The Main Interest in Life and Work Is to Become Someone Else That You Were Not in the Beginning

The main interest in life and work is to become someone else that you were not in the beginning. If you knew when you began a book what you would say at the end, do you think that you would have the courage to write it? The game is worthwhile insofar as we don’t know what will be the end. Michel Foucault, Technologies of the Self University of Alberta Candida and the Discursive Terms of Undefined Illness: Ghostly Matters, Leaky Bodies and the Dietary Taming of Uncertainty by Alissa Overend A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy Faculty of Physical Education and Recreation Department of Sociology ©Alissa Overend Fall, 2010 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission. Examining Committee Dr. Sharon Rosenberg, Sociology Dr. Debra Shogan, Physical Education and Recreation Dr. Cressida Heyes, Philosophy Dr. Amy Kaler, Sociology Dr. Pirkko Markula, Physical Education and Recreation Dr. Shelley Reuter, Sociology, Concordia University This dissertation is dedicated to my parents—to my father who passed away years before I ever considered graduate school, and to my mother who saw me through to the very end. Abstract This dissertation examines the discursive terms upon which people come to understand their experiences with a yeast-related disorder known speculatively within biomedical practice as “Candida”. Following the critical interrogations posed by feminist and poststructural theorizings, I aim not to prove or disprove Candida’s etiological case. My aim, rather, is to question what can be learned about the social workings of undefined illness through attending to how people talk about their experiences with Candida. I am concerned both with people’s experiences of Candida, and in how these illness experiences come to be structured in and through the wider discursive framings of biomedicine, gender and dietary discipline. As Candida continues to emerge as unintelligible—and thus disorienting—form of illness, the urgency lies, I argue, not only in representing these often nebulous illness experiences, but also in questioning how these illness experiences come to be shaped. Acknowledgements Seven years of living and working three flat provinces away from home merits a few key acknowledgements. My foremost thanks go to my two doctoral supervisors: Dr. Sharon Rosenberg and Dr. Debra Shogan. Debra: thank you for being a friend, mentor and coach and for seeing me through in spite of—or rather in lieu of—your retirement. Sharon (wherever you may be): thank you for encouraging me to ask difficult questions (both of the world, and of myself), and for helping give me the courage to write. My appreciation also extends to my supervisory committee: Dr. Cressida Heyes, Dr. Amy Kaler, Dr. Pirkko Markula, and Dr. Shelley Reuter (as well as to Dr. Judy Davidson and Dr. Denise Spitzer who worked with me in the early stages of this project). Thank you for your time, care and interest both in me, and in this research. And, to the twenty-four people who participated in this research, thank you for your candidness. In terms of personal acknowledgements, I would like to recognize the following people and groups: Joelle Reynolds and Jacynthe Arsenault for being welcoming without fail; Rod Murray for being an ally in feminism and football; the boys of Alberta Beef—namely Melisa Brittain, Lucas Crawford and Barb McLean—for helping bring out whatever prairie cowboy I had in me; the women of Rockers Rugby for never ceasing to rise as an underdog; Carolina Cambre for thoughts idle and fecund; Rebecca Lock for approaching rugby and thinking with the same (admirable) reckless abandon; Natasha Hurley and Susanne Luhmann for their friendship, mentorship and neighbourliness (and for the countless number of sapid meals); Lara Fenton for dance, hockey and football moves good and bad; Angela, Judy, Neal and the rest of the Robinson gang for being one of my families away from home; Donia Mounsef for being a kindred; Amy Swiffen for being a friend; and finally, Sahana Parameswara for always gently encouraging me to continue opening rather than closing myself. To the many significant people not specifically mentioned here, you are not forgotten. After twenty-six consecutive years in school my deepest gratitude goes to my family. To the Overends on the other side of the Rockies, to my aunt Christine and to my brother Colin (whom I have never met) thank you for being a part of me. To my brother Marcus and sister-in-law Wendy, thank you for always making sure that my now 3 year-old niece Kaitlyn, and 5 year-old nephew Oliver, knew me by name. To Mika (the small dog with a big heart), thank you for keeping me company during many summer afternoons spent indoors. And at last, to my mother Francesca, thank you for being ahead of your generation, a ruthless scrabble player, a feminist, and for fostering in me your sense of independence. To my late father Neil, thank you for your love of language and big thinking— both of which I came to understand and appreciate more throughout this project. Table of Contents CHAPTER 1 A Double(d) Science: Candida and the Discursive Terms of Undefined Illness 1 A Double(d) Science 6 Illness and the Practices of Narrative Representation 10 De-centering Humanist Notions of Experience 16 Methods 20 The Interviews 21 Epigraphs and Interludes 24 A Foucault-Inspired Notion of Discourse 27 Reading Through 31 Project Organization 33 INTERLUDE I Naming the Unnamable 37 CHAPTER 2 Systemic Yeast Overgrowth 51 What is Candida? 52 Reasons for Yeast Overgrowth 59 Broad Spectrum Antibiotics 60 Immunosuppressants and the Birth Control Pill 61 Diet 62 Cultural and/or Environmental Factors 63 Candida and the (lack of) Immunological Response 64 “A Female Problem” 67 Diagnosing Candida 70 Blood Test 72 Saliva (ELISA) Test 73 Urine Test 73 Stool Test 74 Gut Fermentation Test 75 Applied Kinesiology 75 Crook’s Questionnaire 76 Treating Candida 78 Diet 78 Antibiotics, the Birth Control Pill and Immunosuppressant Medications 80 Antifungal (prescription) Medications 81 Anti-yeast (herbal) Medications 84 Yeast Vaccine 86 Summary 88 CHAPTER 3 Illness as Metaphor: Candida as Biomedicine’s Ghostly Matter 90 Ghostly Metaphors 92 Making Science Ocular 97 Traces of the Barely Visible 102 Possessions 106 Specters of Death: Loss of Certainty 110 Lessons from the Ghost 113 CHAPTER 4 Candida, Leaky Bodies and the Feminization of Yeast 117 New Materialism(s) 119 Materialization 120 Corporeal Feminism 122 Intra-Action 125 Contained Male Corporealities 128 Leaky Female Corporealities 136 Summary 146 CHAPTER 5 Taming Uncertainty: Food, Discipline and the Care of the Self 150 Food as Pathogen/Food as Cure 154 Diet as Disciplinary Regime 160 Diet as a Practice in the Care of the Self 169 Negotiations of/with the Self 178 INTERLUDE II Between Health, Illness, Hope and Cure 182 CHAPTER 6 Stories without End: A Return to Difficult Knowledge 189 REFERENCES 199 APPENDICES Appendix 1: List of Interview Questions 219 Appendix 2: Symptom List (Alphabetical) 220 Appendix 3: Crook’s Diagnostic Questionnaire 221 Appendix 4: Natural Antifungal Medications 222 1 CH. 1 A Double(d) Science: Candida and the Discursive Terms of Undefined Illness Candida is very complex. It’s got a life of its own, and it tries to out-fox me everyday and in every way it can. Sue The modern lifestyle of chlorinated water, bad diet, heavy stress loads, frequent use of antibiotics, steroids, chemotherapy, all sorts of other drugs, and probably also the bombardments of radiation from computers and microwaves, are taking a very heavy toll on our immune systems, and this is giving Candida a big, big chance to grow at the expense of our friendly bacteria. Diana There are no soft places to land with Candida. You have to be so on top of things just to be normal. Meena How do I understand Candida? It’s difficult to define, really. I see it as a condition that affects the mind, the body and the spirit. Janine Candida is what it is and it’s going to be what it is until it isn’t what it is. Will People often ask me what my research is about. I tell them it is about understanding the experiences of a largely undefined disorder known speculatively within medical practices as “Candida”. And then they ask the inevitable question, a question with no simple or straightforward answer: what is Candida? While I detail the medical case of Candida in the following chapter, for now, I will say that Candida is a yeast-related disorder of vague symptomatology, classifiable under what Malterud (1992) terms “undefined disorders”—an illness with no objective pathological (biomedical) trace. 2 While some of my initial interests with this project stemmed from my own mystifying and maddening experiences with what I later assumed to be Candida, my interests in this project are not only about these experiences. I use the case of Candida to explore sociological questions concerning undefined illness, the body, and experience.

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