Taking Shit From Others

Recent FDA regulation of shit as a medical treatment brings to light the ambivalence of excrement.

Shit, that most abject of materials, can save lives. Fecal transfer has been known and practiced for millennia, most notably in Chinese medicine. It has been officially practiced in the U.S. since 1958, although marginalized and under-researched. Recent attempts at U.S. regulation have focused new attention on this little-known treatment, which can cure chronic diseases and challenges the assumptions of filth and shame, the shit that adheres to shit.

Last year, the United States FDA declared shit an Investigational New Drug, restricting its use for medicinal purposes. Patient advocacy groups have rallied to protest the decision, which threatens the existing infrastructure of stool banks. These banks are exactly what they sound like: schemes where donors offer their shit to strangers suffering from serious intestinal conditions. The only other resource for chronically ill people is to approach relatives and friends for donations, which can be embarrassing, time-consuming, and difficult for people whose symptoms have left them isolated. For many, fecal transfer is still worth it despite these barriers, as for some patients it can effect dramatic improvements.

Donor shit displaces bad bacteria and fosters the development of more robust microbiota that are able to fight infection. Fecal transplants are used for treating the bacterial infection C. difficile, as well as a number of other internal conditions like IBS, Crohn’s disease, colitis, and constipation. Some trials show it’s even effective as therapy for Parkinson’s disease. Enemas are the most common exchange method, but one of the motives behind FDA regulation is to facilitate the development of shit pills for less invasive transfer.

In 2012, a team of MIT affiliates launched the first official, FDA-approved U.S. stool bank, OpenBiome. Registered donors can make $40 per day. If the compensation seems generous (though it’s comparable to sperm donation), it’s because OpenBiome is able to profit from the sale of small samples, literalizing the psychoanalytic link between shit and money. Despite the amazing healing properties of shit and the FDA’s support, OpenBiome was initially greeted with suspicion. One MIT colleague was convinced that the project was a joke.

Report after report on fecal matter transfer refers to the practice as a miracle cure. Despite this, the U.S. medical establishment has taken a long time to accept the benefits of shit, partly because it’s hard to monetize, and partly because of cultural perceptions that shit is self-evidently just gross. Collective shame around shit looms so large as to seem like an unchangeable fact, even as fecal transfers offer significant curative properties. How many of us shit as discreetly as possible to avoid being heard? How many avoid shitting in front of intimate partners? Against all this erasure, the image of the stool bank conjures the earliest gesture of babyhood: shit as gift, one of the first things we are able to give to the people around us.

The shame of shit is a shame, not least because two-thirds of the immune system is found in our gut. There are 10 times as many microflora living in our digestive tract than there are cells in the entire body. Over the course of our lifetimes, our floral microbiota bloom and react to the composite of factors in our physical and emotional lives. Geography is a huge initial determinant; our microbiota bear the signature of the literal places of our birth. They are also passed on generationally. Over time, our flora respond to everything we experience: stress, joy, trauma, rage, and so on. Recent studies shows that shifting the balance of our gut bacteria can positively affect anxiety and depression. That “feeling in your gut” is more than a metaphor for something deeply felt—it marks the relation between our intestinal residents and our emotion. High-stress, high-anxiety environments disrupt microbiota and, inversely, microfloral imbalances can produce depressive and neurological symptoms. To put it simply: 100 trillion tiny creatures inside us carry the extent and impact of our external lives. They are living their life, we are living ours, and those life acts are nonlinearly interlinked. Their collective existences are contained within ours, and vice versa.

How does the medicalization of shit impact our understanding of the microbiome and its intimacies? If the sharing of shit becomes more generally normalized, as it already is among those engaging in fecal matter transfer, will this shift our understanding of shit? The fecal transplant constitutes a transfer of the accumulation of other people’s sensations and emotions from one gut to another. Unlike genes, flora don’t code our initial formation—they code the ways in which our environments and histories have impacted our insides. You can test a stool sample for hepatitis, but not for heartbreak.

Like most physical acts, shitting is imbued with gendered meanings. A company that marketed post-shit perfume spray to women managed to sell nearly 4 million bottles in just a few years. The specter of a special taboo on women shitting echoes psychoanalytic theories that link the stool and the phallus: Femme people aren’t supposed to shit because shit has phallic connotations. Alternatively, perhaps the taboo springs exactly from the gender-indeterminacy of the anus. The perception of shitting as unfeminine reinscribes gender in a place where it threatens to disappear: the asshole. Other things can also disappear there; thousands of ER visits are made in the U.S. every year by people who inserted objects without flared bases—vibrators, pencils, remote controls, and so on—into their anuses and couldn’t get them out. Unlike the vagina, to which the cervix and uterus serve in the heterosexual imaginary as a properly reproductive stopping point, the anus opens out onto the endless coiling vista of the intestine, passing all the way through the body to the mouth. This infinity evokes the possibility of castration and phallic disappearance. What goes in might never return. But the social signification of the cis man’s body is a huge flared base that lets him withdraw even from the asshole with his privilege intact.

Mary Douglas’s book Purity and Danger explores the construction of dirt and impurity across different cultures. Dirt is matter out of place (on our clothes, under our fingernails, in corporate tax records, etc). Perception of this dirt as ungraceful and even dangerous requires the fantasy of otherwise good order. Douglas writes of dirt, “It implies two conditions: a set of ordered relations and a contravention of that order. Dirt then, is never a unique, isolated event. Where there is dirt there is system… uncleanness or dirt is that which must not be included if a pattern is to be maintained.” In a system that tries to flush away and hide shit’s existence, shit is problematic evidence that the products of the body, and bodies themselves, can disperse and be out of place. It is this that gives shit the power of taboo, the power to disgust or arouse.

From this perspective, the dispersed bodies of colonialism are also impure. White-supremacist metaphors of excrement and dirtiness stick to people and cultural practices. For example, colonial narratives have depicted brown peoples as dirty and smelly, and nonwestern toilet practices as primitive. In the colonial system, the existence/resistance of colonized people is the grit in the machine, the dirt antithetical to the clean and ordered relations of the colonizer. Western-style toilets are designed to put as much distance as possible between the body and its waste. You can be filthy rich, but the white rich are not filthy. The function of patriarchy, professionalism, and plumbing here has been to separate the human/proper/white body from dirt and ascribe that dirt to others. Whether what’s pushed away is shit, people, or disturbing ideas, the agent of this rejection is always an asshole.

But shit can be shared, and shit can heal, because it is the mark of our contiguity with our environments. No one lives autonomously, even within a single body. The microflora that inhabit our guts have their own response to our existences. The digestive system, a body within a body, terminates at either end in the emotionally charged orifices of mouth and anus that mark the boundary of inside and outside. The lives of our digestive microbiomes reflect and refract back onto the conscious life of that other body of head and limbs. The surface of the body can appear in the world, but the bag of the stomach and the lossy whorls of the intestine are internal, secret, fleshy and mysterious. Respectability relies on denying them social meaning, while this same denial produces undercurrents of desire and curiosity. Alien life populates our innermost parts. Our microbiota hold deep levels of possibility and feeling, but they die under conditions of duress. They are who they are, and they are us too. They hold both life and life’s consistent death.

In Roald Dahl’s Big Friendly Giant, the title character and his giant colleagues move through the world collecting dreams from sleeping humans and storing them in great warehouses. They then redistribute those dreams to other sleeping humans by blowing them into their ears. The BFG is the only giant who happens to exclusively collect and distribute good dreams (which can still be full of various sadnesses) and refuses to eat humans. Despite the consent forms and now FDA regulation, a stool bank feels more similar to a warehouse full of dreams than a blood repository: the freezers are full of subconscious matter. In the stool bank, the fecal transplant is sanitized and rendered anonymous, as are the moments of giving/shitting and taking/insertion. But at the moment that the anonymous donor’s shit is sent into the vast possibility of the recipient gut, creatures who have lived by the trillion in another microbiome interact for the first time with their counterparts in an unfamiliar body. Microbiotic dreams, stored joys and trauma, move between individual bodies and transform them.