Hello and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by fab Network. My name is Kathryn MacKay, and today I'm joined by Jane Dryden, from Mount Allison University in New Brunswick, Canada to discuss her paper, which is entitled, 'the gut microbiome and the imperative of normalcy.' Hello, Jane.
Hi. So happy to be here.
Thank you so much for joining me. I'm looking forward to talking about this with you. So to get us started, could you give us the kind of overview of your paper?
Absolutely. There's a lot going on in it. Here we go. The paper argues that microbiome research and a lot of the public discourse around it so like think the hype around probiotics, prebiotics, tending one's gut garden, that kind of thing, that a lot of this is steered by what I call an imperative of normalcy. And so this, for this imperative, I'm drawing on both health ism and ableism. So health ism, insofar as it sets up an expectation that health is our primary value, and it frames health around like individual personal responsibility ableism, in that it contains a set of social norms and expectations around what so called normal human behavior ought to be such that we end up with a hierarchy of body minds according to proximity to these norms. So in the imperative of normalcy, I kind of see this as like a linking thread between these two kind of concepts, that highlights an insistence on controlling and curing the body mind, and devaluing those who fail to live up to their apparent like individual responsibility to meet the standards of normalcy. So for microbiome research, what this does is that I argue that it focuses attention much more on getting people to normal, whatever normal is, and we're normal is like heavily shaped by social norms and expectations. And so the paper takes on two examples of this one around fatness which is medicalized as obesity. And throughout the paper, I use fatness as a descriptor and obesity, what I'm talking about the medicalized term, and then autism. So these are at least two examples, we can see this. So with fatness, the discourse around microbiome therapies focuses on weight, rather than on any other sorts of health markers that might be relevant to individual fat people, which kind of goes along with what fat studies researchers have frequently pointed out that weight obscures other health concerns. And then with autism, we see a really frequent focus on whether microbiome therapies will reduce autistic behaviors, rather than how they might actually help with particular gut issues like pain, discomfort that autistic people often experience. So the hope is by sort of drawing attention to the work of the imperative of normalcy in these therapies, that we can then sort of try to resist that imperative to then help sort of open our minds and curiosity towards exploring the sort of real complexity and potential of the microbiome and how it might help us, like, rethink ourselves. So that's, I guess, a big nutshell.
Thank you. I have, I think I have a really basic kind of question. But as I was wondering, do we know what a quote normal microbiome is?
Oh, that's a really good question. I think they want to know what a normal one is. And what's actually really interesting in the research, is that what you'll see is a gesture, usually at the outset. So I'm thinking about, like popular writing with the microbiome. I'm thinking about press releases, I'm thinking about interviews that you can find microbiome researchers doing. And also some of the ways in which studies get written up. What shows up sort of in the introductory text versus what kind of comes out later on. What you'll see initially is a gesture towards, oh, well, we all have, you know, we all have a slightly different microbiome, it's really dependent on where you grew up, how you grew up, whether you have dogs, what kind of diet you have, so on and so forth. So that's usually the outset. But then through the article, they'll start using language around like optimizing the microbiome, and we have found that particular particular sets of the sort of composition like the particular makeup of the microbiome seem better. There's also a lot of, there's a lot of work, arguing that microbiome diversity is good, because in ecology, usually we think that diversity is good. And so we're going to assume that microbiome, diversity is good. And then when we don't find that diversity, we're going to argue that it's because the diversity isn't there. And so there's some so this is actually something that I've been looking at alongside of alongside with a colleague of mine here at Mount Allison, in philosophy of biology, Dr. Drew Inkpen, who knows much more about the philosophy of biology and of things than I do. And we've actually sort of been looking at this really sort of interesting discourse around, do we actually know what a normal microbiome ought to look like? There's also a lot of, there's a lot of sort of research around microbiomes in different parts of the world, and research done on the heads of people in Tanzania. That sort of goes well, like, clearly their microbiome, because it hasn't been tainted, by our industrial ways, is the one that we should return to, which I mean, that that can do to sort of bolster that whole other set of kind of guiding assumptions and approaches. And there's a really good article a couple of years ago by Amber Benezra, about race in the microbiome that again, also takes up these these assumptions. I in the in the paper itself, I, I gesture a little bit to some of these questions about like, do you even know what a normal microbiome is? And I kind of I back away from sort of trying to posit, you know, here's what a microbiome ought to look like. I kind of raised questions about that. Because at this point, we really, like we really don't know. Yeah.
Yeah, that's so fascinating. And what you were just saying about looking at the untainted microbiome of certain groups of people that just sounds so reminiscent of the sort of work that was happening around genomes, right. It's like, find the purest, which is, in an indigenous culture that hasn't been, you know, mixed, or something like that. It's just so very essentializing.
yeah. Oh, no, incredibly Oh, my colleague and I were the paper that we gave at, for us, the Society for social studies of science back in the fall, and that we're giving at sea ships, the Canadian Society for history and philosophy of science, this, oh, dear, next month. We're getting a paper on the sort of continuity of some of the assumptions between, between genome research and microbiome research, and how there's all this hype around microbiome research, especially around this idea of malleability. Like you can't control your genome. But you can control your microbiome. I mean, you can't really, this, this believes that we will be able to somehow, and yeah, at around this, how these sort of underlying kind of essentialism, sort of narratives of like, this is what it ought to be, this is what normal health ought to be that we can kind of know this, that we can claim this, that these all sort of run, run underneath. I mean, you, you can have, like some aspects of you kind of some aspects of control, but it's really still so far beyond us, like you can have, it's more like you can have you have some effects on it. But there's so much activity in our environment that shapes our microbiome that, you know, ultimately, we don't really affect. I could get into that later.
Sure, I'm sure we'll come back to that. I was gonna pick up on something else that you'd said in your overview, which was, you refer to some of the sort of like popular literature. And that's something that you talked about in your paper too. So you're sort of talking about the, a couple of, shall we say, arch narratives, I guess, that are happening in society right now. One, which really connects into the overall sort of like wellness, culture, about, as you were saying, taking control and like, optimizing (the most cursed word). But I wanted to ask you a little bit about I mean, I guess I was wondering if seeing these trends in popular health literature was something that motivated you to get into this right, this work?
Yeah. Oh, that's a really good question. So yes, and no. So part of it is that I'm coming from a background in philosophy disability, which I've been working on for about 10 years. And in my original training, oh, the twists and turns you take in our lives. My original training is in history philosophy, primarily around 19th century German philosophy. And then I moved into philosophy disability as well, but a lot of my work has been looking on has been looking at ideas around what human beings ought to be like how we ought to cultivate ourselves, that like are certainly present in the 19th century German philosophy. I mean, it were kind of Hegel, like there's, like, there's all sorts of add in German philosophy. And so I've been really interested in like, what, what are ideas of the normal? What are ideas of how we ought to cultivate ourselves? My department, we have an undercurrent of Aristotle alien ism throughout the department, like we all sort of have a soft spot for Aristotle. But similarly to this idea of like, what is excellent for a human being like How should a human being develop themselves? And so these have been questions I've been worried about for a while. And then, and then right after I got tenure, I gave a paper at the Canadian Society for women in philosophy about Hegel. And the way asparagus makes your pee smell funny. And it's was like, Thank goodness for tenure, because, and the reason is because he makes this a side comment in his philosophy of nature about, you know, he's talking about digestion. And he talks about how even through digestion, we still never completely assimilate what we eat, as is evidenced by this interesting remainder. And I was really interested in that, and what it meant for how we think about our interaction with the world around us. Like we don't completely assimilate things around us, even when it comes to digestion, which should be the simultaneous. And that they lead me into this really deep interest in digestion generally, and what it meant for how we think of ourselves this weird like inside outside phenomenon of digestion. And so it was actually this, this deep interest in digestion and our relationship to our gut. That led me into microbiome stuff. And then as soon as I was reading about the microbiome stuff, I was like, wow, there's all that normalcy happening. And that was kind of the that was kind of the, the trajectory. So I think it was the digestion. And the microbiome that led me more into looking at the kind of I mean, it's, as soon as you look, it's so hard to, it's so hard to ignore. These are deep presence of all this culture throughout us. But I think I got to it through a kind of circuitous kind of route.
Really interesting, a really interesting route. Yeah. And, and so you focused on fatness, as you said, and autism in this paper, and what was it that made you pick those?
Yeah, so a few reasons. And this was certainly something one of the reviewers of the paper asks, like, why these? So I was like, Oh, I guess I should guess it's actually have a reason other than just I think they're interesting, but I think that's, that's it, they come up so regularly. So every, every press release about autism research, like, you know, so and so has such and such Institute has gotten so many millions of dollars for studying microbiome stuff. Every press release, every, you know, kind of like women's magazine article about your gut garden. Always, all of the kind of introductory matter that tends to happen at the beginning of articles, it will frequently have this like list of like microbiome science is really emerging. And we now think it offers cures for I don't know the list of strain of conditions. You know, what conditions like Crohn's colorectal cancer like, like very serious conditions. And interestingly, obesity and autism always show up on these lists. And what I find interesting about them is one, there's controversy about whether Obesity is a disease. It's been named a disease, obviously, by the World Health Organization by the American Medical Association, so on so forth, but obviously, there's been a lot of pushback about whether obesity in and of itself, as a state of human beings ought to be considered to see. So that's, I find that interesting that like, you know, we keep mentioning this thing, there's controversy about it. And similarly with autism, there's there's a similar, very strong pushback from Autistic Self Advocates about like, you know, certainly this is something that makes us this different, but like, as a disease, disease has connotations that, that don't necessarily seem to they don't necessarily seem to fit. And so I think to some extent, I chose them because they were really good examples of this kind of work of normalcy at play. Were the only reason they're on this list, like obesity is basically defined according to BMI. So it's, it has nothing about actual health status. It's just the statement about the relationship of health and weight. And similarly with autism, I mean, of course, it's defined in psychiatric literature, it's defined in the DSM. But again, with the sort of single minded focus of the research is on behaviors, you just see this again and again and again. Now with autism, there's a lot of studies that do show a correlation between being autistic and having and having various forms of gut issues. Like they're just really common. The exact prevalence varies a lot depending on the study. But this this correlation kind of comes up again and again. And so you can pretty and you can pretty reasonably ask, you know, would it be helpful if we found sort of useful, useful treatments for this? But the focus is so often on the behaviors. So for example, autistic people frequently stim right So kind of repetitive movements and motions and so forth that are aimed at sort of self soothing, and, you know, just interacting with the environment. And the and so the one of the measures of well, did this microbiome therapy work as well? Was there less stimming? And did the person make more eye contact? It's like, Well, are we worried about this? Or are we worried about whether their stomachs feel okay? And it's one thing, and maybe on a bit of a tangent to this pipe, it's one thing when this is research that's being done on, you know, three year olds who maybe can't fill out a form with a Likert scale on it. But some of this research is then done on adults. And you're like, Well, you could just ask them, how they're, how their stomachs feel? And they would they would tell you, yeah, so these two examples are just seemed particularly good. And also, it's in these two examples that you can see this this work of the the imperative normalcy really strongly, and, and in which the sort of focus on things like behavior and appearance is is strongest. At some point, at some point, I think I would find it interesting to go into how well, the focus of microbiome therapies actually hits on the particular concerns of people with more definite gut issues that are more sort of definitely diseases. But I would be reluctant to do so by myself, I would want to do so probably with a collaborator who was deeply knowledgeable, ideally, you know, someone with like lived experience of having that so that they could, you know, so we could work together on what priorities ought to be. So I haven't looked deeply into that side of things. I did get a question through the review process about why I didn't also look at research around microbiomes, and microbiome therapies and moods. So for example, there's a lot of research developing right now, especially for people like John Cryan, in Ireland, and Timothy Dinen [both at University College Cork], I don't know how to say his last name, also in Ireland, they've been doing a lot of research about microbiome and mood. And I think that's, I think that's really interesting as well. They've primarily got mouse studies, which, you know, always are sort of like, how do you know if a mouse is depressed? How do you know if a mouse is anxious, but they've got some starter pilot human studies going in which they, you know, have sort of tentative reasons to go forward. I think that's definitely something to keep an eye on. But this sort of question about an imperative of normalcy. And something like depression, I think, raises a pile of other issues that I didn't want to pull into this particular paper.
It's really interesting to me, and this is a kind of tangential comment. But it is really interesting to me how often autism and obesity are linked in unexpected things. Like they're both one of those things that people have been claiming that breastfeeding prevents. And when I say people, I mean, like, public health agencies, there's almost no evidence, no evidence. And it's very puzzling. I am really curious to know more about this interesting link that's drawn between these two seemingly very disparate issues.
Yeah, no, it's, it's really fascinating. I mean, if if nothing else, I would love if someone read the paper and was like, yeah, these do come up a lot. Why? Really interesting, because there's, there's so much really neat work being done at FOSS studies, there's so much really neat work being done by autistic folks, you know, autistic researchers. And, and it would be really lovely to see people, people looking at the connections of how these are treated, I think, I mean, like something like fat acceptance, and autistic acceptance, I'm just accepting that there can just be different kinds of bodies and different kinds of minds that don't have to fit a particular visual and behavioral sense of like, what is normal? It, it kind of just opens up the it opens up the gates suddenly to a whole set of questions about, you know, how human beings ought to be in the world and the kind of world that we ought to be designing and the kind of world that we ought to have space for. And obviously, this is where, you know, I sort of put a lot of disability theory into the, into the paper because, you know, if we, if we accept that the world ought to recognize that, hey, look, there's fat people, and it's fun, like, you know, like, particular fat people may have health concerns, and that's cool, we'll treat them but we don't have to cure fat. Then suddenly, we have a whole pile of questions about the sorts of spaces that we design and the kinds of expectations we have about what spaces if we accept, if we accept that, you know, hey, there's not just a fix, and they do things differently, then suddenly, we have to kind of recalibrate our sense of like, okay, well, then, you know, how, you know, how do we set up educational systems? What are our expectations around employment? Like, what are our expectations around? It? I think, for example, that one of the things that comes up a lot in the microbiome therapy research as a metric by which they measure Autistics, after they're got therapies, is eye contact, like this comes up so often. In a way, like, who cares? It's sort of like, first thing, but second, I think, like researchers don't observe, ironically, maybe there is sort of focus on having and maintaining eye contact is really culturally specific. Anyway. Right, like, so for example, I'm on Nigma territory here in what's known as New Brunswick. And, you know, it's common for, you know, it's common for me, my folks not to give direct eye contact, right? It's sort of like a form of, it's a form of respect, right? You're not gonna just be gazing deeply into someone's eyes. And so, so it's already kind of culturally contingent, whether we expect eye contact or not. And so why is this this metric for how autistic people ought to be in the world? Like, I think it just opens so many questions about the sort of limits of our tolerance for people who seem different from quote, unquote, normal. Yeah. And there's, there's enough autistic and hope and fat people around that it kind of poses this really regular question, as well.
So were there any challenges that you faced when you were writing this paper?
Yeah, so a few. So for one thing, um, there's just a lot here. It's a really, it's a really, really vast landscape. And I started working on the paper. I had the idea for the paper A while ago, and I started working on the paper all the way back in 2017. And bits of it have been explored in several conference papers. But there was just, there's just so much I mean, it's already come up a little bit in our conversation back and forth. There's, there's so much going on right now with microbiome therapies, and so many different interesting sort of tendrils of interest that could be pursued. And so it took a while to figure out what my argument would be other than just like microbiome, whoa, paper. And the paper, I quote Jake Metcalf, who talks about a kind of ontological whiplash that comes from thinking about how we are more microbe than human. And that was a really big touchstone for the paper early on, where I was just like, Yeah, whoa. So some of that has now been split off into other papers. But as I said, it took a while to figure out a focus and and the paper still feels like it's juggling a lot like any, like, the papers, is held together with Bandy. And little bows, and elastics, and possibly duct tape. And at any moment, it could just spring apart. And, and if anything, I, you know, I hope people pick up on some of the different threads and then run with them, because there's so much there. I mentioned earlier that my training was in history of philosophy, and I've been doing philosophy disability, it took me a while to get up to speed on this set of scientific literature. I never knew back when I was doing my PhD that I would be reading gastroenterology journals. And so one of the main things that I've been really grateful for is the number of people in my life who are willing to help me understand things, which is so so vital. My my partner, my partner, because of what he does, you know, has frequently stopped taught statistics. And so he was able to help me understand and be like, What is significant anyway, by my colleague during Penn, who does philosophy of biology, like I've had him look over stuff and had, I sent the manuscript to other friends to have a look over who sort of know stuff about stuff just to make sure that I wasn't going wrong. I did have a chance. I've presented bits of this regularly at conferences, and I've been very grateful to people who both said, hey, that's really interesting. I think you're on the right track. Have you looked at blah, blah, blah, but also people who said, Hey, use this particular terminology. And I don't think you're using it quite right. Let me explain and I'm a deeply mortified but also be deeply grateful. Because I think, I think when we're kind of in the midst of writing and researching, we forget how collaborative knowledge is. And so this paper is ultimately a reflection of a pile of people. and institutions that have helped me to work through it. So that was I think that was the biggest challenge is a juggling all of this and then be trying to kind of trying to get up to speed. And I think one of the things that paper does that I haven't seen a lot of other papers do is pulled together a discussion of health ism and ableism into the same place, right? There's lots of really good work on ableism. There's lots of really good work on healthism. There's not a lot that I could find that explores how they intertwine and the kinds of joint forces that they have. And and I think that that needs to be done, because some of the questions I mean, we talked earlier about, you know, on obesity, and like, why do these keep going together? I think the more the more that we can join some of these discourses some of these investigations in this theory, I think the more resources we have for really questioning like, what are the ways and structures and pressures by which we are sort of held to very, very specific accounts of how we should be?
Yeah. And it seems like, it's, I think something that your paper highlighted really well is that through this imperative of normalcy, and the effects of health ism and ableism working together, we are constantly thrown up against Silver Bullet thinking, like there's so it's like the gut microbiome is the new silver bullet, for whatever ails us. And I just feel like we have to let that go. Like there is no silver bullet for fatness. And as you said, like, why are we even trying to find one instead of trying to just make people's lives better, and treat people where we can. And then I think you wanted to make a distinction in the paper between treatment, and whatever this is...
So one of the one of the things I draw, one of the texts I draw on in the paper is, is Eli Claire's book brilliant imperfection, which is just really imperfection grappling with cure, which is just a wonderful book, and I teach it in my foster disability class. And Claire makes Claire makes a really, the whole book is exploring what cure could be and how we think about cure. And one of the things that I really appreciate is that he makes a distinction between the way cure can show up as sort of like one possibility amongst many, versus the idea of an ideology of cure, in which you know, you must be cured, you must be fixed. Of course, if you are different, you must have a cure. And I really find that sort of helpful that distinction between cures, like one thing among many, versus this is what you must do. And I, and I wanted to sort of convey that in the paper, right, and talking about different microbiome therapies, and in raising this concern about the imperative, the imperative of normalcy, that that's not meant to say that, like, you know, if you think that you might be helped out, and that you might be more comfortable and have less pain, you know, by exploring different microbiome therapies, like, that's great. That is, that is absolutely wonderful. There's, you know, some of the, you know, microbiome therapies, like they've had some really substantial strong effects. Again, because people's microbiome are different, like, not everything works for everyone. And this is fine. In some of the research I've done elsewhere on on gut issues, and just generally people's experience with gut issues. It's frequently the case that for a lot of people who got to choose, they have to try lots of different things to finally see what works, whether it's nutritional, or a medication, or like a, you know, some sort of microbiome therapy. So that's, that's fine. And in the paper, I cite a few instances where microbiome therapies have been have been genuinely helpful. But it's not it's this isn't just like a, oh, well, I don't mean all therapies, just something like hashtag not all therapies. But I think the part of what's so insidious about the imperative of normalcy, is that it is that in making cure this kind of imperative in sort of making normalcy, this kind of imperative, it actually overshadows and makes it more difficult to sort of do this kind of like exploration about what might work for particular people who have particular concerns and particular health needs, it actually makes it it actually makes it harder. So in saying that I'm, you know, like, yeah, treatment, but anti normalcy. I actually think that that should be hopefully helpful to people who have, you know, like genuine issues that they would generally like to have help with.
Yeah, totally. Well, we've basically come to the end of our time. So I wonder if there are some primary messages that you want The audience slash your reader to leave with.
Yeah, thanks for that. So I mentioned this already, but I would really just love to see more people exploring the intermingling of health ism and ableism. I just think this is a really, really important territory really important. It just opens up as well as just important avenues of solidarity, I think as well. One of my next steps is that I'm interested as well, in developing a kind of more positive account about what kind of relationship we might have to our microbiome, like, what might a relationship to our microbiome oriented, lesser normalcy and more around curiosity and playfulness look like? And I'm exploring this right now a little bit with some help from work by Maria Lugones. Just to put what some possibilities are there. And so, you know, that's kind of where that's kind of where my head is going. And I think I would just love to see more people, more people exploring what microbiome stuff can can mean for us how we can how we can think differently about it. There's some researchers who are doing it, it's great. It's sort of slowly, slowly building we're kind of finding each other and it's just lovely. It's just lovely, and fun and, and provocative. And so, you know, I guess I'd say, like readers and listeners alike, caught in like, it's, it's fun exploring this stuff.
Yeah, that reminds me of one of my, one of my favorite lines in the paper, which I'm not going to get right, exactly. But you just said something about how the microbiome and just the plethora of microorganisms that we live with are just changing the idea of what we are. Yeah. I think that's really cool.
Yeah, it's wonderful. And, and so far, like, so much of our thinking about it, is taking the existing models that we have for the world and just applying them in. And it's just like, I mean, I understand, like, scientists have to start somewhere. But it's like, we can also just really, like explore, it's we're at this amazing crossroads of understanding who and what we are and how we fit into our environment and how our environment isn't just outside of us, but living inside of us as well. Where this amazing, amazing sort of crossroads, we could, this could totally sort of rethink like how we're embedded in our world. Or we could make it like one more tool to make people the same.
That's a great message. Thanks so much for speaking with me, Jane. This has been really fun.
Great. Thank you so much.
And thank you for listening to this episode of FAB Gab. You can find the paper that we've discussed LinkedIn is episodes notes, along with the transcript of gab is hosted and produced by me Kathryn MacKay. You can find our other episodes on Spotify, Apple podcasts, or wherever you get your podcasts of quality. You can subscribe to FAB Gab so that you'll never miss an episode. Thanks again for listening. Bye!
