The Human–Hookworm Assemblage: Contingency and the Practice of Helminthic Therapy
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University of Kentucky UKnowledge Theses and Dissertations--Geography Geography 2014 THE HUMAN–HOOKWORM ASSEMBLAGE: CONTINGENCY AND THE PRACTICE OF HELMINTHIC THERAPY Sophia Anne Strosberg University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Strosberg, Sophia Anne, "THE HUMAN–HOOKWORM ASSEMBLAGE: CONTINGENCY AND THE PRACTICE OF HELMINTHIC THERAPY" (2014). Theses and Dissertations--Geography. 21. https://uknowledge.uky.edu/geography_etds/21 This Master's Thesis is brought to you for free and open access by the Geography at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Geography by an authorized administrator of UKnowledge. For more information, please contact [email protected]. STUDENT AGREEMENT: I represent that my thesis or dissertation and abstract are my original work. Proper attribution has been given to all outside sources. 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REVIEW, APPROVAL AND ACCEPTANCE The document mentioned above has been reviewed and accepted by the student’s advisor, on behalf of the advisory committee, and by the Director of Graduate Studies (DGS), on behalf of the program; we verify that this is the final, approved version of the student’s thesis including all changes required by the advisory committee. The undersigned agree to abide by the statements above. Sophia Anne Strosberg, Student Dr. J. Anthony Stallins, Major Professor Dr. Patricia Ehrkamp, Director of Graduate Studies THE HUMAN–HOOKWORM ASSEMBLAGE: CONTINGENCY AND THE PRACTICE OF HELMINTHIC THERAPY _________________________________ THESIS _________________________________ A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in the College of Arts and Sciences at the University of Kentucky By Sophia Anne Strosberg Lexington, Kentucky Director: Dr. J. Anthony Stallins Lexington, Kentucky 2014 Copyright © Sophia Strosberg 2014 0 ABSTRACT THE HUMAN–HOOKWORM ASSEMBLAGE: CONTINGENCY AND THE PRACTICE OF HELMINTHIC THERAPY Through a qualitative analysis of the use of intestinal parasites for treating immune system disorders, this research illustrates how contingency emerges in the context of the human relationship to hookworms. The affect of the human– nonhuman relationship is an important part of understanding the direction of evolutionary medicine today, and has implications for the politics of biological health innovations. The shift from the bad parasite to a parasite that at least sometimes heals, discursively and materially, has opened new spaces for patients to change the way they relate to medical knowledge, medical professionals, and pharmaceutical companies. Hookworms are banned by the FDA, which sets the scene for lively, but sometimes rebellious, hybridity between host and parasite. Underground and do-it-yourself hookworm therapy cultures have sprung up in around the site of the gut. I argue that not only is material hookworm affect as important as human discourses in negotiating the rapidly advancing field of biome reconstruction, but it also plays a role in how that biome reconstruction takes place, conventionally or otherwise. KEYWORDS: assemblage, contingency, health geography, helminthic therapy, microbiome Sophia Anne Strosberg 8 May 2014 THE HUMAN–HOOKWORM ASSEMBLAGE: CONTINGENCY AND THE PRACTICE OF HELMINTHIC THERAPY By Sophia Strosberg Dr. J. Anthony Stallins Director of Thesis Dr. Patricia Ehrkamp Director of Graduate Studies 8 May 2014 Date 0 ACKNOWLEDGMENTS Thank you first to Tony Stallins, not just for his support in the thesis process and for reading all those half-finished drafts, but for always being ready to experiment and generate new ideas together. I couldn’t have done it without Tad Mutersbaugh and Anna Secor, my committee members, as well as the other professors who read through my work, listened to my ideas, encouraged me, and kept me on my toes. Thanks to Dr. Shannon for his humor, technical knowledge, and everything else. Thanks to Lori Tyndall and the other university staff. Also, thanks to the Mezzanine crew for keeping all of us fed, even on the hectic days. Anyone who has been to grad school in social science knows that you can’t do it without fellow students. There are simply too many people to list them here individually, but three groups should get special acknowledgement: my grad student cohort, my officemates, and the wonderful people at Ham Palace. Thanks to all of those who willingly (and unwillingly) hashed through topics lofty and otherwise, even—or perhaps, especially—when we disagreed. Leif Johnson, B Miller, Carrie Ann Welsh, Stefanie Wolf, the Oakland warehouse, the Brooklyn warehouse—the people I’ve lived with will know the enormous role they have played in my getting to and through this work. My family has been wonderful: Jeff Strosberg, for helping me put things in perspective; Marilyn Strosberg, for always lending an ear; Jack Moss, for sharing your passion for care; Benjamin, for philosophizing with me; and Vivian, my amazing sister, confidant, and friend. Thanks in particular to Lillian Moss, my mother, with whom I know I can always have long and honest conversations about materiality, affect, liveliness, possibility, and medicine. She gave me the drive to question and the tools with which to do so. Thanks to all of my patient interviewees, who took the time to chat with me, sometimes for more than an hour, about their personal experiences with helminths and disease. Their insights will always be invaluable, and should never be overlooked. iii TABLE OF CONTENTS Acknowledgments……………………………………………….......………………….ii List of Figures……………………...……………………………………….…………...vi Notes on Terminology………………………………………………………………...vii Chapter One: Introduction ………………..…………………...……………..………..1 Chapter Two: Background………………..…………………………………………….4 Autoimmune disease on the rise…………..…………………………………..4 Evolutionary medicine…………….……………………………………………4 Helminthic therapy………………………………..…………………………...10 Crohn’s disease and hookworm.………………..…………………………11 Parasite pirates…………………………………………………………………13 Chapter Three: Theory and Methods……………..………………………………… 15 Theory Assemblage………….………………………………………………………….15 Affect…………………………………………………………………………….16 Materiality………………………………………………………………………17 Research questions.………………….……………………..…………………..20 Question One: How do humans learn to be affected by hookworms?.………………………………………………..…………………..21 Question Two: Which aspects of hookworm therapy aid incorporation into institutional medicine, and which hinder incorporation?…….......…..23 Methods Epistemology……………………………………………………..…………….25 Online Ethnographies………………………………………...………………. 27 Interviews with helminthic therapy patients.……………………………… 27 Interviews with both informal and institutional medical researchers, providers, and journalists ………………………………..…….29 Data collection and analysis…………………………………………………..31 iv Rigor and reliability.……………………….………………………………….31 Chapter Four: How Humans Learn to Be Affected by Hookworms………..……34 0. The phase between the hookworms: separation………………….…………34 1. Turning toward the helminth………………………………………………….37 2. Overcoming the “yuck” factor……………………………………...………….41 3. Acquiring helminths, facing the law……………………………………..……45 4. Contact, mutual conditioning, and the production of difference……..……49 5. Conclusion……………………………………………………………………….52 Chapter Five: How Hookworms Become a Part of Institutional Medical Practice—Or Evade It………………………….………………………………………54 Hookworm Aids Incorporation………………………………………………….54 Hookworm bodies subsumed……………….……………………………….54 Hybrid experiments……………………………………...…………………….56 Hookworm Discourages Incorporation………………………………………….62 Chapter Six: Discussion……………………………….……………………………….67 Appendix…………………………………………………………….………………….74 References…………...………………...……….……………………………………….75 Vita…………………………………………………………………...………………….86 v LIST OF FIGURES Figure 1, Some of the many news headlines about biome restoration with parasites*……….……………………………….…5 Figure 2, A sampling of the known immunomodulatory effects of helminths…...7 Figure 3, Inverse relationship between autoimmune disease and helminths……..………………………….….…………9 Figure 4, Inverse relationship between infectious diseases and immune disorders……..………………………….….……………...9 Figure 5, The aesthetic charisma of the hookworm………….………..………………………….….………………………22 Figure 6, List of all patient interviewees*…………..……………….……………….28 Figure 7, Greg shows me his hookworm rash*……………………….………………..………………………….….…..…….45 Figure 8, Screenshot from Crohnology.com……….….…………….………………61 *created by author vi NOTES ON TERMINOLOGY