Modern biomedicine sees the body as a closed mechanistic system. But illness shows us to be permeable, ecological beings.
Ms Smith is a 40-year-old woman who comes to see me in clinic, having suffered for years with nausea, bloating and irregular stools. She’s been to two gastroenterologists before me, and nothing they recommended was any help. All her tests came back normal – but something’s wrong, no question, and getting worse.
There’s pain in her joints now, and sometimes her brain goes foggy. She wakes up most mornings with a migraine, and by the middle of the afternoon, it feels like she’s running on fumes. The gastrointestinal symptoms were bad enough, before whatever is wrong with her started bleeding from the inside out.
She stops here to apologise for the messiness of her story, with all its twists and turns. She wishes it weren’t so. She knows from experience how quickly doctors like me defer to the limits of their subspeciality training, prioritising problems that can be localised to a single organ system.
But that’s actually why she’s come to see me. Some independent reading has brought a new diagnostic possibility to her mind: what about leaky gut syndrome, a potent albeit controversial diagnosis in which the bowel loses its ability to function as a defensive barrier, becoming suddenly unable to protect the body from its contents?
Popular handbooks have taught her about a healthy intestine’s exquisite ability to selectively absorb nutrients while keeping toxins out. This insight has begun to change how she thinks about her digestive tract, from a self-contained inner tube into a sprawling interface with the wider world. Some people’s guts are more permeable than others, she’s learned, leaving them prone to infiltration by an array of noxious exposures.
What if all her problems had been caused by a hidden weakness in her intestinal walls? She understands that leaky gut syndrome is a new idea, and that the science behind it is incomplete. But she also knows that more conventional diagnoses have all proven, in her case, inadequate. At least this new one holds within it an intuitive logic, perhaps explaining why her body no longer feels governed by the usual organising lines.
Those lines are reinforced by the conventions of contemporary healthcare, which often tends to cloister itself from the outside world. In the office where I work, some of the exam rooms have big, south-facing windows, which I love for the way they let in the changing light, helping me keep track of time and the weather.
But the rooms themselves are prototypical, outfitted with adjustable tables and wall-mounted otoscopes, desktop computers and stainless-steel sinks. I’ve lived in four different cities since my medical education began, and it’s the same basic arrangement everywhere. This standard design fosters a static clinical atmosphere that pervades all my patient interactions, no matter the season or the state, the year or the president.
Compartmentalisation recurs as a theme in modern medicine, among buildings as well as bodies. Another name for the sort of healing I practise is biomedicine, which emphasises the historical convergence of hospital and laboratory that now governs mainstream views on how we get sick.
The emergence of germ theory in the 19th century attributed previously amorphous diseases such as cholera and puerperal fever to discrete pathogens with clear modes of physical entry. By the 20th century, new diagnostic technologies like urinalysis and X-rays had cast fluids and organs as not only fundamentally mechanical, but also universally legible. Over time, our bodies became closed systems, each the rationalised sum of measurable parts, readily explained under controlled conditions.