Anxiety – Page 2 – The Gothstomate

The Romantic Wasting Disease

Cancer, Colostomy and my Goth Identity

I have an identity that is surrounded by elements and ideas that deal in darkness and death. How is it possible that I can continue with my following of Goth culture now that I have been dealt my own, chillingly personal, taste of real mortality? I honestly don’t know. I am not Kurona the Goth anymore. I am Kurona with Cancer. Kurona with a Colostomy. My diagnosis has robbed me of my identity.

Its easy to think of Goth as a subculture dominated by a music genre and a fashion following. So why would my diagnosis interfere so much with that? Because for me, it is something that goes far deeper than simply wearing black and listening to loud music. During my time studying cultural history, I have discovered the roots of Goth culture go back far further than a music based revolution of the 1970s and 80s, all the way back to the latter years of the 1700s, and the beginnings of the Romantic Movement, and of the Gothic Revival. It was a cultural explosion born of the French Revolution, caused by a desire to reject the cold, hard science of the Age of Enlightenment and to rediscover and embrace a love of the past, for the beauty of the picturesque and the mystery and magic of the sublime, and the allure of darkness and beyond. It covered all corners of Art, Literature and Architecture, and spilled into the veins of the Romantic Movements of the 19th Century. The wave ran throughout the 1800s and crashed after the First World War, it was abused by the Nazis during the Second World War, it found a hiding place in The realms of Middle Earth, Narnia and Gormenghast, ridiculed by the modernists of the 50s and 60s, until it was reborn through the music and alternative art movements of the 1970s and 80s.

In those times, death was a constant presence in the outside world, not hushed up and hidden away like it is now, despite our stereotypes of Victorian prudishness. It was loud and it was vivid and it had its own place and belonging in Art. 19th Century Gothic is filled with references to death. In fact, an entire culture all of its own sprang up around it. From ideals of “the good death” to burial customs, a “Cult of Mourning”, Cemetery Architecture all of its own with its own unique messages and symbolisms, to Memento Mori Photography and Keepsakes of departed loved ones, to whispers of ghostly activity, séances and contact from the “beyond”. A long, slow, “romantic” idea of death and of mourning dominated art and literature and fashion.

Ophelia. Elizabeth Siddal’s 12 hour pose in a bathtub of cold water for John Everett Millais’ painting affected her health and contributed to her early death

Its easy to imagine a sick gothic maiden of 19th Century Art and Literature. Perhaps even beautiful to imagine her. It’s anything but beautiful to BE her. I am not reading this story, I am living it. Conjuring the mental images of reclining into a chaise longe, falls of untamed pre raphaelite hair and flowing pseudo-medieval gown, a pale face with a heated tint of rose, coughing blood into a hankerchief, regretting the opium heavy lifestyle and the mortal pricetag that it carried.. That is no challenge for me. I could easily invent that character as much as re enact her. she is ready to die the good Victorian death and be loved and remembered by all, forever.

But is that going to happen to me in my reality, in the modern world? I think not. The reality of dying with Cancer is ugly, messy and terrifying, far removed from the Victorian ideal associated with a long and drawn out wasting disease. Plus I highly doubt a life trapped in the benefits system is going to grant me the Gothic funeral or gravestone I want.

While my identity is not limited to the music I listen to or the clothes I wear, they still feature very heavily in my expressing of it. My fashion following ideally is something of a Medieval/Victorian hybrid, with a little Industrial and Cyber for good measure. Though it is difficult to find gothic clothing that both caters to my size, shape and sensory comfort, let alone poor budget, so ordinary days are often spent wearing very ordinary clothes, just with a strict gothic colour scheme of black with a hint of maybe purple or red or teal. I don’t tend to go crazy on makeup much either, no chalk white cheeks here. Just a little black lippy will do just fine. My music taste is far removed from the likes of Siouxsie or The Damned, favouring more Symphonic Metal and Dark Ambient, Neo Medieval, Viking and Industrial/EBM.

Cybergoth-ing at my regular Industrial Club, pre Covid

Dead Space Chamber Music at St John On-The-Wall, Bristol, January 2020

My interpretation of Goth having been born of the Gothic Revival influences the books I read. And those I write. The Art I produce. The places I go to in search of inspiration and peace. The way in which I decorate my personal space. Even the mental “safe space” I am being trained to create is itself a gothic edifice. I love the darkness of nighttime, as darkness seems to possess so much more truth. I love the Art and symbolism found in Cemeteries, Churches and Graveyards. They’re peaceful, beautiful places far removed from the chaos and noise of the living world, As well as losing myself in the perfect atmosphere for althe kind of chilling tales I revel in. I love Autumn and I am a bonefide Halloween Queen. I love broken things and abandoned places. I listen to stories of true hauntings, true crime and unsolved mysteries to go to sleep. It is the heart within my heart. And Cancer has broken it.

I’m in love with the darkness of the night
I’m in love with all that’s out of sight
I’m in love with the magic of the moon
And the darkness loves me, too
Xandria, “In love With The Darkness”.

There is more to be said for embracing darkness and shadows. Something that goes beyond even literature and art and finding inspiration. It gives me somewhere to hide. I have CPTSD. I have failed to get anywhere further than square one for my entire adult life. It has been a ride of constant struggles, illness, conflict and hitting brick walls and dead ends. Life seems to want to show me lovely things, then take them away again. What are you to do when you feel that life doesn’t want you? You embrace Death. I became Goth because I am grieving for a life I couldn’t have. I embraced Goth as a trauma response as much as an inspirational calling from the night. I am Goth because I am angry, with myself for failing at life and at life for failing me. There have been many times where I have seen Death as the only alternative to living through what I was experiencing. I feel for the things and people and places that have been broken and abandoned and forgotten, because I have been there too. But now I have Cancer, and Cancer could kill me. Everything has changed. Where I once chased beauty in darkness, where I had surrounded myself in beautiful associations with death, they aren’t so beautiful anymore. They make me feel sick.

Is it a prerequisite of being Goth to love death? If so, I will have to count myself out. I feel I am on the verge of abandoning my following of Goth altogether. when faced with my actual mortality all references to death, to horror, to all those things that once filled me with inspiration now make me feel sick and frightened. The music i once loved now triggers me, and the thoughts of permanent, inescapable darkness, stirred up by cemeteries, skulls and coffins fill me with dread instead of inspiration. I feel like a hypocrite, a contradiction. One half of me wants to be healthy and prolong life for as long as possible and has an irrational fear of just ceasing to exist, while the other half has had enough, too exhausted to fight anymore and just desperate for it all to be over with. I can even say I hate being alive because I am being forced to endure death. That long, drawn out, slow death so often depicted in the Gothic Art and Literature that I love is what I truly fear the most. Far more than my fear of falling out the sky in a plane crash, getting mangled by a car or just suddenly dropping dead in the middle of watching the TV. I had long hoped that it would be quick, painless and doing something I loved.. maybe a bizarre urbexing accident. I don’t want a finite amount of days where I can count them down with acute awareness, where every minute I will be desperately seeking pleasure, desperately making the most of what I experience for the final time, and hanging on to any scrap of hope but knowing all too well that it is too late. Can I even call myself Goth when I am clinging this tightly onto life? Was I ever truly Goth? Or just a fucking joke?

Should I be lucky enough to survive this, Am I going to owe life some kind of debt for my second chance? Perhaps paid for in abandoning Ghosts and graveyards and embracing sunshine and butterflies? Will I ever feel comfortable again, let alone comforted, drifting through graveyards and ruins?

And should I somehow survive this Cancer and this surgery and hold on to my Goth identity through this, how am I going to live as a Goth with a permanent Colostomy.. A Gothstomate? How will I be able to wear goth clothes with a Stoma and a bag full of poo to accommodate? I don’t know how I will be able to show my face in my clubs or at my concerts without the fear that I am being constantly looked at and judged, knowing what gross things are going on under my clothes. I don’t know anyone in my Goth Community with a Stoma that I can reach out to, to ask how they cope, how they can wear their clothes and go to their clubs without feeling like they stand out with their disability. In fact I don’t know any Goths with Stomas at all. I feel utterly isolated.

I have caught myself daring to dream of one day perhaps being able to model Goth fashion as plus size and disabled, be a representative for Ostomates in the Goth Community, as so far I just haven’t seen any to help me feel less alone, to give me any confidence that I can carry on wearing my signature style, that I can continue to identify as Goth. But that may only come from surviving cancer first.

Diseased and Dysmorphic

Perfect illustrative representation of Body Dysmorphia, by Travis Millard. Found via Pinterest.

The date has been set. I am to be condemned, or cured, on 10th March 2022. I have exactly 10 days left to make the most of my bagless, normal body. The problem is that it is not “normal”. In fact, I already hate it. Now the body I already hate and have been fighting with for years is about to get even uglier. Even more unmanageable. Even more unacceptable. Even more repugnant.

One of the many Mental Health Conditions I have is something called Body Dysmorphia. It is where the body you look at is a completely different vision of the body you actually have, skewed by poor confidence and esteem. The pic above that I gleaned from my Pinterest Account is a pretty accurate artistic interpretation of the condition. Those who reckon I look “pretty”, like my partner David, my closest friends, and even a few randoms I run into online, I can’t bring myself to believe them. I can’t see whatever it is they see. To believe would mean I am promoting being Fat and unhealthy. I am accepting my size instead of doing everything I can to change it. And above all of that, I am being narcissistic. The last thing I was to is to be a narcissist.

I am size 18 and revolting, with or without clothes. If I drew a picture of how I see my body (which I can’t, because I can’t draw!) it would include all of these: Frizzy unmanageable hair. Early onset elderly person face wrinkles. Spotty mottled skin that has to be hidden under layer upon layer of makeup. Double chin. Unattractive broad shoulders. Heavy, sagging boobs with heat rash zone. Arms covered in Self harm scars. Smelly, sweaty pits due to Mental Health meds. Overhanging belly full of junk and booze and covered in stretch marks. More permanent smelly sweat rash. Thighs that are a chub rub zone.. And a “please don’t look here” when sitting down. Bum – don’t even go there. Giant calves mean I can’t wear any knee high boots. Feet are covered in eczema and blisters but at least they work. Attractive?? Sexy?! Hell.. I don’t even qualify as pretty.

I wish that losing weight was as simple as it is made out to be. I am up against so much more than self control and “watching what I eat”. I have battled weight issues and body size and shape for my whole adult life. It’s been a long and losing battle. I was going to the gym at least 3x a week, often more, I walked everywhere and was mostly active. The Pandemic destroyed all of that and the pounds piled on. In a time where I was confined to the four walls of my small Flat, my only sources of enjoyment were food and drink. During the first Lockdown I remember spending hours in the kitchen just cooking and cooking, stocking my freezer for the inevitable closing down of the entire world. And my anxiety towards the Pandemic led me to spend hours drinking. I would pour what was probably a triple measure of Gin, drink that while I sat on the bed out the way of David as he worked from home in the other room, then got up and poured another. And then another. And then another. Not to mention the bottles of Red Wine. I was likely borderline alcoholic by the time that Lockdown was over.

Being Autistic means I have alot of sensory issues around food, while my far from ideal home life means I can’t make a constructive psychological routine around eating, especially when I have to eat either standing up in the kitchen or sitting on the sofa, resulting in both of these being associated with food. I was on birth control drugs for years that are known to put weight on, along with beta blocking drugs to counter Anxiety, also notorious for weight gain. I hate feeling hungry all the time and always being on the look out for food. I have average portion sizes but rarely feel satisfied. I have bent over backwards with calorie counting, food diaries and appetite suppressants, and gruelling workouts in the gym. I was doing 3 classes per session, with a warm up beforehand, but there was never any evidence on my body to show for my hard work. It seems like anything I consume just adds to the inches around my girth.

Mental health and lack of help meant I had to resort to any coping mechanism I could find, so I turned to food and especially to drink. I’m constantly changing my diet. Trying new things. Stopping eating this and eating that instead, but the motivation never lasts. The next wave of Mental health hell rolls in and it’s back to square one. Willpower alone is no match for Anxiety, Depression and Trauma.

There is also the guilt. Did my eating and drinking cause this Cancer? Is it because of my unhealthy lifestyle? I’ve tried starving myself. I’ve tried deliberately making myself sick. And neither worked. I always went crawling back to food and drink in order to get through my waking hours with some semblance of joy. The only way I have ever successfully lost weight is through being so ill and anxious that I couldn’t keep food down for weeks, and keeping the weight off then never lasted longer than a year.

And then there is the economic barrier. In Post Brexit, Post Pandemic Britain, fewer and fewer enjoyments in life are in reach for people in poverty. As are fewer and fewer healthy eating options. Noom and Slimming World don’t work in conjunction with the Food Banks. We are being told to do away with our gym subscriptions and “avocado on toast” so we can save up to buy a place to live. Junk food is cheap. Junk food is quick. Junk food is less hassle and less time consuming for people run ragged by jobs, chores, kids, stress. They never mention anything like this in the endless diet ads on TV.

It all seems like little money, little energy, poor mental health and now poor physical health is going to work together to stand between me and any chance I have of getting thin.

Getting dressed of a morning is filled with intrusive thoughts of “can I still wear that?” “do these still fit me?” or “like hell can I get away with wearing THAT when I look like THIS.” I remember the words of my Mum telling me to “flatter my figure”, which in my beyond broken brain is code for “wear something that hides how you really look”. I don’t have a figure. I have an abomination that needs clothes to hide under. So where are the clothes that fit?? Being stuck wearing clothes that either ride up or roll down is a sensory nightmare in itself, let alone a kick in the confidence every time I get dressed for the day. I have a choice between shapeless sacks of fabric or outfits tailored to skinny people then just scaled up in size. Body shape and comfort has been merely an afterthought. I love my goth clothes, but finding outfits I can get away with wearing is a neverending struggle. The fashion industry rarely considers the wants of bigger women because they don’t want to convey the idea that they are promoting obesity, while encouraging weight loss by providing fewer and fewer nice looking clothes that fit so we feel worse about how we look.. Ergo we will force ourselves to lose weight. The goth fashion industry isn’t much better. Some companies don’t make clothes over a size 16, and even then their idea of a 16 doesn’t fit reality. Once again I would like to shout out to the likes of Killstar, EMP, Disturbia, Attitude and Banned and all the goth labels I wear to PLEASE do more to represent us, we big and disabled girls who want nothing more than to be able to dress for our chosen identity, and unfortunately endless 1950s style dresses isn’t the answer either.

One glance in a mirror and I am instantly full of shame. Full of guilt. Full of hate. And all of this is just how I am now. Pre Surgery. Pre Bag.

I have begged to my Dietician in Pre-Hab. I’m desperate to lose weight. I’m desperate to be thin. I don’t want to be Fat and have a Stoma. I don’t want to be consumed by the Type 2 “It’s All Your Own Fault” Diabetes that I can see on the horizon. How am I going to manage when I was so dependent on the Gym and now have no intensive exercise options to fall back on? I want my surgery and rehabilitation to push me to lose weight, but I have read about the weight gain that having a Stoma will cause. And I know that rehab and therapy is up against my mental health conditions that are now 30 years strong. I feel like I am caught in the middle of a losing battle. I want this to be where I learn how to associate food and drink with being fuel for health and nutrition and not a distraction from sadness and fear. That I find better coping strategies that don’t involve food and drink. That my every waking minute doesn’t revolve around when the next meal is. That I just stop feeling constantly hungry or my mouth stops feeling constantly bored. To maybe even go into a job as a fitness instructor who has goth gym wear and teaches HIIT to heavy metal has been a thought sometimes. That would be nice, but as with everything I look towards in my life, is it even possible? Not right now.

What am I to do when I am told I have a problem for every solution?

The surgeons are more than welcome to chop out any fat they see when they come to chop my Cancer out.

The Nuclear Fallout

One day, I might be able to tell the story of what I have overcome and how. But until then, this is the story of how I can barely cope with what is to come.

Even though I had long ago foreseen that I would eventually have Cancer, I never considered THIS CANCER. or THIS EARLY. Couldn’t I have at least got to the age of forty first? Why not one that was in a less embarrassing place? Colorectal Cancer is something that happens to old men. Colostomies are for the elderly. They lurk in the sleazy dark corners of life, unspoken, dirty, secret things that only crop up in crude humour like Cards Against Humanity and sly jokes about incontinence. Even an old sketch from BBC’s “Dead Ringers” has repeated over and over in my head:

Well, I had a bit of trouble capturing the water, but I’ve adjusted my colostomy bag and it’s fine now..
Watercolour Challenge Sketch, Dead Ringers, BBC1

After all, there’s nothing like a little snickering about someone who can’t control their toileting.
I lost my childhood to Bullying. I lost my Twenties to Mental Illness. To Abusive relationships. To Poverty. I couldn’t keep a job, let alone find a career. My original job saw me thrown out after five weeks and I still to this day don’t know why. My second job alongside my MA degree landed me with my first Mental Health Diagnosis and what turned out to be massive Burnout, from which I still haven’t recovered. No employer wanted someone with useless knowledge and no experience, let alone someone with Mental baggage and behaviour that looked brattish, over dramatic and self centred. Now I’m losing my Thirties to Cancer, and the real chance I won’t even make it to my Forties.

I instantly felt old. Like 2 thirds of my life had suddenly dissolved into history, wasted and irretrievable, and the last third brutally visible and finite; dominated by hospital appointments, tests, further diagnoses and further treatment, languishing in bed and in pain instead of going out there to make the most of whatever is left of myself.

I saw my whole life as if I had already lived it.. And the inertia of my life, plunging ahead and me, powerless to stop it. “
Rose DeWitt Bukater, Titanic (1997)

How am I ever going to progress from this? I don’t know anyone with this that I can relate to, let alone anyone who is goth, or female, or as fat as me. How am I supposed to tackle this on top of all my existing conditions? Isn’t severe Anxiety and Depression, Autism and Complex PTSD enough already? What about my dignity? What about what’s left of my self worth and self confidence? My coping mechanisms that are utterly dependent on food and drink? My sensory issues that mean I can barely tolerate tags in clothes? The prospect of facing a life of being constantly dirty, smelly, incontinent, uncomfortable, paranoid and utterly humiliated? How am I ever going to show my face anywhere again, constantly aware of people feigning sympathy while quietly sneering at my disgusting disability? I wam never going to leave my flat again. How am I going to live in a society that is already angry with me for being mentally defective and unproductive and now having a taboo physical health condition on top? How am I going to live with this? Am I even going to live at all?

Everything running through my head was how a Stoma was going to ruin my life, and even darker, how it wasn’t even going to be worth it because the cancer was going to kill me anyway. My life was going to be measured in months, not years. Having my entire GP surgery saying how they were all in shock at the diagnosis didn’t exactly fill me with confidence either. After the diagnosis, the Stoma Nurse had given me a Colostomy Starter Pack to practise with and get an idea of what a Stoma and a bag was going to feel like. I was instantaneously repulsed. It made a horrible crinkling sound like a crisp packet was shoved down my Knickers. It looked and felt just so intimidating and medical. And it fell off. The practise Stoma lost its stick and fell off. The bag filled up with water when I tried practising with it in the shower, and it too fell off. I couldn’t find the gel that was supposed to mimic poo ((oh, I now have to call it “Output”.. My bad)) so I first tried with water, which leaked everywhere. Then with rice, which made it fall off yet again. If I can’t even manage the practise ones, how am I ever going to cope with the real thing in less than a few months time, forever.

Trying the practise Stoma bag. I looked and felt vile.

I didn’t feel safe anywhere, not even in my own body. The inside of me felt contaminated, and I wanted to tear myself open and escape. I don’t want it taking me down with it. I felt guilty. I felt like I deserved it. Like I had put it there with my bad attitude and bad choices and bad temper and bad habits. And once again the Bullies had been proved right. I was the one in the wrong, the one that needed teaching a lesson, the one that deserved all these kicks in the head year after year instead of progression or success. I wasn’t good enough for that. I hadn’t worked hard enough. didn’t deserve it. A problem instead of a person. And I felt stupid. Stupid for all those months spent terrified and hiding from Covid when I had Cancer the whole time.

I thought of those who had been so cruel over the years and would actually celebrate in my death. We told the kids not to tell their Mum and her new partner about my diagnosis because they would be delighted that I had finally got my comeuppance. Those that had said they wanted me to die from Covid. Said that I was beyond help. Those who called me a home wrecker. A man eater. A gold digger. A leech. Those who hate me for the inappropriateness of the things I love and how I express my fascination. Those who find me an endurance test, those who I physically and mentally drain of energy. Those who believe I am an abuser or I am manipulative and play games with their lives. And of course the government and society who see me as a drain on their resources and a miserable statistic that would be better off gone.

The things I love now brought me no joy. The things that had once been so special to me and had brought me comfort like my pretty things and sensory things and favourite clothes and foods and makeup and jewellery. What was the point in them anymore? It’s not like I could take anything with me into that darkness of non-existence, cold under the ground. The things I enjoyed doing the most all faded to nothing. My history studies. My specialist subjects like the Titanic and Chernobyl and Crystal Therapy. My religion that I had not long rediscovered. Watching true crime Documentaries or quiz shows or horror movies. Photography made me feel particularly sick, as did any of my associations with the goth culture I had made myself home in for so many years. My whole identity had been eroded, and that impact warrants its own post. Many of my beloved things even became triggers. I still can’t listen to music as it reminds me of better times that I will never experience anymore, or become associated with this darkest point in my life. Even my Cats became difficult to be around, with my knowing full well that if I end up having Chemotherapy in the future I may have to Re home them all as they can affect the treatment.

Nothing mattered anymore. I started on the self deprecation jokes. I always knew some a*hole would try and kill me, never expected it to be my own. I’m done looking for life goals, now I should start thinking if afterlife goals. What do I want to be when I’m dead? Maybe become a Poltergeist and smash the crockery in No. 10 Downing Street. Sounds like a fun career move.

Pulling jokes could only go so far. My self care went to pieces. And the self harm started. I couldn’t eat. I couldn’t face food. And then I was so ravenously hungry that I didn’t care what I ate or how much. During the first Lockdown for Covid I became borderline alcoholic due to being unable to adapt, and that crutch was once again the only thing propping me up where my friends and family couldn’t reach. I stood in my destroyed kitchen drinking wine at 10am. I would sit and stare. Or stand and stare. Nothing got done unless it involved drinking to dissolve the thoughts and numb the feelings.

Wherever I had to go I broke down. I had to go to the GP for a routine blood test and I broke down there. Had to get David out of work to come and pick me up and I had to be given an emergency GP appointment because I went straight into a panic attack. I broke down in front of the local council campaigners when they knocked on my door with their leaflets. I couldn’t bear to be awake but I also couldn’t sleep. The nightmares and the morning Anxiety attacks were intolerable. I wrote to the Colostomy UK Facebook Group that I wanted to cancel the surgery because I couldn’t go through with it.

Kitchen chaos as I failed to keep on top of the chores

When I finally kicked myself out of the flat to try and go for a walk, I walked miles with Wine in my water bottle and all my mental health meds in my purse. I wanted to go to Cathays cemetery or Llandaff cathedral graveyard, but somehow I ended up at the blackweir bridge. It was freezing and desolate despite the presence of cyclists and dog walkers and joggers. I didn’t take the pills this time. I thought of my surgery team and the effort they were making to try and save me. I felt I was throwing their care and commitment back in their faces, the epitome of all those accusations of selfishness and ingratitude over the years. I felt abhorrent.

In the end I had to give in. I knew I couldn’t look after myself, especially when David started his new job and I had to face hours completely on my own. I couldn’t make decisions by myself. I couldn’t function. I couldn’t cope. The last thing I wanted for David was for him to lose his new job because I couldn’t hack it on my own. So I bought a train ticket and ran away, back to my parents and the place where I was born.

I felt awful for dumping myself on my parents. Yet again I come home with my tail between my legs because I have utterly failed to live in the outside world. Just a frightened, helpless kid in an adult’s – now failing – body. They had to do all the psychological heavy lifting. Help me to eat properly again. Cut down drinking. Keep on top of hygiene and the simplest self care. They took me out places so I wouldn’t languish in my bedroom. They had me get into some TV dramas – Chloe and The Killing and Peaky Blinders – to distract me from my brain. They even paid for me to get my hair cut and re-coloured so I would look and feel just a little less of a wreck. And they have had to tough their way through all of my breakdowns, constantly repeating over and over again the same things that my head refuses to digest. That I’m not on death row. That I’ve not been condemned. That I’m not going to be a messy embarrassment.

Just after having my hair done. I am still asking this question.

The surgery team, Mr Ansell and Angel, said the chances of the cancer still being there after the surgery were small. But the chances of it being this form of Cancer were also small, so I just don’t believe anyone anymore. And the horror stories I have since been exposed to of living with cancer, of life as an Ostomate.. Well, they will have to be given a post all of their own.

I was supposed to have been turning my life around. I was meant to be blogging about my travel adventures and photography. But instead I am blogging about Cancer and a life with a prosthetic bowel.