Category Archives: Psychiatry
A couple of weeks ago I bought a secondhand copy of The Fortean Times Book of Weird Sex by Steve Moore (mainly because it cost me only one pence at an online book store). One of the stories (on pp.96-97) concerned a bizarre story of an autoerotic death involving an adolescent boy. I checked out the reference list at the back off the book to see where the story had originated and the source was listed as an Associated Press story from Knoxville (Maryland, USA). It didn’t take me too long to track down the press release on the internet. The report said:
“A 16-year old boy in Knoxville was found dead in his bedroom in what police describe as a gruesome, horrifying death. Firefighters were called to the scene Monday morning by a neighbor who smelled something burning. When the firemen found the remains of the teenager they called the police in to investigate. At first investigators believed that they were dealing with a ritualistic murder. Posters of heavy metal rock and roll groups covered his bedroom walls, groups which are often connected with satanic worship and rituals. According to a firefighter who was on the scene, the boy was found nude, with the remains of a cow’s heart attached to his genitals. Wires had been attached to the heart and plugged into a wall socket. The boy died from electrocution, then the electricity literally cooked his remains. Investigating Officer Hardaway dismissed the ritual murder theory when detectives found several underground pornographic magazines under the boy’s mattress. One of the magazines, called ‘Ovid Now’, describes a sexual ‘toy’ that can be made from the fresh heart of a cow, a simple electrical circuit, and some batteries. This deviancy is apparently gaining limited popularity in the rural South. Practitioners get the dead heart to beat, and then use the beating organ for sexual perversions. ‘This is one of the most gruesome things I have ever seen. I can’t believe that there are people who actually enjoy this sort of thing’ Hardaway commented. The boy’s parents are currently on vacation in Florida, where they were contacted and informed about the tragedy. They were unavailable for comment”.
As I have already written a previous blog on electrophilia and published an article on the ten strangest autoerotic deaths (in the magazine Bizarre) I thought it would make the basis for a good blog. However, after a bit more investigation I discovered the story to be a fake. The Snopes.com website (also know as the Urban Legends Reference Pages) investigated the story and showed it to be completely false. The author of the article (Barbara Mikkelson) wrote:
“The [cow heart masturbation story] isn’t a bona fide Associated Press article. No such death has been recorded, let alone been reported on by the Associated Press. What we have here is a work of fiction, an inventive leg-pull. Pranksters are everywhere, both on-line and off-line. In this case, someone took his best shot at presenting a gruesomely salacious story as a news item by dressing it up to mimic the style he assumed wire service copy adhered to, resulting in a laughable Associated Press pastiche”.
The same article also reported another fictitious tale of masturbatory death by animal (in this case a lobster). Here, the story was that a women had masturbated using a live lobster and that the lobster had defecated into her vagina, implanting brine shrimp eggs that then hatched inside her. Additionally, there are a few fictional cases in literature, the most infamous being the use of an animal liver as a masturbatory aid in Philip Roth’s 1969 novel Portnoy’s Complaint. The novel is basically the monologue of (as Wikipedia describes) “a lust-ridden, mother-addicted young Jewish bachelor who confesses to his psychoanalyst in intimate, shameful detail, and coarse, abusive language”. In my previous blog on sitophilia (sexual arousal from food), I did note that processed animal tissue has been used as a masturbatory aid (the most notable being botulinonia that involves the sexual use of sausages).
However, there is one case report in the scientific literature that is definitely true. It was published in a 1990 issue of the American Journal of Forensic Medicine and Pathology by Dr. Barry Randall, Dr. Richard Vance, and Dr. Timothy McAlmont and was simply titled ‘Xenolingual eroticism’. The paper described the case of a 29-year old female that presented at an abortion clinic saying that she had missed her periods and that she had a possible pregnancy that required termination. She was given a D&C (dilatation and curettage) and a muscular “pale grey tissue mass” measuring seven centimetres in length and 3 centimetres in diameter was found inside her vaginal passage. The object removed from her vagina turned out to be a deer tongue that the woman has been using as a masturbatory aid. At the time their case study was published, Dr. Randall and colleagues reviewed all the relevant literature on masturbatory practices in the Index Medicus database and found 42 papers (of which 27 detailed autoerotic deaths and 14 describing the psychology of autoeroticism). They then noted that:
“Only one reference reviewed various nonlethal autoerotic practices. Over a 42-year period, Aliabadi et al. recorded 18 patients, only three of whom were women, who presented with foreign body insertion for erotic purposes. All three women had inserted foreign bodies into the urinary tract. Acts of autoeroticism involving vaginal masturbation with foreign objects are perhaps more common. None to our knowledge have been reported because these do not result in death or injury, and typically would not come to medical attention. The literature discloses examples of foreign bodies extracted from the male and female lower urinary tract because objects of small diameter may be retracted by natural muscular impulses into the proximal urethra and/or bladder. Indeed, according to Kinsey and others >90% of foreign bodies found in the female bladder or urethra are there as a result of masturbation. Also, large objects retrieved from the vagina are found mostly in married women aged 17-30 [years]. However, these objects, most commonly bananas, cucumbers, and other large vegetables, rarely come to surgical attention. The medical literature reveals only seven references to bestiality. None of them deals with the issue of using nonviable animal tissue for autoerotic purposes. This report is presented so that xenoerotic objects may be placed on the list of possible masturbatory tools that may come to the attention of medical personnel”.
As far as I am aware, the case study by Dr. Randall and colleagues is the only academic paper on the use of animal tissue as a masturbatory aid. I did actually cite this study in a previous blog in relation to Dr. Anil Aggrawal’s 2011 typology of zoophiles in the Journal of Forensic and Legal Medicine. The case cited by Randall and colleagues could be classed as a fetishistic zoophile. According to Dr. Aggrawal, these individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Obviously the use of a deer tongue is rare but appears to fit the definition of a fetishistic zoophile.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.
Aliabadi, H., Cass, A.S., Gleich, P., & Johnson, C.F. (1985). Self-Inflicted foreign bodies involving lower urinary tract and male genitals. Urology, 26, 12-16.
Brown, S. (1995). The Fortean Times Book of Weird Sex. London: John Brown Publishing.
Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.
Mikkelson, B. (2006). Cowboy heart. Snopes.com, May 13. Located at: http://www.snopes.com/risque/kinky/cowheart.asp
Randall, M. B., Vance, R. P., & McCalmont, T. H. (1990). Xenolingual autoeroticism. The American Journal of Forensic Medicine and Pathology, 11, 89-92.
Snopes (2000). Lobster love. Snopes.com, January 26. Located at: http://www.snopes.com/risque/juvenile/lobster.asp
Snopes (2006). Deerly beloved. Snopes.com, February 26. Located at: http://www.snopes.com/risque/animals/deertongue.asp
“Real happiness consists in not what we actually accomplish, but what we think we accomplish” (Charles Green Shaw, American abstract artist)
Ever since I can remember I have always been someone that compiled lists. Back in my youth it was lists of my favourite pop groups, film stars, sports stars, etc. I still make loads of lists but these days they are more likely to be long ‘to do’ lists (in fact, I’ve even written articles on getting the most out of ‘to do’ lists and being organized – see ‘Further reading’ below) or writing articles in the form of lists (in fact, I used to write what I called ‘psychol-lists’ for the British Psychological Society’s in-house magazine The Psychologist). When I make lists I feel more productive, and they are often the spurs to get things done (as long as I actually do the things on the list).
Obviously, list making can be an important activity in the organizational skills of many working individuals. Based on my own observations, most people make lists so they (i) don’t forget things, (ii) don’t procrastinate, (iii) feel in control and focused in what they are doing, (iv) can relieve stress, and (v) can cross things off the list and feel a sense of accomplishment. However, for a minority of people, making lists appears to be obsessive and a mental health issue. In short, there may be a fine line between being organized and being neurotic. From my own personal experience, I know that writing lists can be related to perfectionism. But life isn’t perfect and not completing activities on ‘to do’ lists can raise stress and worry levels. Ironically, the only way some people can deal with this is to make even more lists of things to do.
Obsessive list making is sometimes referred to as glazomania (check out the ‘Manias’ page at The Scorpio Tales website). Online dictionaries tend to define glazomania as either “a passion for list making” or “an unusual fascination with making lists”. However, the term ‘glazomania’ doesn’t appear to be used much academically. I did come across one recent paper in Distinktion: Scandinavian Journal of Social Theory, by Dr. Urs Staeheli that mentioned it:
“Recently, quite a number of coffee-table books have been published that collect different sorts of everyday lists. Some authors even speak of a ‘glazomania‘ (Cagen 2007) – that is, an uncontrolled urge to produce lists and a fascination with list-making”
However, there was no other information provided. I managed to track down the 2007 reference to Sasha Cagen’s book (To-Do List: From Buying Milk to Finding a Soul Mate, What Our Lists Reveal About Us). The book includes creative list-making exercises with the aim of helping individuals to “get in touch with their passion for life, inside and out of work, and refocus them on what brings them alive”. Cagen now makes a living on writing and giving workshops on the benefits of list making (one of her major clients being Google)
Although the term ‘glazomania’ is seldom used academically or clinically, obsessive list making is often mentioned as one of the symptoms of obsessive-compulsive disorder. As one online admission I came across noted:
“I have OCD, and recently my OCD flares up in the form of compulsive list making. This behavior totally affects my ability to be productive because I am constantly afraid of forgetting something and of spending time doing the wrong thing. Does anyone have any tips on how to break the cycle?”
The Wikipedia entry on obsessive-compulsive personality disorder notes that the main symptoms are “preoccupation with remembering and paying attention to minute details and facts, following rules and regulations, compulsion to make lists and schedules, as well as rigidity/inflexibility of beliefs or showing perfectionism that interferes with task-completion. Symptoms may cause extreme distress and interfere with a person’s occupational and social functioning” (my emphasis)
Psychologically, an argument could be made that obsessive list makers are simply trying to create an illusion of control in otherwise chaotic lives. The reason whyindividuals with OCD make lists compulsively is that they often afraid (in some cases, to the point of being phobic) that they will forget something important (even though research shows they do not have memory problems). These (arguably unnecessary) lists provide a reminder to carry out daily activities (i.e. brushing teeth, making breakfast, etc.). As with other OCD-type behaviours, the action of making a list helps the individual to feel psychologically better (albeit temporarily). The etiological roots may lie in the fact that the sufferer may at some point in their past history have been reprimanded severely, or repeatedly, by others for innocently forgetting things that were important. The OCD Types website adds:
“They never learn that they do not need the list to remember things. People with OCD may also make lists to remember things that may be contaminated to later wash or avoid, which also contributes to the OCD process. List-making can be in writing or verbalized aloud”.
In 2010, the BBC reported an exhibition at the Archives of American Art in Washington featuring lists made by eminent artists (everything from “scribbled on scraps of paper” to the “elaborately illustrated” including lists by Pablo Picasso, Alfred Konrad, Oscar Bluemner, Eerp Saarinen and Harry Bertoia). Bluemner even kept lists of lists. The curator of the exhibition (Liza Kirwin) told the BBC that:
“In trying to give order to his life, [Bluemner] obscures the clarity of the inventory of his work. He’s completely obsessed with this type of record keeping…This very mundane and ubiquitous form of documentation can tell you a great deal about somebody’s personal biography, where they’ve been and where they’re going. People can relate to this form of documentation because so many people are list keepers and organise their lives this way”.
In the same article, the BBC interviewed the US psychoanalyst Dr. Michael Maccoby who claimed that there are various types of list makers. However, there was little detail and the only quote in relation to types of list makers claimed: “The extreme is the obsessive who has to make lists of everything. These are people who have an unconscious fear that everything is going to be out of control if they don’t make a list”. As far as I am aware, there is no published empirical research on personality types and list making although there is some psychological literature showing that list making – as part of time management practices – appears to have some beneficial effects on both student grade point averages and workplace productivity.
Finally, a few months ago, an online article by Dr. Carrie Barron at the Psychology Today website provided a brief summary of why making lists is psychologically good for people. I’m not sure about the empirical basis of her claims but they seem to have reasonable face validity. I’ll leave you with her reasons (her verbatim list of “six great benefits”!). In summary, Barron believes that lists:
- “Provide a positive psychological process whereby questions and confusions can be worked through.
- Foster a capacity to select and prioritize. This is useful for an information-overload situation.
- Separate minutia from what matters, which is good for identity as well as achievement.
- Help determine the steps needed. That which resonates informs direction and plan.
- Combat avoidance. Taking abstract to concrete sets the stage for commitment and action. Especially if you add self-imposed deadlines.
- Organize and contain a sense of inner chaos, which can make your load feel more manageable”.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Barron, C. (2014). How making lists can quell anxiety and breed creativity. Psychology Today, March 9. Located at: http://www.psychologytoday.com/blog/the-creativity-cure/201403/how-making-lists-can-quell-anxiety-and-breed-creativity
Cagen, S. (2007). To-Do List: From Buying Milk to Finding a Soul Mate, What Our Lists Reveal About Us. Chicago: Touchstone.
Griffiths, M.D. (1995). Psycholo-lists. The Psychologist: Bulletin of the British Psychological Society, 8, 240.
Griffiths, M.D. (1996). More psycholo-lists. The Psychologist: Bulletin of the British Psychological Society, 9, 384.
Griffiths, M.D. (2006). Tips on…To do lists. British Medical Journal Careers, 332, 215.
Griffiths, M.D. (2008). Tips on…’To do’ lists. Psy-PAG Quarterly, 68, 27-28.
O’Brien, J. (2010). The art of list-making. BBC News, March 3. Located at: http://news.bbc.co.uk/1/hi/8537856.stm
OCD Types (2014). About obsessive-compulsive disorder. Located at: http://www.ocdtypes.com/unusual-compulsions.php
Staeheli, U. (2012). Listing the global: Dis/connectivity beyond representation? Distinktion: Scandinavian Journal of Social Theory, 13(3), 233-246.
Wikipedia (2014). Obsessive-compulsive personality disorder. Located at: http://en.wikipedia.org/wiki/Obsessive–compulsive_personality_disorder
Throughout my career, I have constantly pointed out that I met very few people that are genuinely addicted to playing weekly or bi-weekly Lotto games. When stating this, some people counter my assertion that they know people who spend far too much money on buying Lotto tickets and that it is areal problem in their life. However, this is a classic instance of confusing ‘problem gambling’ with ‘gambling addiction’. These two terms are not inter-changeable. When I give lectures on gambling addiction I always point out that “all gambling addicts are problem gamblers but not all problem gamblers are gambling addicts”.
Nowhere is this more relevant than in the print and broadcast media. For instance, I have been one of the co-authors on the last two British Gambling Prevalence Surveys (published in 2007 and 2011). In these surveys we assessed the rate of problem gambling using two different problem gambling screens. Neither of these screens assesses ‘gambling addiction’ and problem gambling is operationally defined according to the number of criteria endorsed on each screen. For instance, in both studies we used the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to estimate the prevalence of problem gambling. Anyone that endorsed three or more items (out of ten) was classed as a problem gambler. Anyone that endorsed five or more items was classed as a pathological gambler. Pathological gambling is more akin to gambling addiction but we found only a tiny percentage of our national participants could be classed as such. What we did report was that 0.9% of our sample were problem gamblers (i.e., they scored three or more on the DSM-IV criteria).
What we didn’t say (and never have said) was that 0.9% of British adults (approximately 500,000 people) are addicted to gambling. However, many stories in the British media when they talk about problem gambling will claim ‘half a million adults in Great Britain are gambling addicts’ (or words to that effect). I am not trying to downplay the issue of gambling addiction. I know only too well the pain and suffering it can bring to individuals and their families. Also, just because I may not define a problem gambler as being genuinely addicted (by my own criteria as outlined in a previous blog), that doesn’t mean that their problem gambling might not be impacting in major negatively detrimental ways on their life (e.g., relationship problems, financial problems, work problems, etc.).
However, returning to the issue of being ‘addicted’ to Lotto games I have always stated in many of my published papers on both addiction and (more specifically) gambling addiction, that addictions rely on constant rewards. A person cannot be genuinely addicted unless they are receiving constant rewards (i.e., their behaviour being reinforced). Playing a Lotto game in which the result of the gamble is only given once or twice a week is not something that can provide constant rewards. A person can only be rewarded (i.e., reinforced) once or twice a week. Basically, Lotto games are discontinuous and have a very low event frequency (once or twice a week). Continuous gambling activities (like the playing of a slot machine) have very high event frequencies (e.g., a typical pub slot machine in the UK has an event frequency of 10-12 times a minute). Gambling activities with high event frequencies tend to have higher associations with problem gambling, and are more likely to be associated with genuine gambling addictions.
That doesn’t mean people can’t spend too much money buying lottery tickets. Buying ticket after ticket can indeed lead people to have a gambling problem with Lotto. However, I know of no addiction criterion that relates to the amount of money spent engaging in an activity. Obviously the lack of money can lead to some signs of problematic and/or addictive behaviour (such as committing criminal activity in order to get money the person hasn’t got to gamble) but this is a consequence of the behaviour not a criterion in itself. In most of the behavioural addictions that I carry out research into (exercise addiction, sex addiction, video game addiction, etc.), there is little money spent but some of these behaviours for a small minority of people are genuinely addictions.
One of the reasons I felt the need to write this article was a press release I saw the other day from the Salvation Army in New Zealand. The story basically said that for some people, playing Lotto was an addictive activity. Here are some of the things the press release said:
“The Salvation Army Problem Gambling service is seeing an increase in the number of clients for whom Lotto products has become a problem for them and their families. ‘When it becomes an addiction, gambling creates havoc in people’s lives’, says Commissioner Alistair Herring, National Director of Addiction Services. ‘The gambling of some of our clients has led to criminal offending, domestic violence, loss of the family home, and – most commonly – children going without food and other basic needs. Regrettably, some people are unable to buy a simple product like a Lotto ticket without it leading to harm for themselves and others. A Lotto ticket can seem harmless but once their purchase becomes an addiction the results can be devastating’…In the past year, The Salvation Army problem gambling programme assisted over 1400 clients most of whom used Lotto. Fifty-seven clients said Lotto was the most significant aspect of their gambling problem. ‘This sort of sales promotion without fully understanding the damage the product can have on an individual and their family is irresponsible. New Zealand is moving toward food labelling that identifies additives dangerous to health. Yet Lotto tickets are sold without any warning that they can lead to health dangers through addiction’. One of the results of Lotteries Commission activity is that Countdown supermarkets recently started selling Lotto tickets at the checkout”.
Many of you reading this may think I am being a little pedantic but while I don’t doubt that buying too many Lotto tickets can be problematic if the person buying them simply can’t afford it, the resulting behaviour is ‘problem gambling’ not ‘gambling addiction’. In relation to my own criteria for addiction, the only way someone could be addicted to Lotto was if they were actually addicted to the buying of the tickets rather than the outcome of the gamble itself. This is not as bizarre as it sounds as some research that I carried out in the late 1990s and early 2000s with Dr. Richard Wood appeared to show that a small proportion of adolescents (aged 11 to 15 years) were addicted to playing both Lotto and scratchcard lottery games.
While it is theoretically possible for kids to be hooked on lottery scratchcards (as you can play again and again and again if you have the time, money, and opportunity), we found it strange that adolescents should have ‘addiction’ problems with Lotto. However, in follow-up qualitative focus groups, some adolescents reported that they actually got a buzz from the buying of Lotto tickets and scratchcards because it was an illegal activity for them (i.e., only those aged 16 years or older can play lottery games in the UK so the buying of tickets below this age is a criminal offence). Basically, there was a small minority of kids that were getting a buzz or high from the illegality of buying a lottery ticket rather than the gambling itself.
Along with Michael Auer, I published a paper in the journal Frontiers in Psychology where we argued game type was actually irrelevant in the development of gambling problems. We provided two examples that demonstrate that it is the structural characteristics rather than the game type that is critical in the acquisition, development and maintenance of problem and pathological gambling for those who are vulnerable and/or susceptible. A ‘safe’ slot machine could be designed in which no-one would ever develop a gambling problem. The simplest way to do this would be to ensure that whoever was playing the machine could not press the ‘play button’ or pull the lever more than once a week. An enforced structural characteristic of an event frequency of once a week would almost guarantee that players could not develop a gambling problem. Alternatively, a risky form of lottery game could be designed where instead of the draw taking place weekly, bi-weekly or daily, it would be designed to take place once every few minutes. Such an example is not hypothetical and resembles lottery games that already exist in the form of rapid-draw lottery games like keno.
Although many people (including those that work in the print media) may still use the terms ‘problem gambling’ and ‘gambling addiction’ interchangeably, hopefully I have demonstrated in this article that there is a need to think of these terms as being on a continuum in which ‘gambling addiction’ is at the extreme end of the scale and that ‘problem gambling’ (while still of major concern) doesn’t necessarily lead to problems in every area of a person’s life.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, 3, 621. doi: 10.3389/fpsyg.2012.00621.
Griffiths, M.D. & Wood, R.T.A. (2001). The psychology of lottery gambling. International Gambling Studies, 1, 27-44.
Leino, T., Torsheim, T., Blaszczynski, A., Griffiths, M.D., Mentzoni, R., Pallesen, S. & Molde, H. (2014). The relationship between structural characteristics and gambling behavior: A population based study. Journal of Gambling Studies, in press.
McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.
Parke, J. & Griffiths, M.D. (2006). The psychology of the fruit machine: The role of structural characteristics (revisited). International Journal of Mental Health and Addiction, 4, 151-179.
Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp.211-243). New York: Elsevier.
Salvation Army (2014). Buying Lotto…Winning a gambling addiction. July 2. Located at: http://www.scoop.co.nz/stories/CU1407/S00032/buying-lotto-winning-a-gambling-addiction.htm
Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.
Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M.D., Constantine, R. & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: The Stationery Office.
Wood, R.T.A. & Griffiths, M.D. (1998). The acquisition, development and maintenance of lottery and scratchcard gambling in adolescence. Journal of Adolescence, 21, 265-273.
Wood, R.T.A. & Griffiths, M.D. (2002). Adolescent perceptions of the National Lottery and scratchcards: A qualitative study using group interviews. Journal of Adolescence, 25/6, 655 – 668.
Wood, R.T.A. & Griffiths, M.D. (2004). Adolescent lottery and scratchcard players: Do their attitudes influence their gambling behaviour? Journal of Adolescence, 27, 467-475.
In a previous blog on five ‘weird addictions’ I briefly mentioned pagophagia, a craving and compulsion for chewing ice. Pagophagia is a type of pica (which I also covered in a previous blog). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Although the incidence of pagophagia appears to have increased over the last 30 years in westernized cultures, Dr. B. Parry-Jones (in a 1992 issue of Psychological Medicine) carried out some historical research and pointed out that both Hippocrates and Aristotle wrote about the dangers of excessive intake of iced water. Parry-Jones also noted that references to disordered eating of ice and snow were also recorded in medical textbooks from the sixteenth century. However, the first contemporary reference to pagophagia appears to have been a 1969 paper by Dr. Charles Coltman in the Journal of the American Medical Association entitled ‘Pagophagia and iron lack’.
Pagophagia is closely associated with iron deficiency anemia but can also be caused by other factors (biochemical, developmental, psychological, and/or cultural disorders). If pagophagia is due to iron deficiency (such as case studies of those with sickle cell anemia), it may sometimes be accompanied by fatigue (e.g., being tired even when performing normally easy tasks). Dr. Youssef Osman and his colleagues published a number of case reports of pagophagia in a 2005 issue of the journal Pediatric Haematology and Oncology including the case of a child with sickle cell anemia and rectal polyps (that caused a lot of bleeding and made the anemia worse):
“An 8-year-old Omani boy, a known case of sickle cell anemia…presented with history of craving for ice. The child was noticed over the last 4 months to like drinking very cold water and to open the deep freezer and scratch the ice and eat it. The parents tried to stop him from doing so, but they failed…The child was started on oral iron therapy…and his craving for ice was completely stopped. Meanwhile, the rectal polyp was removed surgically”.
Other potential health side effects include constant headaches (a ‘brain freeze’ similar to ‘ice cream headache’) and teeth damage although this is thought to be relatively rare. However, a recent paper by Dr. Yasir Khan and Dr. Glen Tisman in the Journal of Medical Case Reports highlighted the case of a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water.
Khan and Tisman also suggested that some people who are deficient in iron experience tongue pain and glossal inflammation (glossitis). Others claim that chewing ice may help those with stomatitis (i.e., inflammation of the mucous lining inside the mouth). A recent 2009 case study published by Dr. Tsuyoshi Hata and his colleagues in the Kawasaki Medical Journal, reported the case of a 37-year old Japanese women who ate copious amounts of ice to relieve the pain of temporomandibular joint disorder (i.e., chronic pain in the joint that connects the jaw to the skull). Khan and Tisman also claim that the classical symptoms of pagophagia have changed in the last 40 years since Dr. Coltman’s initial paper in the Journal of the American Medical Association.
“This may probably be the result of advances in technology and changes in culture. When initially described [by Coltman], pagophagia was defined as the excessive ingestion of ice cubes from ice trays and the ingestion of ice scraped from the wall of the freezer. With the advent of ice cube makers and auto defrosters, the presentation of pagophagia has changed in a subtle manner as described in…our patients. Now we observe a subtler ingestion and/or sucking of ice cubes from large super-sized McDonald’s-like cups and from the use of popular bottled water containers that have been frozen”.
There have been few epidemiological studies examining the prevalence of pagophagia. Such estimates vary widely within particular populations but (according to Dr. Youssef Osman and his colleagues) have been shown to be more common in low socioeconomic and underdeveloped areas. Pagophagia is thought to be relatively harmless in itself or to one’s health, although there are some claims in the literature that pagophagia can be addictive. However, empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. As a consequence, some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships.
Treatment for pagophagia can often be overcome with iron therapy and Vitamin C supplements (to supplement iron deficiency if that is the cause). For instance, Dr. Mark Marinella in a 2008 issue of the Mayo Clinic Proceedings successfully treated a 33-year old woman with pagophagia following complications with gastric bypass surgery:
“The patient received red blood cells, iron sucrose, and levofloxacin. On further questioning, the patient denied taking vitamin, mineral, or iron supplements since surgery and reported prolonged, heavy menstrual cycles. She consumed large amounts of ice daily for several months. The patient’s husband frequently observed her in the middle of the night with her head in the freezer eating the frost off the icemaker. The patient admitted to awakening several times nightly for months with an uncontrollable compulsion to eat the frost on the icemaker. This craving resolved after transfusion and iron administration”
However, if the condition is psychologically or culturally based, iron and vitamin supplements are unlikely to work, and other psychological treatments (such as cognitive-behavioural therapy) are likely to be employed.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Coltman, C.A. (1969). Pagophagia and iron lack. Journal of the American Medical Association, 207, 513-516.
de Los Angeles, L., de Tournemire, R. & Alvin, P. (2005). Pagophagia: pica caused by iron deficiency in an adolescent. Archives of Pediatrics, 12, 215-217.
Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E., Jones, S. Laryea, H. & Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.
Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.
Khan, Y. & Tisman, G. (2010). Pica in iron deficiency: A case series. Journal of Medical Case Reports, 4, 86. Located: http://www.jmedicalcasereports.com/content/4/1/86
Kirchner, J.T (2001). Management of pica: A medical enigma. American Family Physician, 63, 1177-1178.
Marinella, M. (2008). Nocturnal pagophagia complicating gastric bypass. Mayo Clinic Proceedings, 83, 961
Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.
Parry-Jones, B. (1992). Pagophagia, or compulsive ice consumption: A historical perspective. Psychological Medicine, 22, 561-571.
Alcohol dependence is often viewed as a cluster of behavioural, cognitive, and physiological phenomena that in most affected people includes a strong desire to consume alcohol, and have difficulties in controlling their drinking. According to a 2013 report by Alcoholics Anonymous, alcoholism kills more people in the UK than any other drug apart from nicotine. Based on Government statistics, they claim one adult in every 13 is alcohol-dependent (although this is much higher than data collected from the most methodologically robust studies – see below). The General Household Survey (GHS) and the General Lifestyle Survey (GLF) have been measuring drinking behaviour for over 30 years. In relation to alcohol use, the latest 2013 Office for National Statistics (ONS) report notes that:
“The Department of Health estimates that the harmful use of alcohol costs the National Health Service around £2.7bn a year and 7% of all hospital admissions are alcohol related. Drinking can lead to over 40 medical conditions, including cancer, stroke, hypertension, liver disease and heart disease. Reducing the harm caused by alcohol is therefore a priority for the Government and the devolved administrations. Excessive consumption of alcohol is a major preventable cause of premature mortality with alcohol-related deaths accounting for almost 1.5% of all deaths in England and Wales in 2011”.
The ONS notes that obtaining reliable data on drinking behaviour is difficult. Compared to national alcohol sales, surveys carried out by social scientists consistently record lower levels of how much alcohol they consume because participants may consciously and/or unconsciously be underestimating alcohol consumption (e.g., alcohol use in the home may be based on the number of glasses of wine drunk with the amount poured into the glass being much greater than a standard unit of alcohol). In the most recent 2013 report (based on data collected in 2011), participants were asked two questions about their alcohol consumption. These were (i) maximum amount of alcohol drunk on any one day in the previous seven days, and (ii) average weekly alcohol consumption. The survey also obtained three measures of maximum daily alcohol consumption.
- Exceeding the recommended daily alcohol limit. This measure assessed the proportion of men and women exceeding the recommended units of alcohol on their heaviest drinking day (i.e. 4 units for men, 3 units for women).
- Engaging in binge drinking (i.e., intoxication). This measure assessed the proportion of men and women who exceeded the number of daily units considered as intoxicating (i.e., 8 units for men, 6 units for women).
- Engaging in heavy drinking. This measure assessed the proportion of men and women who drank more than three times the recommended daily units of alcohol (i.e., more than 12 units for men and more than 9 units for women).
The results indicated that:
- Over half of all adults (59%) reported that they had consumed alcohol in the week prior to the survey.
- Men (66%) were more likely than women (54%) to have had an alcoholic drink in the week before the survey
- More men (16%) drank on at least five out of seven days than women (9%) in the week prior to the survey.
- Almost one in ten men (9%) drank alcohol every day in the week prior to the survey compared to only one in twenty women (5%).
- More men (34%) exceeded the daily recommended units of alcohol than women (28%).
- More men (18%) were binge alcohol drinkers than women (12%)
- More men (9%) were heavy drinkers than women (6%)
- Heavy drinking was most prevalent in those aged 16 to 44 years
- Drinking alcohol was also associated with smoking nicotine with smokers being more likely to be binge drinkers and heavy drinkers.
Another major report on alcohol use in England was recently published by the Lifestyle Statistics, Health and Social Care Information Centre (in 2013). Their analyses were mainly obtained from the Health and Social Care Information Centre (HSCIC), Hospital Episodes Statistics (HES), and prescribing data. They reported that:
- 61% of men and 72% of women had either drunk no alcohol in the last week, or had drunk within the recommended levels on the day they drank the most alcohol.
- 64% of men drank no more than 21 units weekly, and 63% of women drank no more than 14 units weekly.
- 12% of school pupils had drunk alcohol in the last week. This continues a decline from 26% in 2001, and is at a similar level to 2010, when 13% of pupils reported drinking in the last week.
- In 2011/12, there were 200,900 admissions to English hospitals where the primary diagnosis was attributable to alcohol consumption (a 1% increase on the previous year).
- In 2011/12, there were an estimated 1,220,300 admissions to English hospitals related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (an increase of 4% on the previous year).
- In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community (an increase of 6% on the previous year).
Arguably the most robust data on alcohol dependence in the UK comes from the 2009 Adult Psychiatric Morbidity Survey (APMS) carried out by the National Centre for Social Research and University of Leicester. Alcohol problems (including alcohol dependence) were measured using the AUDIT (Alcohol Use Disorders Identification Test) and the SADQ-C (Severity of Alcohol Dependence Questionnaire, community version). An AUDIT score of eight or more indicated hazardous drinking, and 16 or more indicated harmful drinking. SADQ-C scores of 4-19 indicated mild dependence; 20-34, moderate dependence; 35 or more, severe dependence.
Using the AUDIT, the prevalence of hazardous drinking was 24.2% (33.2% males, 15.7% females). A total of 3.8% of adults (5.8% males, 1.9% females) drank alcohol at harmful levels, i.e., around 1 in 25 adults. Among males, the highest prevalence of both hazardous and harmful drinking was in 25-34 year olds, whereas in females it was in 16 -24 year olds. Using the SADQ-C, the prevalence of alcohol dependence was 5.9% (8.7% males, 3.3% females), i.e., around 1 in 16 adults. For males, the highest levels of dependence were identified in those between the ages of 25-34 years (16.8%), whereas for females it was between the ages of 16-24 years (9.8%). Most of the recorded dependence levels were mild (5.4%), with relatively few adults showing symptoms of moderate or severe dependence (0.4% and 0.1% respectively). Compared to the previous APMS survey in 2000, the prevalence of alcohol dependence was lower for males in 2007, whereas it remained at a similar level for females.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Lifestyle Statistics, Health and Social Care Information Centre (2013). Statistics on Alcohol: England, 2013. Located at: https://catalogue.ic.nhs.uk/publications/public-health/alcohol/alco-eng-2013/alc-eng-2013-rep.pdf
National Centre for Social Research/University of Leicester (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. London: NHS Information Centre
Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.
Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
As regular readers of my blog will know, I have a long-standing psychological interest in any extreme human behaviour. This also encompasses the world of popular culture and includes individuals that engage in extreme art (such as surrealists like Salvador Dali), extreme fashion (such as those that wear extreme lingerie, extreme body art (including both extreme tattooing and extreme body modification), and/or fetishistic body costumes), and extreme music (such as bands like Throbbing Gristle and the Velvet Underground).
Back in 1997 I was one of the many people that visited the controversial art exhibition Sensation at the Royal Academy of Art that featured a wide range of work by the ‘Young British Artists’ (and all owned by Charles Saatchi) such as the ‘shock art’ by Damien Hirst (‘The Physical Impossibility of Death in the Mind of Someone Living’), Tracy Emin (‘Everyone I Have Ever Slept With 1963–1995’), Jake and Dinos Chapman (‘Great Deeds Against the Dead, 1994’), Marcus Harvey (‘Myra’), and Ron Mueck (‘Dead Dad’). One of the pieces that I was particularly struck by was ‘Self’ a sculpture by Marc Quinn that was a cast of the artist’s own head made from approximately nine pints of his own frozen blood. As the Wikipedia entry on Quinn notes:
“In interview in 2000, reflecting on the iconic artwork, [Quinn] remarked, ‘Well, I think it’s a great sculpture. I’m really happy with it. I think it is inevitable that you have one piece people focus in on. But that’s really good because it gets people into the work’. Described by Quinn as a ‘frozen moment on life support’, the work is carefully maintained in a refrigeration unit, reminding the viewer of the fragility of existence. The artist makes a new version of ‘Self’ every five years, each of which documents Quinn’s own physical transformation and deterioration”.
In interviews about his body of work (no pun intended), Quinn has said that he has gravitated towards the use of unconventional materials that address his “preoccupation with the mutability of the body and the dualisms that define human life”. In a short (but interesting) interview with The Huffington Post, he was asked how the metaphorical immortality in his work given that his work literally contained a part of him. He replied that:
“In a funny way I think ‘Self’, the frozen head series, is about the impossibility of immortality. This is an artwork on life support. If you unplug it, it turns to a pool of blood. It can only exist in a culture where looking after art is a priority. It’s unlikely to survive revolutions, wars and social upheaval, I also think that the total self portrait-ness of using my blood and my body has an ironic factor as well, in that even though the sculpture is my form and made from the material from my body, to me if just emphasises the difference between a truly living person and the materials which make that person up. The sort of literalist point that has been missed by the cryogenicists who freeze themselves for supposed future regeneration”.
I was reminded of Quinn’s extreme art more recently when I was interviewed about the art of 36-year old Australian-based artist Dr Rev Mayers for the Discovery television series Forbidden (a program on which I am the resident psychologist. You can see Dr. Rev and my appearance on this programme here). As the documentary’s production notes made clear:
“Dr. Rev loves to paint. Like most artists he tries to put something of himself in to all his creations. But Dr Rev takes this concept to a whole other level. His paintings are created using his own blood, pumped fresh from his own veins and sprayed direct on to the canvas…He’s a natural born showman, lapping up the attention he gets while performing his death defying blood art stunts in front of live audiences. He’s survived his last feat – a live show painting with the blood being pumped directly from his arm – though he’s vowed never to try it again. ‘It’s a dangerous process if the airbrush had have blocked up, blood could have been pushed back into my body. I could have suffered a heart attack and died’…Mayers has just quit the tattoo business and blood painting is now his fulltime job. He’s been doing it for 6 years ever since he convinced his nurse to let him take home a vial of his own blood”.
Mayers describes himself as borderline bipolar, a showman and a talker. The motivation behind his art appears a lot less intellectual than that of Quinn with a seemingly simple rationale for doing what he does – contradiction and shock value. As he noted in the television program: “I don’t mean to sell myself but I’m certainly not boring and if it’s shocking that you guys want then you’ll get shocking!” Mayers also claimed that he likes the idea of contradicting the stigma that surrounds blood: “It’s not scary. It’s what gives us life”
Quinn and Mayers’ artworks might be considered less extreme than examples of other ‘bodily fluid’ art that I came across during my research for this article. Many of you reading this may be familiar with the art of English Turner Prize winner Chris Ofili who often incorporates elephant dung into his paintings. However, the late Italian artist Piero Manzoni (who died in 1961 at the age of 29 years) filled ninety 30-gram tin cans with his own faeces (labeled ‘Merda d’artista’ that translates as ‘The Artist’s Shit’). Each in was valued as its weight in gold and the most recently sold can went for about £100,000. It is thought that none of the 90 cans has ever been opened so no-one is entirely sure whether they really contain Manzoni’s excrement or not. In an online essay about Manzoni by Stefano Cappeli, the author briefly made reference to the more psychological (in this case psychodynamic) elements of the faecal artwork:
“Manzoni’s cans of Artist’s Shit have some forerunners in the twentieth-century art, like Marcel Duchamp’s urinal (‘Fontaine’, 1917) or the Surrealists’ coprolalic wits. Salvador Dalì, Georges Bataille and first of all Alfred Jarry’s ‘Ubu Roi’ (1896) had given artistic and literal dignity to the word ‘merde’. The link between anality and art, as the equation of excrements with gold, is a leitmotiv of the psychoanalytic movement (and Carl G. Jung could have been a point of reference for Manzoni). Manzoni’s main innovation to this topic is a reflection on the role of the artist’s body in contemporary art”
Another controversial piece of art containing the artist’s own bodily fluid was American Andres Serrano’s 1987 photograph Piss Christ. The photograph depicts Jesus on a small plastic crucifix drowning in a glass of yellow liquid (i.e., Serrano’s own urine). His artworks also include other iconic statuettes in liquids such as blood and milk. Unsurprisingly, accusations of “cheaping Christianity” have been made towards the artist. But Serrano has consistently stated that Piss Christ is itself “a commentary on the cheapening and commercialization of Christian icons in the modern age”.
Other artists that have incorporated bodily fluids into their artworks include those that have used human sweat (e.g., ‘Waste to Work: Everyman’s Source’ by Daniela Kostova and Olivia Robinson that explores the relationship between work, sweat, pay, and unemployment), vomit (e.g., ‘Nexus Vomitus’ by Millie Brown, a half-hour operatic vomit performance), and menstrual blood (e.g., Ingrid Berthon-Moine’s portrait photographs such as ‘Forbidden Red’ and ‘Rouge Pur’ where lipstick is always replaced by menstrual blood).
The psychological motivations and eccentricities of artists such as Leonardo da Vinci, Van Gogh, Andy Warhol, and Salvador Dali have long been the discussion of both academics and non-academics alike. Abnormal psychology specialist Professor Gordon Claridge noted that many psychological studies have examined the minds of artists. This research has often showed a pattern of unhappy and/or lonely childhoods, and that artists are often highly sensitive individuals that may have experienced trauma (pushing them into art as a form of escapism, self-expression and/or therapy).
A study of 291 world famous men by Dr. Felix Post in a 1994 issue of the British Journal of Psychiatry found that over two-thirds (69%) had a mental disorder of some kind. More specifically, scientists were the least affected by mental health problems, while artists and writers had increased diagnoses of psychosis (i.e., mental conditions that involve losing touch with reality and may in extreme cases result in various types of hallucination). In her 1996 book Touched With Fire: Manic Depressive Illness And The Artistic Temperament, the psychiatrist Dr. Kay Redfield Jamison concluded that, among eminent artists, the rate of depressive illnesses (particularly bipolar disorder) was 20 times more common than in the general population. For instance, Picasso, Gauguin, Michelangelo and Jackson Pollock are all thought to have suffered from bipolar disorder, and Andy Warhol appeared to demonstrate all the signs of Asperger’s syndrome (i.e., a type of autism). Whether those engaged in extreme art activities are any more psychologically prone to mental disorders than ‘normal’ artists remains to be seen.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Capelli, S. (undated). Artist’s shit: Consumption of dynamic art by the art devouring public magic bases – Living sculptures. Located at: http://www.pieromanzoni.org/PDF/EN/Manzoni_Shit.pdf
Frank, P. (2011). Marc Quinn discusses self-portraits made of his own blood. The Huffington Post, June 8. Located at: http://www.huffingtonpost.com/2012/06/08/marc-quinn_n_1581132.html
Jamison, K.R. (1996). Touched With Fire: Manic Depressive Illness And The Artistic Temperament. New York: The Free Press.
Jones, J. (2011). Andres Serrano’s Piss Christ is the original shock art. The Guardian, April 18. Located at: http://www.theguardian.com/artanddesign/2011/apr/18/andres-serrano-piss-christ-shock
May, G. (2013). 10 crazy pieces of art made from bodily fluids. Listverse, July 27. Located at: http://listverse.com/2013/07/27/10-exceptional-pieces-of-art-made-from-bodily-fluids/
Post, F. (1994). Creativity and psychopathology. British Journal of Psychiatry, 165, 22-34
Smith, S. (2011). When blood runs cold. Big Tattoo Planet, June 22. Located at: http://www.bigtattooplanet.com/features/artist-interview/when-blood-runs-cold-dr-rev
Spooky (2012). Dr. Rev’s creepy artworks are painted in blood. Oddity Central, May 8. Located at: http://www.odditycentral.com/pics/dr-revs-creepy-artworks-are-painted-in-blood.html