Boundary Work and Boundary Objects: Synthesizing Two Concepts for Moments of Controversy

Abstract

There are two boundary concepts utilized in technical and professional communication (TPC) scholarship: boundary work and, to a lesser degree, boundary objects. Boundary work functions to demarcate, incorporate, and expel particular ideas, groups, and practices from a field or profession. Boundary objects enhance the capacity of ideas, practices, and theories to translate across different groups. Together, these concepts are useful to TPC scholars interested in moments of controversy. In this essay, I explore the dialectical relationship between these two concepts and apply the resulting synthesis to a contemporary case study, the use of fecal microbiota transplants. I argue that the human microbiome functions as a boundary object and opens space within medicine’s own boundary work for the inclusion of fecal microbiota transplants. Together, the dialectical concepts of boundary work and boundary object create a new kind of analytic that allows TPC scholars to map boundary transformations, recognize moments for intervention, and create strategies for collaboration.

Keywords

boundary object boundary work human microbiome fecal microbiota transplants collaboration

There are two “boundary” concepts currently being used by technical and professional communication (TPC) scholars: boundary work and boundary objects. These two concepts are often not used together. When they are, they are either conflated as one and the same or related in only limited ways. My goal is to clarify and synthesize these two concepts for TPC scholars and practitioners by considering them dialectically. Doing so creates a stronger theoretical suite of concepts that can aid TPC scholars who seek to map boundary transformations, recognize moments for intervention, and create strategies for collaboration.

This essay takes up a specific case: the use of fecal microbiota transplants (FMTs) as a medical treatment. The case of FMT demonstrates the dialectical relationship of the two boundary concepts as medical boundary work is challenged by the human microbiome as a boundary object—reframing feces as a possible cure for a recurring nosocomial disease. The resulting synthesis alters the boundary of medicine and introduces FMTs as an innovative medical therapy.

A children’s book illustrates FMT succinctly. In 2013, Tracy Mac (the founder of the website The Power of Poop) posted a children’s story called The Queen of All Things Fecal that described a “Humble Turd” as having “magical healing properties” and containing the “Great Microbiome that bequeaths life, health and vitality to those it inhabits.” The goal of The Queen story was to help children understand how FMT works, as FMT is often administered in homes. This is because its use in doctor’s offices has been limited. Mac’s website was a place for patients to share their stories, news, research, and do-it-yourself instructions for/about fecal transplants. Her fecal advocacy website was part of a growing network of patients, researchers, doctors, and journalists exploring and advocating for fecal therapies to treat a variety of digestive diseases, especially recurring Clostridioides difficile infections (or RCDI). However, fecal transplants (the use of healthy donor feces to alter the microbial composition of a sick patient’s colon) are simply disgusting. A major obstacle advocates must face is disgust—among family, donors, friends, policy makers, researchers, and doctors. The use of feces as a medical treatment challenges the boundary of acceptable medical intervention and the role of disgust in doing medical boundary work. The question this essay asks: how did the boundary of medicine change to include fecal transplants as potential treatment? It is this phenomenon that has lead me to explore the relationship between boundary work and boundary objects.

I will start by describing how TPC scholars have used and defined these two concepts. I will then synthesize these two concepts and use that dialectical synthesis as a lens to explore fecal transplants as a case study. I will show that the human microbiome functioned as a boundary object that altered previous medical boundary work regarding FMTs. I argue that thinking about the relationship between these two concepts dialectically rather than hierarchically allows their inherent tension to be collectively productive, particularly for expanding boundaries. Finally, I will conclude with recommendations for furthering this new boundary theory for the broader field of TPC beyond the case I have elaborated on in this essay.

Boundary Work

The concept of boundary work was developed by sociologist Thomas F. Gieryn (1983, 1999) to make sense of moments of conflict regarding what counts as scientific knowledge and how scientists generate epistemic authority over truth claims about nature. As scholars attempted to theorize the essential character of science, they increasingly found that their theories applied to realms of nonscience, and there were instances where science-in-practice did not fulfill their criteria. In other words, they struggled to find inherent or unique characteristics that demarcated science from nonscience. Instead, he argues that science is an ideological effort by scientists to distinguish their work and products from the work and products of nonscientific intellectual activities.

Gieryn utilizes a cartographic metaphor to describe the mapping of what counts as science in his use of “boundary” (as one might demarcate a material region or place), and he uses “work” to describe an ongoing process of demarcating, incorporating, and expelling epistemic practices within the realm of science. Metaphorically, boundary work functions like a series of maps. Consider what we call today the United States: the maps change due to natural features, cultural practices, and political battles. Likewise, science as epistemic authority is continually being made and remade over time. Gieryn (1999) writes, “Epistemic authority does not exist as an omnipresent ether, but rather is enacted as people debate (and ultimately decide) where to locate the legitimate jurisdiction over natural facts” (p. 15). Boundary work is the parsing of epistemic authority (typically claimed in the name of science).

Gieryn (1983) described boundary work as an ideological effort of analyzing the social functions of ideologies, which requires a focus on “patterns in the symbolic formations and figurative languages of ideologists” (p. 782). This includes analysis of public addresses, popular writings, arguments regarding disciplinarity, and policy communication. It is from his recognition of the rhetorical work facilitating the ideological edifice of science that Gieryn first deploys his definition of boundary work: the “attribution of selected characteristics to the institution of science (i.e., to its practitioners, methods, stock of knowledge, values and work organization) for purposes of constructing a social boundary that distinguishes some intellectual activities as ‘non-science’” (p. 782). He describes boundary work as an ideological strategy for professionalization, particularly toward goals of expansion, monopolization, and protection of autonomy. In his case studies, Gieryn found several contradictions in the ways science and scientists were described (e.g., as “theoretical and empirical, pure and applied, objective and subjective, exact and estimative … ”). These “internal inconsistencies in what scientists are expected to be provide diverse ideological resources for use in boundary-work” (p. 792). Gieryn describes boundary work as a kind of rhetorical style of ideologists.

However, Gieryn’s use of “rhetorical style” as a strategy deployed by scientists doing boundary work is not adequate to describe boundary work from the position of rhetorical scholars. Holmquest (1990), drawing on the work of Karlyn Kohrs Campbell and Thomas Goodnight, argues that Gieryn’s rhetorical strategy is one of argument, not of style. For rhetorical scholars, “style” refers to postthought expression (generally occurring after the invention of argument and pertaining to delivery), which does not fit with Gieryn’s characterization of boundary work. Gieryn’s own description of boundary work is the act of selecting specific “scientific” characteristics to construct a boundary between “science” and an opponent’s intellectual activity as “nonscience.” This description of boundary work “presupposes that rhetoric provides inventional strategies by which scientists map out boundaries in response to obstacles” (Holmquest, 1990, p. 237). Holmquest clarifies her position stating, “obstacles in audiences are resources for invention,” which “is exactly the kind of view that Gieryn must presuppose when he says that the demarcation of science from non-science is a rhetorical problem” (p. 237). The problem as it is described is one of argument, not style.

After Holmquest’s rhetorical re-orienting of Gieryn’s boundary work from style to argument, this concept is taken up by many communication scholars attempting to understand the rhetorical assignation of power among groups to claim epistemic authority and turf (Barley et al., 2012; Carlson, 2016; Derkatch, 2012; Endres et al., 2016; Friman, 2010; Holmquest, 1990; Kinsella, Kelly, & Autry, 2013; McGreavy, Hutchins, Smith et al., 2013; Scott, 2016). For example, TPC scholar Jennifer Scott (2016) argues that the vaccine versus antivaccine debate has morphed what counts as scientific evidence among scientists and antivaccine groups creating an unrealistic standard of science: absolute safety. These rhetorical case studies have shown the internal inconsistences and contextual exigencies used by those engaged in boundary work. In addition, outside the field of communication, sociologist of science Yael Keshet (2009) argues that the collectives or groups engaged in a controversy over boundary work are rhetorically heterogeneous and this heterogeneity can make distinguishing biomedical boundaries ambiguous. There exist many different arguments within collectives for and against a particular biomedical practice, not a coalescing of perspectives into clear positions. Finally, Wainwright et al. (2006) state that “Gieryn’s formulation suggests that non-science must be excised from science, our data show that non-science, in the form of ‘ethics’, is becoming an integral part of maintaining the image of science” (p. 735). Basically, ethical boundary work actually enhances the authority of nonscience and deprivileges science. The contentious process of maintaining epistemic authority can create seemingly impossible rifts between scientists and lay communities (e.g., vaccine vs. antivaccine groups), scientists and regulatory organizations (e.g., stem cell research), and among different scientific domains (e.g., alternative medicine).

Boundary work is an ongoing rhetorical process and not necessarily strategically deployed. It is an argumentative credibility contest among various peoples where some are denied credibility. Gieryn (1999) describes the stakes of these contests, stating,

To the victors go the spoils of successful cultural cartography [or boundary work]: not only do their claims become real enough for others to act on them, not only is their authority to make truth provisionally sustained, but they enjoy (for a while anyway) the soaring esteem, cascading influence, and possibly abundant material resources (cash, equipment, bodies-and-minds) needed to make still more truthful tales. (pp. 13–14)

The problem is that entrenched boundaries often prevent cooperation and too porous boundaries make legitimacy and action too difficult due to a lack of demarcation—boundaries are necessary. However, because boundaries can never be fully closed off, I would like to argue that the other conceptual focus of this essay, boundary objects, can open up new pathways for rhetorical invention to help groups overcome entrenched moments of boundary work.

Boundary Objects

Boundary object comes from the work of science and technology studies scholars Susan Leigh Star and James Griesemer’s (1989) study of the Berkeley Museum of Vertebrate Zoology. Star and Griesemer were interested in processes of cooperation without consensus among different groups working toward a shared goal. This included amateur naturalists, trappers, professional biologists, philanthropists, and university administrators creating a natural history museum in the early 1900s. The assumption is often that in order for folks to cooperate, they must begin with consensus or a shared understanding of meanings and practices. However, this is often not how heterogeneous groups work together—consensus is rarely reached, it is fragile when it is, and yet often cooperation continues (Star, 2010).

To understand this process of cooperation without consensus, Star and Griesemer developed the concept boundary object, an object or entity that enhances “the capacity of an idea, theory or practice to translate across culturally defined boundaries, for instance between communities of knowledge and communities of practice” (Fox, 2011, p. 71). A boundary object is an ill-structured artifact (often technologies, but also drawings, sets of rules, research projects, or documents) that reside between social worlds and are capable of bridging perceptual and practical differences (Huvila, 2011). Kimble and Hildreth (2005) describe their usefulness writing, “During discussions around the [boundary object] document, other new and innovative ideas would often be triggered; as well as identifying projects already listed on the document, new ideas emerged that could form the basis for further participation” (p. 108). When necessary, the object is worked on by local groups who maintain its vague identity as a common object while making it more specific, more tailored to local use within a social world. Star (2010) argues that “what is important for boundary objects is how practices structure and language emerge, for doing things together” (p. 602). In contrast to boundary work, boundary objects do not function to standardize or professionalize a group. Rather, their liminality allows them to open up a shared space for cooperation among different groups circulating different meanings.

Boundary object is a theoretical concept that has not been utilized as much as boundary work within the field of TPC. However, as I will argue, its focus on heterogeneity and cooperation makes it very useful to those interested in moments of conflict, not just those intentionally working toward shared goals (the focus of most studies of boundary work). Scholars have argued that boundary objects facilitate the reading of alternative meanings in processes of design (Henderson, 1991), they reinforce the codependence of different groups on one another (Sundberg, 2007), and they help us understand the adoption of particular technology over others through positive or negative social meanings (Fox, 2011).

However, as scholars in information studies and organizational communication point out, boundary objects are not neutral or consensual (Boland & Tenkasi, 1995). As Kimble et al. (2010) write, “By looking more closely at the interplay between broker and boundary object we can reveal how the selection of the boundary object can be a political act directed towards maintaining or redefining the direction of the group’s activities” (pp. 442–443). In addition, Barley et al. (2012) explain that maintaining the ambiguity of a boundary object allows actors to work strategically in pursuit of their own goals. It matters who chooses the boundary object and how they orient it (individually or collectively) because these decisions are caught up with political power (Huvila, 2011).

Overall, boundary objects tend to be used by different groups pursuing a shared goal, like the creation of a Natural History Museum or creating a content management system. These objects form liminalities between communities and have a dynamic nature (Gal et al., 2004). Importantly for this essay, boundary objects can be used among groups to transform knowledge by articulating alternative views (Feldman et al., 2006). As I argue later, they can also be useful in thinking through conflicts that manifest due to boundary work, and for TPC scholars, they offer a way to reframe entrenched boundaries.

Boundary Work and Boundary Objects

In pulling these two concepts together, we find that they share particular dimensions including use of the word “boundary,” origins in studies of science, a focus on work, focus on different groups, discussions of consensus, and finally a recognition of the heterogeneity of meanings, ideas, and peoples. In other words, the concepts (on their own, or together as I will demonstrate) offer a rich set of tools for theorizing communicative practices.

However, in studies that have brought these two concepts together, boundary objects are described as a subcategory of boundary work (Clark et al., 2010; McGreavy, Hutchins, Smith et al., 2013). This line of scholarship describes the use of boundary objects, due to their interpretive flexibility, as a temporary tool one can use to get different groups to cooperate in the transformation of the boundary object into an epistemic object for doing boundary work—strategically expanding their epistemic authority (Jahn et al., 2012; McGreavy, Hutchins, Smith et al., 2013). By stratifying the relationship between these two concepts, the purpose of boundary objects is reduced to the limited role identified by critical scholarship described earlier: they become merely tools of political power, enabling more powerful actors to shape the collaboration process. In the hierarchical relationship of boundary objects as a subset of boundary work, the focus becomes individually oriented instead of collectively oriented. This strategic deployment of boundary objects for doing boundary work may indeed occur in certain situations, but our focus as TPC scholars should also capture the possibilities boundary objects offer when thought through in a dialectical relationship, rather than a hierarchical one. Here, I would like to work through the tensions—shared attributes and divergences—between these two boundary concepts as grounds for this new kind of boundary analysis.

In their shared use of the word “boundary,” we find two key divergences—boundary work speaks to a line or means of demarcating this from that, and boundary object speaks to the overlap or liminal space different groups share. In other words, boundary work is an attempt at producing and maintaining a bright-line border among communities. Boundary objects, on the other hand, are the objects that arise because those bright lines are actually not that clear or obvious. Boundary objects exist within the already porous border that boundary work is continually producing. In synthesizing these concepts dialectically, we will continue to maintain this tension of bright-line division and ambiguous space of the boundary.

In many ways, these two concepts are about varied orientations on moments of controversy—the tug and pull among meanings, materiality, and power. Power here refers to the ability of groups of people to control meanings and truths about nature. Where these concepts differ is in terms of the scale of this power. Where boundary work functions to maintain jurisdiction over nature through standardization and professionalization, boundary objects work at a smaller scale, offering localized power over meanings and practices without standardization. Boundary objects keep grand scale power open for specific groups’ localized goals. These scales of power are why these concepts manifest among communities of knowledge and communities of practice. Boundary work is done to orient the flow from communities of knowledge (e.g., using the case I will explore later, microbiologists) to communities of practice (e.g., physicians and entrepreneurs), and boundary objects allow different groups (e.g., microbiologists, physicians, entrepreneurs, the U.S. Food and Drug Administration, and patient advocates like Tracy Mac) to share some common meanings while completing their own work.

While consensus is a shared dimension of both of these concepts, they diverge on the role each plays in cooperation. Boundary work requires consensus before cooperation, and for boundary objects, cooperation occurs without consensus to complete work. The trouble is that consensus is a fragile and rare occurrence within most social worlds, and consensus can often mask the heterogeneity that is present prior to and within processes of standardization (Bowker & Star, 2000). In the end, a boundary object enhances the capacity of an idea, theory, or practice to be worked on across culturally defined boundaries, created by boundary work, which is itself an attempt to close off meanings and practices to produce recognizable authority, standards, and infrastructure. Put simply, boundary objects can transform the boundaries of boundary work and potentially redistribute power. Together, as I will show in the following case study, these analytic tools allow for thinking about the transformation of feces as a treatment (i.e., FMTs) within medicine. In the next section, I will show how these two concepts illuminate both (a) how feces has been historically utilized by physicians who work to bracket off practices and objects that are seen as carriers of disease and (b) how the human microbiome as a boundary object opened up space for rethinking feces as potential cure.

Fecal Transplants, Boundary Work, and Boundary Objects

To show the theoretical advantage of synthesizing boundary work and boundary objects, this essay focuses on a controversial medical treatment—fecal transplants—used to treat a disease called RCDIs. Fecal transplants were subjected to boundary work in medicine, which has traditionally excluded objects and practices seen as filthy or disgusting. This boundary work typically hinges on a hygiene/disgust binary used by medical professionals to exclude fecal transplants from medical practice. This includes the use of feces as a cure for RCDI. However, a boundary object, the human microbiome, has injected ambiguity into the previously stark medicine/waste dichotomy produced via this boundary work. This ambiguity resulted in the transformation of fecal transplants into FMTs. This will be an admittedly brief sketch of a complex medical controversy, but this case informs the usefulness of a boundary work/boundary object synthesis in technical communication.

1. On RCDI. RCDI is often described as “deadly diarrhea” by the U.S. Centers for Disease Control (“CDC—Clostridium difficile infection—HAI,” n.d.), and it has become a serious threat in medical settings comparable to Methicillin-resistant Staphylococcus aureus. Patients suffering from RCDI often experience diarrhea (or watery and bloody stools), abdominal cramps and tenderness, fever, pus or mucus in the stool, nausea, and dehydration. The disease arises when C. difficile reaches a tipping point in the human intestine (often after the use of antibiotics) and crowds out other bacteria and becomes a serious infection. Most troublingly, RCDI often occurs in hospitals; it is a nosocomial disease. The most common treatment for this antibiotic-associated disease is yet more antibiotics, primarily metronidazole, vancomycin, or fidaxomicin. However, when these treatments fail and the disease recurs, it has become increasingly acceptable for physicians to turn to a treatment that has been around for centuries, and yet is still controversial: the use of fecal transplants, the sharing of healthy human feces between a patient and a fecal donor.

2. Feces, Medicine, and Boundary Work. The use of feces to treat a disease is, understandably, controversial. In the early 1980s, studies showed that using fecal transplants to treat RCDI was effective or should continue to be explored (Bowden et al., 1981; George et al., 1980). However, not long after those studies, a book on intestinal microflora by leading gastroenterologist John G. Bartlett (1983) dismissed “manipulations of fecal flora,” writing, “Despite the theoretical advantages on the basis of pathophysiological concepts, this approach is unlikely to gain widespread acceptance due to the distinct lack of aesthetic appeal as well as the possibility of transmitting an enteric pathogen” (p. 464). Here, we see a moment of boundary work, placing fecal transplants on one side of a bright line, and contemporary medical practice on another. “Aesthetic appeal,” put simply, means feces are disgusting, and in medical boundary work, disgusting things carry unwanted pathogens. Both Bartlett’s concerns about transmitting an enteric pathogen and its lack of aesthetic appeal are carried forward to our contemporary moment as this procedure struggles to be accepted as a legitimate treatment option for patients with RCDI (Bartlett, 2008; DePestel & Aronoff, 2013; C. P. Kelly & LaMont, 2008). Medical professionals argue that fecal transplants are risky due to the possibility of transmitting an unknown pathogen, and it is a procedure many physicians describe as too unappealing to be used by their patients (Zipursky et al., 2012, 2014). In this way, conceptualized fecal transplants as disgusting and as a possible means of spreading pathogens functions to place this promising procedure outside the bright-line demarcating legitimate medical treatment from illegitimate practices. On the other side of that bright line, we find antibiotics as the safe, pallatible, and legitimate means for treating this disease (Apisarnthanarak et al., 2002; Bartlett, 1990, 1994; Bentley, 1990)—even though antibiotics are often the cause of RCDI in the first place.

Here, the medical professionals are doing boundary work that maps roughly onto preexisting boundaries between hygiene and disgust. An example of this perspective is found in the work of Valerie A. Curtis of the Hygiene Centre at the London School of Hygiene & Tropical Medicine. Curtis (2007) describes hygiene as “the set of behaviors that animals, including humans, use to avoid infection,” and she takes what she calls an historical evolutionary perspective in understanding disgust as a human emotion toward the avoidance of infectious threats (p. 660). Curtis argues that human hygiene behaviors are motivated by disgust, and these behaviors are biologically adaptive in the species to prevent infectious¹ disease. She argues, “hygiene behavior and disgust predate culture and so cannot fully be explained as its product” (Curtis, 2007, p. 660). The boundary work being done by physicians between hygienic and disgusting practices reflects what Daniel Kelly (2011) calls a “better safe than sorry logic that is built into the cognitive system itself” (p. 143). Disgust is a powerful tool for those doing boundary work.

This natural biological orientation to disgust, hygiene, and infectious disease is part of the boundary work physicians do to demarcate their profession as grounded in science. The power of medicine as science comes from a specialized knowledge of microorganisms and access to specialized resources to construct and manage microbial life. Physicians have the ability to order laboratory tests to determine the infectious threats harbored in their patient’s feces (or other bodily secretions). Then, they alone have access to antibiotics to treat patients suffering from particular bacterial infections. It is also their domain to posit how patients might have put themselves at risk of contracting these microbes often from other people. Finally, physicians may prescribe changes in hygienic behavior to avoid further contraction of pathogens (e.g., hand washing, the use of condoms, or the avoidance of disgusting/nonhygienic things like feces). The power of this boundary work lies in the physicians’ ability to not only demarcate themselves as the sole domain for access to the microbial world but also as an “obligatory point of passage” for determinations of healthy human and microbial relations (Callon, 1984).

Returning now to the use of fecal transplants, physician concerns about the aesthetics and risks of this procedure continued from the 1980s up through today (Brandt, 2012; Brandt & Aroniadis, 2013; Zhang et al., 2012). The disgust one may encounter at the thought of putting another person’s feces inside one’s body is a kind of truth of this procedure as unhygienic and an infectious threat. From a natural biological perspective, feces is disgusting because it carries disease—an emotional truth thus aligns with a seemingly biological truth. This alignment creates a very powerful kind of boundary work for physicians and patients to traverse because of the social and biological fusion occurring around germs and disgust—a very real example of Donna Haraway’s (2003) “natureculture.” Thus, there is a bright line here between fecal transplants and modern medical practices. Rather than rely on fecal transplants to treat diseases like RCDI, we use antibiotics. Fecal transplants are found on the outside of medical boundary work.

3. The Human Microbiome as Boundary Object. However, something that complicates the stark hygiene/disgust boundary work in medicine is a new object, the human microbiome. Rather than seeing the human microbiome as a product of boundary work, we must consider it as a boundary object that has opened up a once-closed space among disgust, bacteria, and disease, and in doing so it has for many groups rerepresented feces, providing language for cooperation without consensus.

The human microbiome is described by the National Institutes of Health’s Human Microbiome Project as “the collection of all microorganisms living in association with the human body” (“NIH Human Microbiome Project—About the Human Microbiome,” n.d.). Human microbiomes include the microbes living on human skin, in their bloodstreams, and, as I will discuss later, in their colons. The Human Microbiome Project was established in 2008 after the development of new DNA sequencing technologies called metagenomics. Metagenomics is a necessary element in understanding the growing social, cultural, and scientific significance of microbiomes and the human microbiome. Metagenomics refers to “the culture-independent analysis of a mixture of microbial genomes (termed the metagenome) using an approach based either on expression or on sequencing” (Schloss & Handelsman, 2005, p. 229). This approach allows microbiologists to get past the limitations of studying the genome of an individual bacterial strain grown in a laboratory. This older method was only effective for studying roughly 1% of prokaryotes (or unicellular organisms like bacteria). The National Research Council Committee on Metagenomics (2007) describes the impact of this new approach stating,

The science of metagenomics, only a few years old, will make it possible to investigate microbes in their natural environments, the complex communities in which they normally live. It will bring about a transformation in biology, medicine, ecology, and biotechnology that may be as profound as that initiated by the invention of the microscope.

While metagenomics is best understood as a new approach to the study of communities of microbial life for microbiologists, it has reinvigorated discourse more generally into the role of microorganisms in human health and disease. For example, discourse about the human microbiome tends to describe the microbes (including bacteria and viruses) that call the human body home as “not harmful” or even “friendly” (Peterson et al., 2009; Pollan, 2013). In Scientific American, Katherine Harmon (2012) writes,

We have long focused on single bacteria as sources of disease (E. coli or streptococcus, for example). But we have now been learning that, for the most part, these trillions of microbes that make their homes in and on us do an excellent job keeping us healthy (crowding out harmful microbes) and sated (breaking down a lot of the food we ingest).

This positive language about microorganisms within and on the human body has lead to discussions of the human as a superorganism, as an ecosystem, or home to a powerful microbial organ within the body system (Juengst, 2009). The human microbiome has also brought about business ventures like uBiome providing customers with opportunities to sequence their microbial selves (Hill, 2012) and large-scale microbiome data gathering via open-source projects like The American Gut Project (“American Gut Overview,” 2015). In much of the journalism about the human microbiome, microbes are being increasingly described as the solution to many contemporary Western health problems from depression to obesity (Thaiss, 2018; Wright, 2014). Microbes and their microbiomes are everywhere, doing everything, and we humans only need medicine as science to find ways to put them to work on our behalf.

Thus, metagenomics as a new method of study and the microbiome as a new object of study has generated collaboration among scientists, physicians, entrepreneurs, theorists, and amateurs to produce representations of nature (Star & Griesemer, 1989, p. 408). It is not that all of these groups agree on the meanings of the human microbiome specifically, but there are common or general meanings that allow these groups to cooperate without consensus around this object.

As such, the human microbiome is a boundary object. It is ill structured, heterogeneous, used by different groups (physicians, researchers, the food and drug administration [FDA], patients, fecal transplant advocates, entrepreneurs, health institutes, science journalists, hospitals, etc.), but also it has come to be a common object—a representation of the microbial organisms that live on and in the human body and are necessary for human health and well-being. As a boundary object, it has the common-ambiguous/local-specific binary. The human microbiome as a common object can be put to specific localized uses by diverse groups. For example, the human microbiome as a boundary object is represented as a new use for genetic sequencing to software developers, a vast new frontier of study for microbiologists, a way to reinvigorate marketing for probiotics, and a means of conveying the benefits of fecal bacterial diversity for fecal transplant advocates. As a boundary object, the human microbiome has the capacity to enlist other objects and entities into its liminal space for re-representation.

As a key component of the human microbiome, microbe-rich feces has come to be reinterpreted by fecal transplant advocates as something that should be utilized as a medical treatment. Thus, the boundary object microbiome is challenging the previous boundary-producing, hygiene/disgust work done by medical professionals. The discourse of the human microbiome is increasingly used to rationalize medical research about fecal transplants (National Research Council, 2007). For example, Gianotti and Moss (2017) write, “This unusual therapy remained a medical curiosity until the 2000s, when the emergence of epidemic strains of Clostridium difficile, and major advances in microbial sequencing [metagenomics], resurrected [fecal transplants] as a novel approach to treat recurrent C. difficile infection” (RCDI, p. 209). The human microbiome, as already discussed, has come to represent a positive relationship between humans and their microbial mates, and fecal transplant researchers were already thinking about the necessity of diverse communities of microbes to maintain human health within the colon. In this way, the logics emerging around the human microbiome were evidenced in this specific medical procedure, which had an 80% to 90% success rate in approximately 200 case reports (Bakken et al., 2011; Bowman et al., 2015).

And the meeting of the boundary object “human microbiome” and the previous boundary work-excluded fecal transplants is symbolized in a new name: fecal microbiota transplants. Fecal transplants, as already noted, are an extremely old procedure with many names—yellow soup, transfaunation, restoring normal colonic flora, creating floral homeostasis, fecal bacteriotherepy, and simply fecal transplantation. However, today, 13 leading medical researchers studying fecal transplants from the American Gastroenterological Association write, “Because the exact agent or combination of agents which may affect the cure is unknown, the terms ‘fecal transplantation’ and ‘Fecal Bacteriotherapy’ will henceforth be replaced with a new term: ‘Fecal Microbiota Transplantation (FMT)’” (Bakken et al., 2011, p. 3). The rationale for this change in language is precisely because “microbiota” allows for ambiguity as the “exact agent” or “combination of agents” that make this procedure successful are unknown. The introduction of “microbiota” between “fecal” and “transplants” articulates fecal transplants with the human microbiome, making it ambiguous by bringing a boundary object to bear on a practice that was previously excluded due to boundary work. Ambiguity is also apparent in the various ways that the term “microbiota” is defined as part of the human microbiome. Microbiota has referred to localized spaces within the body that collectively compose the human microbiome (e.g., mouth, vagina, colon, skin, etc.), and it has also meant the taxa of microorganisms that make up the human microbiome (Fujimura et al., 2010; Ursell et al., 2012).

Use of microbiota here allows FMT researchers to share the burden that ambiguity can have in scientific research, which had previously been used to raise concern about the use of fecal transplants and their possibility of passing on unknown pathogens. The ambiguity in earlier studies functioned to do boundary work against this promising procedure (adhering to the “better safe than sorry” logic): we do not know what bacteria we introduce if we do this (unhygienic) procedure. However, by articulating fecal transplants via the new term microbiome to produce fecal microbiota transplants, this ambiguity is reappropriated within the human microbiome’s discourses of possibility. As a boundary object, the human microbiome’s ambiguity is something shared across many fields of science and no longer solely the burden for this localized group. Today, FMT is recommended for RCDIs by the American College of Gastroenterology and the European Society of Clinical Microbiology and Infectious Disease (Bowman et al., 2015). The human microbiome as a boundary object allowed FMT providers to translate this procedure across groups (or specialties) within medicine without consensus over specific practices or concrete knowledge of mechanisms. Before, fecal transplants were clearly on the wrong side of the bright line of boundary work. Now, they are ambiguously acceptable.

However, it is not as if a boundary object eradicates previous boundary work. Boundary work often returns. In this case, feces’s status as a disgusting object may be more difficult to overcome. With regard to the unappealing aspects of this procedure, the most commonly agreed goal among FMT providers, patients, the U.S. Food and Drug Administration, and entrepreneurs is to eliminate the use of raw feces transplantation and instead develop a fecal pill. FMT researcher Johan S. Bakken (2009) writes,

Future identification of specific key bacteria that are most important for upholding balance in the colon may permit the development of commercial, storable ‘synthetic stool’ products that will resolve many of the practical and perceived [a]esthetic problems that are associated with fecal bacteriotherapy today. (p. 288)

This would infrastructuralize FMTs, and in this process, the ambiguity brought about by the boundary object of the microbiome, with its concomitant inclusion of a wide range of microbes, would be erased. The older boundary work of medicine, centered the stark divide between hygiene and disgust, would reassert itself. However, even in the case of a fecal pill, a sanitized version of feces could move across the bright line and make its place within the infrastructure of biomedicine.

Conclusion

In synthesizing the two communication concepts boundary work and boundary objects dialectically rather than hierarchically, a new kind of analysis becomes possible. Focusing on moments of controversy, such as the introduction of fecal transplants as a cure for a disease, boundary objects can create bulbous moments—imagine the puff of air necessary to expand the colon for visualization during a colonoscopy. The tense space created by boundary objects reminds us that a border is a space, not an infinitely thin line between realms, despite the best efforts of those who do boundary work. Boundary objects make boundaries tense, and boundary work produces the pressure necessary to expel, incorporate, and demarcate, resolving this bulbous moment. Thus, together, these concepts help us understand how boundaries are transformed and simultaneously maintained. Together, these concepts can point researchers to moments rich with possibilities for collaboration and also help us recognize the contours and power dynamics of boundaries at work.

Utilizing this dialectical synthesis, TPC scholars could revisit other significant controversies—climate science, reproductive health, antivaxxers, and so on—to ascertain if there are any bulbous moments, any moments where boundary objects are present. Those objects might be productive for intervention in the conversation. Or, they may be ripe for critique of their political uses in supporting the boundary work sustaining the controversy. In addition, TPC is a discipline continually caught up in its own boundary work—as a bridge discipline between the humanities and sciences (Allen, 1990; St. Amant & Meloncon, 2016; Meloncon & St. Amant, 2018). It might be useful to stop thinking of TPC as doing boundary work and begin to think about TPC as a boundary object. As a boundary object, TPC has been caught up in institutional strategies to legitimize the disciplinary boundary work of other disciplines (e.g., engineering, English) and has often lost its ability to define itself (Blakeslee, 2009). While this may sound dismissive, it is not meant to be. What this essay shows is that if they are thought about dialectically, boundary objects—like TPC itself—are not solely a tool for those doing boundary work; they can disrupt, enhance, and reframe the boundaries. Boundary objects can make innovation possible, and this is the value of much TPC scholarship working in the in-between. Ultimately, boundary work allows us to see how power is recaptured, and boundary objects can allow us to see how power can be redistributed.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jessica R. Houf

Note

Author Biography

Jessica R. Houf is a visiting assistant professor of communication studies at Louisiana Tech University.

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