Gut feeling:
an embodied compass?
By Marilyne Carignan
Marilyne Carignan Jacob is a first-year student in the Cultural and Social Analysis doctoral program at Concordia University, Montreal. The main focus of her research is on the contemporary forms of eco-anxiety and how discourses on climate change and future(s) shape emotions, meaning and practices.
In the literature, gut feeling is used for two categories of research. First, there is research on the gut in itself, its microbiome, and its conceptualization as a “second brain” that informs the health of the body and is informed by it, contributing to overall well (or un-well) being (Holzer 2017; Mathias and Moore 2018; Ochoa-Repáraz, Ramelow, and Kasper 2020). Secondly, there is much research, particularly in the last decade, about the gut feeling as a sixth sense of “embodied intuition” (Stolper 2010), which has attracted particular interest in the context of decision-making amongst health care professionals, such as general practitioners (Stolper 2010; Charles-Moore 2019), nurses (Hams 2000), paramedics (Wyatt 2003), and psychiatrists (Waern, Kaiser, and Renberg 2016). This entry will focus on the second branch: gut feeling as an embodied intuition or sixth sense. I will begin by reviewing dictionary definitions of gut feeling before turning to consider the current literature on gut feeling as a sixth sense for healthcare professionals. Finally, I will contextualize gut feeling in the sensory history of medicine, followed by how gut feeling could be further explored through the (anxious) patients’ perspective.
Gut feeling according to dictionaries
The online Oxford English Dictionary does not have a definition for gut feeling. However, a definition can be found under the word “gut,” as a reaction that is “instinctive and emotional rather than rational” (“Gut Feeling” n.d.). Another definition can be found in the online third edition of Oxford’s A Dictionary of Marketing, in which gut feeling is defined as “an instinct or hunch, based on intuition and accumulated experience, rather than logic, research, and facts. [It is] often used by experienced marketers and salespeople as a substitute for detailed research and planning.” (Doyle 2011). In these two definitions, gut feeling is rooted in a dualistic and mutually exclusive approach of reason/emotion and is conceptualized as emotional and devoid of rationality. Indeed, the conventional approach to reason and emotion, or intuition, opposes them (Barbalet 2001, 29–30). Gut feeling is then officially defined as something that is not based on facts. As we shall see, in the current research on healthcare professionals, this emotion/reason dualism is still operative, and structures a certain tension in the quest to define the sixth sense sensory experience of gut feeling.
A compass in general medical practice? Sensing disease through gut feeling
In the last decade, some research on the health and medical professions began to take an interest in gut feeling (Charles-Moore 2019; Hams 2000; Wyatt 2003; Waern, Kaiser, and Renberg 2016), starting with Erik Stolper and his colleagues (2010). As part of his research for his Ph.D. thesis, Stolper et al. (2010) assembled focus groups with general practitioners (GPs) in the Netherlands to investigate this sensory experience. The objective of Stolper et al. was to deepen the knowledge on the functioning of this sense, after noticing that “sometimes GPs base their clinical decision on this gut feeling alone” (p. 47), which goes against the hypothetico-deductive method based on “testing hypotheses” (p. 88) and the prevailing way in which diagnostic skills are taught in medical schools (p. 54). In the focus groups’ discussions, gut feeling was conceptualized and lived as a sensory embodied form of knowledge, like a compass in the decision-making process (p. 55).
Stolper et al. discovered that “two types of gut feeling were mentioned by the participants [of the focus groups]: a sense of alarm and a sense of reassurance” (Stolper et al. 2010, 50). Indeed, when faced with a particular situation, GPs, without carrying out an immediate factual and rigorous analysis of a medical case, would often have an intuition that told them that something was wrong or right (p. 50-51). The practitioner experienced a sense of alarm when something was wrong without “objective arguments” and when the patient’s case did not fit the pattern they expected (p. 50, 53). They were also “unsure about prognosis and therapy” (p. 55). This feeling unfolded in the form of an embodied sensation felt in the abdomen or the heart (p. 50). It was gradual or sudden, such as a sensation of a mild heart attack or a heart missing a beat (p. 51). This physical discomfort could go away as quickly as it arrived (p. 51). When the GPs had a sense of reassurance, it was because the patient’s symptoms were consistent with what they expected (p. 53), and they were “sure about prognosis and therapy” (p. 55).
Stolper et al. (2010) also discovered that various external variables influenced gut feeling, such as knowing the patient and their situation’s context, and the emotions the GPs felt towards their patients (p. 53-54). Furthermore, the physician’s values were also found to impact the practice of diagnosis: a physician who valued rationality had a reluctance towards the gut feeling, saying that it had not yet been scientifically proven (p. 54). The physician’s personality was also found to play a role: if the physician had high self-esteem, they were more tolerant of the risks and uncertainty associated with trusting their gut feeling (p. 54). Equally, a physician with less confidence had less trust in their gut feeling (p. 54). Finally, experience turned out to play a key part. Health care professionals with less experience still followed what they learned at school, while experienced professionals were more attuned to the patient’s individual experience and its nuances, and thus, relied more on their gut feeling (p. 54). Experience also developed a sense of probabilities, which transformed into “implicit knowledge” that became automatic (p. 54). This dimension of professional experience, and implicit knowledge over time, has been found in much of the literature on the gut feeling experience, as we shall explore in the following few examples.
Rationalizing gut feeling: a sum of experiences and knowledge
For Françoise Charles-Moore (2019), gut feeling is an intuition and can be described as more of a clinical sensibility than a sixth sense (p. 320). The author argues that this clinical sensibility results from experience and attention to the particularity of a situation with a patient in the management of a new situation (p. 320-321). Charles-Moore also argues that this intuition is possible today in France due to a transformation in the physician-patient relationship following the implementation of the Kouchner Law in 2002 (p. 319). This law requires the physician to inform the patient of the details of their health, leading to a less paternalistic approach to clinical medical care (p. 319). Charles-Moore does not take an explicitly sensory approach to the analysis of gut feeling but recognizes the importance of “science, experience, intuition” (p. 321) and the physician-patient relationship in the decision-making process.
Although this latest research was also on GPs, other research explored this sensory phenomenon with health care professionals, such as paramedics and psychiatrists. Andrea Wyatt (2003) inquired how paramedics in Australia navigate with this gut feeling. The author conceptualized the gut feeling as a judgement of a situation based on experience (p. 8). Wyatt, too, wants to move away from the sensory part of gut feeling toward a more rational decision-making process (p. 1). In this paper, new paramedics tended to follow the rules they learned, while experienced paramedics tended to place more trust in their judgment in unusual situations (p. 8). In other research on how psychiatrists assess suicide risks in Sweden, Margda Waern et al. (2016) noticed that gut feeling was often discussed. When psychiatrists evaluated the potential risks of patient suicidal intentions, they based their decision in part on a gut feeling informed by “implicit and emotional information” (p. 7). Experience, here again, made this process and evaluation “semi-intuitive” (p. 7).
Interestingly, Charles-Moore (2019), Wyatt (2003), and Waern et al. (2016) rationalize the sense of gut feeling, focussing less on its sensory aspects and instead conceptualizing it as grounded in experience and memorized (acquired) knowledge. Only Stolper (2010) dives into the details of its embodied and sensory experience, building concepts of the senses based on the GPs discourses: sense of alarm and sense of reassurance. Although some authors (Charles-Moore 2019; Wyatt 2003; Waern, Kaiser, and Renberg 2016) remain shy of building a sensory approach to the conceptualization of gut feeling, in his review paper on intuition amongst nurses, Steven P. Hams (2000) defends gut feeling as a way of knowing that needs to be recognized and valued. Indeed, according to Hams, nurses, who do not make medical decisions have the capacity, through their close relationship with patients, of sensing changes before “actual changes in the common physiological indicators” (p. 311). Rather than using words that rationalize the experience of gut feeling such as “judgement” (Wyatt 2003) or “clinical sensibility” (Charles-Moore 2019), Hams (2000) directly uses the words intuition and gut feeling to acknowledge what he deems legitimate ways of knowing. It is instructive to note that, in the history of modern medicine, sensing (as distinct from examining) patients and their symptoms was a task relegated to the nurses (Howes and Classen 2014, 48). This might explain Hams’ (2000) assertive willingness to defend the recognition of this sense as legitimate and why there is more research in nursing work on gut feeling and intuition.
Situating the senses in the history of medicine
It is important to bear in mind that the practice of medicine based on a sixth sense such as the gut feeling goes against not only the hypothetico-deductive model of clinical training and practice, but also against sight as the primary sense through which medicine evaluates and heals since the Enlightenment (Howes and Classen 2014, 46). As observed by David Howes and Constance Classen (2014), before the Enlightenment, all of the senses were used by the patient and healers across different eras and cultures as a way of sensing, knowing and curing illnesses in Western societies (p. 38). From the seventeenth century onwards, medical perception was transformed by the incorporation of the model of the body as a machine, with the doctor as the only legitimate observer of the disease in the form of clinical evaluation, and rejecting the subjectivity of the patient and any other sensory form of knowledge (p. 46-47). With sight and observable facts as guides to evaluate, diagnose and heal, modern medicine was built on Cartesian dualisms, and therefore rationality, which entailed rejecting or suppressing what is categorized as irrational, such as emotions, intuition and embodied feeling (Williams and Bendelow 1996, 26; Harris 2021). The hypothetico-deductive model continues to inform how medicine is taught today (Stolper et al. 2010).
Beyond healthcare professionals: gut feeling amongst (anxious) patients
Gut feeling is an embodied sensory form of knowing and a compass (Stolper et al. 2010) in the decision-making process that informs different healthcare professionals, such as GPs (Stolper et al. 2010; Charles-Moore 2019), paramedics (Wyatt 2003), psychiatrists (Waern, Kaiser, and Renberg 2016) and nurses (Hams 2000). The researchers in the literature surveyed in this entry agree that it is based on previous knowledge and that it becomes implicit and automatic with experience (Stolper et al. 2010; Wyatt 2003; Waern, Kaiser, and Renberg 2016; Charles-Moore 2019). It can take the form of a sense of alarm with a physiological anchor similar to a heart attack or a sense of reassurance, and it tends to be more employed by healthcare professionals who have high self-esteem and are experienced (Stolper et al. 2010). The presence of gut feeling as a way of knowing through the senses reverses both the “medical gaze” and the primacy given to reason based on calculated, analyzed and evaluated facts in clinical medicine since the Enlightenment (Howes and Classen 2014; Williams and Bendelow 1996), although most of the authors (Charles-Moore 2019; Wyatt 2003; Waern, Kaiser, and Renberg 2016) discussed here tend to want to rationalize it.
Further research is necessary to investigate this sixth sense since the embodied and sensory emphasis remains underexamined. As per the practitioner-patient relationship discussed in Charles-Moore’s article (2019) and the healthcare professionals’ perspective documented in the literature in this entry, gut feeling should be investigated from the patient’s perspective to contribute to the understanding of this sensory experience. Promisingly, a collaborative research program on Gut feelings in general practice (Gut feelings in General Practice 2021) in Europe, involving Erik Stolper, has recently published two abstracts for a workshop presentation on their website in which they started to explore gut feelings amongst patients (Stolper et al. 2021; van de Wiel et al. 2021). In one of their papers, the authors (Stolper et al. 2021) present how gut feeling is indeed present amongst Dutch and Flemish patients, especially the sense of alarm. This sense of alarm that is, as previously noted, experienced as akin to a small-scale heart attack, could also be analyzed amongst patients with anxiety or anxious individuals, more generally. Anxiety can be similar to being in a constant state of alarm, with its physiological manifestation such as trembling (Freund 1998, 284). How is gut feeling experienced amongst people with different sources of anxiety when the sense of alarm is more often activated? As anxious behaviours and emotions have a long history of being classified as irrational, deviant, emotional, hidden, or to be treated with drugs or other therapies (Scott 2006; Tone 2009; Shorter 1997), and, therefore, not a source of knowledge, how might a sensory approach with the sixth sense of gut feeling front of mind contribute to the expansion and refinement of medical perception?
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