elsewhere. Whatever happens, the bioscience model of medicine has failed to provide the means for the patient to act like a patient and the doctor to act like a doctor; that is, the physician did not heal and the patient did not recover. If the enactment of biomedicine occurs at the moment its body of knowledge encounters a body, the body of the environmentally ill obscures that moment and effectively prevents the encounter.
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Why is the profession of medicine unable to certify MCS as a legitimate physical disorder? Perhaps it isn’t one. That is the simplest answer. It is more complicated and more interesting, however, to consider MCS as a theory of the body and the environment that contests both the medical profession’s responsibility to define bodies and several of its paradigmatic assumptions about disease.
First, medicine works closely with the state to define and regulate bodies in the interest of cultural and capital production (Foucault 1973; Turner 1995). Capitalism in the waning years of the twentieth century is interested in bodies insofar as they are able to work and consume, and do so in a flexible manner (Martin 1990; Harvey 1989). The healthy body, in other words, is one that goes to work regularly, purchases and consumes the products of its or others’ labors, and is capable of adapting quickly to changing modes of production and skill requirements. A putative somatic disorder that denotes change in the definition of the body in its relationship to common consumer products and domestic and workplace environments, therefore, is likely to be scrutinized closely before it is officially recognized as a disease. The environmentally ill body is, of course, anything but flexible. But something more basic than an abstract political economy is at work here.
Howard’s unfortunate predicament suggests that a formidable problem for attending physicians is the result of the limitations of their diagnostic technologies in certifying something called MCS. Medical technology is built to measure and test the assumptions of the biomedical model. Among the many assumptions in this model are two that are particularly relevant to MCS. From classic toxicology comes the supposition that a relatively small number of individuals are sensitive to low, but nevertheless measurable, exposures to certain toxins. From allergy comes the classic IgE-mediated responses by atopic individuals with overactive antibodies that mistake ordinary environmental stimuli (ragweed, pollen, dust, and so on) for poison. What the biomedical model does not assume, however, is a third, entirely different, type of sensitivity.
A principal characteristic of MCS is that after the initial sensitization, there is no identifiable threshold or exposure level below which there is a negligible risk of becoming sick (Davis 1986, 12). People who identify themselves as environmentally ill report that an acute or chronic exposure to chemicals sensitizes their bodies to respond adversely to extremely low, subclinical exposures to a seemingly endless array of unrelated chemical compounds. (The term subclinical is used here to denote the absence of a diagnostic technology capable of identifying the quantity of chemicals that purportedly change the bodies of the chemically reactive.)
Canada’s Ministry of Health concludes in a report on MCS that “affected persons have varying degrees of morbidity and no single laboratory test including serum IgF is consistently altered” (Davis 1986, 35). Acknowledging this limitation, the National Research Council (1992) concludes quite simply that the “symptomatology related to multiple chemicals is a distinct feature of [EI] patients that is not classifiable by existing criteria used in conventional medical practice” (5). Multiple chemical sensitivity, in other words, is a medical anomaly; and like all scientific anomalies it is approached as an “untruth, a should-be-solvable-but-is-unsolvable problem, a germane but unwelcome result” (Mastermind 1970, 83).
But MCS is more than an awkward fact for the profession of medicine. Indeed, medical anomalies are common. At this time, for example, the etiologies of Sjögren’s syndrome and idiopathic pulmonary fibrosis are simply unknown and treatments difficult to prescribe. A new strain of tuberculosis is resisting proven antidotes and spreading to dangerous levels in urban areas. And AIDS continues its deadly course, labeled but eluding cures. But most medical anomalies, including those just mentioned, are puzzles whose solutions will not change the cultural definition of the body. Multiple chemical sensitivity, on the other hand, is more a mystery than a puzzle. If a puzzle is a game to exercise the mind by encouraging a search for the solution, a mystery admits of no solution unless the rules of the game itself are changed. More than a puzzle or awkward fact, MCS would change the rules of the game by changing what is known about bodies and supposedly safe environments.
At the heart of this undecided battle are the environmentally ill, challenging the received wisdom about the body by linking their somatic disorders to rational explanations borrowed from the profession of medicine. It is not, in other words, the languages of the occult, New Age, or Eastern philosophy that are adopted by the chemically reactive to interpret their somatic misery. It is not crystal therapy, homeopathy, past-life regression, or obeisance to self-appointed gurus that serves as a resource for knowing. Rather, these individuals are apprehending their bodies using the rational, Enlightenment language of biomedicine. If Carl Sagan (1996) truly laments the modern revolt against science and the resurgence of a “demon-haunted world,” he should be pleased to hear of ordinary people who are struggling to know something logical and reasonable about their bodies.
The environmentally ill are likely to apprehend their somatic misery using the technical language of biomedicine rather than some variation of New Age knowledge for at least one rather obvious reason: they experience their bodies changing in the presence of consumer items commonly regarded as safe and in ordinary environments commonly regarded as benign. Consider, for example, the following field note describing an incident that occurred during an interview with a person who claims to be environmentally ill:
I sat roughly twenty feet from Jack. We were in his living room. Jack’s house is set up for someone who is environmentally ill. Air-filtering machines are running in several rooms. Magazines, newspapers, and other printed materials are noticeably absent. A plastic housing covers the TV screen to block harmful low-level electromagnetic waves emitted from the picture tube.
I am properly washed and attired. (That is, I showered without using soap and am wearing all cotton that has been washed dozens of times.)
Shortly after starting the interview, Jack became visibly agitated, lifting himself from side to side and up and down in his chair. Red blotches appeared on his arms and face. He started to slur his words. He explained that he was reacting to something new in the house. Since I was the only new thing around, he started to ask me questions: Was I wearing a cologne? Was I wearing all cotton? Could I have washed my clothes using a fabric softener? And so on. With the exception of the cotton question, I answered “no” to each query.
His symptoms were increasing in severity. He looked at my pen and asked if it contained a soy-based ink. I told him I bought it at a bookstore without checking the chemical composition of the ink. He smiled knowingly and asked me to put the ink pen outside. Within a few minutes his symptoms subsided.
The question is not whether Jack’s body changed in front of me. It did. The question, rather, is how to interpret the change. Using a process of elimination, Jack concluded that the one foreign item in his house responsible for his somatic distress was an ordinary ballpoint pen. Remember, the distance between Jack and the pen was approximately twenty feet. I asked him to explain how he knew the cause of his symptoms was the pen and how an ink pen that was twenty feet away could affect him so seriously. He told me about the synthetic chemicals in ink and their particular effects on him. He explained how the air circulator in the living room was pointing at my back and facing him. Thus, it blew the offgassing ink from the point of my pen toward him.
Jack’s carefully thought-out explanation of his somatic distress struck me as interesting, if debatable. Every move in his “first-this-and-then-that” style of reasoning is grounded in a testable assumption. And Jack was not surprised when his symptoms subsided after the pen was removed from the house. “What else could it have been?” he reasoned. Jack is in the habit of theorizing his illness by constructing what for him and, at least some, others are reasonable accounts of the causes of his misery. For Jack, theorizing his illness in a language of instrumental rationality allows him to explain his body to others and, importantly, allows him to live with some degree of self-respect in a very sick body.