Holding space for nuance in irritable bowel syndrome: the ethical dimensions of medical ambiguity

Abstract

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is common and yet remains perplexing for physicians and patients alike. Symptoms can be ambiguous, and understanding of this disorder has been limited, in part, by blunt diagnostic tools. Ironically, the lack of sophisticated scientific approaches itself has contributed to the perception that IBS is a less objective diagnosis. A syndrome that rests among intricate and poorly delineated relationships between biologic, psychologic, and social domains, IBS does not always lend itself well to traditional clinical discussions. Here, I offer narrative ethics as a potential tool to carry the nuances of this diagnosis. Invocations of narrative demand interrogation of stories and how they operate, and I argue stories work particularly potently for IBS patients. Finally, I consider how lay narratives about IBS may contribute to care disparities among different groups. Through these three sections, I seek to explore the ethical considerations of ambiguity within medical spaces and the traps that exist when dealing with illness that lies just beyond the margin of contemporary scientific understanding.