Monthly Archives: October 2013

Fat chance: The British ‘obesity epidemic’

Obesity has become a major problem across the Western world including Great Britain. Some academic scholars claim that obesity is a natural consequence of ‘food addiction’. While I can share this viewpoint, there are many examples of obese people whose eating behaviour would not be classed as addicted using the addiction components model. However, that does not mean obesity is not a problem. Academically, I only became interested in obesity when I was appointed a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity chaired by Professor Stuart Biddle and led to a major report that we published on obesity and sedentary behaviour in 2010 (see ‘Further reading).

Obesity is measured using a calculation based on a person’s Body Mass Index (BMI). BMI is calculated by dividing a person’s weight measurement [in kilograms] by the square of their height [in metres]. In adults, a BMI of 25kg/m2 to 29.9kg/m2 means that person is considered to be overweight, and a BMI of 30kg/m2 or above means that person is considered to be obese. A recent 2013 report by the Health and Social Care Information Centre presented a range of information on obesity in England drawn together from a variety of sources. The report noted that:

“NICE [National Institute for Health and Care Excellence] guidelines on prevention, identification, assessment and management of overweight and obesity highlight their impact on risk factors for developing long-term health problems. It states that the risk of these health problems should be identified using both BMI and waist circumference for those with a BMI less than 35kg/m2. For adults with a BMI of 35kg/m2 or more, risks are assumed to be very high with any waist circumference”.

The main source of the report’s data on the prevalence of overweight and obesity is taken from the annual Health Survey for England (HSE) that is written by NatCen Social Research, and published by the Health and Social Care Information Centre (HSCIC). Most of the information presented in the 2013 report is taken from the HSE 2011.The main findings were that:

  • The proportion of adults with a normal Body Mass Index (BMI) decreased from 41% to 34% among men and from 50% to 39% among women between 1993 and 2011.
  • The proportion that were overweight including obese increased from 58% to 65% in men and from 49% to 58% in women between 1993 and 2011.
  • There was a marked increase in the proportion of adults that were obese from 13% in 1993 to 24% in 2011 for men and from 16% to 26% for women.
  • The proportion of adults with a raised waist circumference increased from 20% to 34% among men and from 26% to 47% among women between 1993 and 2011.
  • In 2011, around three in ten boys and girls (aged 2 to 15) were classed as either overweight or obese (31% and 28% respectively), which is very similar to the 2010 findings (31% for boys and 29% for girls).
  • In 2011/12, around one in ten pupils in Reception class (aged 4-5 years) were classified as obese (9.5%) which compares to around a fifth of pupils in Year 6 (aged 10-11 years) (19.2%).
  • In 2011, obese adults (aged 16 and over) were more likely to have high blood pressure than those in the normal weight group. High blood pressure was recorded in 53% of men and 44% of women in the obese group and in 16% of men and 14% of women in the normal weight group.
  • Over the period 2001/02 to 2011/12 in almost every year more than twice as many females than males were admitted to hospital with a primary diagnosis of obesity.
  • In 2011, there were 0.9 million prescription items dispensed for the treatment of obesity, a 19% decrease on the previous year.

Using regression analysis, the HSE also examined the risk factors associated with being overweight and obese. For both men and women, being ‘most at risk’ was positively associated with: age; being an ex-cigarette smoker; self-perceptions of not eating healthily; not being physically active; and hypertension. Income was also associated with being ‘most at risk’, with a positive association for men and a negative association for women. It was also reported that among women only, moderate alcohol consumption was negatively associated with being ‘most at risk’.

Another summary report on adult weight published earlier this year by the National Obesity Observatory briefly reviewed the scientific data and concluded that in the UK: (i) an estimated 62% of adults (aged 16 and over) are overweight or obese, and that 2.5% have severe obesity; (ii) men and women have a similar prevalence of obesity, but men (41%) are more likely to be overweight than women (33%); (iii) the prevalence of obesity and overweight changes with age, and prevalence of overweight and obesity is lowest in the 16-24 years age group, and generally higher in the older age groups among both men and women; and (iv) women living in more deprived areas have the highest prevalence of obesity and those living in less deprived areas have the lowest, but there is no clear pattern for men.

The 2013 Health and Social Care Information Centre report also contextualized the obesity problem in the UK by comparing obesity rates with other European countries and worldwide using data published by the Organisation for Economic Co-operation and Development (OECD). In 2012, the OECD has published a number of ‘Health at a Glance’ reports including one on European health comparisons, and one on worldwide health comparisons (published in 2011). The data from these reports was summarised as follows:

“More than half (52%) of the adult population in the European Union reported that they were overweight or obese. The obesity rate has doubled over the last twenty years in many European countries and stands at between 7.9% in Romania and 10.3% in Italy to 26.1% in the UK and 28.5% in Hungary. The prevalence of overweight and obesity among adults exceeds 50% in 18 of 27 EU member states…[Worldwide] more than half (50.3%) of the adult population in the OECD reported that they were overweight or obese. The least obese countries were India (2.1%), Indonesia (2.4%) and China (2.9%) and the most obese countries were the US (33.8%), Mexico (30.0%) and New Zealand (26.5%). Obesity prevalence has more than doubled over the past 20 years in Australia and New Zealand. Some 20-24% of adults in Australia, Canada, the United Kingdom (UK) and Ireland are obese, about the same rate as in the United States in the early 1990s. Obesity rates in many western European countries have also increased substantially over the past decade. The rapid rise occurred regardless of where levels stood two decades ago. Obesity almost doubled in both the Netherlands and the UK, even though the current rate in the Netherlands is around half that of the UK”.

From an addiction perspective, there’s also some interesting data examining the co-relationship between obesity and drinking alcohol. For instance, a 2012 report by Gatineau and Mathrani examining the relationship between obesity and alcohol consumption reviewed the literature and made a number of conclusions. These were that (i) there is no clear causal relationship between alcohol consumption and obesity, although there are associations between alcohol and obesity and these are heavily influenced by lifestyle, genetic and social factors; (ii) many people are not aware of the calories contained in alcoholic drinks; (iii) the effects of alcohol on body weight may be more pronounced in overweight and obese people; (iv) alcohol consumption can lead to an increase in food intake; (v) heavy, but less frequent drinkers seem to be at higher risk of obesity than moderate, frequent drinkers; (vi) the relationships between obesity and alcohol consumption differ between men and women; (vii) excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis; and (viii) there is emerging evidence of a link between familial risk of alcohol dependency and obesity in women.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families.

Gatineau, M & Mathrani, S. (2012). Obesity and alcohol: An overview. Oxford: National Obesity Observatory.

Health and Social Care Information Centre (2013). Statistics on Obesity, Physical Activity and Diet: England, 2013. London: Health and Social Care Information Centre.

Organisation for Economic Co-operation and Development (2011). Health at a Glance 2011. Available at: http://www.oecd.org/dataoecd/6/28/491 05858.pdf

Organisation for Economic Co-operation and Development (2012). Health at a Glance: Europe 2012. Available at: http://www.oecd.org/health/healthatagla nceeurope.htm

National Obesity Observatory (2013). Adult weight. Oxford: National Obesity Observatory.

Flesh start: A beginner’s guide to Windigo Psychosis

In previous blogs I have examined various culture bound syndromes (i.e., a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies). Arguably, one of the most interesting culture bound syndromes is (the much disputed) ‘Windigo psychosis’ that was said to have been reported among Algonquian native tribes (which are among the biggest and most widespread of North American natives and who lived around the Great Lakes of Canada and America). The disorder allegedly comprised individuals who intensely craved human flesh and who believed they would turn into cannibals.

The windigo was a cannibalistic spirit forest creature that appeared in Algonquian legends, and was known by lots of other names and variants (including – among 37 others identified by John Columbo in his 1982 book Windigo – wendigo, weendigo, windiga, waindigo, windago, wihtikow, and witiko). For instance, the Ojibwa tribe (a Native American people originally located north of Lake Huron before moving westward in the 17th and 18th centuries into Michigan, Wisconsin, Minnesota, western Ontario, and Manitoba) believed the windigo was a ferocious ogre that took children away if they did not behave themselves.  More generally, it was believed that the windigo could possess and infect human beings and transform them into cannibalistic creatures. Such cannibalistic practices were said to have begun in times of extreme winter famine when families were isolated and confined to their cabins because of heavy snowfall. Legend also has it that the infected sufferer would have their heart turned to ice.

However, windigo is a disorder that has been continually challenged across many decades as a myth (for instance, Dr. R.H. Prince in a 1992 issue of Transcultural Psychiatric Research Review; Dr. R.C. Simons and Dr. C. Hughes in a 1993 book chapter on culture bound syndrome; Dr. P.M. Yap in a 1967 issue of the Australia New Zealand Journal of Psychiatry). Whether the condition genuinely existed or not, no-one disputes that the number of cases reported over the last hundred years are minimal.

According to John Columbo, the first derivation of the word ‘windigo’ (i.e., the word ‘onaouientagos’ meaning both ‘cannibal’ and ‘evil spirit’) first appeared in print as long ago as 1722 in an account by Bacqueville de la Potherie, a French traveler. Windigo psychosis was said to occur when an individual became highly anxious that they were transforming into a windigo and believed that other humans that they lived among them were edible. Symptoms of the psychosis were said to include nausea, vomiting, poor appetite and anti-social behaviour. In extreme cases, the psychosis was said to produce suicidal tendencies (as a way of preventing possession by the windigo) and/or homicidal tendencies (to eat the human flesh of others). A book (The Lost Valley and Other Stories) written by Algernon Blackwood in 1910 featured a horror story (called ‘The Wendigo’), and was widely believed to be based on the Algonquian windigo legends.

In the 1982 book Windigo: An Anthology of Facts and Fantastic Fiction edited by John Columbo, he noted that:

“Windigo has been described as the phantom of hunger which stalks the forests of the north in search of lone Indians, halfbreeds, or white men to consume. It may take the form of a cannibalistic Indian who breathes flames. Or it may assume the guise of a supernatural spirit with a heart of ice that flies through the night skies in search of a victim to satisfy its craving for human flesh. Like the vampire, it feasts on flesh and blood. Like the werewolf, it shape-changes at will”.

In an online article about ‘culture specific diseases’, Denis O’Neil claims that modern medical diagnoses might label windigo as a form of paranoia because “of the irrational perceptions of being persecuted”. Here, O’Neil argues that it is the windigo monsters who are the persecutors (i.e., the windigo monsters are trying to turn people into monsters like themselves).  O’Neil also argues that in contemporary North American culture “the perceived persecutors of paranoids are more likely to be other people or, perhaps, extra terrestrial visitors”. 

Writing in a 2006 issue of the journal Transcultural Psychiatry, Dr. Wen-Shing Tseng said that it’s important to re-examine the sources of knowledge for each culture-related specific syndrome (including windigo which she also examined). She acknowledged that literature relating to windigo dated back to the 17th century, she made a lot of reference to the work of J.E. Saindon and the Reverend J.M. Cooper who both worked among an Algonquian community in the 1930s. She argued that the reports of both Saindon and Cooper “were based on second-hand information provided by non-clinical observers”. She then noted that the pioneering cultural psychiatrists of the 1950s and 1960s dealt with these early accounts “as though they were well-defined clinical entities with the diagnostic term witiko psychosis”.

In a paper by Dr. Lou Marano in a 1982 issue of Current Anthropology, it was noted that aspects of the Windigo belief complex may have had components in some individual’s psychological dysfunction. However, he concluded that after (i) five years’ field experience among Northern Algonquians, (ii) extensive archival research, and (iii) a critical examination of the literature:

“There probably never were any windigo psychotics in an etic/behavioral sense. When the windigo phenomenon is considered from the point of view of group sociodynamics rather than from that of individual psychodynamics, the crucial question is not what causes a person to become a cannibalistic maniac, but under what circumstances a Northern Algonquian is likely to be accused of having become a cannibalistic maniac and thus run the risk of being executed as such”.

In essence, Marano’s conclusion was that windigo psychosis was simply an artifact of research that was conducted without sufficient knowledge of the indigenous experience.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Colombo, J.R. (1982). Windigo: An Anthology of Facts and Fantastic Fiction. Lincoln: University of Nebraska Press.

Marano, Lou (1982). Windigo psychosis: The anatomy of an emic-etic Confusion. Current Anthropology, 23, 385-412.

O’Neil, D. (2010). Culture specific diseases. October 7. Located at: http://anthro.palomar.edu/medical/med_4.htm

Prince, R. H. (1992). Koro and the Fox Spirit on Hainan Island (China). Transcultural Psychiatric Research Review, 29(2), 119-132.

Simons, R. C., & Hughes, C. (1993). The culture bound syndrome. In A. Gaw (Ed.). Culture, Ethnicity and Mental Illness (pp. 75–99). Washington, DC: APA.

Tseng, W-S. (2006). From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcultural Psychiatry, 43; 554-576.

Wikipedia (2012). Wendigo. Located at: http://en.wikipedia.org/wiki/Wendigo

Yap P. M. (1967). Classification of the culture-bound reactive syndromes. Australia New Zealand Journal of Psychiatry, 1, 172-179.

Yap, P. M. (1969). The culture bound syndromes. In W. Cahil., & T. Y. Lin. (Eds.). Mental Health Research in Asia and the Pacific (pp. 33-53). Honolulu: East West Centre Press.

Shaving accounts: A brief overview of depilation fetishes

In a previous blog I looked at hair fetishism. While researching that blog, I came across what might be considered the opposite (i.e., depilation fetishes – those who derive sexual pleasure and arousal from lack of body hair). The fetish appears to take many different forms and might include being sexually aroused by (i) the sight of a shaved area of the human body such as a bald pubic area, (ii) the sight of someone actually shaving an area of their body (e.g., their pubic region), and/or (iii) the actual act of shaving someone’s body parts. The fetish may overlap with other sexual paraphilias such as olfactophilia (i.e., deriving sexual arousal and pleasure from certain smells) as those individuals with a depilation fetish may find the odour of shaving cream or aftershave products additionally attractive.

Dr. Brenda Love in her Encyclopedia of Unusual Sex Practices devoted a reasonably large section on sexual depilation and claimed that in some countries, the origins of sexual depilation preferences are conditioned by early pre-adolescent experiences. She claimed that:

“Shaving or removal of the pubic hair was practiced in Rome, the Middle East, Japan, China, India, and North Africa. Sex in many of these countries began during pre-pubescence before either partner had developed pubic hair. The male and female became conditioned to respond sexually to bald genitals. Some later in life became impotent at the sight of pubic hair on a partner”.

She also referred to the act of pulling out clusters of pubic hair produce an orgasm in some men. Her research had indicated that this particular type of sexual service was offered in Moorish baths in North Africa, by women who were skilled at this art. A short article on the Alternative Lifestyle website claims that depilation fetishes are usually genitally based and may overlap with those into sexual sadism and sexual masochsim. More specifically:

“Men especially are often attracted to a shaved public area and enjoy watching or performing depilation on a partner. The entire act is often very sensory and erotic. In cases of both female and male depilation, shaving creams usually are applied and lathered which can cause arousal from touch. There is a huge aspect of trust involved in depilation as a fetish too because razors or scissors are in such close proximity to the sensitive genitals. Depilation can also be a fetish is a much different way, especially in BDSM. Because hairstyle is very important in many cultures, dominants often shave the heads of their slaves. This is particularly true in cases when a female is in the submissive role”. 

Such practices were also noted in Dr. Love’s Encyclopedia of Unusual Sex Practices as she noted that depilation or shaving is used in sex play as part of body worship and bondage. She reported that dominant partners “shave their slaves to put them into a psychological role of submission, exposure, humiliation and shame”. It was also noted that depilation may be a necessary for aesthetics in transvestism, infantilism, and/or body painting.

As far as academic research goes, I have only managed to find one study that has specifically examined depilation practices. A paper published in a 2008 issue of the journal Body Image led by Dr. Yolanda Martins (“Hair today, gone tomorrow”) and compared body hair removal practices among gay and heterosexual men. The team based at Flinders University (Adelaide, Australia) A sample of gay (n=106) and heterosexual men (n=228) participated in a survey assessing “whether they had ever removed their back, buttock or pubic hair, the frequency with which they did so, the methods used and their self-reported reasons for removing this hair”. The results showed that most men had engaged in hair removal practices but that heterosexual men (33%) were much less likely than gay men (63%) to have removed their back and/or buttock hair at least once in their lives. In relation to removal of pubic hair, heterosexual men (66%) were again much less likely than gay men (82%) to have removed their pubic hair at least once.

The authors also reported that the frequency of hair removal “was also associated with the motivational salience component of appearance investment”. In laymen’s terms, men basically removed their back, buttock and pubic hair to improve their appearance (either for themselves or others). The men surveyed also reported that they preferred the feeling and sensitivity of smooth skin. Results also showed that the removal of back and buttock hair was never done for sexual and/or fetishistic reasons. However, in relation to pubic hair removal, 9% of gay men and 20% of heterosexual men had removed their pubic hair for sexual and/or fetishistic reasons. It was also reported that 14% of gay men and 10% of heterosexual men had removed their pubic hair to make their genitals look bigger and/or more appealing. Dr. Martins and her colleagues concluded that their findings offered further support to the premise that gay and heterosexual men exhibit similar body image concerns.

In a previous blog on fetishism, I wrote at length about a study led by Dr G. Scorolli (University of Bologna, Italy) on the relative prevalence of different fetishes using online fetish forum data. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). Their results showed that there were 864 fetishists (less than 1% of all fetishists) comprising non-head body hair fetishes including depilation sites, beards, and pubic hair.

As far as I can ascertain, there have been no case studies published examining depilation fetishes. The Sexy Tofu website interviewed ‘Adam’, a 45-year old male depilation fetishist from Illinois (US) about his sexual interest in depilation. Adam was asked about when his interest first occurred:

“It started when I first got pubic hair. I’m not sure why, but my first thought was ‘Shave it’. I did, but I had to be careful as a teenager — having shaved pubes in the boys’ locker room back then would have made me pretty ‘out there’, and I wasn’t ready for that. So I’d shave only during the summers. I didn’t have much chest hair back then but once I got to college and it started growing, I would shave it fairly often. I finally took the plunge and shaved my entire body about 15 years ago. I have remained mostly hairless since…It’s both the act of shaving, changing my body look, and being smooth skinned. I have done some shaving as part of sex. Once I let a woman tie me up and she shaved my pubic hair and my head. That was really a hot scene…Sadly, I have not been able to find too many partners willing to shave me or be shaved”.

Unfortunately, there is too little information provided by Adam in his interview to make any informed speculation as to the causes and/or motivations for his depilation fetish. They obviously started in early adolescence and has developed over the subsequent thirty years. Clearly the visual element is crucial for sexual arousal (but that is the case with most paraphilias and fetishes). Adam’s account also suggests it is a minority interest based on the fact that the number of willing and/or reciprocal partners has been minimal. Like many other fetishes and paraphilias that I have examined in my blogs, this is yet another one where there is a great need for further research.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

The Bedpost (1999). Depilation for the terrified. Located at: http://www.cleansheets.com/archive/archarticles/bdsm_3.10.99.html

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Martins, Y., Tiggemann, M. & Churchett, L. (2008). Hair today, gone tomorrow: A comparison of body hair removal practices in gay and heterosexual men. Body Image, 5, 312-316.

Scorolli, C., Ghirlanda, S., Enquist, M., Zattoni, S. & Jannini, E.A. (2007). Relative prevalence of different fetishes. International Journal of Impotence Research, 19, 432-437.

Sexy Tofu (2011), Fetish Friday: Trichophilia. December 2. Located at: http://sexytofu.com/2011/12/02/fetish-friday-trichophilia-hair-fetish/

Herd in-stink-t: A brief look at cow dung and cow urine therapy

“Hindu nationalists in India have launched a marketing exercise to promote cow’s urine as a health cure. They say the urine, being sold for 30p a bottle, can be used for ailments ranging from liver disease to obesity and even cancer. The urine is being sold under the label ‘Gift of the Cow’, and is being enthusiastically promoted by the government of Gujarat. The urine is collected every day from almost 600 shelters for rescued and wounded cattle, and is available in about 50 centres in Gujarat. It also comes in tablets or a cream mixed with other traditional medicinal herbs and demand is currently outstripping supply…The healing properties of cow dung and cow’s urine are mentioned in ancient Hindu texts and authorities claim research conducted by doctors at the cow-protection commission indicates the urine can cure anything from skin diseases, kidney and liver ailments to obesity and heart ailments. Although most Indian doctors view the medicines as eccentric, several advocates of the treatment have come forward in Gujarat to support the claims…They include Vidhyaben Mehta, a 65-year-old woman with a cancerous tumour on her chest who has been taking cow’s urine for the past three years. She says she is no longer in pain and has survived in spite of medical predictions that she would die two years ago” (News report, India Divine website, February 17, 2002).

As regular readers of my blog will know, I’m not averse to writing about matters concerning bodily waste products (i.e., urine and faeces) in that I have covered urophilia (sexual arousal to urine), coprophilia (sexual arousal to faeces), zoocoprophilia (sexual arousal to animal faeces), copraphagia (eating human and/or animal faeces), and the making of jenkem (fermenting human urine and faeces as a way of getting high and intoxicated). Today’s blog takes a brief look at the use of cow urine and cow dung for allegedly medicinal purposes.

As far as I am aware, the only country in the world that uses cow dung and cow urine to treat disease and illness is India. Much of the reasoning behind the use of cow waste products to treat illness is rooted in Hindu beliefs about the cow. Many of you reading this will be aware of the ‘sacred cow’ in Hindu religion. However, as a number of articles I have read on Hindu culture point out, Hindus don’t actually worship cows (in the sense that they worship a deity), but ‘respect, honour and adore’ them because cows give more than they take, and for Hindus, cows symbolize all other animals. In Hindu religion, the cow also symbolizes dignity, strength, endurance, maternity and selfless service. As one article I read noted:

“To the Hindu, the cow symbolizes all other creatures. The cow is a symbol of the Earth, the nourisher, the ever-giving, undemanding provider. The cow represents life and the sustenance of life. The cow is so generous, taking nothing but water, grass and grain. It gives and gives and gives of its milk, as does the liberated soul give of his spiritual knowledge. The cow is so vital to life, the virtual sustainer of life, for many humans. The cow is a symbol of grace and abundance. Veneration of the cow instils in Hindus the virtues of gentleness, receptivity and connectedness with nature…The generous cow gives milk and cream, yogurt and cheese, butter and ice cream, ghee and buttermilk. It gives entirely of itself through sirloin, ribs, rump, porterhouse and beef stew. Its bones are the base for soup broths and glues. It gives the world leather belts, leather seats, leather coats and shoes, beef jerky, cowboy hats – you name it”.

All over India, the cow is honoured, garlanded and given special feedings at festivals (including the Gopashtama annual festival). But where does the use of cow urine and cow dung come in? Basically, the five products (pancagavya) of the cow – milk, curds, ghee butter, urine and dung — are all used in Hindu worship (puja), in addition to extreme penance rites. As another article I read explains:

“The milk of the family cow nourishes children as they grow up, and cow dung (gobar) is a major source of energy for households throughout India. Cow dung is sometimes among the materials used for a tilak – a ritual mark on the forehead. Most Indians do not share the western revulsion at cow excrement, but instead consider it an earthy and useful natural product…[Over time] Hindus stopped eating beef. This was mostly like for practical reasons as well as spiritual. It was expensive to slaughter an animal for religious rituals or for a guest, and the cow provided an abundance of important products, including milk, browned butter for lamps, and fuel from dried dung”.

As a result of Hinduism’s reverence of the cow, cow urine and cow dung has become big business in India’s Nagpur region. Scientific research into the health benefits of cattle waste products is being carried out by Go-vigyan, a research and development organization. Some of the products that Go-vigyan makes (and I’m not making this up) include cow urine shampoo and cow dung toothpaste.

Cow dung and urine are used in the treatment of several disorders including renal disorders, leucoderma, arthritis, and hyperlipidemia. It’s also been claimed that panchagavya products show excellent agricultural applications. For instance, cow urine and neem leaves have been combined to make pesticides and insect repellent. The best selling medicine in the Nagpur region is Gomutra Ark, which is nothing more than distilled cow urine (Go=Cow, Mutra=Urine, Ark=medicine). Those who take it believe it can prevent and/or cure anything from the common cold to cancer, tuberculosis, and AIDS.

If you go onto YouTube, there are quite a few short video clips showing urine being massaged from cows and dung being collected in cattle sheds. Skilled cow handlers massage and encourage the cows to urinate. There are also clips of Indian women making cow dung soap. I wouldn’t have believed it myself if I hadn’t watched it with my own eyes. You can also check out photos of Indian women undergoing cow dung therapy at the Science Photo Library.

It’s difficult to assess the extent to which there is a placebo effect operating here but there’s no doubting some people’s beliefs that cow dung and urine are miracle cures for a wide range of illnesses and diseases. There’s even a dedicated webpage of testimonials from people who claim they have been cured of their diseases (e.g., AIDS, cancer, heart problems, etc.) by cow urine. I did come across a 2009 academic paper by Dr. R.S. Chauhan and colleagues in The Indian Cow: The Scientific and Economic Journal. They reported that cow urine had been granted U.S. Patents (No. 6896907 and 6,410,059) for its medicinal properties “particularly for its use along with antibiotics for the control of bacterial infection and fight against cancers. Through extensive research studies a cow urine distillate fraction, popularly known as ‘ark’, has been identified as a bioenhancer of the activities of commonly used antibiotics, anti-fungal and anti-cancer drugs”.

The authors reviewed the literature on the use of cow urine for medicinal purposes and reported that cow urine therapy provides promising results for the treatment of cancer. They noted that the anti-cancer potential of cow urine therapy was “reflected by several case reports, success stories and practical feedback of patients for the treatment of cancer”. They claimed that cow urine “enhances the immunocompetence and improves general health of an individual; prevent the free radicals formation and act as anti-aging factor; reduces apoptosis in lymphocytes and helps them to survive; and efficiently repairs the damaged DNA, thus is effective for the cancer therapy”. They also claimed experiments (presumably done in India) proved that cow urine above all other urine was the most medically effective as “scientific validation of cow urine therapy is required for its worldwide acceptance and popularity”. I remain open to the idea that cow urine may be of medical benefit, but remain to be convinced on what I have read to date.

http://www.cowurine.com/testimonials.html

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Chauhan, R.S., Dhama, K. & Lokesh, S. (2009). Anti-cancer property of cow urine. The Indian Cow: The Scientific and Economic Journal, 5(19), 22-58.

Joseph, M. (2004). Cattle, the research catalyst. Wired, November 16. Located at: http://www.wired.com/culture/lifestyle/news/2004/11/65717

Go-Vigyan Anusandhan Kendra (undated). Medical products development. Located at: http://www.govigyan.com/medicalproducts.htm

India Yogi (undated). Why is the cow ‘sacred’? Located at: http://www.indiayogi.com/content/symbolism/answer.aspx?id=3

Nair, R.J. (2010). Cow dung, urine as medicine? Discovery News, March 2. http://news.discovery.com/human/health/cow-dung-medicine-spiritual-india.htm

National Hindu Students Forum (2004). Why do Hindus worship the cow? Located at: http://www.nhsf.org.uk/index.php?option=com_content&view=article&id=526 (reprinted from an article in Hinduism Today)

Religion Facts (2012). The cow in Hinduism. December 21. Located at: http://www.religionfacts.com/hinduism/things/cow.htm

Bitter sweet? A brief look at ‘addiction’ to Candy Crush

Earlier this week, the ‘addictiveness’ of the game Candy Crush made the national newspapers when the Daily Mail published the story with the headline ‘How women blow £400,000 a day playing Candy Crush, the most addictive online game ever’. The Mail article said:

“Look around any busy train or bus and it seems every other person with a smartphone or tablet is hooked on Candy Crush Saga, the latest online game to have taken the world by storm. With its twinkly lights, hypnotic music and comic sound effects, it has millions of people in its grip – and, like 2010’s Angry Birds, which even numbered [British Prime Minister] David Cameron among its fans, it has become an online sensation…An astonishing 700million games of Candy Crush are played every day on mobile devices alone, according to AppData, a leading authority on social media trends. But, unlike so many video games, it appears that instead of teenage boys and men, it’s mostly women who are in thrall to Candy Crush. According to the game’s creators, King.com, women aged 25-55 are the demographic most loyal to the game…According to ThinkGaming, Candy Crush makes an estimated £400,000 a day for King. That’s £146m a year, figures which have prompted the Office of Fair Trading to voice concern that guidelines are needed to stop firms exploiting young users.King claims that 90 per cent of its players are over 21, but maturity doesn’t seem to prevent women…from falling under Candy Crush’s spell”.

I was interviewed by the journalist that wrote the article [Jill Foster] who wanted to know why it was such an ‘addictive’ game and why so many women played it. I told her that Candy Crush is a gender-neutral games that has a ‘moreish’ quality (a bit like chocolate – although this analogy didn’t end up in the article) and can fit in flexibly around what women do in their day-to-day life. The game takes up all the player’s cognitive ability because anyone playing on it has to totally concentrate on it. By being totally absorbed players can forget about everything else for a few minutes. I speculated that this may be particularly appealing to many women whether they are a stay-at-home mother who has ten minutes to play it in between childcare, or a business executive on her commute. It’s deceptively simple and fun. I also noted that unlike many online games, Candy Crush doesn’t involve killing or fighting, and it doesn’t feature strong male characters or highly sexualized female characters. For those of you reading this that have yet to play Candy Crush, the Mail report provided a good description of the game:

“The rules of Candy Crush are indeed simple. Players move a variety of brightly coloured sweets – or candies – around a grid and line up at least three of the same sweet in a row. Every time a row is completed, the line explodes, making way for more sweets to drop in. With more than 400 different stages, each more difficult than the last, and more being added all the time, players never need run out of challenges. As a so-called ‘freemium’ product, basic access to the game is free, but users must pay for ‘premium’ services. Players aren’t charged to advance through the first 35 levels but after that, it costs 69p for another 20 levels, although it is possible to avoid paying by asking your Facebook friends to send you extra lives. However, the cost can rise as players are encouraged to buy ‘boosters’ such as virtual ‘candy hammers’ for around £1”.

In typical tabloid style, the Mail article had interviewed a number of women that were used as examples to demonstrate the existence of Candy Crush ‘addiction’. For instance, Lucy Berkley, a 44-year old company director from Ashford in Kent told of how she came into her office on a Monday morning with severe back pain. All of her work colleagues could clearly see she was in much discomfort. The cause of her back pain was Candy Crush that she had played for ten hours over the weekend hunched over her iPad. She claimed I couldn’t help it, it was so addictive. The extraordinary thing was that almost everyone else in the room admitted they too were addicted. Now we’re all competing”. Another woman, Steph, a mother-of-one interviewed for the Mail article said:

“I’m thinking about it all the time. I call it “crack candy” because I imagine giving up is like trying to break a crack habit. I hadn’t heard of it until I saw that many friends – all intelligent, creative women – were playing it on Facebook. I’ve never played any other game on my phone. But I don’t like going a day without my ‘fix’. I play it whenever I have a free moment. In the morning I play on my commute and when I look around the train, nearly every other person seems to be doing the same. I’ll have a sneaky game or two at lunchtime. When I get home, I’ll leave the ironing or the housework and have half an hour – or more – on the iPad. [At the weekend when] I’ve got up and read the papers, I’ll start playing and that’s me sorted for the next three to four hours. In fact, I only usually stop when my iPad runs out of battery. My boyfriend thinks I’m mad. My son Ben, who is at boarding school, can’t understand my obsession. I’ve been known to meet him off a train and rather than give him a hug I’ve said ‘Just a minute Ben, I’m just getting on to the next level!”

She then went on to say:

“Over the past four months I’ve probably spent around £150 playing it. But it’s worth it…I’m thinking about it all the time. I wake up and the first thing I do is pick up my phone to have a game, then I’ll be playing if I get a spare second before work. I play it on my walk from the car to the office. When I come home, I play it while I’m cooking the evening meal or watching TV. [My partner] Martin thinks I’m bonkers. When the lights go out and we’re in bed he’ll say: ‘I know you’re playing it because I can see the light from your phone’ so I have to play it under the covers. My son asks: “Why are you playing that game again Mum?’ It’s as if our roles have been reversed. It’s taking over my life. I don’t know if I’ll ever be able to stop”.

Although none of the cases covered in the piece appear to be genuinely addicted by the criteria I use to assess addiction, that doesn’t mean the cases are uninteresting psychologically or that games like Candy Crush are totally innocuous. I have noted in a number of my more general writings about games played via social networking sites that ‘freemium’ games are psychological ‘foot-in-the-door’ techniques that lead a small minority of people to pay for games and/or game accessories that they may never have originally planned to buy before playing the game (akin to ‘impulse buying’ in other commercial environments. I’ve also argued that many of the games played on social network sites share similarities with gambling. As I noted in my interview with the Mail:

‘On first look, games like Candy Crush may not seem to have much connection to gambling, but the psychology is very similar. Even when games do not involve money, they introduce players to the principles and excitement of gambling. Small unpredictable rewards lead to highly engaged, repetitive behaviour. In a minority, this may lead to addiction”

Basically, people keep responding in the absence of reinforcement hoping that another reward is just around the corner (a psychological principle rooted in operant conditioning and called the partial reinforcement extinction effect – something that is used to great effect in both slot machines and most video games). Another woman interviewed for the Mail story (Jenni Weaver, a 40-year-old mum of four from Bridlington) is worried that she’s addicted to Candy Crush (and based on her interview quotes, she certainly appears to display some signs of bona fide addictive behaviour) She told the Mail that her Candy Crush addiction was beginning to affect family life:

‘I’m playing it for eight hours a day now and it’s become a real problem. My daughter told me about it. I was hooked straight away. The longest I’ve played for is 12 hours with just a few short breaks in between. It’s worse than smoking…Housework has gone to pot. I’ve even been late picking my ten-year-old up from school because I’ve been stuck on a level. I’ve burnt countless dinners and let vegetables boil dry because I’ve been engrossed. I’m trying to limit myself, but I can still spend eight hours a day playing it. It’s ridiculous.’

Earlier this year, I was interviewed at length by Mike Rose (for Gamasutra, the online magazine about gaming issues), who wrote a really good set of articles about free-to-play games. In one of Rose’s articles I argued that even in games where no money is changing hands, players are learning the mechanics of gambling and that there are serious questions about whether gambling with virtual money encourages positive attitudes towards gambling. As I have noted in a number of my recent articles, the introduction of in-game virtual goods and accessories (that people pay real money for) was a psychological masterstroke. It becomes more akin to gambling, as social gamers know that they are spending money as they play with little or no financial return. The real difference between pure gambling games and some free-to-play games is the fact that gambling games allow you to win your money back, adding an extra dimension that can potentially drive revenues even further. The lines between social free-to-play games and gambling is beginning to blur, bringing along with them various moral, ethical, legal, and social issues. The psychosocial impact of free-to-play games is only just beginning to be investigated by people in the field of gaming studies. Empirically, we know almost nothing about the psychosocial impact of gambling or gaming via social networking sites, although research suggests the playing of free games among adolescents is one of the risk factors for both the uptake of real gambling and problem gambling.

Postscript: Following the Daily Mail story I was also interviewed at length for a story that appeared in Yahoo! News – you can read my in-depth comments here.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Foster, J. (2013). How women blow £400,000 a day playing Candy Crush, the most addictive online game ever. Daily Mail, October 17. Located at: http://www.dailymail.co.uk/femail/article-2463636/How-women-blow-400-000-day-playing-Candy-Crush-addictive-online-game-ever.html

Griffiths, M.D. (2010). Online gambling, social responsibility and ‘foot-in-the-door techniques. i-Gaming Business, 62, 100-101.

Griffiths, M.D. (2010). Gaming in social networking sites: A growing concern? World Online Gambling Law Report, 9(5), 12-13.

Griffiths, M.D. (2012). The psychology of social gaming. i-Gaming Business Affiliate, August/September, 26-27.

Griffiths, M.D. (2013). Social gambling via Facebook: Further observations and concerns. Gaming Law Review and Economics, 17, 104-106.

Hall, C. (2013). Just how addictive are mobile games? Yahoo! News, October 18. Located at: http://uk.news.yahoo.com/how-addictive-are-mobile-games–143654713.html#P1M3U7a

Lagorio-Chaflkin, C. (2013). Candy Crush Saga’s intoxicating secret source. Inc.com, July 25. Located at: http://www.inc.com/christine-lagorio/candy-crush-secret-sauce.html

Pressman, A. (2013). Candy Crush: Insanely addictive today, but likely on borrowed time. The Exchange, July 11. Located at: http://finance.yahoo.com/blogs/the-exchange/candy-crush-insanely-addictive-today-likely-borrowed-time-171103788.html

Rose, M. (2013). Chasing the Whales: Examining the ethics of free-to-play games. Gamasutra, July 9. Located at: http://www.gamasutra.com/view/feature/195806/chasing_the_whale_examining_the_.php?page=7

Tat’s entertainment: A brief look at ‘My Tattoo Addiction’

Regular readers of my blog will be aware that I have taken a passing interest in body tattoos both in relation to those who are sexually aroused by them (see my previous blog on stigmatophilia) and the representation of tattoos in films. I also have to admit that I’ve been watching the UK Channel 4 television series My Tattoo Addiction (mainly because it had the word ‘addiction’ in the title). Although I aim to look at the issue of ‘tattoo addiction’ in more academic terms in a future blog (so apologies for those of you wanting something empirically-based), but I just wanted to quickly examine whether any of the people featured across the television series could be classed in any way as ‘addicted’ to having tattoos.

Most of the time, the programme simply followed various British people where a story involving a tattoo made good (in this case ‘car crash’) television but had nothing to do with ‘addiction’. For instance, one story involved a trans-gendered individual who had his wife’s name tattooed on his arm but then changed gender so she had it changed into another different tattoo representing a symbolic transformation from man to woman. Another moving case story was of a woman who had a double mastectomy following breast cancer and then had nipples tattooed onto her reconstructed breasts following cosmetic surgery. A regular segment followed the events in one of the many tattoo parlours in Magaluf (in the Spanish island of Majorca) where almost all the people filmed were on ‘18-30’ type holidays. All of these appeared to be completely inebriated and having tattoos they would ultimately regret. Most of the cases featured young men and women having the names of people they had met that night and/or bizarre designs (such as the ‘burger nipple’) tattooed on their buttocks (at least that’s the take home message I took from it).

A number of the cases followed described themselves as having an “obsessive personality” and at least two of the cases were arguably obsessed with fictional literary characters that resulted in lots of tattoos (but I’ll come back to them in a minute). One of the men filmed for the documentary was 34-year old Mark from Buckinghamshire, and described by the programme as a “full blown tattoo addict”. He started off having a sole tattoo done when he was 22 years of age “then two, then three…and now it’s crept up on to [his] head”. Mark’s tattoos included one of the glamour model Jordan (i.e., Katie Price) with the words ‘Rape Me’ written across her chest, another of Audrey Hepburn with a sadomasochistic ball gag in her mouth, and another of a prudish Victorian lady reading a pornographic book about anal sex. When asked the reason for getting such extreme tattoos, Mark simply said he liked “the individuality, the outlet, and the shock factor” of his tattoos. Shocking, arguably. Addicted to tattoos? Not by my criteria.

Arguably one of the most sensational segments of the series was the controversial body art styled by tattooist Woody (who had gained much “notoriety for his challenging artwork”) including a tattoo of Adolf Hitler holding a large piece of paper with the words ‘Gas Bill’ on it. Woody claimed he liked his tattoos to “make statements”. The whole of his chest and stomach was taken up with a single tattoo that simply said “Pure F**king Hate” and his back was taken up with a single tattoo that reads “100% C**T” (without the asterisks – I just thought I’d add those for my readers with a sensitive disposition).

Of all the people featured in the series, two most caught my interest (psychologically), Jay – a 29-year old bodybuilder from Kent, and Kathy – a 52-year old woman from Reading. Jay was first described as having a “secret in his attic”. Since he was a boy, he has been an avid collector of super-hero action figures. His whole attic was full of unopened super-hero action figures (thousands of them it looked to me). His collection obsession was argued by Jay to be no different to someone who collects stamps – “just on a bigger scale”. The programme claimed that his “obsession [was] growing and manifesting itself in a new way” because he was getting his back tattooed with eleven large female super-heroes (the programme showed him having his sixth one done in a marathon 10-hour session). The programme narrator then went on to say that although Jay had only just started getting tattooed, he was already giving as much dedication to his tattoos as he was to his collecting.

Jay claimed that whenever he did anything in life he always ‘gave it his all’ and that his reasons for getting super-hero tattoos ran deeper than most.  He has dedicated his whole life “to the pursuit of physical excellence” and in his early twenties competed in the World’s Strongest Man competition. Unfortunately, he had to give it up after a serious heart failure but now devoted to bodybuilding despite being on heart medication for the rest of his life. It appeared to me that Jay was constantly replacing one highly salient activity with another (much like ‘reciprocity’ found in addicts that give up one addiction only to replace it with another).

He was told by a friend to fill his life with “something positive otherwise you’ll self-destruct”. It was during this period that Jay’s interest in super-heroes took on greater significance. It helped him come to terms that he would never reach his dream of becoming the world’s strongest man. I also noticed that around his house there were many items of super-hero memorabilia and accessories along with loads of super-hero DVDs.  Jay questioned himself as to whether he has an obsessive or compulsive behaviour. His response was something that I would wholeheartedly agree with given my views on the differences between healthy and addictive behaviour: “As long as the obsession doesn’t ruin my life, why is it such a bad thing? With what I’ve done it’s given me the life I’ve got…it’s the will to do what I do, the best I can”.

Kathy began her story by recounting that in 2010 she had “stumbled across the book that would change her life forever [about a] young and unassuming girl that doesn’t fit in, and comes to the attention of [a] family…it’s just a love story”. The narrator claimed the book “spoke to Kathy in a way she had never experienced before”. The book in question was Twilight (the young adult vampire-romance novel by Stephanie Meyer). She went and got The Twilight Saga DVDs and became “totally hooked”. The books and DVDs weren’t enough and she started getting Twilight characters tattooed on her body to the point where her whole back is now covered in them, along with her arms, legs, and upper chest. Kathy’s husband Colin was “very tolerant” of Kathy’s tattoos and his only stipulation was that he didn’t want her to have any tattoos on her face. The interviewer asked Kathy if she had an “obsession with Twilight” to which she simply replied that she did. While being filmed at a local tattoo convention, Kathy says that:

Every two weeks after pay day she got another tattoo. At the time of the programme she had undergone 91 hours of tattooing and was just about to have another tattoo put on some remaining space on one of her legs. Most of her tattoos were of (or related to) the character Edward Cullen (played by Robert Pattinson). Kathy’s husband Colin was “very tolerant” of Kathy’s tattoos and his only stipulation was that he didn’t want her to have any tattoos on her face. The interviewer asked Kathy if she had an “obsession with Twilight” to which she simply replied that she did. While being filmed at a local tattoo convention, Kathy says that:

“Tattooing is addictive. This is my form of getting my fix. It’s not a bad thing. Obviously there’s a certain amount of pain [but] it’s what I get a buzz off now”.

Although a late starter in the tattoo world, Kathy said she couldn’t now imagine a life without tattoos and that without them her life would be “very boring” and that she wouldn’t be the person she now is. However, she admitted the tattoos had caused family conflicts. She hadn’t spoken with her brother in five years because he was too embarrassed by her tattoos, and her father refuses to be seen with her in public. Her sisters were more supportive and noticed that the tattoos had brought Kathy “out of her shell”. The tattoos had apparently turned Kathy from a “wallflower” into someone quite extrovert.

I was interested in how she came to tattoing so late in her life. Kathy revealed that became very depressed after the death of her 63-year old mother in 1999 and it was then that her weight started to balloon through overeating, and she developed a very low self-esteem. She refused to have photographs taken and was “ashamed” of what she looked like. After becoming “hooked” on the first Twilight book, she said it gave her life focus. She had now read it so many times she’s had to buy new copies as well read copies had become dog-eared.

She then bought the music soundtracks and then started exercising to the music. She would even exercise in front of the DVDs for two or three hours at a go. It was then she started losing weight and began getting tattoos. She said that the tattoos gave her focus and was a permanent reminder of how she had got her life “back on track” and kept her “feeling young”. The constant new tattoos were “costing [her] a small fortune – just over eight and a half thousand pounds so far”. She then went on to say that in terms of what she has planned in the future, the total cost of the tattooing will be between £17,000 and £25,000. She says it’s keeping her “permanently broke” but despite the cost she’s “not stopping”.

Based on the information in the documentary, both Jay and Kathy appeared to display elements of addictive and obsessive behaviour. However, I would argue that the addictive elements are more to do with something external to the tattoos (i.e., super-heroes and bodybuilding for Jay, and the Twilight story for Kathy) rather than the tattoos themselves (even though Kathy said that the act of getting tattoos was a buzz and addictive). There appeared to be some conflicts in both of their lives (health, financial, and/or family conflicts) although none that suggested that either were truly addicted to anything (tattoos or otherwise). For both of them, the behaviour they engaged appeared to make them feel better about themselves rather than being something negatively detrimental. As I have said time and time again, the difference between a healthy enthusiasm and an addiction is that healthy enthusiasms add to life and addictions take away from them.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Duggal, H.S. & Fisher, B. (2002). Repetitive tattooing in borderline personality and obsessive-compulsive disorder. Indian Journal of Psychiatry, 44, 190–192.

Irwin, K. (2003). Saints and sinners: elite tattoo collectors and tattooists as positive and negative deviants. Sociological Spectrum, 23, 27-57.

Raspa, R.F. & Cusack, J. (1990) Psychiatric implications of tattoos. American Family Physician, 41,1481-1486.

Wohlrab, S., Stahl, J. & Kappeler, P.M. (2007). Modifying the body: Motivations for getting tattooed and pierced. Body Image, 4, 87-95.

The beliefs are falling: The illusion of control in gambling

For the professional gambler, being in control of the situation is paramount. However, one of the psychological ploys that the gaming industry likes to exploit is the fact that gamblers often perceive they have more control than they have in actuality. Probably one of the most single influential contributions to the psychology of gambling was Ellen Langer’s series of experiments on the illusion of control in the 1970s. Her theories were based on the observations that some people treat chance events as controllable. For instance, it isn’t uncommon for dealers and croupiers who experience runs of bad luck to lose their job. Back in the 1960s, sociologists studying craps players noticed those throwing the dice behaved as if they were controlling the outcome of the toss. Typically, craps players threw the dice softly for low numbers and hard for high numbers. In a follow-up experimental investigation, psychologists showed that when playing with dice, people bet less money and were less confident if asked to bet after someone else had thrown the dice rather than throwing it themselves, even though the probability of success was the same in both situations. Ellen Langer argued that these behaviours are totally rational if gamblers believed their game was a game of skill.

The “illusion of control” was defined by Langer as being “an expectancy of a personal success inappropriately higher than the objective probability would warrant.” Put simply, gamblers think they have more chance of winning than they actually do. She tested for this in a series of experimental studies that supported her original idea (that under some circumstances, gamblers will produce skill orientations towards chance events). Langer’s experiments convincingly showed that players bet more when playing cards against a ‘nervous’ competitor than against a ‘confident’ one. She also demonstrated that players would sell previously bought lottery tickets for a higher price if they had picked the numbers themselves as opposed to having them picked by someone else. Her other groundbreaking experiments showed that certain factors such as the nature of the competition, the familiarity of the task, and the degree of personal involvement influence the belief that skill is a controlling force, stimulates the illusion of control, and produces skill orientations. In a later study involving the prediction of ‘heads’ or ‘tails’ after a coin was tossed, she also showed that early wins during chance games induced a skill orientation even though the activity was totally chance determined.

Many regular gamblers (such as roulette players) passionately believe their game is skill-based, and offer explanations of why they failed to win when their number doesn’t come up. Such beliefs have been tested experimentally by US psychologist Thomas Gilovich in a study of the biased evaluations in gambling behaviour. In three studies using people who bet on football games, Gilovich demonstrated that gamblers transformed their losses into ‘near wins‘. Gamblers pinpointed random or ‘fluke’ events that contributed to a loss but were unaffected by identical events that contributed to a win. I’m sure you can all think of instances like this when watching football. When your team loses, it’s not uncommon to berate the referee for a dodgy penalty decision or deride the linesman because he failed to spot an offside. You may end up blaming your team’s loss on one particular event. Had your team won with the dodgy decision going your team’s way, you would probably rationalise it and say your team would have won anyway because of their superior playing ability and skill. Gilovich also reported that gamblers spent more time discussing their losses and discounting them. For example, after a loss, a lot of time may be spent analysing a small incident of a few seconds duration even though the game lasted 90 minutes. What’s more, we make ourselves feel better by blaming the loss on something or someone external. Interestingly, exactly the same effects have been found in gambling activities in which losses could not easily be explained away (such as Gilovich’s experiments using computerised bingo gambling).

Many psychologists have consistently highlighted the irrational perceptions people produce while gambling. Many studies have evaluated the cognitive activities of gamblers while they play on slot machines or roulette using the ‘thinking aloud’ method. This basically involves getting gamblers to think aloud while they are gambling. Typical results have shown that erroneous and irrational perceptions of the gambling activity far outnumber the logical and rational perceptions. In these situations, gamblers attribute their success to personal factors such as skill whereas external factors (like bad luck) account for losses. For instance, in my own research on slot machine gamblers, I found that when slots players were winning they would attribute their success to their playing strategy and skill. When they lost it was because of something external in the gambling environment. For example, someone had put them off by talking to them or watching them while gambling. Similar findings have reproduced by psychological experiments in Canada, Australia and the USA (including some of my own). The illusion of control is just one of the many ways in which a gambler distorts the perceptions of their gambling. These are sufficient enough to show that psychological factors can influence the way in which people gamble and continue to gamble.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Coventry, K. & Norman, A. (1998). Arousal, erroneous verbalizations and the illusion of control during a computer generated task. British Journal of Psychology, 89, 629-645.

Gilovich, T. (1983). Biased evaluation and persistence in gambling. Journal of Personality and Social Psychology, 44, 1110-1126.

Gilovich, T. & Douglas, C. (1986). Biased evaluations of randomly determined gambling outcomes. Journal of Experimental Social Psychology, 22, 228-241.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351-369.

Griffiths, M.D. (2011). Gambling, luck and superstition: A brief psychological overview. Casino and Gaming International, 7(2), 75-80.

Griffiths, M.D. (2013). Is ‘loss of control’ always a consequence of addiction? Frontiers in Psychiatry, 4, 36. doi: 10.3389/fpsyt.2013.00036

Griffiths, M.D. & Wood, R.T.A. (2001). The psychology of lottery gambling. International Gambling Studies, 1, 27-44.

Henslin, J. (1967) Craps and magic. American Journal of Sociology, 73, 316-330.

Langer, E. J. (1975). The illusion of control. Journal of Personality and Social Psychology, 32, 311-328.

Langer, E.J. & Roth, J. (1975). The effect of sequence outcome in a chance task on the illusion of control. Journal of Personality and Social Psychology, 32, 951-955.

Rogers, P. (1988). The cognitive psychology of lottery gambling: a theoretical review. Journal of Gambling Studies, 14, 111-134.

Rogers, P. & Webley, P. (2001). It could be us! Cognitive and social psychological factors in UK National Lottery play. Applied Psychology: An International Review, 50, 181-199.

Taylor, S. E. (1989). Positive illusions: Creative self-deception and the healthy mind. New York: Basic Books.

Wagenaar, W. A. (1988). Paradoxes in Gambling Behaviour. London: Erlbaum.

Clowns’ syndrome: A brief look at coulrophilia

There are various websites that list hundreds of different types of sexual paraphilias. Many of these paraphilias are simply the names of specific phobias with the suffix ‘-phobia’ replaced by the suffix ‘-philia’. Examples of this include: agoraphobia and agoraphilia (fear of the outdoors; sexual arousal from the outdoors), cremnophobia and cremnophilia (fear of steep cliffs and precipices; sexual arousal from steep cliffs and precipices), and kynophobia and kynophilia (fear of getting rabies; sexual arousal from getting rabies). Another sexual paraphilia that often appears in these lists is coulrophilia (sexual arousal from clowns) that I assumed was just based on the opposite phobia (coulrophobia – fear of clowns) and didn’t really exist (especially as it doesn’t appear in either Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices. Furthermore, there is not a single reference to coulrophilia in any academic article or book that I am aware of. The most in-depth piece of text that I came across was this snippet from the online Urban Dictionary that notes:

“Coulrophilia is the paraphilia involving sexual attraction to clowns, mimes and jesters. The most likely reason behind this is because of lack of childhood, but some say the attraction is because the person behind the face paint could be anybody that you may or may not know”

I had all but given writing up a blog on coulrophilia until I (by chance) stumbled upon an online forum where a group of people were discussing their respective clown fetishes. I’ve picked out some of the more interesting admissions and have attempted to provide a little commentary on each extract and then a more general summary at the end of the blog. Obviously I have no way of knowing how truthful any of these accounts are, but they appeared genuine to me (particularly given the detail that some of them go into).

Case 1 (Gay male): “I think my fetish started out as more of a fetish for face painting, which has turned me on [for] as long as I can remember…Until I found this [paraphilia] site I always thought I was pretty much alone. Most of the comments I’ve seen elsewhere revolve around scary clowns. Not for me. My face paint interest has always been about silly, the sillier the better! That goes for clowns too, the clown face always seemed like the goofiest, silliest face paint you could possibly put on. One thing led to another and I went from painting my face to buying a clown nose, to the whole deal, costume, paint, wig, gloves, bow tie, shoes, you name it. I think for me the turn on comes from the willingness to look silly. I’ve always been very stoic and uptight to a fault, I find it very hard to let my hair down and relax. So, I think it’s the fear of being silly in front of other people that gives me a rush. To see someone not only look goofy in front of other people, but to actually want to do it, and enjoy it, is overwhelming to me…Although most people don’t find this stuff sexual and would never know the difference, in my mind I’d be doing something private out in the open. My partner has been wonderful with this. I got up some incredible courage one day and put on a clown nose in front of him and to my surprise he wasn’t the least bit put off. I eventually felt him out a bit more here and there and then just told him everything, since then he’s been very supportive and helped me embrace my fetish and the happiness it brings me”.

Commentary: This person notes that their initial sexual arousal dates back (presumably) to childhood, and was for face painting rather than clowns. It appears there was a gradual generalization process that changed the sexual focus from face painting to clowns. In addiction terminology, this individual seems to have developed a kind of ‘tolerance’ over time as the sexual focus went from just buying a clown nose to gradually buying the whole costume to satisfy their sexual needs. The ‘high’ or ‘buzz’ came from the silliness associated with wearing clown’s clothing although I am unsure as to whether it is genuinely just the ‘silliness’ or whether it might be some sort of feeling humiliated (but that’s pure speculation on my part). Given the partner supports the fetish, there is no problem with the behaviour. The fetish only appears to be manifested when the individual wears the clown outfit himself.

Case 2 (Heterosexual male): “I am a very lucky man. Roughly ten years ago, I completely opened up to my then girlfriend of a few months, admitting everything to her…That I loved seeing girls get pied in the face and have buckets of slime dumped on their heads. And that what I promoted as an irrational fear of clowns was to hide the fact that I actually was heavily aroused whenever I saw a female clown. That I really just wanted to dress in baggy pants, wear greasepaint and a big red nose, hurl pies, spank with rubber chickens and have a good silly ****. She said ‘okay’. It was no big deal. Years of repression and guilt and I had nothing to fear. She loved me and was willing to indulge in my fetish sparingly. I felt like the luckiest guy in the world”.

Commentary: As with Case 1, the partner was supportive of the fetish (following an ‘opening up’ conversation) and therefore there is no problem. Interestingly, the person pretended to be afraid of clowns as a way of masking his true feelings (and is something that is not unusual in the more general fetish literature). The most interesting observation is the fact that there is also a crossover with ‘pie fetish’ (the throwing of pies at people) that is a form of salirophilia (sexual arousal for messiness) that I outlined in a previous blog. The reference to spanking with ‘rubber chickens’ may also suggest (at least in part) a spanking fetish. The fetish appears to be located in the visual attraction to women in clown’s clothing rather than wearing it himself.

Case 3 (Bisexual male): “I have always had a clown fetish as long as I can remember. Even before I knew what arousal was, or fetishes for that matter, any of it, I have been strangely interested in clowns. I used to think of clowns before I went to sleep at night…I honestly thought it was because I hated clowns and wanted to fight them, but I realize it was the other way around. I would imagine myself at an entire circus surrounded by clowns and going on adventures to fight them…So I don’t remember thinking about clowns that much after I was really young until puberty hit…Throughout my teens and beyond, I’ve fantasized about clowns. I’ve also have always liked both sexes of clowns, male and female. My fetish can work with both, honestly…I’ve always been into a classical clown look, circus type, hilarious and silly…In my late teens and early adulthood, when the internet was becoming more common, I would talk to others that had clown feelings like me. It was a shock, at the time, to log online to look up pictures of clowns and suddenly realize that others had your fetish. As tame as my fetish is, it honestly takes up the primary desire of my sexuality and to meet others that felt the same way, it was cool. Clowning also introduced me to the pie fetish, which I like as well but honestly, it’s the clowning that does it for me”.

Commentary: This person’s clown fetish again began at an early age and appears to have built through thinking about clowns before going to sleep every night (and thus sexualizing the content even if the individual was unaware that the content was sexual. There appears to be what Sigmund Freud would call a latent period (the years before puberty) when the sexualization of clowns all but disappeared only to re-appear in his teenage years (i.e., am adolescent ‘awakening’). Like Case 2, it appears the individual is sexually aroused by watching clowns (irrespective of gender) rather than dressing up as a clown himself. Also like Case 2, he mentions an associated ‘pie fetish’ (i.e., a possible salirophilia crossover fetish). He describes is love of clowns as his “primary desire” indicating that it may well be a true fetish rather than just a strong liking for clowns. It appears he has met other like-minded coulrophiles on the internet, and as I argued in one of my recent papers on paraphilias, it is the rise of the internet that has facilitated the growth of this little known paraphilia.

Case 4 (Heterosexual female): “I’m an 18 year old chick and well I’m not sure how it all started. But I’ve always thought of clowns as being so sexual and crazy. I get turned on by the way they act and make perverted jokes. The make-up and clothes are really fun and exciting. Recently I went to Halloween horror nights and had a blast. At the center of the amusement park there were these clowns just messing with people and scaring them…The main clown was on a podium…I went to go get a picture with him and…he said ‘hey how about me and you go behind that ice-cream truck and I give u a little popcicle treat eh?’…He pulled me closer to him with the cane and I almost went crazy. I wanted to **** that guy in the costume so bad. I don’t see clowns as innocent childhood ideas. I see them more as erotic fantasy sex trips”

Commentary: This person is unsure of how her clown fetish began but appears to suggest it started back in her childhood given she “always thought of clowns as sexual”. It is unclear whether this person’s experiences of coulrophilia have gone beyond masturbatory fantasies but does seem to have a clown fetish rooted in make-up and dressing-up (two activities that she may have enjoyed as a child and more likely to be encouraged by parents as she was female rather than male).

Case 5 (Bisexual male): “Well, at first I never really liked clowns. In fact, I hated them but I was never afraid of them…One day, I went to my granny’s house after school. I had this one massage ball/stress ball or whatever and occasionally put it close to my nose and looked in the mirror and thought it looked like a clown nose. But this particular day, I had this odd thought that my math teacher wanted me to dress up as a clown and entertain some younger kids to bring out my happiness or some crap like that. The thought seemed stupid to me at first, but at my granny’s house I was known for being mischievous, curious, overly imaginative, and above all weird. So I had to try it and pretend. I made a hole in the ball so it could fit on my nose, got some of my granny’s old baggy scrubs, some fluff, and markers. I sort of looked like a clown so I danced around a bit and made silly faces in the mirror then I put the costume away. A couple days later I was at my granny’s house again and I had the ball on my nose again and I had the urge to masturbate…After I would go to my granny’s house every now and again and I had the urge to masturbate but with the ball on my nose. It never occurred to me that I needed the ball to masturbate with but without it, it wouldn’t feel as good. Eventually, I started picturing myself in a full clown suit with make-up on when I masturbated…I realised that I had a sexual attraction to clowns and I would fantasise about them…I fought this fetish for years…[At school] in the drama room…I found a real clown nose in there…and I had so much fun with it but I would always feel guilty afterwards…Now I can be attracted to someone without being a clown but if they are dressed as clowns, it turns me on waaaay more. So now I’m bisexual and I have a clown fetish”.

Commentary: This person’s sexual interest in clowns doesn’t appear to have begun until the onset of puberty, and even then it was only through associative arousal where the masturbatory spherical stress ball eventually represented a clown’s nose. The clown’s nose is then becomes central to all masturbatory fantasies so much so that it has to be present for sexual arousal to manifest itself (and thus a true fetish). As with Case 1, there is a kind of ‘tolerance’ behaviour where more and more aspects and items of a clown’s clothing have to be present to feed the sexual fantasies. There also appears to have been some associative pairing (i.e., a classically conditioned response) between an attractive teacher and the thought of him as a clown entertaining the children in his class.

Case 6 (Gay male): “I honestly do not recall when I started liking clowns, I was not a big fan of the circus and I do not remember seeing lots of clowns on TV or in real life… Somewhere in high school, I remember seeing some guys with their faces painted (I recall being at some sort of carnival or fair). One of these guys had his face painted like a clown…I remember being mesmerized by his painted clown face. I started fantasizing about myself painted up like a clown. Then I started having fantasies about a guy dressed up like a clown coming up to me and painting my face like a clown. These fantasies stuck with me for years. I knew they excited me, but was not ready to admit to myself that I found clowns sexy…A couple years later I was in some store, around Halloween…Suddenly my eyes focused on a clown makeup set…I painted my face up like a clown – it was amazing! There is just something about becoming a clown, your face underneath all that makeup, it’s silly, exciting, humiliating, liberating, and sexy all at the same time, at least for me…Several times during college I grew a beard, but I would always end up shaving it off, so I could paint my face up like a clown…I find it is such a turn on to think of a guy protesting, adamantly refusing to wear clown makeup and a clown costume, swearing up and down he is not a clown, will NOT dress up like a clown, yet somehow he ends up dressed and painted up like a clown anyway…Somewhere in my childhood I also discovered I love seeing guys hit in the face with a nice, thick cream pie (and of course getting hit in the face with a pie or twenty myself)…Becoming a clown and being pied is a big turn on for me…I would love to find a guy someday who understood this, who loved to take or throw a pie, loved clowns or loved being a clown”.

Commentary: This person does not recall how his clown fetish developed but given he did not like circuses or clowns in childhood it is something that developed during adolescence. There was clearly a key incident of seeing someone with a painted face and feeling sexually attracted towards that person which initiated the fetish (again through associative pairing). As with Cases 2 and 3, there is also a salirophilic pie fetish and he loves to dress up as a clown himself as well as finding other people dressed as clowns sexually arousing. He also describes the act of dressing in clown’s clothes as simultaneously “silly, exciting, humiliating, liberating and sexy”. Again, this suggests there are some sexually masochistic desires underlying the behaviour. He also says that “being pied” is a sexual turn-on (which again has sexually masochistic undertones).

Case 7 (Male, unknown sexual orientation): I loved clowns ever since I was about 5 [years old]. I don’t know exactly how it started (probably me seeing them on TV)…but one night I decided that I really wanted to be a clown. This gradually grew into a full-blown fetish as I got older, and I would create fantasies about them and masturbated whenever I had time alone…Above all things, I had always wanted a clown nose. For some reason, that part of the costume just turned me on the most (especially the honking ones)…Oddly enough, when I’m not thinking about clowns, I am a VERY serious, nerdy, and down-to-earth student…After a trip to the grocery store in my mom’s car, I decided to take a detour to a party/costume place nearby and pick up everything clown-related that I wanted. Ironically, most of my fantasies involve other people laughing at my stupidity, despite the fact that my friends are convinced in real life that I can’t take a joke…The few friends who actually know about my fetish are generally supportive”.

Commentary: This person’s clown fetish appears to have started in early childhood as they “loved” clowns from an early age. As with other cases discussed here, masturbatory fantasies appear critical to the development and maintenance of the fetish through repeated associative pairing of fantasies about clowns and sexual arousal. Interestingly, this person appears to use the dressing up in clown’s clothing as an escape from his day-to-day life. As with Case 1, the clown’s nose appears pivotal in the development of their sexual fetish. This person appears to only derive sexual arousal from dressing in clown’s clothing himself (as a form of escape) rather than watching other people dressed as clowns. There is also a masochistic element to the behaviour as he admits that he enjoys others laughing at his “stupidity” at wearing a clown’s outfit.

Looking at all the cases as a whole, there are some commonalities – even among such a small number of cases. On the whole, coulrophilia appears to originate from a young age, mostly male-based, and arguably there appear to have been associative pairings from this young age (between sexual arousal and clowns) resulting in classically conditioned behavioural responses (i.e., sexual attraction to clowns). There also appear to be overlaps with other sexually paraphilic behaviours (i.e., salirophilia in the form of ‘pie fetishes’ and transvestic dressing-up). Also, Halloween appears to be a time that some enjoyed as an annual opportunity to engage in their preferred sexual behaviour. There didn’t seem to be any association between coulrophilia and sexual orientation as even among such a small number of cases, there were homosexual, bisexual and heterosexual orientations. Whether any empirical or clinical research into coulrophilia will ever be carried out remains debatable, but these few cases at least suggest the paraphilia may exist.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Fighting talk: How much should we worry about the playing of violent video games?

The following blog is based on an article I had published in the October 4 (2013)  issue of video game magazine MCV Interactive Entertainment Weekly. 

The issue of video game violence has once again arisen following allegations that Aaron Alexis, the man who killed 12 people last month (September 16, 2013) at the Washington Navy Yard, played violent video games for up to 18 hours a day. I was asked to comment by various national newspapers on whether the playing of violent video games had any role in the subsequent killings.

While there’s a growing body of research (particularly in America) that claims there’s a link between the playing of violent video games and subsequent behaviour, the problem with most of it is that it doesn’t follow people over a long period time. In short, most of the research is what we researchers call ‘cross-sectional’ – it only examines players at one particular ‘snapshot’ in time. As a result, I don’t think that there is any scientific research shows a definite link. Furthermore, much of the research has been carried out has been experimental and carried out in non-ecologically valid settings (i.e., in a laboratory setting). In fact, all of the measures used to assess “aggression” are proxy measures that are not related to actual violent actions (because it is unethical to try and induce actual violent acts within a research experiment).

The published survey studies – including my own – are mostly of a correlational nature and none of these demonstrate causality (only that – at best – there may be an associative link). One of the major problems with all of the research is that studies typically fail to take into account all the other types of violence that individuals are exposed to day-to-day (such as the violence they see on the news, the violence they see in films and television, and the violence seen in their own lives and local community). Another problem is that many academic journals only publish studies that show statistically significant findings (meaning that they are more likely to publish a study that suggests a link between playing violent video games and subsequent aggression rather than those that do not).

Personally, I believe people like Alexis were pre-disposed towards violence to start with and there was probably something inherently wrong with him in the first place (particularly as some reports claim that he often heard hallucinatory voices suggesting some kind of psychosis). Therefore, someone like Alexis would choose or seek out the most violent video games to play, and to watch the most violent and bloodthirsty films.

Someone like Alexis may have had an inherent trait towards violence that meant he sought those particular activities out. Video games may have had an influence in informing how he might do something and give him ideas, but they are unlikely to be the root cause of any actual violence. If I played those games all day every day, I really don’t think it would turn me into a homicidal maniac. Alexis may have been exposed to violence when he was younger because research shows what we’re exposed to in our childhoods has a great influence in later life.

I must have watched thousands of violent events (both fictional and real) and I have played the occasional violent video game but it hasn’t changed my behaviour in any way (at least I don’t think it has). Saying that, I’m a father to three screenagers and I don’t let them play violent video games. Just because I don’t personally think the evidence shows there’s a link, that doesn’t mean there isn’t any effect. It’s just science has failed to demonstrate a conclusive cause.

It’s not about putting the blame on the game. At best, playing violent video games is at best a contributory factor to violence. But it shouldn’t be a scapegoat because all individuals have to take responsibility for their actions.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Anderson, C.A., Gentile, D.A., & Dill, K.E. (2012). Prosocial, antisocial and other effects of recreational video games. In D.G. Singer, & J.L. Singer (Eds), Handbook of Children and the Media, Second Edition, (pp. 249-272). Thousand Oaks, CA: Sage.

Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B.J., Sakamoto, A., Rothstein, H.R., & Saleem, M. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in Eastern and Western countries. Psychological Bulletin, 136, 151-173.

Bartlett, C. P., Anderson, C.A. & Swing, E.L. (2009). Video game effects confirmed, suspected and speculative: A review of the evidence. Simulation and Gaming, 40, 377-403.

Ferguson, C. J. (2007). Evidence for publication bias in video game violence effects literature: A meta analytic review. Aggression and Violent Behavior, 12, 470-482.

Ferguson, C. J. (2013). Violent video games and the supreme court: Lessons for the scientific community in the wake of Brown v. Entertainment Merchants Association. American Psychologists, 68, 57-74.

Ferguson, C. J., San Miguel, S. & Hartley, T. (2009).  Multivariate analysis of youth violence and aggression: The influence of family, peers, depression and media violence. Journal of Paediatrics, 155, 904-908.

Gentile, D. A. & Stone, W. (2005). Violent video game effects in children and adolescents: A review of the literature. Minerva Pediatrics, 57, 337-358.

Griffiths, M.D. (1998). Video games and aggression: A review of the literature. Aggression and Violent Behavior, 4, 203-212.

Griffiths, M.D. (2000). Video game violence and aggression: Comments on ‘Video game playing and its relations with aggressive and prosocial behaviour’ by O. Weigman and E.G.M. van Schie. British Journal of Social Psychology, 39, 147-149.

Grüsser, S.M., Thalemann, R. & Griffiths, M.D. (2007). Excessive computer game playing: Evidence for addiction and aggression?  CyberPsychology and Behavior, 10, 290-292.

McLean, L. & Griffiths, M.D. (2013). The psychological effects of videogames on young people. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 31(1), 119-133.

McLean, L. & Griffiths, M.D. (2013). Violent video games and attitudes towards victims of crime: An empirical study among youth. International Journal of Cyber Behavior, Psychology and Learning, in press.

Mehroof, M. & Griffiths, M.D. (2010). Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety and trait anxiety. Cyberpsychology, Behavior, and Social Networking, 13, 313-316.

Swearing blind: A brief look at Anton-Babinski Syndrome‬

The last time I examined some aspect of blindness in my blog was when I examined amaurophilia, a sexual paraphilia where the individual derives sexual pleasure and arousal “by a partner who is blind or unable to see due to artificial means such as being blindfolded or having sex in total darkness”. In today’s blog I briefly examine Anton-Babinski Syndrome (ABS), a rare symptom of occipital lobe brain damage in which sufferers who are “cortically blind”, adamantly claim they are capable of seeing and/or experiencing strange hallucinatory episodes. Consequently, confabulation is common among ABS sufferers. (Confabulation is viewed as a memory disturbance characterized by verbal statements or actions that do not accurately reflect the facts and evidence. Some have described it as “honest lying” because the person usually has no intention of to deceiving the people they are talking to and are usually unaware that the things they are saying are false). For instance, Raj Patel in a 2009 book The Value of Nothing reported one female ABS patient saw a new village outside her window that she couldn’t recall being built. On another occasion she saw a girl in her house that she claimed needed food.

ABS was named after Gabriel Anton (an Austrian psychiatrist and neurologist) and Joseph Babinski (a French neurologist of Polish heritage), and is a form of anosognosia (i.e., an unawareness of severe bodily impairment or disability) that typically arises following a stroke or head injury. According to a 2009 case report by Dr. M. Maddula and colleagues in the Journal of Medical Case Reports, ischemic cerebrovascular disease is the most common etiology of cortical blindness in ABS. A literature review in a 2012 issue of the Journal of Behavioral and Brain Science notes that other diseases described as causes of cortical blindness leading to ABS are “MELAS [Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], preeclampsia, obstetric hemorrhage, trauma, adrenloeucodistrophy, hypertensive encephalopathy and angiographic procedures”.

In the late 1890s, Anton described three patients (one denying blindness, one denying deafness, and one denying left-sided paralysis) although it was Babinski that coined the term ‘anosognosia’ in 1914 (derived from the Greek for ‘lacking knowledge about disease’). Similar cases were then published sporadically over the next 50 years including Pötzl (1924), Nielsen (1946), Hécaen and de Ajuriaguerra (1954), Levin, Povorinsky, and Tonkonogy (1961), and Hécaen (1972). Some view this condition as the conceptual opposite of blindsight. The Wikipedia entry on ABS notes that:

“The sudden development of bilateral occipital dysfunction is likely to produce transient physical and psychical effects in which mental confusion may be prominent. It may be some days before the relatives, or the nursing staff, stumble onto the fact that the patient has actually become sightless. This is not only because the patient ordinarily does not volunteer the information that he has become blind, but he furthermore misleads his entourage by behaving and talking as though he were sighted. Attention is aroused however when the patient is found to collide with pieces of furniture, to fall over objects, and to experience difficulty in finding his way around. He may try to walk through a wall or through a closed door on his way from one room to another. Suspicion is still further alerted when he begins to describe people and objects around him which, as a matter of fact, are not there at all. Thus we have the twin symptoms of anosognosia (or lack of awareness of defect) and confabulation, the latter affecting both speech and behaviour”.

According to the US National Institute of Health, ABS affects less than 200,000 people in the whole of the US population. ABS sufferers typically explain their bruises and injuries as a result of clumsiness or absentmindedness (rather than poor vision or blindness). Consequently, confabulation is often a way in which ABS can be diagnosed.

There are a number of theories as to how ABS occurs as no-one knows for sure why patients deny they are blind. One school of thought is that visual cortex damage may result in an inability to communicate with the brain’s speech-language areas (i.e., visual information is received but not interpreted correctly and a verbal response is confabulated). In fact, Dr. G. Goldenberg and colleagues in a 1995 issue of the journal Neuropsychologia claim that damage to the visual association cortex is thought to be one of the main causes explaining the loss of awareness of the visual deficit. Others postulate that ABS patients are simply having hallucinatory sensations (unrelated to their actual surrounding reality).

In a 1978 French neurology journal, Dr. J.M. Verret and Dr. J. Lapresle described a female ABS patient presenting with an accompanying delusional conviction in which she “recognised her left upper limb with the aid of her right hand, but immediately denied its existence when she viewed it directly. In contrast, when placed in front of a mirror, she recognised this upper limb perfectly, recognition disappearing again when direct vision was associated with vision in the mirror”. The authors suggested there was a possibility of a resurgence in adult life of the duality of the visual body image, direct or reflected, such as is normally experienced in childhood and, more prolonged, in identical twins.

The most recently published paper on ABS was a 2012 paper by Dr. Juan Carvajal and his colleagues in the Journal of Behavioral and Brain Science. They reported the cases of two ABS patients. The first was a 96-year-old male with visual anosognosia secondary to cerebral artery thrombosis, and the second was a 56-year-old female with ABS secondary to central nervous system angiitis in relation with multiple sclerosis and Hashimoto’s thyroiditis. They reported that although ischemic vascular cerebral disease is a frequent etiology with ABS (as noted above), they believed that this was the first report of ABS in relation to angiitis with a clear autoimmune pathogenesis. ABS can be treated with cognitive therapy although in some instances it may simply fade away over time (but most in the medical profession recommend treatment rather than just letting it fade).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Anton, G. (1898). Über Herderkrankungen des Gehirns, welche vom Patienten selbst nicht wahrgenommen werden. Wiener klinische Wochenschrift, 11, 227–229.

Anton, G. (1899). Über die selbst wharnehmoung der herederkrankungen des gehirns durch den kranken der rindenblindheit und rindentaubheit. Archiv für Psychiatrie und Nervenkrankheiten, 32, 86–127.

Babinski, J. (1914). Contribution à l’étude des troubles mentaux dans l’hemiplegie cerebrale (anosognosie). Revue Neurologique, 27, 845–847.

Carvajal, J.J.R., Cárdenas, A.A.A, Pazmiño, G.Z., & Herrera, P.A. (2012). Visual anosognosia (Anton-Babinski Syndrome): Report of two cases associated with ischemic cerebrovascular disease. Journal of Behavioral and Brain Science, 2, 394-398.

Critchley, M. (1953). The parietal lobes. London: E. Arnold and Co.

Goldenberg, G., Mullbacher, W. & Nowak, A. (1995). Imagery without perception: A case study of anosognosia for cortical blindness. Neuropsychologia, 33, 1373-1382.

Hécaen, H. (1972). Introduction a la neuropsychologie. Paris: Larousse.

Levin, G. Z., Povorinsky, Y. A., & Tonkonogy, J. M. (1961). Analysis of the case with agnosia of faces developed after air embolism of cerebral vessels [in Russian]. In G. B. Abramovich & G. Z. Levin (Eds.), Problems of Localization and Focal Diagnostic in Neurology and Psychiatry (pp. 111-123), Leningrad: Bechterev Institute Press.

Maddula, M., Lutton, S. & Keegan, B. (2009). Anton’s Syn-drome due to cerebrovascular disease: A case report. Journal of Medical Case Reports, 3, 9028.

McGlynn, S.M. & Schacter, D.L. (1989). Unawareness of deficits in neuropsychological syndromes. Journal of Clinical and Experimental Neuropsychology, 11, 143-205.

Misra, M., Rath, S. & Mohanty, A.B. (1989). Anton Syndrome and cortical blindness due to bilateral occipital infarction. Indian Journal of Ophthalmology, 37(4), 196.

Nielsen, J. M. (1946). Agnosia, apraxia, aphasia: Their value in cerebral localization. New York: Hoeber.

Patel, R. (2009). The Value of Nothing: How to Reshape Market. London: Portobello Books.

Poetzl, O. (1924). Uber die Storungen der Selbst wahrnehmung bey linksetiger hemiplegie. Zeitschrift für Neurologie und Psychiatrie, 93, 117–168.

Verret, J.M. & Lapresle, J. (1978). [Anton-Babinski syndrome with recognition of the left upper limb on visualization in a mirror] (Article in French). Rev Neurol (Paris), 134, 709-713.

Wikipedia (2012). Anton-Babinski Syndrome. Located at: http://en.wikipedia.org/wiki/Anton–Babinski_syndrome