing of sex: that is, not the rigor of a taboo, but the necessity of regulating sex through useful and public discourses" (25). Likewise, I suggest that GI disorders and distress are tightly regulated by common rhetorical routines, and like Foucault, I question these "useful and public discourses," which define what GI disorders are and can be. In response, I argue that those with GI disorders intervene in these rhetorics.
My suggestion that those with these disorders "take control" of GI rhetorics is complicated by my desire to follow Susan Wendell's suggestion that those with chronic disorders and pain relinquish the "myth of control." She claims that "a major aspect of the suffering caused by pain, is the desire to get rid of it," and she suggests a "cultivated attitude of acceptance toward [pain] can reduce the suffering it usually causes" (326), though she is hesitant to accept the concept of "making friends" with pain (327). In many ways, I have embraced this approach to managing pain; however, I am suggesting that we do quite the opposite regarding rhetorics of GI disorders, because language has rhetorical and material effects, meaning that reconceptualizing these disorders may influence the experience of pain. By recasting "out of control" rhetorics of GI disorders, we harness the strong directive that we definitively control our bodies, and shift that controlling impulse to rhetoric itself. Put more simply, I believe the way we talk about GI disorders shapes our experience of them; thus, GI rhetorics deserve our attention and influence.
* * *
The Harvard Women's Health Watch provides a decent map of IBS:
Irritable Bowel Syndrome is a chronic disorder characterized by recurrent bouts of constipation, diarrhea, or both, as well as abdominal pain, bloating, and gas. Twice as common in women as in men, it's the most common diagnosis made by gastroenterologists and second only to the common cold as a cause for absences from work. IBS is a functional disorder, which means that it's not attributable, as far as we know, to any underlying disease process or structural abnormality.1 It's thought to involve various, often interacting factors — infection, faulty brain-gut communication, heightened pain sensitivity, hormones, allergies, and emotional stress. ("Experts")2
According to this description, I seem to either have a relatively light IBS case (I don't miss work for it) or am a seasoned suffer (I often have symptoms). It is this fluctuating nature, these "recurrent bouts," that make IBS difficult to define. In "The Politics of Shit," Cindy LaCom asks whether the sporadic nature of her Crohn's Disease requires her to constantly rearticulate her identity, and she claims that she is "constantly faced with the question of how to disclose [her] Crohn's disease" at moments when it is not evident. Similarly, using Ellen Samuels' terminology, IBS is sometimes "nonvisible," meaning that bodies appear "unmarked," sometimes "visible" (particularly in food-related conversation), and sometimes "invisible," where misunderstandings of IBS provoke social critique and bias. GI disorders can often be seen, heard, and sensed: my compatriots linger in bathroom stalls, pop lactose pills before creamy desserts, read bottles in the fiber aisle, and ask restaurant servers for clarifications of ingredients (like wheat). These experiences do not represent all those with IBS, nor does my story, which I weave in below. But my telling does signify an initial claiming of spastic colon/IBS and a re-claiming of GI rhetorics by those who have such disorders.
"She Doesn't Like Spicy Food": Food Refusal & Disability Disclosure
In Feast: Why Humans Share Food, Martin Jones explains that for most animals, placing food in the center of a group is a "clear recipe for conflict and violence," but in ritualizing the shared human meal, "our own ancestors turned those danger signals around and transformed them into the very essence of conviviality that defines humanity" (2). He suggests a difference between a "meal" and a "feast," claiming that a familiar meal has a "pro-social" tenor with little judgment, while a feast can be "antisocial" and highlight various hierarchies in a group (150). Mary Douglas similarly notes that "[i]f food is treated as a code, the messages it encodes will be found in the pattern of social relations expressed," which are often about inclusion and exclusion (61).
At a feast with friends or strangers, those with GI disorders are particularly aware of these hierarchies and boundaries, which are inflamed and violated when food is refused. When I face down kale or curry at a feast, multiple taboos intersect: the taboo of refusing food; the taboo of mentioning GI disorders (shit) at the dinner table; and the taboo of experiencing GI distress at someone's home or restaurant. In these moments, IBS becomes evident by my discomfort from eating the food, by my disclosure of my disorder to assuage hurt feelings of refused food, or by well-meaning others who report my disorder to excuse my refusal. That food rituals are now about mystery and presentation, rather than long-held customs of preparing food in a conversation circle (Jones 134), puts me at a disadvantage: in many cases, I must ask what is in the food. While such a request is initially regarded as a compliment, my sometimes subsequent food refusal is not.
Food refusal is consistently read in terms of food preference: food is turned down because it's not liked, not because it causes sickness. Food intolerance is thus misread as "food aversion" (Macbeth & MacClancy 102), and in many cultures, food refusal is interpreted as an insult (Dresser 72, also see Wilson-Howarth 23-31).3 Those who refuse food can seem childish, for as noted by Leon Rappoport in How We Eat, people are "generally accepting [of] the foods of our culture or subculture without much thought," except "during childhood and adolescence, when a novel, 'foreign' dish occasionally confronts us as a frightening enigma" (15), or when a teenager rejects "familiar food items" in trying to establish her own identity (34). By refusing food, I appear conservative, fearful, even selfish, as when "people reject food, they are rejecting a fundamental shared value of the community" (Rappoport 34). Even the way I eat, which typically involves eating around possible offenders (what Rappoport calls "picky and pokey" ) is up for critique, as "one of the most common and relatively subtle but important ways we get to know others, gaining impressions of their personalities, is through their eating habits" (52). And if it is true that "people will make fairly consistent judgments of others based on their grocery shopping lists" (Rappoport 52), my plate of mashed potatoes and meat, with no salad or sides, is as impressive as my shopping cart full of frozen waffles, Cheerios, and canned fruit.
Sometimes my disorder is evidenced as I slip some food onto my husband's plate, though as Samuels notes, "In the absence of recognized nonverbal signs, we often resort to the 'less dignified' response of claiming identity through speech" (241). When I disclose my disorder (sometimes as "stomach troubles"4), I often receive layperson dietary suggestions (such as becoming a vegetarian, though leafy greens are my nemesis). At friends' homes, my disclosures can result in "special" meals made for me, which though sweetly meant, are a little embarrassing, flag my disorder (as being "special" so often does), and are sometimes worse for my bowels. These well-intentioned moments reflect an understandable attempt to create a meal situation that mitigates the food refusal my disorder invokes; such "special" meals are, in fact, others' attempts to help me "pass" as an able-eater, sometimes against my will. Such meals also make it difficult for me to eat something I have refused in the past (because I am doing well or throwing caution to the wind), as I might be called out ("I thought you couldn't eat spinach?").
The dinner-table questions about my disorder are an outgrowth of human curiosity, a form of rhetorical staring. In Staring: How We Look, Rosemarie Garland Thomson explains that "staring is an interrogative gesture that asks what's going on and demands a story" (3), and with rhetorical staring, such a story is verbally required since it cannot be visually perceived. To see someone refusing "good food" is unusual, and others want to know what is going on — so they ask, sometimes in a somewhat rude, right-to-know sort of way, and sometimes in a simple curious way (that makes me want to answer). As Thomson notes, a "staring interchange can tickle or alienate, persist or evolve" (4), and I wouldn't claim that rhetorical staring is always bad, for it can be "a spontaneous moment of interpersonal connection," in which "two people have the opportunity to regard and to be known to one another" (Thomson 33). The trouble comes when the curious rhetorical stare is accompanied by judgment, disbelief, or dismissal.
As disability scholars have described (see Thomson's rich work, Adams, and others), I can sometimes take the opportunity to stare back, typically by clarifying that it isn't that I don't "like" certain foods, it's that I "can't" eat them. People can be surprised by the directness with which I make this statement, and it sometimes backfires, when people see my comment as an invitation into a conversation I was trying to end. As Thomson notes, "the question is not whether we should stare, but how we should stare" (185), and rhetorically, this probably means a bit more thoughtful curiosity on the part of starers, but also, a more clear stance from me as staree, whether that means passing or claiming or something else. The trouble is that my disorder is caught up in so many other rhetorics — about food, politeness, and custom — that even if I introduce it, I cannot control the discussion. Most everyone has had diarrhea, has been constipated, and it takes time to defamiliarize these concepts to enable understanding of GI disorders. The many metaphors around eating and digesting compound these issues, as accepting is "swallowing," considering is "chewing," and understanding is "digesting" (Kövecses 73). In contrast, stomach and bowel trouble is associated with disgust and fear (Goatly 237), such as, "it made my stomach turn." This is a feeling I can experience in my most comfortable of moments.
Cindy La Com argues that "taboos which enforce silence about our bowels [are] so pervasive" that when engaged, "conversation stops cold and verbal constipation becomes the order of the day." Similarly, in A Sociological History of Excretory Experience, David Inglis asserts that "mention of words connected to lavatorial matters cause feelings of unease, even profound embarrassment, among both the speaker and those who listen to such utterances" (1). The rhetorical site of the shared meal, however, can override such taboos: speakers believe they are talking about food, not shit, even if my only response can be, "because it makes me sick" or something more descriptive. Inglis claims that excretory matters involve "defecatory," "sensory," and "verbal" practices (Sociological, 44-45), and in the context of the communal meal, the rules surrounding verbal practices appear relaxed. In the History of Shit, Dominique LaPorte rightly claims: "To touch, even lightly, on the relationship of a subject to his shit, is to modify not only that subject's relationship to the totality of his body, but his very relationship to the world and to those representations that he constructs of his situation in society" (29). For the person with IBS, such modifications and rearticulations may occur at every feast.
"Leave No Trace": Gendered Rhetorics of GI Disorder
Rhetorics of GI disorders are strongly gendered, with imperatives that women control their pain, their sounds, and their smells. To explore how gender shapes the controlling rhetorics of GI disorders, I connect two rhetorical sites: the hysterical positioning of women with GI distress in two 19th century medical texts, and a related "male" representation of IBS in a popular contemporary novel. I situate my own gendered experience within my analysis, particularly my encounters with weight loss and women, and an unexplained doctor's prescription.
In the 1874 "Constipation, Hypochondriasis, and Hysteria: Their Modern Treatment," Richard Epps claims that "bad cases of constipation are [unsuited] to self and empirical treatment" (66), and he discounts the possibility of (typically female) self-diagnosis and warns against hypochondria. He also suggests exercise, specifically: "All light household occupations are advantageous; dusting ornaments, picture-frames, etc., with long light feather-brushes in common use, is a good exercise, and has a beneficial influence on the abdominal walls and the contained viscera" (80). In this text, the space of the body is territorialized as a subset of the home space, and a clean home is equated with a functioning body. In a related chapter entitled "Constipation of Women," Epps castigates women for their "repugnance to seek advice for this ailment" (77), and he explains this is partly because "[c]onstipation is one of the symptoms of hysteria, a disease peculiar to women" (78). He demonstrates his intolerance of this "disease" in discussing a case of a woman with "hysteria and obstinate constipation," whom he describes as beginning to "sob and choke" in describing her symptoms (98). She is given the homeopathic "tincture" of Ignatia,5 and Epps knights himself as her savior in noting that when he saw her next, "she had neither had a return of the hysteria nor of the constipation" (99). He then moves on to describe the "imaginary ailment" of another constipated woman (which relieves him of having to "cure" her).
In this medical text, women with bowel problems are positioned as hysterical and silenced with various medications, and I would argue that little has changed. Though Epps recommends opium for constipation, in an 1848 treatise on digestive issues, Diseases of the Digestive Organs and Constipation, Treated Homeopathically, W. Broackes suggests opium as a treatment for diarrhea brought on by "fear, anxiety, and generally from strong emotions" (92). While Broackes makes some bizarre suggestions, such as that diarrhea "frequently arises from cold" (94), he also indicates belladonna for dysenteric diarrhea. This surprised me, as when I was diagnosed with IBS I was given a belladonna derivative to take "as needed." Belladonna is derived from the plant Atropa belladonna, and while the National Institute of Health claims that some preliminary studies reveal its effectiveness in managing IBS symptoms, "[T]here is currently insufficient scientific evidence regarding the use of belladonna for this or any other indication" ("Belladonna"). As the young dutiful patient, I tried to take the medication as prescribed, but found it made me dopey (in plant form, belladonna can cause hallucinations), so I quit. Like 19th century women, it seems I was being subtly prescribed anti-anxiety medication for my bowel problem, and I remember there being little conversation with my doctor regarding why I needed to take this drug, or what it was even supposed to do.
As the years have passed, I have found that conversations with doctors about my IBS consist of brief confirmations that I still have the disorder. The one exception was when I applied to Kaiser Permanente for independent health insurance at age 22, and was turned down when I disclosed my IBS (which Kaiser had earlier diagnosed). I was able to obtain coverage after writing a pleading letter that specified that I had not, and would not, be seeking treatment for my IBS. Much like the 19th century woman with her "clean house," or the woman with an "imaginary ailment," I realized I had to present my disorder as "under control," despite any evidence to the contrary. Indeed, as a consequence of Kaiser's initial refusal, I was discouraged from asking for tests for more serious problems, such as Crohn's disease; instead, I have self-diagnosed through absence of symptoms over the last decade (and remain in the Kaiser system).
Though conversations with doctors regarding my IBS have been infrequent or silenced, I found that conversations with other women regarding my disorder are relatively common. Initially, my disorder was evidenced by rapid weight loss of nearly 20 pounds in a six-month period (as I limited my diet to primarily bagels and cream cheese6 to avoid symptoms). My thin frame was obvious to those around me, and I found that with women, primarily my age at the time (18-22), my "stomach problem" was often a cause for envy, not concern, as these women would sometimes claim that they wished they had my disorder, so they could be "thin like me, without trying." (This desire to embrace disability or disorder seems rare, though other examples may include recreational use of certain drugs, and the primarily female pro-anorexia movement.) Conversely, I do not remember having, or initiating, many conversations with men about my disorder, especially in the first few years after I was diagnosed. A notable exception was a conversation with my father, who suggested I might have an eating disorder, as my already-thin frame was worsened by a trip to Europe (where I could eat little) and a bad stomach virus. The typically-female conversations I've had about my disorder may reflect a perhaps stereotyped willingness of women to talk to other women about their bodies (see Weiner), though I have also felt that men regard my "problem" as something I should solve on my own.
Though often cast as a "woman's disease," a fairly well-known — and male — representation of IBS is Tim Phelan's Romance, Riches, and Restrooms: A Cautionary Tale of Ambitious Dreams and Irritable Bowels, which has received a fair amount of press, from larger news organizations (such as U.S. News and World Report), NPR affiliates, and self-promotion.7 Phelan traces his struggle with IBS primarily in terms of being near a bathroom, and he consciously tells his story from a "male" perspective, as revealed in one of his "solutions" to his disorder:
Even if I wanted to, how would I begin to explain my unusual — not to mention embarrassing — symptoms? And who exactly would I explain them to? A primary-care physician? A psychiatrist? A proctologist? No thanks. So instead, applying a modicum of intrinsic male logic, I crafted a solution that was as ingenious as it was straightforward. To keep my gastrointestinal tract from spilling its contents all over my life, I would head down to the store, pick up some supplies, and build a dam. (82)
This obviously doesn't work, but more interesting is his self-defined "male logic," which is rooted in controlling his disorder at all costs, at least publicly. Phelan would rather remove people from his life than have them learn of his disorder, as occurs in his description of a failed relationship early in the book: "In the end, I concluded that I'd prefer to have Kelly think of me as a complete ass rather than someone who's scared he can't control his ass" (26).
Of more concern is the way that Phelan positions himself as a hyper-masculine male with IBS. I was surprised to see his book win an award, as I was troubled by his descriptions of dating, and of women in general. In one case, he refers to a semi-drunk woman on his apartment couch as a "buying signal" that meant he should "shut up, stop selling, and close the deal" (177). Indeed, the book is largely framed by his attempt to find a female partner (as the title indicates), and his IBS is explicitly or implicitly to blame when these relationships fail. By making his disorder the trope of his failed masculinity, Phelan misrepresents IBS, which does not necessarily lead to ruined relationships or necessitate pity.8 Indeed, Phelan's hyper-masculine, aggressive stance regarding women seems an attempt to counteract his having a disease that is more common in women. He ends up misrepresenting IBS as a social disease (rather than a disorder with social ramifications), and offending this female reader with IBS.
In Recovering Bodies, G. Thomas Couser notes that those writing about disability and chronic disorder/illness "may have difficulty reconciling their experience of illness with the comic plot expected of autobiography" (5). In contrast, Phelan's narrative ends on a happy note after describing his success with cognitive behavioral therapy. Though he claims, "I'd be lying if I said I'd cured my IBS" (246), the "rhetoric of 'my old self' and 'my new self,'" as described by Kristen Lindgren, characterizes his narrative, which imagines IBS as some sort of "alien invasion" (148). Phelan shows himself as conqueror of this "invasion," as after many chapters about how his dating life was thwarted by his IBS, the book ends by proudly declaring his marriage, which strangely stands in as the "cure" often found at the end of disability narratives (see Mitchell and Snyder). This idea that bodily dysfunction can be cured by marriage is not new,9 as Ehrenreich and English claim in For Her Own Good: Two Centuries of the Experts' Advice to Women. They argue that the "sexuo-economic" relation of marriage in the 19th century "confined women to the life of the body" (118), and that while marriage did not actually cure disorders, it provided a tolerant space for the "sick" woman, particularly for the middle class (white) woman who had domestic help. Thus, disorders in women commonly attributed to "hysteria" were claimed to be cured by marriage, and sometimes more specifically, sexual satisfaction (see Maines). Similarly, while Phelan's IBS cannot be cured by marriage, he can minimize the "feminine" nature of his disorder through heterosexual marriage, and assumedly sex, both of which elude him in his novel until its conclusion.
Thus, there are some shared traits in the ways women and men are represented with IBS, as both the 19th century woman and the modern man can seek marriage as a partial "cure." However, these representations differ in that there is more attention to the "cause" of GI disorders in women (both in the 19th century and in my experience). Put another way, Phelan spends no time discussing where his IBS may have come from, while textual representations of women with IBS seem particularly interested in why she has the disorder.
Mother's Little Helper? Advertising for IBS Products
Harvard Women's Health Watch provides a list of possible IBS treatments, including: antibiotics; fiber; FDA-approved drugs; antispasmodics; psychological therapies; and anti-depressants ("Experts"). As noted above, my own treatment of IBS has not been particularly influenced by doctors (except by omission), though I am apparently unusual in this respect. In "Patient Educational Media Preferences for Information about Irritable Bowel Syndrome," Halpert et al note that of the 1,232 subjects who filled out online and mail-in questionnaires, 79% had seen an MD for their IBS in the last six months. Fifty-one percent (626 people) claimed that they had received helpful information about IBS in the past, with 43% of that group claiming they received information from their doctor (the highest percentage), and 36% claiming they received information online. Of these same 626 people, 556 claimed they want more information about IBS in the future, with MDs and the Internet again ranking high as information sources (67% and 55%, respectively).10
While those with IBS have prioritized conversations with their doctors, the most repeated and recognized message about IBS to those with and without the disorder has likely been direct-to-consumer advertising for the drug Zelnorm, and more recently and less explicitly, advertising for Dannon's Activia yogurt. The prolific ad campaigns for these products have served to both validate that IBS exists, and pathologize those who have not "cured" themselves. High-profile spoofs — such as Saturday Night Live's take on Activia and its spokesperson Jamie Lee Curtis ("Saturday") — reveal the wide circulation of these ads, which invite all to "diagnose" people with, and the meaning of, IBS.
On July 24, 2002, The New York Times ran the headline, "FDA Approves Controversial Bowel Drug," noting that Zelnorm had been approved for women with constipation-dominant IBS. On March 30, 2007, Novartis complied with the FDA in taking the drug off the market, and the Zelnorm website noted that this was because of "a small imbalance that was statistically significant in the number of cardiovascular ischemic events in patients taking Zelnorm."11 The same day, an "FDA Public Health Advisory" noted that 13 patients treated with Zelnorm had such serious effects, including one person who died ("FDA"). The drug returned to the market in a "restricted access program" on July 27, 2007 ("Zelnorm Most"), but this program was closed on April 2, 2008. Zelnorm is still sold outside the U.S., sometimes as Zelmac (for a critique, see "Novartis").
I would argue that the perception of IBS in public discourse was nearly non-existent before Zelnorm advertising, which fastened a medical identity to IBS. What is interesting is that unlike much of the medical research, which often defines IBS as the result of various "nervous personalities," Zelnorm defined IBS as a purely medical ailment that could be fixed. By doing this, Zelnorm's advertising is in curious relationship to what is often called the "medical model" of disability, in that while Zelnorm proposes a medical solution, it resists the pathologization of IBS that is evident in the medical literature. This is achieved where medical and advertising rhetorics collide, as Zelnorm had to articulate IBS as a "problem" without offending potential buyers. For me, this was successful: while I found the style of the advertising to be curious, I was not particularly troubled or confused when I saw the ads.
Zelnorm engaged in an advertising blitz that announced IBS and the ability to "norm" it. The ads primarily featured good-looking women exposing their midriffs, with messages about their symptoms, and/or improvement after Zelnorm, written in dark pen on their abdomens.12 For example, one ad has a woman in a sky blue shirt and button-up cardigan, holding up her top to expose "Abdominal discomfort, Bloating, and Constipation" handwritten in dark pen on her stomach above the navel. She has short dark hair, is smiling brightly, and wears a gold bracelet and wedding ring. In 2005, these TV advertisements were ranked as the "most recalled by consumers" of the 31 new prescription drug ads for both new and existing drugs ("Zelnorm Most"). In 2006, roughly $5 billion was spent on such consumer marketing campaigns, and Zelnorm engaged in a $314 million consumer ad campaign and had sales of $560 million in 2006 alone (Blankenhorn). A research study revealed that for Zelnorm, there was a 40% increase in sales after advertising, though this flattened out (Sellers; Fox).
The ads claimed, "It's in your body, not your head," and that you can "Be yourself again". The images of good-looking women smiling while supposedly experiencing bloating and constipation were memorable, and not without their critics. On his blog, Brian Kobashikawa commented on the use of Jean-Jacques Perrey's "E.V.A" in Zelnorm ads, claiming that "the buzzes and grooves that Perrey lovingly arranged back in 1969 now translate to explosive diarrhea and constipation in 2005" (Kobashikawa). On his blog, Jeremy Brown satirically referred to the held-up shirts as "gastrointestinal pornography," and declared: "[T]here's no way these duodenal debutantes are the real deal .These women are faking gastric disorders just for the glamour, and I find that offensive." He then explains his experience with Zelnorm and warns away those who don't really need it (Brown). More seriously, an early Novartis advertisement entitled "Beating IBS" was taken to task by the FDA for making false claims. The original ad had a subtitle: "Novartis and Gloria ended 30 years of debilitating abdominal pain, bloating and constipation in just 3 days." The FDA was critical of the three-day claim, the idea that the drug was a cure for everyone, and the failure to include references to what the FDA called "serious safety concerns" ("Novartis/Zelnorm"). Despite these concerns, and the eventual removal of Zelnorm from the market, many consumers desperately want the drug back. On an IBS blog, various sufferers declare: "Zelnorm literally saved my life"; "I would pay $10.00 a pill if I could buy them from a drug pusher on a dark street corner"; and "FDA please bring it back" ("Zelnorm Alternatives"). This primarily female group speaks of crying, having portions of their intestines removed, and of the relief Zelnorm gave them. Unfortunately, their voices do not ring-out as loudly as Zelnorm's advertising once did.
The rhetoric of cure contained in Zelnorm's advertising was not a simple message from corporation to patient; instead, it introduced a new rhetoric of IBS into the general population. This advertising arguably created more awareness of, but less tolerance for, those with IBS, who were expected to obtain a cure. With Zelnorm, unsolicited medical advice from non-practitioners became a new way to respond to IBS, in the form of, "Isn't there something you can take for that now?" I responded to such questions a few times, noting that Zelnorm was new, or that it was taken off the market in part because a test subject died (though I never intended to take the drug). As G. Thomas Couser explains, "The treatment of illness or disability typically, and necessarily, involves a sort of narrative of collaboration between doctor and patient — the creation of a new 'life text'" (Recovering 10). Zelnorm's public discussion of IBS invited all to share in crafting such texts, and to a degree, in exercising control over patients' lives.
Though Zelnorm is no longer widely available in the U.S., there are newer, non-prescription remedies for IBS with similarly high-profile advertising campaigns. This includes advertisements for Dannon's Activia yogurt, which Dannon claims "is a creamy, blended, probiotic-cultured, lowfat yogurt" which "helps with slow intestinal transit and contains a unique culture — Bifidus regularis." While Zelnorm came in with $560 million in sales in the first year, Activia brought in a not-so-shabby $130 million, which Lauren Sandler of slate.com calls "a very unusual success for a new food product's first year." Unlike the Zelnorm ads, the Activia ads are careful to avoid any reference to specific ailments and instead refer to "tummy troubles," as naming constipation — a disease — would require the FDA to approve Dannon's product (Sandler). Still, there is the appearance of science, particularly the trademarked Bifidus regularis, whose actual scientific name is the less savory Bifidobacterium animalis (Sandler). The Activia website cites two studies proving that Activia "works," though these studies only refer to "intestinal transit" (how long food stays in the intestinal system). A four-page handout "for healthcare professionals" is provided ("Gastrointestinal"), alongside an offer to "sign up to receive a referral pad," though Activia is not a prescription product. Much like Zelnorm, I have received layperson advice on eating Activia (or other probiotics), making the fake referral pad seem ironically useful.
In early 2008, a California woman launched a lawsuit against Activia, Activia Lite, and DanActive, claiming that the "scientifically proven" claims had no backing, even from Dannon, and that consumers overpaid because they believed they were getting effects that did not occur (Reuters). In September 2009, Dannon agreed to set up a $35-million dollar fund to reimburse consumers who bought the products, though as noted by Nathan Olivarez-Giles in a Los Angeles Times article, the company admitted no wrongdoing. The company also agreed to "increasing the visibility of the scientific names of the 'probiotic' cultures" in the yogurt, and to "remove the word 'immunity' from its DanActive products" (Olivarez-Giles). Based on my viewing of TV advertisements, this settlement has not changed the content or delivery of the Activia ads.
Like Zelnorm, Activia ads feature images of slim female stomachs, though neither Zelnorm nor Activia are weight loss products. The image below appears in Activia print and TV ads, and it pictures a thin, naked mid-section of a thin but curvy woman, with a yellow arrow pointing down superimposed on the stomach, encircled by the words "helps naturally regulate your digestive system." The seemingly unnecessary arrow on the stomach is mirrored on the product name, where the middle "I" in Activia has a yellow arrow pointing down. This sexualized image is amplified in Activia ads in other countries, such as an image from the UK Activia website, which again includes a naked mid-drift and yellow arrow, though this time the top of a salmon-colored waist ban, and a white sports bra, are included. The woman's body from the shoulders up is cut off, and her hands are placed somewhat suggestively beneath her navel, and frame the yellow downward arrow (for similar examples, see "How"). This ad is outdone by a Brazilian Activia ad, which includes a rather thin woman naked from the waste up, with windblown hair, an exposed breast, and closed eyes, along with a yogurt container in one hand and a spoon of yogurt in the other.13 This time the arrow on her stomach is green (and unfortunately the ad is no longer online). What Jeremy Brown wittily referred to as "gastrointestinal pornography" in Zelnorm ads becomes more of a reality with Activia advertising. Sexualized representations of these female-marketed products stand in contrast to male-marketed advertising for products for GI distress, which often feature the "macho eater" at a diner, in a purely desexualized scene.14
Of course, neither Zelnorm nor Activia will make me thin or beautiful, and the visual rhetorics and printed claims of such advertising leave little room for those who choose to manage this disorder without dangerous or pricey products. Further, such advertising not only suggests that I be cured, but that I have an idealized shape as well.
Back to the Beginning: Rhetorics of Control and Treason
The likely first recognition of our bowel system (and problems with it) comes when we are told to control it. For sanitary reasons, it's likely impossible (and perhaps unwise) to entirely do away with rhetorics of control related to bowels, though we must be more aware and tolerant of the various ways that people deal with their own waste.15 The rhetorical initiation of bowel control partly begins in children's books, which encourage children to talk about, then control, their bodies. In The Truth About Poop, Susan Goodman explains that since we poop every day (or are supposed to), we should talk about it, but instead, "once we're old enough to do it by ourselves, we go into the bathroom and close the door" (4). In Flush! The Scoop on Poop Throughout the Ages, Charise Harper ends with a poem entitled "Finally," which clarifies that while the book only alluded to the word "poop" throughout its pages, the author is now "going to write it just for you" so everyone can say it out loud together — in a controlled fashion. Howard Bennett's It Hurts When I Poop! A Story for Children Who are Scared to Use the Potty, tells of a man named Bill, who didn't take his trash out. Bennett notes that the trash "got in [Bill's] way and kept him from having fun. It was time to let the trash know that he was the boss around here" — that he would take control. Such stories make it confusing to know what to do if you are visiting the dumpster several times a day or just waiting by the curb, desperately hoping to get rid of the trash. The either/or binary in these early lessons of bodily control leaves little room for the often incomplete control of those with GI disorders.
Once we gain control of our bowels, or something close, the controlling impulse shifts to managing the gaseous rhetorics of noise and smell. Clare Brant refers to these rhetorics as "odor poetics," and she is particularly interested in the desire to banish smells:
[W]hat was it in smell that overlaps with the idea of treason? Is it that we want to displace the betrayal of ourselves as animals, after all? Or is it that the power to banish reinstates us as entities in control, able to dismiss that which has crept under our noses? (552)16
For fear of such "treason," I've seen women who wait in stalls for someone else to flush or turn on a hand dryer to disguise noises they may make. But Brant raises a larger issue — why have traces of toileting, particularly scent, become tantamount to treason? Do we believe that if we avoid the sounds and banish the smells — and carefully control our shit-related conversations — that we will in fact cease to need the bathroom at all? With so many flowery bathroom sprays on the market, and entire shows dedicated to your high-end bathroom,17 this seems suggested.
Unruly intestines challenge this tidy, never-heard-from, scent-free ideal, which is why those with such intestines are misrepresented as childish people who don't like your food, as hysterical women and unlovable social outcasts, and as those who simply refuse an "easy cure." Such rhetorics not only affect how others see those with gastrointestinal distress and disorders, but how we see ourselves, as rhetorical representations have material effects (what we eat, who we talk to, where we go to the toilet). We can respond by more consciously observing and transgressing the limiting rhetorics of gastrointestinal issues, because it's not just about how we control our bodies (or don't), but about who controls these rhetorics. If it is true that "personal narratives may individually and collectively help to reclaim bodies from medical colonization, to reinvest bodily dysfunction with meaning" (Couser, Recovering 295), then it makes sense to engage these rhetorics. To be sure, this betrays the impulse to tightly control shit, but I position myself as a rhetorical traitor who reclaims the rhetorics that control an important part of who I am: my bowels.
- Adams, Rachel. Sideshow U.S.A.: Freaks and the American Cultural Imagination. Chicago: University of Chicago Press, 2001.
- Avinger, Charles, Edith Croake, and Jean Kearns Miller. "Breathing Underwater in Academia: Teaching, Learning, and Working with the Hidden Challenges of Invisible Illness and Hidden (Dis-) Abilities." Disabled Faculty and Staff in a Disabling Society: Multiple Identities in Higher Education. Ed. Mary Lee Vance. Huntersville, NC: AHEAD, 2007.
- "Belladonna: (Atropa belladonna L. or its variety acuminata Royle ex Lindl)." Medline Plus, A Service of the National Library of Medicine and the National Institute of Health. 1 February 2008. Accessed 19 March 2009. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-belladonna.html
- Bennett, Howard J. It Hurts When I Poop!: A Story for Children Who Are Scared to Use the Potty. Illustrated by M.S. Weber. Washington, D.C.: Magination Press, 2007. np.
- Black, Maggie and Ben Fawcett. The Last Taboo: Opening the Door on the Global Sanitation Crisis. London/Sterling, VA: Earthscan, 2008.
- Blankenhorn, Dana. "Best Way to Sell Drugs is to Talk to Your Doctor." ZDNetHealthcare. 4 September 2008. Accessed 13 March 2009. http://healthcare.zdnet.com/?p=1316
- Brant, Clare. "Scenting a Subject: Odour Poetics and the Politics of Space." Ethnos 73.4 (December 2008): 544-563.
- Broackes, W. Diseases of the Digestive Organs and Constipation, Treated Homeopathically. New York: William Radde, 1848.
- Brown, Jeremy. "The Seduction of the Irritable." [Weblog entry.] Who Knew? 31 May 2007. Accessed 13 March 2009. http://www.whoknew.us/archives/2004/02/
- Couser, G. Thomas. "Disability as Metaphor: What's Wrong with Lying." Prose Studies 27.1-2 (August 2005): 141-154.
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- Ehrenreich, Barbara, and Deirdre English. For Her Own Good: Two Centuries of the Experts' Advice to Women. New York: Anchor Books, 2005.
- Epps, Richard. Constipation, Hypochondriasis, and Hysteria: Their Modern Treatment. 2nd ed. London: Ouver and Boyd, 1874.
- "Experts Revise Guidelines for Irritable Bowel Syndrome." Women's Health Watch. March 2009. 6-7.
- "FDA Public Health Advisory: Tegaserod maleate (marked as Zelnorm)." U.S. Food and Drug Administration. 30 March 2007. Accessed 20 March 2009. http://www.fda.gov/cder/drug/advisory/tegaserod.htm
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- "The Gastrointestinal Tract, the Intestinal Microflora, and Intestinal Transit." Information packet from Dannon Activia. 4 October 2009. Accessed 15 March 2009. http://www.activia.us.com/pdf/Act_scientific_summary.pdf?v1.
- Goatly, Andrew. Washing The Brain: Metaphor and Hidden Ideology. Amsterdam/Philadelphia: John Benjamins Pub. Co, 2007.
- Goodman, Susan E., The Truth About Poop. illustrated by Elwood H. Smith. New York: Viking, 2004. np.
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- Harper, Charise Mericle. Flush! The Scoop on Poop Throughout the Ages. Publisher New York: Little, Brown, 2007. np.
- "How Your Digestive System Works." Danone Activia (UK site). Accessed 1 October 2009. http://www.danoneactivia.co.uk/youandyourtummy/tummycare/digestivesystem.aspx.
- Inglis, David. A Sociological History of Excretory Experience: Defecatory Manners and Toiletry Technologies. Lewiston, NY: The Edwin Mellen Press, 2000.
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- "Novartis Example." Consumers International. Accessed 13 March 2009. http://www.consumersinternational.org/Templates/Internal.asp?NodeID=96154
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An exception is giardia-influenced IBS, see Morken et al.
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For those reading with IBS: this recent newsletter clarifies that IBS does not correlate to an increased risk of IBD or colorectal cancer.
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Dresser also clarifies that in some cultures, food must be refused a certain number of times before it can be accepted, complicating "real" food refusal (74).
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Avinger et al suggest that the use of such euphemistic terms wrongly minimizes perceptions of IBS. Thanks to Margaret Price for directing me to this source, which details the experiences of Milo, a community college professor with IBS.
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Some websites still claim Ignatia is a cure for "hysteria" (http://abchomeopathy.com/r.php/Ign).
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My then doctor did not suggest that I might be lactose intolerant, as many with IBS are. I did not discover my intolerance for more than five years.
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See http://www.romancerichesrestrooms.com/ for a list of reviews.
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My argument here is similar to Couser's regarding Lauren Slater's use of epilepsy as a metaphor in her book Lying. He notes that "her choice of a disability as a metaphor for her experience involves her in a misrepresentation of all those who have that condition" ("Disability" 142). I would argue that Phelan uses IBS in similarly troubling metaphoric ways (and far less consciously than Slater).
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I am thankful to an anonymous DSQ reviewer for helping me make this last connection.
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I was surprised by the low percentage of those who had received information from "other people" about their disorder (16%). But then again, I have not reached out in significant ways to my compatriots, nor is IBS much engaged in disability studies.
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This information from 3/30/07 was obtained by searching for 'www.zelnorm.com' using the "way back machine" at http://www.archive.org.
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Some of the old Zelnorm ads are on YouTube, see http://www.youtube.com/watch?v=xqrYsax8qHc.
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Topless women in advertising are more common in Brazil, and my concern lies with the idealized body, not necessarily the exposed breast.
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It is also of note that at least in the U.S., the women in Zelnorm and Activia ads are often white and appear to have middle class lifestyles (Zelnorm's women are sometimes in cardigans, and Jamie Lee Curtis talks from a modern "home"). I thank Susan Burch for pointing this out to me, as it needs more attention as I continue to work on this topic.
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By this, I mean those who may use personal and technological assistance in toileting, as well as those put at risk by strictly gendered bathroom spaces (see Mog). Also, Black and Fawcett explain that in some cultures, women are exposed to danger when they must go out only after dark to toilet and/or must walk far from town.
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Brant integrates the need to control smell with an increased corporate scenting of environment, noting that the "[p]ersonal masking of bodily smells now co-exists with a masking of personal choice by public scentedness," which impacts those with Multiple Chemical Sensitivity (559).
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As LaPorte notes: "Even the most banal media advertisements still tout the myth that infection can be exorcised through the eradication of smell, or by finding ways to camouflage bad smells with good ones" (81). (For a study on the impact of human gas output on "likeability," see Li et al.) As for TV shows, I'm thinking of HGTV's "Save My Bath," which often remarkably avoids actual toileting matters.
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