myths, and legends?” Simon and colleagues label the environmentally ill victims of, simply put, bad reasoning. Like Lévy-Bruhl’s primitive, they cannot discern what is real from what is imaginary. Thus for some experts MCS is a result of behavioral sensitization. People associate a smell or taste with a physical symptom, in spite of the fact that there is no clinical relationship between the two. For others, MCS is a consequence of a tendency to react unreasonably to physical symptoms such as a sore throat or a rash. Investing too much attention in these symptoms, they search for causes and find them in the local environment. Finally, for still others MCS is a result of a faulty mode of reasoning perhaps best called “displacement confusion.” Here a person avoids thinking about the “real” causes of physical distress, unhealthy lifestyles, excessive stress, and so on, and focuses instead on modern culture’s overconcern with the environmental causes of disease (Simon, Katon, and Sparks 1990; see also Simon 1995, 45).
What are we to make of this confusing array of biological and psychological accounts of EI? Those in the medical research community are more sympathetic than their counterparts in clinical medicine to the idea that MCS is a legitimate medical disorder. But research on MCS is just beginning. Indeed, as we write this book, there is not even a commonly accepted case definition of the problem. Thus medical researchers are still debating the essential question: What is it? The clinical medical community appears to be ahead of its research colleagues, at least in knowing what MCS is not. It is not a legitimate physical disorder. While there is some confusion over what MCS might be—a belief, a cult, a psychiatric disorder, or a process of faulty reasoning—it is not recognized as a physical disease by the medical profession.
Thus, what happens when a person who has been closely monitoring his body, matching symptoms with environments, and organizing his local world to make some sense of his distress visits a physician trained to look beyond a patient’s account and examine the body as the source of disease?
Doctors, Patients, and Paradigm Disputes
When physicians receive patients’ complaints, it is their professional responsibility to translate them into a language that is created and controlled by the normal science model of medicine. Although they use the most sophisticated medical technology and are guided by the cultural authority of biomedicine to “define and evaluate their patients’ condition” (Starr 1982, 16), most physicians who treat the environmentally ill fail to heal them.
Imagine the physician presented with a patient such as Howard, complaining of nasal obstruction, sinus discomfort, chest pain, flushing hives, itching eyes, loss of visual acuity, fatigue and insomnia, genital itch, and nausea. Imagine that no accepted tests of organ system function can explain the symptoms. Imagine also that the patient is nonreactive to any conventional treatment plan the physician prescribes. The complaints persist. Finally, imagine that the patient has a theory that explains the origins of the symptoms, but that such a theory does not correspond to any of the accepted etiologies within the biomedical model. It is not unreasonable to assume that patient and physician will tire of this cycle of frustration. The physician might suggest another doctor, or the patient might simply give up and go 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
