Understanding Gut Sensations: Irritable Bowel Syndrome and Diagnostic Fluidity in Danish Clinical Practice

ABSTRACT

Irritable bowel syndrome (IBS) is a prevalent health challenge in a Danish welfare context. Drawing on ethnographic fieldwork at two Danish gastroenterology clinics, and inspired by Charles E. Rosenberg’s idea of styles of explaining widespread diseases, we outline three styles of understanding and treating gut trouble in daily clinical work: “The microbial gut,” “the mindful gut,” and “the lifestyled gut.” Moreover, we suggest the concept of fluidity to characterize IBS as a diagnostic category that allows clinicians and patients to operate through complex understandings of permeable boundaries between body, mind, and environment to negotiate personalized solutions for embodied gut sensations.

KEYWORDS:

• Denmark
• diagnostic practices
• fluidity
• gut
• irritable bowel syndrome
• medically unexplained symptoms

Acknowledgments

We thank health professionals and patients at the two gastroenterology clinics for letting Camilla into their daily work, stories, and reflections on troublesome gut sensations. Furthermore, we would like to thank the editors and the three anonymous reviewers of Medical Anthropology, as well as Mette Bech Risør and Mette Terp Høybye for their useful comments on the manuscript. The data collection was approved by the Danish Data Protection Agency (journal no. 2015-57-0002) and Aarhus University (journal no. 2016-051-000001, sequential no. 560). The Central Denmark Region Committees on Health Research Ethics confirmed that no further ethical approval is required since the study is based on interviews and observation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. The Rome IV Diagnostic Criteria define IBS as being characterized by abdominal pain at least once a week in relation to defecation and/or a change in frequency and/or form of stool. The criteria should be fulfilled for the last three months, with symptom onset at least six months before diagnosis (Sperber and Ford 2021).

2. All names are pseudonyms. Quotes are translated from Danish.

3. These are population-based studies of how many respondents experience symptoms compatible with the international Rome III criteria for IBS. Krogsgaard et al. (2013:528) argue that this is the most precise way of measuring the prevalence rate because only a fraction of those who could be diagnosed with IBS seek health care, and doctors do not always define and diagnose IBS in similar ways. The global prevalence of IBS is difficult to ascertain because studies use different diagnostic criteria and methodologies (Sperber and Ford 2021).

4. Akin to Rosenberg’s use of “style” (Rosenberg 1992), Hacking (1992) describes “styles of reasoning” as eminently public and combinable. Reflecting on the word “style,” Hacking argues that it may refer both to generalized styles which are “the possession of an enduring social unit” (Hacking 1992:3) and to personalized styles which are inimitably people’s own.

Additional information

Funding

This research was funded by the Graduate School of Arts, Aarhus University.

Notes on contributors

Camilla Brændstrup Laursen

Camilla Brændstrup Laursen is an anthropologist. She recently defended her PhD dissertation, Gut Trouble: Irritation, Experimentation, and Welfare in Denmark, which was about IBS and the experience, diagnosis, and everyday management of gut sensations in a Danish welfare context. She is now employed as a postdoctoral researcher in the Danish acute health care system.

Rikke Sand Andersen

Rikke Sand Andersen is an anthropologist. She has written extensively on cancer diagnostics, the medical semiotics of cancer, and health care seeking and currently steers a research project on “solo living,” exploring how notions of solitude and relatedness may be understood through the diseased body. She recently edited Cancer Entangled. Anticipation, Acceleration and the Danish State (Rutgers University Press).

Marie Louise Tørring

Marie Louise Tørring is trained as an anthropologist and epidemiologist. For the past decade she has conducted research on contemporary cancer transitions, focusing in particular on the shaping of the Danish cancer control plans of the 2000s. She currently steers the interdisciplinary research project “When Vaccines Go Viral” exploring the HPV vaccination controversy. She recently edited Cancer Entangled. Anticipation, Acceleration and the Danish State (Rutgers University Press).