Gut Rhetorics: Toward Experiments in Living with Microbiota.
In his article "An Appetite for Rhetoric," Nathan Stormer (2015) suggests that rhetoric scholars have long taken the rhetor's body for granted, when they have not been ignoring it altogether. Most often, he adds, rhetoric scholars have assumed the body "to be well-fed or at least not a starving one" (p. 99), and in so doing, they have limited rhetoricity to a "stunted affective potential and responsiveness to the world" (p. 100). Stormer thus argues that because "rhetoric is enlivened by bodies that eat" (p. 100), rhetoric scholars need to attend to the hungry body and hunger itself as a "material vulnerability to the world" (p. 102). Who among us well-fed academics has not experienced a feeling of being hangry--a portmanteau of hungry and angry--to describe that irritability accompanying extended hunger that emerges when a department meeting pushes against the lunch hour? Attending to bodies that eat enables rhetoric scholars to imagine differently the "material ecologies of rhetoric" and "the evolution of rhetorical capacities" (p. 105).
When considering the material ecologies of the human body, we must also consider the bodies within--at least five hundred known species of microbes, numbering over a hundred trillion and weighing approximately three to five pounds (Hird, 2009; Yong, 2016). Body, microbiota, and their appetites are entangled in intestinal folds so that to (mal)nourish the body is to (mal)nourish microbiota, and vice versa. Attending to the body and its material ecologies, specifically the microbiota, suggests how "the evolution of rhetorical capacities" may have much to do with the hunger of microbes and corresponding bodily activities. Thus, we propose gut rhetorics to acknowledge that being human is living with microbes and that rhetoric is enlivened by both bodies that eat and microbes that eat bodies.
Moreover, we are not simply living with microbes; we are reinventing what it means to be human by reintroducing microbes--through the ingestion of fermented foods, fecal transplants, parasites, and pre- and probiotic diets--into and as part of our bodies, cultivating some as "gut buddies" (Lorimer, 2016) and exterminating others with antibiotics. In short, gut rhetorics reveal the inseparability of epistemological, ontological, and phenomenological realities. The gut has become a both metaphoric and metabolic environment to which we are exposed: a scientifically calibrated representation, a biologically active actant, and a bodily fleshy feeling. The metaphoric and the metabolic contribute to the physiology and psychology--the rhetorical capacities--of the human body. Gut rhetorics (re)compose bodies as metabolizing forces--ingestion, digestion, inflammation, fermentation, and excretion--in which bodies are always on the way to becoming something else yet feeding to maintain a stasis that remains elusive. Gut rhetorics incorporate--bring into the body and, importantly, into the body of rhetoric--the hungry horde within human bodies. If we are to understand rhetorical capacities appropriate to the "material ecologies of rhetoric" (Stormer, 2015) and to "ecological thought," such as vulnerability and resilience (Stormer & McGreavy, 2017), we need our guts--literally and figuratively--not only our intestinal folds and their microbial inhabitants but also our stomach, our appetite for creative experimentation.
We examine the "deliberate reentanglement" (Lorimer, 2016, p. 60) of bodies and the microbiota within two epistemological-ontological-phenomenological formations giving rise to gut rhetorics. We begin by briefly situating our material and methodological commitments within the ontological turn in rhetoric (Graham, 2015; Stormer, 2016, Stormer & McGreavy, 2017) and S. Scott Graham's rhetorical-ontological inquiry. We then trace one probiotic formulation across three scientific studies to show how bodies, affects, and microbes are being calibrated, that is, sorted, classified, and justified (Graham, 2015), at the level of experiment, an "experimental formalization" of the microbiota (Landecker, 2011). Here, we detail how gastroenterologists enact microbes ontologically as a probiotic formulation, epistemologically through diagnostic questionnaires, and phenomenologically by relying on patients' self-reported affects and feelings. In a second formation of gut rhetorics, we stress how similar ontological, epistemological, and phenomenological entanglements are being enacted at the level of everyday practices, noting how probiotic foods and consumer-driven diets advocate other means of living with the microbiota. These everyday gut rhetorics not only focus on discursive appeals to the gut but also orient consumers towards the development of skillful living with the microbiota--a shift from knowing that to knowing how (Ingold, 2011; Coeckelbergh, 2015), a kind of learning through sensual inquiry in an age when knowing is uneasy, not at all comprehensive, complex, and ecological (Meloncon, 2018). In this way, everyday gut rhetorics encourage probiotic experimentation in ways that resonate with recent methodological considerations in the rhetoric of science and medicine, which encourage scholars to play amid environments, give attention to embodiment, and pursue phenomenological inquiry (Gruber, 2018; Meloncon, 2018). Consequently, we outline how gut rhetorics can find room not only for "experimental entanglements" (Fitzgerald & Callard, 2015) but also for "experiments in rhetoric" (Gruber, 2018) to understand how bodies, microbes, and environments metabolize one another.
Rhetorical Ontology: Entanglement and Inquiry
Gut rhetorics begin with the premise that although the living ontology of the body is different than not only our phenomenological experience as a body but also our epistemological concepts used to textually inscribe, describe, prescribe, and proscribe that experience; we cannot simply disregard either bodily experience or metaphoric representation. Put simply, rhetoric scholars should be careful not to abandon language, discourse, and representation in their turn to rhetoric's ontology (Barnett & Boyle, 2016; Stormer, 2016; Stormer & McGreavy, 2017). In this way, we follow Graham (2015) who argues that rhetoric and ontology need each other to think differently, if not move beyond, the "two world problem" of "bifurcations that include the subject/object, culture/nature, and mind/body dichotomies" (p. 16). To counter the "two world problem," Graham develops "rhetorical-ontological inquiry" as a method/ology that accepts ontological multiplicity and ecological entanglement--i nformed by science and technology studies and new materialisms, primarily drawing upon Bruno Latour and Annemarie Mol--while also studying how pain, in his case, is talked about among diverse discourse communities (for example, medical, psychiatric, pharmaceutical professionals) and experienced by patients who report various pain symptoms. Rhetorical-ontological inquiry considers how epistemology, ontology, and phenomenology are inseparable from, yet irreducible to, one another in enacting multiple realities of pain. As such, rhetoric scholars can no longer be content with constructing text-bodies, or bodies-as-texts, and must attend to lived, living bodies. We do so here by studying what Graham calls two "practical regimes of engagement" (p. 270): first, gastroenterological research focusing on probiotic formulations, and second, everyday embodied encounters with probiotics.
In examining these practical regimes of engagement, what becomes apparent is the allusiveness of epistemological and phenomenological accounts alongside the elusiveness of ontological calibration of the microbiota. The absence of certain microbes and their ecologies may be just as consequential as the presence of other microbes. Likewise, the absence of certain gut feelings, or affects, may be as consequential to the inscription of a gut bacteria's agency as the presence of other gut feelings. And the use of specific psychometric questionnaires in gastroenterological studies influences how the participants' feelings are understood and then how gut bacteria are ontologically empowered or delimited. Thus, the following inquiry illuminates the ways we come to know gut bacteria, which are acting in the world and have a material say in how "we see ourselves going forward in that world" (Rickert, 2013, p. xiii) even as they obscure understanding. In short, microbes and bodies are metaphorically and materially shaped even while they shape "our thoughts, feelings, and sociabilities" (Lorimer, 2017, p. 8). Gut rhetorics, accordingly, compose bodies and microbes as ruminations, coughing up the capacitation of rhetoric, a kind of chewing, as well as chewing the cud, that is, thinking with/in the gut.
In her study of the gut and depression, Elizabeth Wilson (2015) writes, "My argument is not that the gut contributes to minded states, but that the gut is an organ of mind: it ruminates, deliberates, comprehends" (p. 5). In like manner, gut rhetorics suggest that rhetoric's ontology arises with the millions of missed, missing, and misfit microbes dwelling with/in a gut that is both environmental and irreducible to representation. In other words, the very capacitation of a rhetoric, such as affective response and conscious feeling, may begin with microbes. As the rhetorical-ontological inquiry in the next section shows, we have much to learn about how bodies and gut bacteria are becoming environmental and to what extent gut bacteria and affect states, such as stress, anxiety, and depression, may be calibrated through gastroenterological research and everyday embodied experimentation.
Understanding microbes, bodies, and bodies of rhetoric as "multispecies achievements" (Lorimer, 2017, p. 8) in living well together--or not so well (see Haraway, 2016; Hird, 2009)--offers an opportunity to advance rhetorical-ontological inquiry. In reflecting upon his study of pain medicine, Graham (2015) notes that he enacts an "empirical-discursive" ontology, "an iterative series of ocular and inscriptive practices so as to create an account of doing" (p. 212). He is an ethnographer, looking at words and observing practices in situ. Alongside this empirical-discursive praxiography, Graham calls for the development of "a more fully interventional form of inquiry" (p. 215). We suggest that gut rhetorics may do so by encouraging rhetoric scholars to enact empirical-phenomenological experience, such an "experiment in rhetoric" (Gruber, 2018) that relies on (microbial) emotions, in tandem with contextual discourses, to augment critique, to explore bodily relations, to feel through rhetorics, to sense the persuasive power of bacterial life, and to invent new possibilities for living with gut bacteria.
Part 1--Rhetorical-Ontological Inquiry: Experiments in Probiotics and Affects
Among the many competing explanations for depression is the presence and influence of microbiota in the gut. The extent to which gut bacteria may make a difference in a given situation remains largely unknown. However, Ali Naseribafrouei and colleagues (2014) situate depression as a "chronic syndrome with a pathogenesis linked to various genetic, biological, and environmental factors," adopting the appropriate hedging as they seek to pinpoint specific gut bacteria associated with patients diagnosed with major depression disorder (p. 1155). Although Naseribafrouei et al. focus on the Oscillibacter type strain of gut bacteria and the negative effects of its valeric acid output, other studies indicate that a Lactobacillus strain along with other lactic acid bacteria can regulate neurotransmitters "implicated in the pathogenesis of anxiety and depression" (Bravo et al., 2011, p. 16050), concluding that individual strains of bacteria "may have beneficial effects in the treatment of depression and anxiety" (p. 16054).
Although it is tempting to suggest that gastrointestinal research is merely in a nascent phase and that these researchers ultimately will delineate which bacteria influence which bodily system to explain how humans might be prone to mood swings or the loss of self-worth associated with depression, the claim proves tentative when the scientific processes of textualizing and calibrating the body and microbiota are brought to the surface. Gut bacteria and symptoms of depression do appear, in some cases, to shift together (Dinan et al., 2015; Petra et al., 2015). In other cases, correlating specific types of gut bacteria with patients diagnosed with depression proves uneven, not statistically significant, or, put simply, a bit tricky (Diop, Guillou, & Durand, 2008). Because depression is diagnosed through patient evaluations involving patient self-narrative and psychometric questionnaires (Matza et al., 2013), the microbiota is composed by a process of textualization. Patients must be sorted into defined categories associated with diagnostic tools such as the Eysenck Personality Questionnaire (Chakraborti et al., 1996), the Spielberger State-Trait Anxiety Inventory (Schmidt et al., 2015), the Hamilton Depression Rating Scale (Gwee et al., 1999), the Hopkins Symptom Checklist, and the Hospital Anxiety and Depression Scale (Messaoudi et al., 2011). Patients are grouped in terms of mood disorders, anxiety disorders, and clinical depression. Sometimes doctors have a say in the process; other times, clinical researchers grade patients based solely on demographics and computational factors (Chakraborti et al., 1996; Schmidt et al., 2015). Whatever the case, patients must be institutionally labeled and correlated with stool or urine samples and examinations of the microbiota over time (Dinan et al., 2015).
This diagnostic process, which primarily constructs bodies-as-texts, allows for claim-making and legitimizes comparisons to animal studies, despite obvious differences in clinical evaluations that determine levels of anxiety in animals versus humans and despite the difficulty of determining whether or not the feelings of rats are at all the same as those of humans. We analyze this complicated scientific process across three studies looking at the effects of one probiotic formulation. Doing so shows how textualization, as an epistemic process inscribing ontological multiplicity, leaves gastrointestinal scholars and scholars of rhetoric with a tangible dilemma--not only how to know a body, but also how to live with bodies that eat. Examining these experimental processes, and how each subsequent study seeks to build upon the last yet confronts divergence and instability, shows how lived bodies and microbes continually efface texts, eluding the processes of textualization brought to bear on them.
Ingesting probiotics, which are complexes of microbes that may have beneficial effects in the human body, has been proposed as one possible response to bring together the known body and the lived body. For example, Michael Messaoudi and colleagues (2011) have attempted to better understand how, when, and why a probiotic formulation (PF)--comprising Lactobacillus helveticus R0052 and Bifidobacterium longum R0175--might mitigate the severity of stress, anxiety, and depression in humans. Messaoudi et al. turn to several other gastroenterological studies examining the same or similar Lactobacillus-based PFs to contextualize their claims and compare outcomes. Exposing disjunctions across the various epistemic resources brought to bear on the microbiota from these studies presents a "praxiography of representation," which is a way of understanding "not so much what people say or what texts mean but rather how representational activity circulates within and contributes to a deeper ecology of practices in which those acts of representation are embedded" (Graham, 2015, p. 69). Specifically, examining the psychometric questionnaires used in each study, how those questionnaires were facilitated, and how they rhetorically and materially established different affect states--namely, "stress," "anxiety" and/or "depression"--and how they were compared to stool or urine samples to draw conclusions about the healthfulness of the PF elucidates what Mol (2003) calls the prescriptive "epistemic normativity" of the field (p. 6). However, attending to the gaps and conflicts that appear across three interrelated probiotic studies, starting with Messaoudi et al. (2011), displays how different psychometric questionnaires compel transformations in key terms, such as "anxiety," which help to determine the results. Gastroenterologists need to contextualize the PF through their colleagues' studies despite obvious and important material differences to secure a space for their work and to draw conclusions that might push forward the science of the microbiota despite differing patient reports. For the rhetoric of health and medicine (RHM), understanding how affect states are forged amid this process brings insight into how, in gastroenterology, scientific calibration--the process through which patients, the microbiota, and probiotics are categorized and legitimized (Graham, 2015)--makes bodies legible and remakes bodies (see Jack, 2009; Wells, 1999).
Because questionnaires inform when and which gut bacteria can be designated helpful or healthy, a rhetorical-ontological inquiry draws out how the microbiota is presumed to alter, to some measurable degree, feelings of self-worth, personal isolation, or in/ability to connect with others as reported by study participants. Finding ways to measure the influence of food choices and one's gut bacteria on sociality and/or self-feeling is essentially the focus of such research. The work re-materializes and medicalizes dinner plates, indicating a rhetorical ontology that is material, phenomenological, and discursive in entwining human and bacterial bodies. Accordingly, we understand PF studies as premised upon a broader cultural insight: "Food communicates values, history, politics, demography, regionality, and culture" such that "what and how much we eat... comes with the promise of ever greater levels of agency" even as food can also "generate identities," contribute to exploitation, and physically change our bodies (Young, Eckstein, & Conley, 2015, p. 198). In like manner, we propose that the various interrelated probiotic studies attempt different ways of "touching" and then securing, if not universalizing, a link between food and human feeling in the mission to increase human agency. They literally forge ontologies in building up knowledge-making relations between the microbiota and personality, appropriate sociality, and appropriate diet.
The praxiography of representation we identify proceeds as follows:
1. Food choices or habits of eating are conceptualized as socially and materially entwined with psychological conditions.
2. Consequently, psychometric questionnaires are employed by scientific/medical communities to determine the kinds of conclusions that might be made by gastroenterological experimentation examining different strains of gut bacteria
3. Claims about unhealthy and healthy strains are dependent on the changes in follow-up responses to participants' psychometric questionnaires.
4. Consequently, gut bacteria become agentive and salient by being calibrated to patients' reported feelings amid different habits of eating, as well as other habits of sleep, habits of work, etc.
5. The gut bacteria, then, in the form of PFs can operate as "punctalized actors," or objects endowed with a particular role for network building (Law, 1992). PFs become a "material delegate" conveying a narrative of healthfulness/unhealthfulness from past research, which is then purported to do something, such as expand agencies and build up networks of PFs to sooth gut remedies (Akrich and Latour, 1992).
The problem is that probiotic formulations hold the promise of "ever greater levels of agency" and personal satisfaction even while psychometric questionnaires across the studies conflict or talk past each other in seeking to measure and categorize different affect states, and often do so differently. Although the psychometric questionnaires are a "materializing force" (Hill, 2016) in gastroenterological research, generating new scientific realities and categories for negotiating the body, they are unable to provide stable accounts of a living body and its hungers. Examining how one study builds claims by including and occluding various forms of psychometric questionnaires helps to illuminate just how an epistemological apparatus grapples with phenomenology to inscribe an ontology of the body.
STUDY #1: MESSAOUDI ET AL. (2011)
Messaoudi and colleagues (2011) hope to mitigate the severity of the stress, anxiety, and depression in humans through discovering viable PF treatments. To measure specific moods that they term "stress, anxiety, and depression," they construct a study that employs four different psychometric measures. Those include:
* Hopkins Symptom Checklist (HSCL-90),
* Hospital Anxiety and Depression Scale (HADS),
* Perceived Stress Scale (PSS), and
* Coping Checklist (CCL).
The first (HSCL-90) is a 90-item questionnaire with a five-point rating scale evaluating "somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, and depression" with individual questions strictly correlated to specific affect states (Derogatis et al., 1974). The second (HADS) uses a 14-item questionnaire on a four-point scale with various answers at either end of that scale ("yes" or "often" or "definitely," etc. as examples of the positive end), evaluating anxiety and depression with seven questions each (see "SVRI"). The third (PSS) uses a ten-item questionnaire with a five-point scale ranging from "never" to "very often" and intends to determine stress levels (Cohen, 1994). The fourth, and final, (CCL) is a 70-item questionnaire on a "yes/no" scale used to determine "a broad range of behavioural and cognitive responses that may be used to handle stress" and can be understood as drawing a distinction in degrees between "normals" and "neurotics" (Rao, Subbakrishna, & Prabhu, 1989). Messaoudi et al. (2011) administer each questionnaire following its own diagnosis protocols--some requiring delivery and interpretation by a trained psychologist or professional and others self-given (1)--and then apply them across two groups of human test participants, a placebo group and a probiotic group. After four weeks of collecting urine samples and giving PF treatment to the test group, they ask the participants to again complete the four psychometric questionnaires.
In this case, the researchers argue that the tested PF treatment mitigates psychological symptoms associated with anxiety and depression: "The beneficial effects of probiotics on anxiety and depression may be explained by competitive exclusion of deleterious gut pathogens, decreases in pro-inflammatory cytokines and communication with the central nervous system via vagal sensory fibres, leading to changes in neurotransmitter levels or function" (Messaoudi et al., 2011, p. 760). In layman's terms, specific strains of microbes ingested seem to force out other bacteria or overwhelm their negative effects by sending new beneficial signals to the brain.
Messaoudi et al. (2011) are unable to pinpoint how or why microbiota seem effective in alleviating symptoms of anxiety and depression, comparing the effects measured in their study against other studies, including ones on aggression in rats (Hanstock, Drew, & Van Kessel, 2004), the gastrointestinal tract of pigs (Estrada et al., 2001), and the sleep rates of elderly people (Yamaura et al., 2007). In each case, similar bacterial formulations were used, but the results varied and depended upon what could be known from the human or nonhuman participants and what kind of epistemic apparatus enabled the practice. Indeed, in reviewing related studies, they spend significant time confronting confounding disjunctions with Diop et al. (2008), which reports no statistically significant effects on anxiety or psychological symptoms, even though the PF did show clear benefits on GI problems. In contrast, Messaoudi et al. argue for their own positive results with the necessary hedging: "These data are preliminary," and "these results provide further evidence that gut microflora play a role [emphasis added] in stress, anxiety and depression" (p. 761); the "role" remains unclear, and the researchers suggest more research is needed (p. 761). Their judicious statement of results is proper to scientific inquiry and ethically composed. Discovering conflicting results is likely always confounding, but reviewing the other studies exposes how, as Mol (2003) says, "ontology is not in the given order of things... ontologies are brought into being, sustained, or allowed to wither away" (p. 6). The ontology of microbes are made and questioned. As the following section shows, knowing the microbiota becomes a complex process of integrating prior studies as well as feeling a way through the practices of other researchers and the reported phenomenological realities of other participants.
STUDY #2: DIOP ET AL. (2008) & STUDY #3: AIT-BELGNAOUI (2006)
For Messaoudi and colleagues (2011), the difficulty in dealing with Diop et al. (2008) is not only that those researchers discovered no significant effects related to what they termed "psychosocial stress" but that the GI problems noted in Diop's participants were strongly correlated to "stress induced symptoms of colorectal dysfunction" by a previous study conducted by Afifa Ait-Belgnaoui and colleagues (2006). In that 2006 study, a separate, but related, Lactobacillus strain showed the ability to prevent colorectal hypersensitivity (p. 1061). Chronologically, the studies proceed as follows: Ait-Belgnaoui et al. correlate GI problems to heightened "stress" in rats and show that a Lactobacillus PF alleviates those GI symptoms for rats, providing no comment on the psychosocial responses. Subsequently, Diop et al. argue that those same microbiota strains do help with abdominal pain and vomiting in humans but show no effect on any adverse psychological symptoms as measured by certain psychometric questionnaires administered before and after PF treatment. Messaoudi et al. then argue for meaningful correlations between their similar Lactobacillus-based PF and the psychological symptoms involved with "anxiety" and "depression" but find nothing in relation to "stress." Thus, we are left with a dilemma about how "stress" could be unaffected while "anxiety" shows improvement, and how GI problems could disappear while the "stress" that purportedly inflamed those problems does not. The inquiry becomes simultaneously semiotic and material, about questions and questionnaires working in tandem with bodies and affects.
Interestingly, Diop et al. (2008) cite the Ait-Belganoui et al. (2006) study as partially motivating their work. They engage in what Charles Bazerman (1988) calls the construction of "the accomplishment," encouraging "some lines of development" through building on what has been done while asserting what has not (p. 13)--in this case, transitioning this PF from rats to humans. In staging the research gap in their introduction, Diop and colleagues state, "Recent studies have shown that lactobacilli prevent visceral pain and stress- induced visceral hypersensitivity in rats [here citing Ait-Belgnaoui et al. and Kamiya et al., 2006]. However, there has been, as of yet, few data available on the effects of probiotics on stress-induced gastrointestinal symptoms in humans" (p. 2) The final line indicates why Messaoudi et al. (2011) would later cite Diop et al.; the effort to correlate psychological symptoms to specific Lactobacillus strains could bolster the power of the PF, thus moving the claim from rat gastroenterology to human gastroenterology to human psychology. The move makes sense: If stress can induce GI problems that are alleviated with the PF, then that same PF might alleviate the related feelings of stress, including anxiety. However, showing affect states changing confronts patients, not to mention a reasonably large epistemic toolkit, rife with choices.
We call attention to not only the shift from animals to humans and the shift in the exact Lactobacillus strains being used--despite their genome similarities and abilities to produce lactic acid (see Salvetti, Torriani, & Felis, 2012)--but also the structure of the study designs. Diop and colleagues (2008), for instance, deviate significantly from Messaoudi et al.'s (2011) study, choosing to construct a specialist questionnaire to test for "stress induced symptoms." Indeed, Diop and colleagues build their own 62-item questionnaire with the aim to "encompass the following areas: gastrointestinal, cardiovascular, sleep disorders, locomotor systems, physical, emotional and psychological symptoms, intellectual problems, spiritual symptoms, and social aspects" (p. 1). Consequently, any direct comparisons between Diop et al. and Messaoudi et al. confront a difference in measurement tools, what questions constitute certain affect states, and how those assessments are administered. Quickly reviewing the questionnaires shows that "anxiety" in one includes questions about "feeling 'wound up'" or having "'butterflies' in the stomach" ("SVRI") while the other asks about the "feeling of being trapped or caught" and having "shakiness inside" (Access Counseling Group). Likewise, one questionnaire determining "stress" asks about "confidence handling personal problems" (Cohen, 1994) while the others do not (Diop et al., 2008).
Fast-forwarding to the Messaoudi et al. (2011) study, those researchers rightly assert, "This discrepancy [in our findings about stress versus the Diop et al. 2008 study] may be due to the duration of the period of administration of the preparation and/or to the use of a different questionnaire" (p. 760). With this explanation, Messaoudi et al. acknowledge that different durations of ingestion may result in different outcomes as the body incorporates new bacterial formulations with old ones, engaging new environments along the way. However, the difference in duration between the two studies is only eight days (Diop et al., 2008). If deemed significant, researchers might argue for the time it takes for a body to "exclude" and "decrease" proinflammatory agents, and if not, then researchers would be left once again with an unknown. What remains, then, are the differences in the questionnaires, the kinds of questions asked, how affect states are conceptualized, and how the calibration process was facilitated.
As with the relations among body, the microbiota and affects like depression, the centrality of textual diagnostic tools can be hard to detect unless they stop working and the results are negative. Nathan R. Johnson (2018) makes this clear in his discussion of medical infrastructures: "Working infrastructure often stays invisible" because when important classifications "function" and "serve audience needs," then the standards and algorithms tend to disappear into the background (p. 64-65). Precisely because one of the four psychometric tests used in the study--the PSS questionnaire--did not show any significant results in response to the PF, Messaoudi and colleagues (2011) are compelled to suggest that patient self-reporting might have been a salient factor. They state, "Taken together, PF appears to show a beneficial effect on general signs of anxiety and depression, which did not generalise to the PSS, although all three tests comprise self-reported measures" (p. 759). One way to read the statement is to see a flaw in the PSS's ability to obtain good patient self-reporting; another way is to see flaws in relying on patient self-reporting, thus taking all the results with a proverbial grain of salt; yet another way to understand the statement is to see patients as more likely to report shifts in anxiety or depression, given the questions on those questionnaires or the nature of the diagnosis. What Messaoudi and colleagues intend remains unclear.
Many scales used for evaluating anxiety and depression do rely upon self-reported measures, but it is important to note that some should be conducted in formal hospital settings for validity or administered by a trained professional (see "SVRI"; Snaith, 2003), while others, such as the PSS, can be much more widely used and filled out privately. Given that the PSS is tailored to identify symptoms of stress and intended for general audiences, Messaoudi et al. (2011) could remark that the PSS is the one scale--of the four used--presumably most likely to be comparable to the 62-question survey created by Diop and colleagues (2008) who specifically make claims about the lack of results tying the probiotic formulation to stress. Perhaps rightly, Messaoudi et al. focus mostly on legitimizing their positive results and the effectiveness of the probiotic for alleviating "anxiety" and "depression" symptoms. Yet, they also, at least for a rhetoric scholar, unintentionally highlight the complexity of deriving any results at all: The variable means of self-reporting, the separate legitimacies of each questionnaire across studies, and the different test periods for similar but not exactly the same PFs, all combine to produce difficulty and suggest future adjustments across variables. Figure 1 outlines the divergences.
If microbiota studies are going to solidify claims about the positive effect of probiotics, they must necessarily rely upon patient accounts because the medical diagnosis of psychological conditions are largely dependent upon feelings of guilt, shame, and self-worth as well as the corresponding narrations about one's own body as documented across various forms of interviews and questionnaires (Evrensel & Ceylan, 2015; Naseribafrouei et al., 2014). If microbiota are "mind-altering micro-organisms," as Cryan and Dinan (2012) declare, they seem to alter the mind because patients say so, reporting life changes, while researchers collect the corresponding samples of gut bacteria. Understanding this complex process illuminates the value of gut rhetorics to learn how to consider material-discursive infrastructures composing the gut and to develop a response to the popularization of microbiota research. Understanding how individual questionnaires ask participants about food habits, sleep, paranoia symptoms, work stress, and lived experience--and ask differently--as well as how probiotics studies forge exigencies by relating their work to previous studies positions gut rhetorics as a vital site of rhetorical-ontological inquiry in RHM.
Figure 1. Study Comparisons Tracing Back Citations from Messaoudi et al. (2011). (Created by authors) Study A Psychometric Questionnaire Participants Messaoudi et al., 2011 * Hopkins Symptom Checklist (HSCL-90) 55 human participants * Hospital Anxiety and Depression Scale (HADS) completed trial; earlier * Perceived Stress Scale (PSS) trial with 36 male * Coping Checklist (CCL). Wistar rats. Diop et ai., 2008 * unique, tailored 62 item questionnaire 75 human participant completed trial. Ait-Belgnaoui, 2006 * No psychometric questionnaire. 80 female Wistar rats. Study A Psychometric Questionnaire Trial Length & Probiotic Messaoudi et al., 2011 * Hopkins Symptom Checklist (HSCL-90) 30-day trial * Hospital Anxiety and Depression Scale (HADS) LactobacillusAci * Perceived Stress Scale (PSS) dophilus * Coping Checklist (CCL). Rosell-52 with Bifidobacterium longum Rosell-175. Diop et ai., 2008 * unique, tailored 62 item questionnaire 21-day trial Lactobacillus Acidophilus Rosell-52 with Bifidobacterium longum Rosell-175. Ait-Belgnaoui, 2006 * No psychometric questionnaire. 15 day trial Lactobacillus Farminus Study A Psychometric Questionnaire Findines Messaoudi et al., 2011 * Hopkins Symptom Checklist (HSCL-90) Measurable effect on * Hospital Anxiety and Depression Scale (HADS) 'anxiety behavior' In * Perceived Stress Scale (PSS) rats; positive * Coping Checklist (CCL). measurable effect in humans on 'anxiety' and 'depression' measures but not 'stress' measures. Diop et ai., 2008 * unique, tailored 62 item questionnaire Measurable positive effect on 'gastrointestinal symptoms' [pain and vomiting'] but not psychological symptoms of a 'stressful life.' Ait-Belgnaoui, 2006 * No psychometric questionnaire. Measurable effect on 'stress induced hypersensitivity' in rats.
The three studies also highlight some confusion in gastroenterology about best means to delineate, capture, and measure affect states to relate them to gut bacteria. Then again, rhetoric scholars have only started to learn how to talk about affect, how to see variable affects, how to relate them to situated encounters, how and when to stage them as universal, and how much to see them as intimately responsive to interventions. In looking outward to other fields, we can also look inward to discover a gut rhetoric right inside ourselves, one that groans for interdisciplinary engagement and epistemological entanglement (Fitzgerald and Callard, 2015) to digest what rhetoric's ontologies demand. And we may begin by considering how living with depression, for example, may call for developing the environmental skill "to meet with" (see Haraway, 2016; Hird, 2009) gut bacteria and their metabolic hungers.
Part 2--Environmental Skill: Experiments in Living with Probiotics
The three probiotic formulation studies reveal how scientists struggle to comprehend the body, or enough of a body to make claims about variables that move in/dependently of the epistemic apparatus and the test participant's experience of those variables. This observation is not made to simply reinforce the need to move beyond representation (Lynch, 2009). Indeed, the problem that gut rhetorics confronts is not simply the need to devise better epistemic modes of data collection, such as textual categorization and patient self-reports. The problem may not be empirical-discursive, but empirical-phenomenological. The problem is coming to grips with unfolding, messy, often subtle and sudden entanglements among bodies and environments. Gut rhetorics within a rhetorical-ontological inquiry foreground microbial life--millions of nonhuman bodies, the new discursive constructions of what it means to be healthy with a microbiota, and the inadequacy of any scientific or epistemic account of how to live with/in this environment.
In pragmatic laboratory terms, Messaoudi and colleagues (2011) demonstrate the lack of conceptual resources for analyzing such complex intra-actions. They administer treatments to a placebo group and a probiotic group, yet they conclude that the reported probiotic effects could result from the presence of beneficial microbiota or the absence of harmful ones, or some other unknown and strange combination. Similarly, in her analysis of antidepression medication and placebos, Elizabeth A. Wilson (2015) argues that "placebos seem to treat and not treat at the same time" (p. 138). She eventually concludes that the "inert placebos also seem to be able to be activated by the forces of persuasion" (p. 124): "If an inert substance can be brought to action by suggestion, if a nondrug can become a drug under the sway of a clinician's care, authority, paternalism, or attention, is there not a muddle (for my purposes, an appealing muddle) between the actions of body and mind?" (p. 124). In brief, body and microbiota are dispersed across "a network of psycho-genetic-i nstitutional-pharmacological action" (p. 138). Accordingly, gut rhetorics must do more than reiterate this observation of ecological entanglement and co-being; it must intensify relationships and discover ways to move with the many realities, agencies, and vitalities--human and nonhuman--that compose a body continuously producing and enacting its relations. Gut rhetorics must have an appetite for metabolic intra-actions as integral to explorations not only of bodies and affect but also of rhetoric's ontologies.
Although we agree with Wilson (2015) by suggesting that rhetoric scholars need to establish more conceptual frameworks to understand material-symbolic intra-actions and to compose new analyses of rhetorical ontology--t hus, our call for gut rhetorics--we also extend beyond the conceptual to posit another, active dimension to gut rhetorics: experiments in living with probiotics. Gut rhetorics cannot be limited to showing how objects and things are "'always already' inextricably and irrevocably implicated, intertwined or even imbricated with everything else" (Ingold, 2017, p. 100). Ontological entanglement is an initializing premise, whereas the practical and practicable challenge becomes how to "join with the texture of the world, with its materials and processes.... The practice of theory, in short, must be a modality of habitation--a way of thinking and working with stuff" (Ingold, 2017, p. 100). If Thomas Rickert (2013) encourages rhetoric scholars to adopt "the more holistic terroir... earth, sun, vine, and weather" in thinking ambiently (p. x)--that is, when the entire world becomes environmental--we must become more capacious still--to include, in our thinking and living, the hungry horde within that makes and arbitrates the terrior. And we must ask how we see ourselves going forward in that world. How do we act, inhabit, dwell?
To enact an active, living rhetorical-ontological inquiry--that is to fold performance and phenomenology into such inquiry--rhetoric scholars may need to diverge from the mapping impulse in Latour's ANT and start ruminating on differently responsive modes of inquiry. Tim Ingold's (2011) SPIDER--Skilled Practice Involves Developmentally Embodied Responsiveness--offers one avenue. When the spider abides at the center of its web, it is "all a-quiver," wherein every movement is a movement of its attention, which, in turn, is an instance of action (Ingold, 2011, p. 93). Ingold suggests that the essence of action occurs in "the close coupling of bodily movement and perception," the activity of a skilled practitioner:
The skilled practitioner is one who can continually attune his or her movements to perturbations in the perceived environment without ever interrupting the flow of action. But such skill does not come ready-made. Rather, it develops, as part and parcel of the organism's own growth and development in an environment. (2011, p. 94)
Skilled activity as moving with the materials of the environment helps to close the gap between knowledge and action, thereby becoming the motivation for moving forward differently in the world. Similar to how the spider spins a web from the materials of its body, gut bacteria and intestines fold into one another, and these intra-actions become a condition of bodily agency and rhetorical capacity. Continually responding to and experimenting with materials, attuning to those intra-actions and the environment in which they emerge means becoming more skilled practitioners.
This impulse to create and engage in bodily experimentation is already evident within the world of consumer probiotics through everyday embodied encounters. In fact, Dannon's Activia brand managers seem to wield experimental life as a strategic marketing campaign. They are not waiting to know more about PF treatments; they do not need more or different knowledge and conceptual frameworks. They are performing a gut rhetoric--the capacitation of rhetoric--as a skilled activity of experimenting with probiotics. Dannon's website for Activia makes not only the entanglements of guts and the microbiota explicit but also the skilled practice involving developmentally embodied responsiveness--a phenomenological investigation of the gut. The website asks, "Gut check. Do you ever feel bloated, gassy, or uncomfortable with rumbling?" ("Activia Challenge," 2016). In promoting its brand of probiotic yogurt containing "a unique cocktail of 5 different cultures," including "billions of bifidus bacteria in every 4 oz. cup," Dannon suggests that Activia allows the consumer to "feel the difference" ("Activia in numbers," 2016). The website explains: "When the intestinal microflora is out of balance, that imbalance may affect overall health. This balance can be disturbed during physical or psychological stress, with age, in menopause, during drug treatment, with an unbalanced diet, and in the event of acute or chronic intestinal diseases" (Dannon, "What role," 2016). Bloating, gassiness, rumbling, and discomfort are agonistic "meetings-with," affective, bodily entanglements among body, microbes, food, nutrients, and other materials.
As Activia's list of imbalances implies, bodily responses are not rational knowledge but more and different kinds of entanglements, attunements, and experiments. In this way, the microbiota does not present a problem to be solved, but the capacitation of a gut rhetoric to be lived--t he very grounding of thought, cognition, and response to the world. With respect to analyzing and performing gut rhetorics, then, skillful living cannot be situated merely as a coming-together but also as a "rumbling" and a "gassiness"--the feeling that something is wrong, the wrangle with misalignment and rupture. Skillful living is a continuous responsiveness to the flow of materials through and with the body. The need to run to the toilet or desire to pull out one's hair are the realities, those living concerns, motivating PF research in gastroenterology as well as experiments in living with probiotics. That Activia's marketing discursively encourages people to feel these ruptures and buy the product to resolve them may, in some ways, introduce skepticism about doing so, but the marketing materials make the overall point--responsiveness to a body-environment can function as experimental means for rethinking how we live and how we might try to (re)attune and then see what happens. In this way, a rhetorical methodology for gut rhetorics deficient in ecological concepts that capture microbial influences must turn to performative phenomenologies (Meloncon, 2018) to see what might "reside at the corner of play and experimentation" (Gruber, 2018, p. 278).
Skilled engagement, rather than detachment from the microbiota, pushes toward "thinking and feeling that grow out of one's engagement with the environment" (Coeckelberg, 2015, p. 179). Such thinking and feeling shifts attention away from theoretical knowledge (knowing that) and to embodied, responsive practices and habits (know-how) (Coeckelberg, 2015). Although everyday gastroenterological experimentation may not precisely calibrate relationships between probiotic formulations and affect states, our bodies do seem to know something--gassiness, rumbling, inflammation--indicating that we could try to eat and live differently: "Rather than reasoning about the environment or having feelings about the environment, we act and think in a relational, environmental way" (Coeckelberg, 2015, p. 97). Savoir faire becomes saveur faire: not only the "art of responding to our environment, which invites us and challenges us to respond" (p. 108), but also "the art of eating well" and "the art of savoring" our relationships with our gut bacteria and probiotics. Developing experiments in living with probiotics offers one possible response "that moves us, makes us care, and makes us more 'environmental,' and thereby lets us, and our environment, flourish" (p. 3). "Rewilding" our guts with probiotics may well be a trope intended to reinstill some cooked-up sense of "naturalness" to human technoscientific engagements; nevertheless, it is also a multispecies achievement that has no final conclusion.
Ingold's SPIDER and Coeckelberg's environmental skill offer non-dualistic, non-modern ways of thinking and being in the world, of living with bodies that eat. On the one hand, the scientific view of gastroenterology treats gut bacteria and probiotics as "things" that may initiate all kinds of reactions, contributing to health or sickness (Coeckelberg, 2015, p. 159). On the other hand, Dannon's Activia may offer a romantic view of "natural" and "authentic" foods, which is equally problematic because it presupposes an ontological division between the two and risks glorifying the agentive power of consumer products. In contrast, a phenomenological approach--the development of environmental skill that hones uneasy feelings to find new ways to live--proposes an active relation to an environment. Examining the textual frameworks and epistemological apparatuses that construct an image of living bodies will not settle how to live with bodies that eat; rather, we need something less rational in composition, not completely content with conceptual network mapping--gut rhetorics that examine how the gut is articulated, what it can do socio-culturally for reformations of brain-body-environment relations, and what it can do within the experiences of living as environmental beings.
Conclusion: Experiments in Rhetoric
We have much to learn about rhetoric from our microbial entanglements, and this knowledge should be both conceptual and skillful. The body does not simply have or not have beneficial or harmful microbiota, and microbiota do not simply inhabit the body; they make the body inhabitable and remake the body. Eating feeds both the body and microbiota that nourish each other. The body and microbiota are entangled and attuned in ways beyond the epistemological scope of science's and rhetoric's textualizations. Indeed, the first material ecology of gut rhetorics--the experimental calibration of probiotic formulations and affect states--reveals a gut rhetoric that is an entanglement of patient self-feeling, patient self-report, psychological assessment, urine samples, and testing kits set both with and against previous findings involving lab rats, electroshock treatments, mazes, bright lights, and so on. This rhetorical-ontological inquiry foregrounds what is absent as much as what is present, what is attuned and not attuned, exposing breakdown and misalignment just as much as ecological connections and compelling relations. We hope not to make too strong a point here about rhetoric scholars ambitiously focusing on ecologies or attunements because, they, too, tap into the enticements of materiality and the formations of a rhetorical ontology. Even so, with intense attention on new materialist approaches in rhetoric and repeated calls to examine how bodies, technologies, places, and things come together (Blackman, 2012; Johnson, 2018; Rickert, 2013), we believe that gut rhetorics emphasize those messy ontological formations dependent upon incompatibilities--what cannot be touched or made palatable, or even made known, just as much as what can be made anew. We suggest that the embarrassing, forceful, disgusting, icky, often surprising, movements of the gut, the tricky ruminations of microbiota, the unexpected affective response, and the suspicion that resides in rhetoric's ability to stir sudden anger or unreasonable outbursts hold something in common--a glimpse into the embodiment, even the very capacitation, of rhetoric.
Consequently, we suggest a second material ecology of gut rhetorics--the active, embodied, and skillful experiments in living with probiotics, specifically, and the microbiota, generally. This environmental skill reminds us again, "No one will ever finally exclaim: 'So, there it is: now, we know all that a body can do! Let's call it a day'" (Gregg & Seigworth, 2010, p. 3). We will never know what a body can do because, in part, microbes blanket the surfaces of the world, literally and figuratively terraforming and sculpting bodies. They are our environment, our bodily materials, a condition of our agency, and therefore an invitation and challenge to our embodiment. They are both our environment and our happening. Microbes have domesticated us, and we attempt to domesticate microbes. Where gut rhetorics makes its contribution, then, is not necessarily in confirming the need for a broader move toward entanglements, but in making explicit the suasive potentials of microbial life and the continuous embodied responsiveness to environmental exposure: "We are stuck here and we have to act everyday as we live alongside an innumerable and unknowable number of species" (Rivers, 2015, p. 433). Environmental skill requires a "knowing how" that surfaces "in the skills of perception and capacities ofjudgment that develop in the course of direct, practical, and sensuous engagement with the beings and things with whom, and with which, we share our lives" (Ingold, 2015, p. 157). Experiments in living with probiotics offers one possibility for ongoing skillful, yet agonistic encounters with microbiota.
Finally, experiments with the dense material complexities of gut bacteria come at a time when scholars grow hungry for expanded analyses involving explorations of affect and the body. Gut rhetorics can serve as a call to investigate how individual strands of bacteria "affect certain consequences in the world" (Stormer, 2016, p. 309) not only by being "good" and producing digestive ease but also by being agonistic to the body and opposed to scientific textualizations. Gut rhetorics goad a challenge to and a project for rhetoricians of health and medicine: As we continue to explore rhetorical ontologies to "meet-with" all that a body can do, we must produce both textualized constructions of bodies across assessment tools, medical charts, consultations, and probiotic consumerism and ontological provocations for how we might live with the realities of microbiota and feel the directions our own bodies are taking us as we feed.
Lisa Meloncon (2018) sets out a similar methodological proposal, arguing that rhetoricians of health and medicine should seek to "understand how the body experiences health and illness individually" as a way to evaluate entwined relations. She suggests folding a "mutual dependence on embodiment and experience into performative phenomenology," by which she means a move to spend more time reflecting on in situ sensory experiences within the formation of otherwise traditional rhetorical analysis (p. 98). David Gruber (2018) offers a similar proposal: Rhetoric scholars seeing the potential to build new theory from neuroscience would benefit from working through performative means, "seeking invention and residing at the corner of play and experimentation" (p. 278). Here, Gruber situates experimentation as both literal and creative, stressing the value of artificial test environments as much as fluid discovery wherein bodies play in new environments that might expose new realities of the gut or realize entirely new conditions for thought and action (p. 278-280).
As such, rhetoric scholars of health and medicine might begin to set up and conduct their own experiment in living with probiotics. Gut rhetorics encourage scholars to feel the inflamed linings of the gastrointestinal tract as a way of beginning to think with the "appealing muddle" (Wilson, 2015, p. 124) of mucilaginous membranes and metabolizing microbiota. Perhaps more salaciously in our conception, gut rhetorics take up a sickening feeling as a starting point for conceptualizing rhetoric as a bodily act and a variable embodied phenomenon that cannot be well ordered or maintained; indeed, gut rhetorics suggest an approach that investigates what does not line up or feel quite right, just as we have done with the examination of disjunctions across PF studies which were interrelated precisely to try to stage, legitimize, and secure the science. However, what is important for gut rhetorics is that this calibration does not occur seamlessly or symmetrically, is not conceptualized as a fluid series of attunements; rather, every gut rhetoric appears as an asymmetric wild fermentation--pungent, intoxicating, repellent. Just as the body is not merely a text, and depression not merely a colonization of the "right" or "wrong" bacteria, nor scientific experimentation merely a material encounter, so must rhetoricians develop environmental skill to attune to all the ways that a body is composed--from within convergences as well as "exclusions" and "deleterious gut pathogens" (Messaoudi et al., 2011, p. 760), all the ways that a body eats and spills its guts.
JASON KALIN is an assistant professor in the Department of Writing, Rhetoric, & Discourse at DePaul University. His research interests include rhetorical theory; visual, material, and digital rhetorics; and rhetorical methods. He has published in Rhetoric Society Quarterly, Space & Culture, and Visual Communication Quarterly, among other forums.
DAVID R. GROBER is an assistant professor in the Department of Media, Cognition and Communication at the University of Copenhagen. His research focuses on neurorhetorics and rhetoric of the body.
Access Counseling Group. (2013). SCL-90. Retrieved from http://accesscm.org/wp-content/uploads/2013/03/SCL-90.pdf
Ait-Belgnaoui, Afifa, Han, Weiping, Lamine, Florance, Eutamene, Helene, Fioramonti, Jean, Bueno, Lionel, & Theodorou, Vassilia. (2006). Lactobacillus farciminis treatment suppresses stress induced visceral hypersensitivity: A possible action through interaction with epithelial cell cytoskeleton contraction. Gut, 55(8), 1090-1094.
Akrich, Madeleine, & Latour, Bruno. (1992). A summary of a convenient vocabulary for the semiotics of human and nonhuman assemblies. In Wiebe E. Bijker & John Law (Eds.), Shaping technology/building society: Studies in sociotechnical change (pp. 259-264). Cambridge, MA: The MIT Press.
Barnett, Scot, & Boyle, Casey. (Eds.). (2016). Rhetoric, through everyday things. Tuscaloosa: University Alabama Press.
Bazerman, Charles. (1988). Shaping written knowledge: The genre and activity of the experimental article in science. Durham, NC: Duke University Press.
Blackman, Lisa. (2012). Immaterial bodies: Affect, embodiment, mediation. London: SAGE.
Bravo, Javier A., Forsythe, Paul., Chew, Mariaane V., Escaravage, Emily, Savignac, Helene M., Dinan, Timothy G.,... Cryan, John F. (2011). Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proceedings of the National Academy of Sciences, 108(38), 16050-16055.
Chakraborti, Sushil K., Dey, Binay K., Ghosh, N., Chaudhury, A. N., & Mazumder, D. N. Guha. (1996). Objective evaluation of psychological abnormality in irritable bowel syndrome. Indian Journal of Gastroenterology, 15(2), 43-45.
Coeckelberg, Mark. (2015). Environmental skill: Motivation, knowledge, and the possibility of a non-Romantic environmental ethics. New York: Routledge.
Cohen, Sheldon. (1994). Perceived stress scale. Menlo Park, CA: Mind Garden, Inc. Retrieved from http://www.mindgarden.com/documents/PerceivedStressScale.pdf
Cryan, John F., & Dinan, Timothy G. (2012). Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nature Reviews Neuroscience, 13(10), 701-712.
Dannon Inc. (2016a). Activia challenge. Retrieved from http://www.activia.us.com/activia-challenge
Dannon Inc. (2016b). Activia in numbers. Retrieved from http://www.activia.us.com/about-activia/who-we-are/activia-numbers
Dannon Inc. (2016c). What role does your digestive system play in your overall health? Retrieved from http://www.activia.us.com/about-us/digestive-health
Derogatis, Leonard R., Lipman, Ronald L., Rickels, Karl, Uhlenhuth, E. H., & Covi, Lino. (1974). The Hopkins Symptoms Checklist: A self-report symptom inventory. Behavioral Science, 19(1), 1-15.
Dinan, Timothy. G., Stilling, Roman M., Stanton, Catherine, & Cryan, John F. (2015). Collective unconscious: How gut microbes shape human behavior. Journal of Psychiatric Research, 63, 1-9.
Diop, Laurent, Guillou, Sonia, & Durand, Henri. (2008). Probiotic food supplement reduces stress-induced gastrointestinal symptoms in volunteers: A double-blind, placebo-controlled, randomized trial. Nutrition Research, 28(1), 1-5.
Estrada, Alberto, Drew, Murray D., & Van Kessel, Andrew. (2001). Effect of the dietary supplementation of fructooligosaccharides and Bifidobacterium longum to early-weaned pigs on performance and fecal bacterial populations. Canadian Journal of Animal Science, 81(1), 141-148.
Everensel, Alper, & Ceylan, Mehmet Emin. (2015). The gut-brain axis: The missing link in depression. Clinical Psychopharmacology and Neuroscience, 13(3), 239-244.
Fitzgerald, Des, & Callard, Felicity. (2015). Social science and neuroscience beyond interdisciplinarity: Experimental entanglements. Theory, Culture & Society, 32(1), 3-32.
Graham, S. Scott. (2015). The politics of pain medicine: A rhetorical-ontological inquiry. Chicago: University of Chicago Press.
Gregg, Melissa, & Seigworth, Greg. J. (Eds.). (2010). The affect theory reader. Durham, NC: Duke University Press.
Gruber, David. R. (2018). Experiments in rhetoric: Invention and neurorhetorical play. In Lisa Meloncon & J. Blake Scott (Eds.), Methodologies for the rhetoric of health & medicine (pp. 276-295). New York: Routledge.
Gwee, Kok-Ann, Leong, Y.-L., Graham, Clive, McKendrick, Michael W., Collins, Stephen. M., Walters, Stephen J., Underwood, James, Read, Nick W. (1999). The role of psychological and biological factors in postinfective gut dysfunction. Gut, 44(3), 400-406.
Hanstock, Tanya L., Clayton, Edward H., Li, Kong M., & Mallet, Paul E. (2004). Anxiety and aggression associated with the fermentation of carbohydrates in the hindgut of rats. Physiology & Behavior, 82(2-3), 357-368.
Haraway, Donna J. (2016). Staying with the trouble: Making kin in the Chthulucene. Durham, NC: Duke University Press.
Hill, Annie. (2016). Breast cancer's rhetoricity: Bodily border crisis and bridge to corporeal solidarity. Review of Communication, 16(4), 281-298.
Hird, Myra J. (2009). The origins of sociable life: Evolution after science studies. New York: Palgrave Macmillan.
Ingold, Tim. (2011). Being alive: Essays on movement, knowledge, and description. New York: Routledge.
Ingold, Tim. (2015). The life of lines. New York: Routledge.
Ingold, Tim. (2017). Surface visions. Theory, Culture & Society, 34(7-8), 99-108.
Jack, Jordynn. (2009). A pedagogy of sight: Microscopic vision in Robert Hooke's Micrographia. Quarterly Journal of Speech, 95(2), 192-209.
Johnson, Nathan R. (2018). Infrastructural methodology: A case in protein as public health. In Lisa Meloncon & J. Blake Scott (Eds.), Methodologies for the rhetoric of health & medicine (pp. 61-78). New York: Routledge.
Kamiya, Takeshi, Wang, Lu, Forsythe, Paul, Goettsche, Gudrun, Mao, Yukang, Wang, Yufang, Tougas, Gervais, Bienenstock, John J. (2006). Inhibitory effects of Lactobacillus reuteri on visceral pain induced by colorectal distension in Sprague-Dawley rats. Gut, 55(2), 191-196.
Landecker, Hannah. (2011). Food as exposure: Nutritional epigenetics and the new metabolism. BioSocieties, 6(2), 167-194.
Law, John. (1992). Notes on the theory of the actor network: Ordering, strategy, and heterogeneity. Systems Practice, 5(4), 379-393.
Lorimer, Jamie. (2016). Gut buddies: Multispecies studies and the microbiome. Environmental Humanities, 8(1), 57-76.
Lorimer, Jamie. (2017). Probiotic environmentalities: Rewilding with wolves and worms. Theory, Culture & Society, 34(4), 27-48.
Lynch, John A. (2009). Articulating scientific practice: Understanding Dean Harrier's "gay gene" study as overlapping material, social and rhetorical registers. Quarterly Journal of Speech, 95(4), 435-456.
Matza, Louis S., Wyrwich, Kathleen W., Phillips, Glenn A., Murray, Lindsey T., Malley, Karen G., & Revicki, Dennis A. (2013). The fatigue associated with depression questionnaire (FAsD): Responsiveness and responder definition. Quality of Life Research, 22(2), 351-360.
Meloncon, Lisa. (2018). Bringing the body back through performative phenomenology. In Lisa Meloncon & J. Blake Scott (Eds.), Methodologies for the rhetoric of health & medicine (pp. 96-114). New York: Routledge.
Messaoudi, Michael, Lalonde, Robert, Violle, Nicolas, Javelot, Herve, Desor, Didier, Nejdi, Amine,... Cazaubiel, Jean-Marc. (2011). Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. British Journal of Nutrition, 105(5), 755-764.
Mol, Annemarie. (2003). The body multiple: Ontology in medical practice. Durham, NC: Duke University Press.
Naserifbafrouei, Ali, Hestad, Knut, Avershina, Ekaterina, Sekelja, Monika, Linlokken, Arne, Wilson, Robert, & Rudi, Knut (2014). Correlation between the human fecal microbiota and depression. Neurogastroenterology & Motility, 26(8), 1155-1162.
Petra, Anastasia I., Panagiotidou, Smaro, Hatziagelaki, Erifili, Stewart, Julie M., Conti, Pio, & Theoharides, Theoharis C. (2015). Gut-microbiota-brain axis and its effect on neuropsychiatric disorders with suspected immune dysregulation. Clinical Therapeutics, 37(5), 984-995.
Rao, Kiran, Subbakrishna, D. K., & Prabhu, G. G. (1989). Development of a coping checklist: A preliminary report. Indian Journal of Psychiatry, 31(2), 128-133.
Rickert, Thomas. (2013). Ambient rhetoric: The attunements of rhetorical being. Pittsburgh: University of Pittsburgh Press.
Rivers, Nathaniel A. (2015). Deep ambivalence and wild objects: Toward a strange environmental rhetoric. Rhetoric Society Quarterly, 45(5), 420-440.
Salvetti, Elisa, Torriani, Sandra, & Felis, Giovanna E. (2012). The genus Lactobacillus: A taxonomic update. Probiotics and Antimicrobial Proteins, 4(4), 217-226.
Schmidt, Kristin, Cowen, Philip J., Harmer, Catherine J., Tzortzis, George, Errington, Stevene, & Burnet, Philip W. J. (2015). Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology, 232(10), 1793-1801.
Snaith, R. Philip. (2003). The hospital anxiety and depression scale. Health and Quality of Life Outcomes, 1(1), 1-4.
Sonnenburg, Justin, Sonnenburg, Erica. (2016). The good gut: Taking control of your weight, your mood, and your long-term health. New York: Penguin Books.
Stormer, Nathan. (2015). An appetite for rhetoric. Philosophy and Rhetoric, 48(1), 99-106.
Stormer, Nathan. (2016). Rhetoric's diverse materiality: Polythetic, ontology, and genealogy. Review of Communication, 16(4), 299-316.
Stormer, Nathan., & McGreavy, Bridie (2017). Thinking ecologically about rhetoric's ontology: Capacity, vulnerability, and resilience. Philosophy and Rhetoric, 50(1), 1-25.
SVRI. (2016). Hospital anxiety and depression scale. Sexual Violence Research Initiative. Retrieved from http://www.svri.org/sites/default/files/attachments/2016-01-13/HADS.pdf
Wells, Susan. (1999). Legible bodies: Nineteenth-century women physicians and the rhetoric of dissection. In Jack Selzer & Sharon Crowley (Eds.), Rhetorical bodies (pp. 58-74). Madison: University of Wisconsin Press.
Wilson, Elizabeth A. (2015). Gut feminism. Durham, NC: Duke University Press.
Yamamura, Schuhei, Morishima, Hiroko, Kumano-go, Takayuki, Suganuma, Nakamori, Matsumoto, Hiroshi, Adachi, Hiroyoshi,... Takeda, Masatoshi. (2007). The effect of Lactobacillus helveticus fermented milk on sleep and health perception in elderly subjects. European Journal of Clinical Nutrition, 63(1), 100-105.
Yong, Ed. (2016). I contain multitudes: The microbes within us and a grander view of life. New York: Harper Collins. Young, Anna M., Eckstein, Justin, & Conley, Donovan. (2015). Rhetorics and foodways. Communication and Critical/Cultural Studies, 12(2), 198-199.
(1) Messaoudi et al. (2011) do not entirely clarify whether HSCL and HADS are administered by professionals, despite recommendations to do so.
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|Author:||Kalin, Jason; Gruber, David R.|
|Publication:||Rhetoric of Health & Medicine|
|Date:||Jun 22, 2018|
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