This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the “gastrointestinal woman,” who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions.
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I use “disorder and distress” to broadly include GI symptoms, particularly in the nineteenth century. IBS is technically a syndrome.
That said, medical education can do more to incorporate disability studies perspectives; see Couser (2011); Campbell (2009).
My thanks to an anonymous JOMH reader who helped me articulate these issues of medical “truth” and neutrality.
Tobin Siebers (2008) makes a similar argument for a minority-based model that has the qualities of identifiability, differential power (to a majority power), differential and pejorative treatment, and group awareness (17).
Interestingly, Wendell notes the presence of GI issues as particularly silenced in a parenthetical: “Consider how rarely anyone admits in public that s/he is depressed, having intestinal cramps, or even just desperate for a toilet, compared to how often you feel that way” (89).
I use “psychosocial disability” to indicate what might otherwise be called “mental illness” or “psychiatric disorder.” My use of the term “psychosocial disability” does not quite match Margaret Price’s (2011) use of “mental disability” (which includes autism, learning disabilities, and the like), though like Price, I treat psychosocial disability as a rhetorical, historical, social, and political phenomenon.
I had to eliminate diarrhea (also a feature of IBS) as a search term because it elicited overwhelming materials on diseases still common in the nineteenth century, such as cholera.
My analysis does not include medical self-help literature that was popular in the nineteenth century, see Connor (1994).
Clark and Halloran (1993) describe the increasingly professional rhetoric of the nineteenth century, which moved from an aim for public consensus to “an emerging individualistic spirit” that emphasized “the authority of the expert” over consensus-based rhetorics (4). This might also explain the maintenance of a first-person narrative style in Donaldson.
Such anatomical confusion was typical, as evidenced by Chapman (1838): “The connection of the rectum with uterine system, and its dependencies, is, indeed, of such an intimate nature, that we are told, in some instances, from the mere irritation of this portion of the bowels, by habitual constipation, the womb enlarges, the mamme swell as in gestation, and finally secrete milk.”
Reading and books are variously connected to GI troubles in the nineteenth century. Donaldson describes constipation in “literary men” (26), and Illoway and Byford (1864) warn against reading at the toilet.
This fixation on autointoxication was part of larger nineteenth-century concerns that civilization caused bodily ills. Whorton notes that constipation was thought to “stem from misordered priorities,” where “[c]ivilized folks felt great reluctance to withdraw, however briefly, from business or social activities for fear of missing a big sale or juicy gossip” (36). Similarly, in Nerves and Narratives, Peter Logan argues that many considered hysteria to be “the consequence of a class-specific form of social life,” caused by such “middle-class conditions as year-round urban residency” (1). Thus, concerns with middle- and upper-class city life, constipation, and “nerves” may all be related, as I suggest later.
There is an interesting pattern of nineteenth-century study on constipation in people incarcerated in insane asylums, see MacDonald (1841); Dixon (1857).
In these chapters and other nineteenth-century sources, opium is also frequently mentioned as a treatment for constipation, though it is constipating. An 1830 article in the Boston Medical and Surgical Journal (later the New England Journal of Medicine) notes that opium can cause “constipation and dryness of the throat” (“Effect” 1830), indicating that using opium to treat constipation was more squarely aimed at the “cause” of constipation: hysteria.
Somewhat similarly, Dewees (1840) discusses a condition called “Irritable Uterus,” which lists constipation and diarrhea among its symptoms (291, 301).
A possible, if dubious, exception is a nineteenth-century publication that contains a “testimonial” by a woman “cured” of constipation (Morgan 1854).
He further notes, “All light household occupations are advantageous; dusting ornaments, picture-frames, etc., with the 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). While the conflation of a clean home and a properly functioning female body is almost humorous, this again sketches the constipated woman as middle or upper class, as she doesn’t work (apparently) and spends her time dusting “ornaments.”
Compared to the nineteenth-century treatises, the contemporary articles do not as consistently paint GI disorder and distress as middle and upper class, though nearly all of the research participants in the contemporary studies I analyze were recruited from gastroenterological or psychological/psychiatric clinics, which at least in the U.S., excludes those without (good) health care.
As Stephen Loftus (2011) notes in his study of pain metaphors, the pervasive metaphor of the body as a machine tends to lead to ideas that it can be “fixed,” and in his study, doctors “felt it was their duty to pursue a clinicopathological diagnosis just in case an organic cause was found” (8–9).
They explain pain catastrophizing as “a specific psychological variable that is associated with an exaggeration of negative beliefs and attitudes toward pain,” and is “related to significant psychologic distress, pain intensity, and depression [citations removed]” (1788).
The researchers are interested in how comorbid disorders might contribute to the “etiology of IBS” (1140), and they focus on a range of disorders more common in women, including fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, TMJ, and interstitial cystitis (1143–45), as well as psychiatric disorders (1146).
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I am thankful to the anonymous JOMH reviewers for their valuable feedback. A previous version of this paper was presented at the Rhetoric Society of America (RSA) conference in 2010.
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Vidali, A. Hysterical Again: The Gastrointestinal Woman in Medical Discourse. J Med Humanit 34, 33–57 (2013). https://doi.org/10.1007/s10912-012-9196-2
- Medical discourse
- Nineteenth century