Category Archives: Psychological disorders
The beast inside: The psychology of animal torture
A few days ago, I was interviewed by the Irish newspaper The Journal about someone deliberately trying to poison a dog by throwing three rat poison-stuffed chorizo sausages into Linda O’Byrne’s garden. But what typically possesses anyone to inflict such acts of intentional animal torture and cruelty (IATC)? In this particular case it may have been done as an act of revenge or as a way to shock O’Byrne to the amusement of the person who did it.
In addition to these reasons, rhere are many types of IATC including individuals that do it (i) as a religious ritual sacrifice, (ii) as an ‘artistic’ sacrifice (e.g., killing animals in films such as the controversial Cannibal Holocaust), (iii) because they have psychological disorders (such as anti-social/psychopathic personality disorders and engage in deliberate acts of zoosadism), and/or (iv) because they have sexually paraphilic disorders (such as crush fetishism in which small animals are crushed for sexual pleasure). Additionally, there is some research showing that in some circumstances, IATC is sometimes used to coerce, control and intimidate women and/or children to be silent about domestic abuse within the home. Although any animal torture is shocking, arguably the most disturbing type of IATC is that which occurs amongst those with anti-social personality disorders.
When the science of behavioural profiling began to emerge in the 1970s, one of the most consistent findings reported by the FBI profiling unit was that childhood IATC appeared to be a common behaviour among serial murderers and rapists (i.e., those with psychopathic traits characterized by impulsivity, selfishness, and lack of remorse). Many notorious serial killers – such as Jeffrey Dahmer – began by torturing and killing animals in their childhood. Dahmer also collected animal roadkill, dissected the remains, and masturbated over the animals he had cut up. Other killers known to have engaged in childhood IATC include child murderer Mary Bell (who throttled pigeons), Jamie Bulger’s murderer Robert Thompson who (who was cruel to household pets), and Moors murderer Ian Brady (who abused animals).
IATC is one of the three adolescent behaviours in what is often referred to the ‘Homicidal Triad’ (the other two being persistent bedwetting and obsessive fire-setting). Some criminologists and psychologists believe that the combination of two or more of these three behaviours increases the risk of homicidal behaviour in adult life. However, scientific evidence for this has been mixed. There has also been research into some of the contributory factors as to why a minority of children engage in IATC. Research has shown that the behaviours in the ‘Homicidal Triad’ (including IATC) are often associated with parental abuse, parental brutality (and witnessing domestic violence), and/or parental neglect.
A number of criminological studies have shown that around a third to a half of all sexual murderers have abused animals during childhood and/or adolescence (although I ought to add that sample sizes in most of these published studies are usually relatively small). However, most research has reported that one of the most important ‘warning signs’ and risk factors (specifically relating to the propensity for sex offending), is animal cruelty if accompanied by a sexual interest in animals. Other researchers have speculated that the zoosadistic acts among male adolescents may be connected to problems of puberty and proving virility.
Another ‘triad’ of psychological factors that have been associated with IATC are three specific characteristics of personality – Machiavellianism, narcissism, and psychopathy (the so-called ‘Dark Triad’). Studies carried out by Dr. Phillip Kavanagh and his colleagues have examined the relationship between the three Dark Triad personality traits and attitudes towards animal abuse and self-reported acts of animal cruelty. They found that the psychopathy trait is related to intentionally hurting or torturing animals, and was also a composite measure of all three Dark Triad traits.
In Germany, there have been an increasing number of violent crimes against horses. This offence of ‘horse ripping’ (i.e., violently cutting, slashing and/or stabbing of horses) has been accepted as a criminal phenomenon in Germany and has led to a number of studies on the topic. Horse ripping has been defined as a destructive act “with the aim to harm a horse or the acceptance of a possible injury of a horse, especially killing, maltreatment, mutilation and sexual abuse in sadomasochistic context”. In 2002, German researchers Dr, Claus Bartmann and Dr. Peter Wohlsein reported a study examining 193 traumatic horse injuries over a four-year period. They reported that at least ten of the injuries (including wounds from knives, spears, and guns) were acts of zoosadism.
There is no easy solution to childhood IATC. Given that most children learn anti-social behaviour from those around them, the best way to prevent it is teaching by example. Here, parents are the key. Pro-social behaviour by parents and other role models towards animals (such as rescuing spiders in the bath, feeding birds, treating pets as a member of the family) has the potential to make a positive lasting impression on children.
Note: A version of this article was first published in The Independent.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Arluke, A., Levin, J., Luke, C., & Ascione, F. (1999). The relationship of animal abuse to violence and other forms of antisocial behavior. Journal of Interpersonal Violence, 14(9), 963-975.
Bartmann, C.P. & Wohlsein, P. (2002). Injuries caused by outside violence with forensic importance in horses. Dtsch Tierarztl Wochenschr, 109, 112-115.
Beetz, Andrea (2002). Love, Violence, and Sexuality in Relationships between Humans and Animals. Germany: Shaker Verlag.
Beirne, P. (1999). For a nonspeciesist criminology: Animal abuse as an object of study. Criminology, 37(1), 117-148.
Felthous, A.R. (1980). Aggression against cats, dogs, and people. Child Psychiatry and Human Development, 10, 169-177.
Furnham, A., Richards, S. C., & Paulhus, D. L. (2013). The Dark Triad of personality: A 10 year review. Social and Personality Psychology Compass, 7(3), 199-216.
Hickey, E. W. (2013). Serial murderers and their victims. Cengage Learning.
James, S., Kavanagh, P. S., Jonason, P. K., Chonody, J. M., & Scrutton, H. E. (2014). The Dark Triad, schadenfreude, and sensational interests: Dark personalities, dark emotions, and dark behaviors. Personality and Individual Differences, 68, 211-216.
Jonason, P. K., & Kavanagh, P. (2010). The dark side of love: Love styles and the Dark Triad. Personality and Individual Differences, 49(6), 606-610.
Kavanagh, P. S., Signal, T. D., & Taylor, N. (2013). The Dark Triad and animal cruelty: Dark personalities, dark attitudes, and dark behaviors. Personality and Individual Differences, 55(6), 666-670.
Macdonald, J.M. (1963). The threat to kill. American Journal of Psychiatry, 120, 125-130.
Patterson‐Kane, E. G., & Piper, H. (2009). Animal abuse as a sentinel for human violence: A critique. Journal of Social Issues, 65(3), 589-614.
Ressler, R., Burgess, A., & Douglas, J. (1988). Sexual homicide: Patterns and motives. Lanham, MD: Lexington Books.
Schedel-Stupperich, A. (2002). [Criminal acts against horses – phenomenology and psychosocial construct]. Dtsch Tierarztl Wochenschr, 109, 116-119.
Wochner, M. & Klosinski, G. (1988). Child and adolescent psychiatry aspects of animal abuse (a comparison with aggressive patients in child and adolescent psychiatry). Schweiz Arch Neurol Psychiatry, 139(3), 59-67.
Can you feel the force? The psychopathology of ‘Star Wars’
A few days ago, my friend and colleague Dr. Andrew Dunn sent all the psychology staff members a paper published in the December 2015 issue of Australasian Psychiatry by Susan Friedman and Ryan Hall entitled ‘Using Star Wars’ supporting characters to teach about psychopathology’. As a fan of Star Wars and science fiction more generally, I immediately read the paper and thought it would be a good topic to write a blog about.
It turns out that Friedman and Ryan have written a series of papers in psychiatric journals over the last year arguing that many of the characters in the Star Wars movies have underlying psychopathologies and that because of the films’ popularity, the films could be used to teach students about various psychiatric disorders. The authors asserted that “supporting characters in Star Wars can be used to teach about a wide variety of psychiatric conditions which are not commonly so accessible in one story, including [attention deficit hyperactivity disorder] ADHD, anxiety, kleptomania, and paedophilia”. I have to admit that in my own teaching I often use characters and/or storylines from film and television to explain psychological phenomena to my own students (and have also published articles and papers demonstrating the utility of using such sources in both teaching and research contexts – see ‘Further reading’ below). Therefore, I was intrigued to read what psychiatric disorders had been attributed to which Star Wars characters.
In the Australasian Psychiatry paper, it is argued that Jar Jar Binks has attention deficit hyperactivity disorder (ADHD):
“Jar Jar frequently overlooks details and makes careless mistakes…His difficulty in sustaining his attention is evident…His difficulty in following instructions almost results in him being put to death…trainees can determine whether [the examples provided] are related to inattention, hyperactivity or impulsivity”.
More controversially, Friedman and Ryan make the case for Qui-Gon Jinn showing paedophilic grooming behaviour.
“In Phantom Menace, Qui-Gon engages in many behaviours with young Anakin Skywalker the same way a paedophile would with a child victim. Anakin seems to fit a pattern which Qui-Gon has of cultivating prepubescent, fair-complexioned boys with no strong male family ties…Anakin’s mother has no power or relations with authority, which decreases the likelihood that either she or Anakin would report the paedophile, or potentially be believed by others…Qui-Gon develops a relationship with Anakin, noting his special features and abilities: he often gives compliments to the child…He fosters a relationship where secrets are kept…and the child is slowly isolated from others…After trust is gained, there is a gradual increase in physical intimacy. In the movies this was symbolised by Qui-Gon drawing blood samples from Anakin. A paedophile may incorporate other children or older victims into the grooming process to further lower the child’s inhibitions”.
I’m not overly convinced by the argument but it does at least lead to discussions on the topic of grooming that I could see having a place in the classroom. Friedman and Ryan also examine a whole species (the Jawas) and claim that they are by nature kleptomaniacs:
“Jawas can introduce the concepts of kleptomania and hoarding, since they ‘have a tendency to pick up anything that’s not tied down’. It is important from a diagnostic point of view to recognise that kleptomania is more than just stealing or shoplifting…To meet criteria for kleptomania, one must recurrently fail to resist the impulse to steal unneeded or non-valuable objects. Tension before committing the theft is followed by gratification or release afterwards. These characteristics of kleptomania can be inferred from the Jawas’ capture of R2D2…The gratification of stealing R2D2 is clear from the Jawas’ excited scream…As for the need or value of the stolen items and the repetitive nature of the theft, the Jawas’ sandcrawler is filled with droids in various states of dysfunction…Although on a desert planet almost anything might have value, the Jawas seem to take this to extremes given the number of broken droids in their possession which do not even appear to be in good enough shape to use as spare parts”.
Elsewhere in the paper is a table listing many Star Wars characters along with “potential concept discussions” related to the characters’ behaviours in the films. This includes (amongst others) Darth Vader (borderline personality disorder, post-traumatic stress disorder), Jabba the Hutt (psychopathy and antisocial personality disorder), Boba Fett (Oedipal issues – Hamlet type), Yoda (dyslexia, malingering), Luke Skywalker (prodromal schizophrenia), Princess Leia (histrionic personality disorder), Padme Amidala (postnatal delirium, postnatal depression), Obi-Wan Kenobi (major depression in old age, pseudo-dementia), and C3PO (obsessive-compulsive personality disorder).
However, given my own research interests, the character that most interested me in Friedman and Ryan’s list was the claim that Lando Calrissian might be a pathological gambler. According to one of the Wiki entries:
“Lando Calrissian was a human male smuggler, gambler, and card player who became Baron Administrator of Cloud City, and, later, a general in the Rebel Alliance. [He] was born on the planet Socorro…During his youth, he became a smuggler and a gambler, playing a card game known as sabbacc. Calrissian was able to make a living by illegally acquiring and redistributing rare or valuable goods. However, due to Calrissian’s penchant for gambling, he and his business partner Lobot were in deep with the wrong people”.
Gambling does make the occasional appearance in Star Wars films – particularly in bar scenes. In describing Calrissian to Han Solo, Princess Leia notes “he’s a card player, gambler, scoundrel. You’d like him“. Qui-Gon Jinn notes in The Phantom Menace that “Whenever you gamble my friend, eventually you’ll lose”. The Star Wars Wiki on gambling notes that it involves “the betting of credits or possessions in wagers or games like sabbacc. For example, Lando Calrissian bet the Millennium Falcon in a game of sabacc with Han Solo, and lost. Gambling was rampant on Tatooine [the home planet of Luke Skywalker]”. The Star Wars Wiki on sabacc also notes that there are several variants of the game and that Calrissian lost the Millenium Falcon to Han Solo while playing ‘Corellian Spike’ and that Solo kept the two golden dice that were used while gambling. A profile article on Calrissian in the Washington Post describes him as a “suave gambler” rather than a pathological gambler.
There is no doubt that Calrissian liked to gamble but there is little evidence from the film that it was pathological. However, other articles (as well as older and newer fiction) about him claim that he is. For instance, in an online article by Shane Cowlishaw discussing the personality disorders of Star Wars characters, the following is claimed:
“He may have ended up leading the final assault on the Death Star, but Lando perhaps was only successful due to being a pathological gambler. Having lost the Millennium Falcon to Han Solo in a bet, conned the Bespin Gas Mine out of somebody and gambling on a deal to betray Han and Chewbacca to the Empire, it is clear he can’t help himself. Lando gambles with the lives of other rebels, albeit successfully, be demanding that the spaceship not abort their mission when Admiral Ackbar orders everyone to retreat from the unexpectedly operational Death Star. A perfect character to debate whether pathological gambling is an addiction or an impulse-control disorder, apparently”
It’s also worth mentioning that Calrissian will also be making an appearance in upcoming Marvel comics. In an interview with writer Charles Soule (who will be scripting the new stories), it is evident that the crux of his character will focus on the gambling part of his personality – but more on the problem side:
“I focused on the whole gambler archetype for Lando; more specifically, the sort of lifelong card player who never really knows when to walk away from the table. He’s always chasing his losses, hoping that if he makes a big enough bet, he can get ahead with just one good hand. It’s tweaked a bit here—the idea is that Lando had something happen to him in his past that put him way behind, and now he’s just trying to get back to even. This isn’t really a financial thing, although that’s part of it – it’s more like a moral thing. Like a life debt. I don’t hit it too hard in this story—it’s all background—but the shading is there…Lando gets into crazy, extreme situations because they’re his version of making big bets at the card table. If he can make it through his next adventure, maybe he can just retire and live a quiet life. It never really works out, though. One step forward, two steps back. That’s Lando Calrissian…It’s a story about a hyper-charismatic, ultra-smooth guy who gets into huge jams constantly, and tends to get out of them through a combination of luck and charm. He’d never punch his way out of a fight; he’d rather buy everyone a few drinks and leave on good terms. Assuming he hasn’t gambled away all his money, that is”.
However, there is also the 2013 novel Scoundrels written by Timothy Zahn featuring Calrissian, Han Solo, and Chewbacca and includes the short story Winner Lose All based on Calrissian’s love of gambling but here, there is nothing to suggest the behaviour is pathological. There is also a fictional online interview with Calrissian that puts forward the idea that he was a professional gambler rather than a pathological gambler:
“Basically I was born to a normal middle class family and found I had a talent for gambling. I traipsed across the universe as a professional gambler, but occasionally need more money so I hired out as mercenary and treasure hunter. Eventually I won the Millennium Falcon, but didn’t know how to fly it. So I paid Han Solo to teach me, he won the ship from me in a game of Sabbac. I won it back but, it like taking your best friend’s girl so I gave it back to him. When I wound up on Cloud City I won my title of Barron Administrator in a card game. The rest is they sat history”.
Finally, on a more academic note, Calrissian also makes an appearance as one of the ‘Gambler’ archetypes the book Archetypes in Branding: A Toolkit for Creatives and Strategists by Margaret Hartwell and Joshua Chen. The book is a novel approach to brand development and includes a deck of 60 archetype cards with the aim of revealing a brand’s motivation and why it attracts certain customers. The authors hope that the book will be used repeatedly to inform and enliven brand strategy. This again suggests that Calrissian’s gambling is not seen as pathological (otherwise he wouldn’t have been included in the book as a brand to be modelled upon).
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Cowlishaw, S. (2015). Star Wars characters and their personality disorders. Stuff, July 8. Located at: http://www.stuff.co.nz/entertainment/film/70017741/Star-Wars-characters-and-their-personality-disorders
Friedman, S. H., & Hall, R. C. (2015). Using Star Wars’ supporting characters to teach about psychopathology. Australasian Psychiatry, 23(4), 432-434.
Friedman, S. H., & Hall, R. C. (2015). Teaching psychopathology in a galaxy far, far away: The light side of the force. Academic Psychiatry, 39(6), 719-725.
Griffiths, M.D. (1996). Media literature as a teaching aid for psychology: Some comments. Psychology Teaching Review, 5(2), 90.
Griffiths, M. (2004). An empirical analysis of the film ‘The Gambler’. International Journal of Mental Health and Addiction, 1(2), 39-43.
Griffiths, M.D. (2010). Media and advertising influences on adolescent risk behaviour. Education and Health, 28(1), 2-5.
Hall, R. C., & Friedman, S. H. (2015). Psychopathology in a galaxy far, far away: The use of Star Wars’ dark side in teaching. Academic Psychiatry, 39(6), 726-732.
Hartwell, M. & Chen, J.C. (2012). Archetypes in Branding: A Toolkit for Creatives and Strategists. How Design Books.
Myth world: Addictive personality does not exist
(Please note: This article is a slightly expanded and original version of an article that was first published in The Conversation).
“Life is a series of addictions and without them we die”. This is my favourite quote in the academic addiction literature and was made back in 1990 in the British Journal of Addiction by Professor Isaac Marks. This deliberately provocative and controversial statement was made to stimulate debate about whether excessive and potentially problematic activities such as gambling, sex and work can really be classed as genuine addictive behaviours. Many of us might say to ourselves that we are ‘addicted’ to tea or coffee, our work, or know others who we might describe as having addictions watching the television or using pornography. But is this really true?
The issue all comes down to how addiction is defined in the first place as many of us in the field disagree on what the core components of addiction are. Many would argue that the word ‘addiction’ or ‘addictive’ is used so much in everyday circumstances that word has become meaningless. For instance, saying that a book is an ‘addictive read’ or that a specific television series is ‘addictive viewing’ renders the word useless in a clinical setting. Here the word ‘addictive’ is arguably used in a positive way and as such it devalues the real meaning of the word.
The question I get asked most – particularly by the broadcast media – is what is the difference between a healthy excessive enthusiasm and an addiction and my response is simple – a healthy excessive enthusiasm adds to life whereas an addiction takes away from it. I also believe that to be classed as an addiction, any such behaviour should comprise a number of key components including overriding preoccupation with the behaviour, conflict with other activities and relationships, withdrawal symptoms when unable to engage in the activity, an increase in the behaviour over time (tolerance), and use of the behaviour to alter mood state. Other consequences such as feeling out of control with the behaviour and cravings for the behaviour are often present. If all these signs and symptoms are present I would call the behaviour a true addiction. However, that hasn’t stopped others accusing me of ‘watering down’ the concept of addiction.
A few years ago, Dr. Steve Sussman, Nadra Lisha and I published a large and comprehensive review in the journal Evaluation and the Health Professions examining the co-relationship between eleven different potentially addictive behaviours reported in the academic literature (smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work, and shopping). We examined the data from 83 large-scale studies and reported an overall 12-month prevalence of an addiction among U.S. adults varies from 15% to 61%. We also reported it plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period, and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors. In short – and with many caveats – our paper argued that at any one time almost half the US population are addicted to one or more behaviours.
There is a lot of scientific literature showing that having one addiction increases the propensity to have other co-occurring addictions. For instance, in my own research I have come across alcoholic pathological gamblers and we can all probably think of individuals that we might describe as caffeine-addicted workaholics. It is also very common for individuals that give up one addiction to replace it with another (which we psychologists call ‘reciprocity’). This is easily understandable as when an individual gives up one addiction it leaves a large hole in the waking lives (often referred to as the ‘void’) and often the only activities that can fill the void and give similar experiences are other potentially addictive behaviours. This has led many people to describe such people as having an ‘addictive personality’.
While there are many pre-disposing factors for addictive behaviour including genetic factors and psychological personality traits such as high neuroticism (anxious, unhappy, prone to negative emotions) and low conscientiousness (impulsive, careless, disorganised), I would argue that ‘addictive personality’ is a complete myth. Even though there is good scientific evidence that most people with addictions are highly neurotic, neuroticism in itself is not predictive of addiction (for instance, there are individuals who are highly neurotic but are not addicted to anything so neuroticism is not predictive of addiction). In short, there is no good evidence that there is a specific personality trait (or set of traits) that is predictive of addiction and addiction alone.
Doing something habitually or excessively does not necessarily make it problematic. While there are many behaviours such as drinking too much caffeine or watching too much television that could theoretically be described as addictive behaviours, they are more likely to be habitual behaviours that are important in an individual’s life but actually cause little or no problems. As such, these behaviours should not be described as an addiction unless the behaviour causes significant psychological and/or physiological effects in their day-to-day lives.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Andreassen, C.S., Griffiths, M.D., Gjertsen, S.R., Krossbakken, E., Kvan, S., & Ståle Pallesen, S. (2013). The relationships between behavioral addictions and the five-factor model of personality. Journal of Behavioral Addictions, 2, 90-99.
Goodman, A. (2008). Neurobiology of addiction: An integrative review. Biochemical Pharmacology, 75(1), 266-322.
Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.
Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.
Kerr, J. S. (1996). Two myths of addiction: the addictive personality and the issue of free choice. Human Psychopharmacology: Clinical and Experimental, 11(S1), S9-S13.
Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136(5), 768-821.
Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.
Marks, I. (1990). Behaviour (non-chemical) addictions. British Journal of Addiction, 85, 1389-1394.
Nakken, C. (2009). The addictive personality: Understanding the addictive process and compulsive behavior. Hazelden, Minnesota: Hazelden Publishing.
Nathan, P. E. (1988). The addictive personality is the behavior of the addict. Journal of Consulting and Clinical Psychology, 56(2), 183-188.
Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 2)
Following on from my previous blog, here are some of my more recent papers with Dr. Edo Shonin and William Van Gordon on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. We are happy for anyone interested in these papers to contact us at the email addresses below.
Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.
- Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on gambling disorder. Recent pilot studies and clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change among individuals with gambling problems. This purpose of this paper is to appraise current directions in gambling disorder research as it relates to mindfulness approaches, and discuss issues that are likely to hinder the wider acceptance of mindfulness as a treatment for gambling disorder. It is concluded that although preliminary findings indicate that there are applications for mindfulness approaches in the treatment of gambling disorder, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed.
Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.
- Although clinical interest has predominantly focused on mindfulness meditation, interest into the clinical utility of Buddhist-derived loving-kindness meditation (LKM) and compassion meditation (CM) is also growing. This paper follows the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines and provides an evaluative systematic review of LKM and CM intervention studies. Five electronic academic databases were systematically searched to identify all intervention studies assessing changes in the symptom severity of Diagnostic and Statistical Manual of Mental Disorders (text revision fourth edition) Axis I disorders in clinical samples and/or known concomitants thereof in sub-clinical/healthy samples. The comprehensive database search yielded 342 papers and 20 studies (comprising a total of 1,312 participants) were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was then used to assess study quality. Participants demonstrated significant improvements across five psychopathology-relevant outcome domains: (i) positive and negative affect, (ii) psychological distress, (iii) positive thinking, (iv) interpersonal relations, and (v) empathic accuracy. It is concluded that LKM and CM interventions may have utility for treating a variety of psychopathologies. However, to overcome obstacles to clinical integration, a lessons-learned approach is recommended whereby issues encountered during the (ongoing) operationalization of mindfulness interventions are duly considered. In particular, there is a need to establish accurate working definitions for LKM and CM.
Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.
- Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade. Although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles such as compassion, loving kindness, and “non-self.” However, due to the rapidity at which Buddhism has been assimilated into the mental health setting, issues relating to the misapplication of Buddhist terms and practices have sometimes arisen. Indeed, hitherto, there has been no unified system for the effective clinical operationalization of Buddhist principles. Therefore, this paper aims to establish robust foundations for the ongoing clinical implementation of Buddhist principles by providing: (i) succinct and accurate interpretations of Buddhist terms and principles that have become embedded into the clinical practice literature, (ii) an overview of current directions in the clinical operationalization of BDIs, and (iii) an assessment of BDI clinical integration issues. It is concluded that BDIs may be effective treatments for a variety of psychopathologies including mood-spectrum disorders, substance-use disorders, and schizophrenia. However, further research and clinical evaluation is required to strengthen the evidence-base for existent interventions and for establishing new treatment applications. More important, there is a need for greater dialogue between Buddhist teachers and mental health clinicians and researchers to safeguard the ethical values, efficacy, and credibility of BDIs.
Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.
- This commentary provides an alternative perspective to some of the key arguments and observations outlined by Monteiro and colleagues (2015) concerning the relative deficiency of authenticity in secular mindfulness-based approaches compared with mainstream Buddhist practice traditions. Furthermore, this is achieved by critically examining the underlying assumption that if secular mindfulness-based approaches represent a more ‘superficial’ construction of mindfulness, then the ‘superior’ approach embodied by present-day Buddhist teachers and traditions should be easily identifiable. More specifically, a means of understanding mindfulness (and related Buddhist meditative principles) is presented that attempts to communicate the versatility and underlying unity of the Buddha’s teachings, and the fact that the scriptural, empirical, and logical grounds for asserting that secular mindfulness-based approaches offer a less authentic practice mode than mainstream Buddhist modalities are not as robust as contemporary general opinion might suggest.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.
- In 2014, over 700 scientific papers on mindfulness were published, which is more than double the amount of mindfulness papers published in 2010. Approximately 80% of adults and 70% of General Practitioners in the UK believe that practising mindfulness can lead to health benefits. The most convincing evidence exists for the use of mindfulness-based interventions (MBIs) in the treatment of depression and anxiety. Meta-analytic studies assessing the efficacy of mindfulness as a treatment for these two disorders have typically reported effect sizes in the moderate-strong to strong range. There is increasing evidence suggesting that mindfulness is an effective means of increasing perceptual distance from distressing psychological and somatic stimuli, and that it leads to functional neuroplastic changes in the brain. However, the aforementioned ‘fashionable’ status of mindfulness amongst both the general public and scientific community has likely overshadowed the need to address a number of key methodological and operational issues concerning its treatment efficacy.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.
Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Teaching ethics in mindfulness-based interventions. Mindfulness, 6, 1491–1493.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.
Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016). Mindfulness and Buddhist-derived treatment techniques in mental health and addiction settings. In Shonin, E., Van Gordon, W., & Griffiths, M.D. (Eds.), Mindfulness and Buddhist-derived Approached in Mental Health and Addiction (pp. 1-6). New York: Springer.
Van Gordon, W., Shonin, E., Griffiths, M.D., & Singh. N.N. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. (pp. 9-27). New York: Springer.
Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Can second generation of mindfulness-based interventions be helpful in treating psychiatric disorders? Australian and New Zealand Journal of Psychiatry, 49, 591-592.
Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.
Van Gordon, W., Shonin, E., Singh. N.N. & Griffiths, M.D. (2015). The mindfulness of emptiness and the emptiness of mindfulness. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness (pp. 159-179). New York: Springer.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Are contemporary mindfulness-based interventions unethical? British Journal of General Practice, 66, 94-95.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for individuals with fibromyalgia syndrome: An interpretative phenomenological analysis of participants’ experience. Mindfulness, in press.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Buddhist emptiness theory: Implications for the self and psychology. Psychology of Religion and Spirituality, in press.
Van Gordon, W., Shonin, E., Cavalli, G. & Griffiths, M.D. (2016). Ontological addiction: Classification, aetiology and treatment. Mindfulness, in press.
Blame it on the fame: The psychology of being ‘starstruck’
“We have an infatuation for famous. It’s gone global. It seems that, with the rise of fame generated through social media sites and TV, we all have this non-specific person, this idol, plonked on a pedestal, simply because they could be bothered to do something to get themselves out there…A lot of [celebrities are] known for their talent, work bloody hard for it, and that’s inspirational. That’s something to idolise – their drive and passion. But being starstruck because of somebody’s position or wealth or title – just think about it. Most of the people who would leave you starstruck will be everyday folk, just getting on with their thing, even if that’s earning £250,000 a week” (from ‘Starstruck, fame-obsessed and suckers for Hollywood culture’ by Bianca Chadda)
Regular readers of my blog will know that I have more than a passing interest in the psychology of fame. For instance, I have looked at many aspects of fame and celebrity including whether fame can be addictive, the role of celebrity endorsement in advertising, individuals that become sexually aroused by famous people (so-called celebriphilia), individuals that are obsessed with celebrity (i.e., celebrity worship syndrome), and whether celebrities are more prone to addictions than the general public, as well a speculative look at the psychology of various celebrities (including – amongst others – Iggy Pop, Lou Reed, Adam Ant, Roland Orzabal, Salvador Dali and Allen Jones).
The reason I mention this is because a few days ago (December 11), I was interviewed by Georgey Spanswick on BBC radio about the psychology of being ‘starstruck’. The first thing that occurred to me was what ‘starstruck’ actually means. I knew what my own perception of the term meant but when I began to look into it there are many different definitions of ‘starstruck’ (some of which hyphenate the word), many of which did not match my own definition. Here are a selection which highlight that some of those differences:
- “Star-struck – fascinated or greatly impressed by famous people, especially those connected with the cinema or the theatre” (Oxford Dictionary).
- “Star-struck – feeling great or too much respect for famous or important people, especially famous actors or performers” (Cambridge Dictionary).
- “Starstruck – particularly taken with celebrities (as movie stars)” (Merriam Webster Dictionary).
- Starstruck – Fascinated by or exhibiting a fascination with famous people” (Free Dictionary).
- “Star-struck – a star-struck person admires famous people very much, especially film stars and entertainers” (Macmillan Dictionary).
- “Starstruck – when you meet someone you are very fond of, like a celebrity, movie star, etc. and you get completely overwhelmed, paralyzed and/or speechless by the experience” (Urban Dictionary).
Of all the definitions listed above, it is actually the final one from the online Urban Dictionary that most matches my own conception. In fact, an article by Ainehi Edoro on the Brittle Paper website provides a lay person’s view on being starstruck and how it can leave an individual:
“What does it mean to be starstruck? You meet a celebrity and you are struck by a force that freezes you, holds you captive. You can’t think, your eyes are glazed over, your heart is beating really fast, open or closed, your mouth is useless – it’s either not making any sound or spewing out pure nonsense. In a flash, it’s all over. The celebrity disappears. And you’re left with a sense of loss that turns into regret and, perhaps, embarrassment”.
However, as there is no academic research on the topic of being starstruck (at least not to my knowledge), the rest of this article is pure speculation and uses non-academic sources. The most in-depth (and by that I simply mean longest) article that I came across on why people get starstruck (i.e., being completely overwhelmed and speechless when in the company of a celebrity) was by Lior on the Say Why I Do website. The article claimed there were five reasons that may contribute to being starstruck. These are being (i) excited from a feeling of anticipation of meeting a celebrity, (ii) pumped up from the effort of wanting to impress a celebrity, (iii) excited from receiving undeserved attention from a celebrity, (iv) starstruck because that is how other people act around a celebrity, and (v) excited from overwhelming sexual tension towards a celebrity. More specifically:
Excited from a feeling of anticipation of meeting a celebrity: This simply relates to the anticipation that is felt after taking an interest in someone that the individual has admired and revered for years (i.e., they have become “idealized” and “bigger than life”). What will the celebrity really be like to the individual? Will they meet the expectations of the individual?
Pumped up from the effort of wanting to impress a celebrity: This relates to the fact that when meeting someone an individual admires (in this case a celebrity), the individual is trying to make the best impression they can and to put forward a persona that the individual would like the celebrity to perceive them as. This can be a situation that brings about a lot of pressure resulting in being starstruck.
Excited from receiving undeserved attention from a celebrity: This relates to the idea that the individual perceives the celebrity as somehow better (i.e., more successful, attractive, and/or talented than themselves) and that to even acknowledge the individual’s existence is somehow undeserved. The lower the self-esteem of such individuals, the more undeserved they feel by attention from a celebrity.
Starstruck because that is how other people act around a celebrity: This simply relates to the idea that individuals feel starstruck because everyone around them does (or they perceive that everyone else does). Similar situations arise when a crowd goes wild, screams, cries and faints when watching their favourite pop bands. As Lior’s article notes:
“Before Frank Sinatra became a celebrity, it wasn’t common at all to see screaming fans. In 1942, a publicity stunt was done to promote the 25-year old Sinatra, where they planted a number of girls in the audience who were told to scream and swoon when he stepped on stage. What began as a publicity stunt spread through the whole theatre to become a mass hysteria of screaming and fainting. It’s in human nature to copy behaviour around us”.
Excited from overwhelming sexual tension towards a celebrity: This relates to the idea that many celebrities are sexually attractive to individuals that admire and revere them. As Lior notes:
“When some people find someone good looking, they may start to behave in a way that’s quite similar to being star-struck. Star struckness from sexual tension may arise for several reasons. It may be a manifestation of embarrassment about having had fantasies about the person who is now standing in front of you. It may be that every time you look at that person, your thoughts go to places you can’t quite control and that makes you unable to think straight”.
If you are someone who thinks they might be starstruck if you met someone famous, there are various articles on the internet that provide tips on meeting famous people either out in public or within the confines of your job (see ‘Further reading’ below). I’ve been fortunate to meet many celebrities in my line of work with all the media work that I do but I always tell myself that celebrities are human beings just like you or I. I treat them as I would any other human being. No worse, no better. I’m friendly and I’m professional (at least I hope I am). I’ve yet to be starstruck although I’ve never met anyone famous that inspired me to get to where I wanted to get. There is a well known cliché that you should never meet your heroes but if David Bowie or Paul McCartney fancy coming round to my house for dinner I’m pretty sure I wouldn’t be lost for words.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Chadda, B. (2013). Starstruck, fame-obsessed and suckers for Hollywood culture. Lots of Words, March 3. Located at: https://biancajchadda.wordpress.com/2013/03/06/starstruck-fame-obsessed-and-suckers-for-hollywood-culture/
Edora, A. (2012). Seven tips on how to avoid being starstruck. Brittle Paper. May 21. Located at: http://brittlepaper.com/2012/05/meet-celebrities-starstruck
Intern Like A Rock Star (2012). Starstruck: How to talk to celebrities you meet at work. January 2. Located at: http://www.internlikearockstar.com/2012/01/starstruck-how-to-talk-to-celebrities.html#sthash.JBtzCC9Y.dpbs
Lior (2011). Why do people get star struck? SayWhyIDo.com. February 7. Located at: http://www.saywhydoi.com/why-do-people-get-star-struck/
Glum drone pleasures: The psychology of Ian Curtis and Joy Division
“Now there’s a really good book…[by French economist] Jacques Attali wrote in the late [1970s] called ‘Noise: The Political Economy of Music’…and the main tenet of that book is that…music is the best form of prophecy that we have…so that working with music or sound is our best way of divining a future, and being able to show to ourselves what’s round the corner in that psychological, or even psychic sense” (writer and graphic designer Jon Wozencroft being interviewed for the 2007 film Joy Division)
As a poverty stricken teenager in the early 1980s, all of my minimal disposable income was spent on buying records, cassettes, and music magazines (and to be honest, 35 years later nothing much has changed except I now buy far too many CDs instead of cassettes). Unlike most of my friends at the time I refused to be pigeon holed as a new romantic, a punk, a mod, or a goth because I liked music from all those genres. In the early 1980s was as equally as likely to buy a record by Adam and the Ants and Bauhaus as I was to buy records by Secret Affair and The Clash. I was also into city music scenes with my favourites being the ‘Liverpool scene’ (Echo and the Bunnymen, Teardrop Explodes, Wah! etc.), the ‘Sheffield scene’ (Human League, Heaven 17, Cabaret Voltaire, etc.), and the ‘Manchester scene’ (Magazine, Buzzcocks, Joy Division, The Smiths, The Passage, etc.).
The Manchester music scene was incredibly buoyant although often portrayed by the music press at the time as psychologically and emotionally ‘miserablist’. My parents could never understand what I saw in the “depressing and alienating music” (as they saw it) of bands like Joy Division and The Smiths. But it was through these bands that I developed an interest in psychology and what could be described as ‘psychgeography of post-punk’. In the case of Joy Division, their geographical location in Manchester and its surrounding area (Salford, Macclesfield) was integral to their music. In fact, a number of commentators (such as Liz Naylor, the co-editor of City Fun fanzine) have asserted that Joy Division “relayed the aura of Manchester” in the late 1970s and early 1980s.
All of my information about Joy Division came from reading the NME, listening to the John Peel Show on Radio 1, and listening to their two studio LPs (Unknown Pleasures and Closer) and assorted singles (that I mainly taped off the radio as most of them were not widely available). I was too young to go to gigs and they rarely appeared on television. Of the four members of Joy Division – Ian Curtis (vocals), Peter Hook (bass guitar), Bernard ‘Barney’ Sumner (guitar), and Stephen Morris (drums) – it was Curtis that captivated my adolescent attention. It was through Curtis’ documented medical conditions that helped develop my interest in psychology. Curtis suffered from epilepsy (like one of musical heroes Jim Morrison of The Doors) and clinical depression. It has also been alleged that he suffered from bipolar disorder (i.e., what used to be called ‘manic depression’) although this was never formally diagnosed (and many of those close to Curtis claim that such a claim is speculative at best).
Descriptions of Curtis’ behaviour on first sight look like bipolar disorder given the reports by his wife and others of his severe mood swings (where on one day he could have feelings of happiness and elation but on the next day could have feelings of intense depression and despair). However, other members of the band claimed that the mood swings were caused by the epilepsy medication Curtis was taking. However, bipolar disorder is not uncommon among musicians given many other high profile rock and pop stars have suffered from it including Brian Wilson (Beach Boys), Syd Barrett (Pink Floyd), Kurt Cobain (Nirvana), Ray Davies (The Kinks), Sinéad O’Connor, Poly Styrene (X-Ray Spex), and Adam Ant (to name just a few). Curtis was never afraid to write about psychological and medical conditions and the song ‘She’s Lost Control’ is arguably the most insightful song ever written about epilepsy (based not on his own experiences, but his observations of a female epileptic client who died while he was an Assistant Disablement Resettlement Officer based at the Job Centre in Macclesfield).
As any Joy Division fan knows, as a result of his severe depression, Curtis committed suicide by hanging himself on May 18, 1980 (a date I always remember because it was my favourite gran’s birthday), just two days before Joy Division were due to go on their first US tour. Even as a 14-year old teenager, I remember going to my local library in Loughborough not long after his death to learn more about depression, epilepsy, suicide, and attempted suicide (as he had two previous attempts to commit suicide earlier that year). I’m not saying that this alone was responsible for my career choice but it certainly facilitated my growing interest in psychology and mental health issues.
It was also through Joy Division that I started to read history books (and still do) on various psychological and non-psychological aspects of Nazism (and is evidenced by my previous blogs on the personality of Adolf Hitler and Nazi fetishism). Back in the late 1970s and early 1980s, Joy Division were often accused of having Nazi tendencies. It didn’t help that their name came from the 1955 novella House of Dolls by Jewish writer and Holocaust survivor Yehiel De-Nu (writing under his pen name Ka-tzetnik 135633). The ‘Joy Division’ was the name given to a group of Jewish women in World War II concentration camps whose only purpose was to provide sexual pleasure to Nazi soldiers. I have to admit I’ve never read any of De-Nu’s books. According to an online article by David Mikies (‘Holocaust Pulp Fiction’), De-Nu’s writings were “often lurid novel-memoirs, works that shock the reader with grotesque scenes of torture, perverse sexuality, and cannibalism“. In the 2006 book Joy Division and the Making of Unknown Pleasures, Jake Kennedy asserted that “Curtis’ fascination with extremes would hint to anyone willing to look beyond the headlines that the choice of name was probably an old fashioned punk exercise, matter of old habits dying hard”.
One of the bands earliest songs ‘Warsaw’ (which was also their band name prior to becoming Joy Division) is arguably a lyrical biography of Hitler’s deputy Führer Rudolf Hess. The song even begins with the lyric “3 5 0 1 2 5 Go!” (Hess’ prisoner of war serial number after he was captured after flying to the UK in 1941). Another of their early songs ‘No Love Lost’ features a spoken word section with a complete paragraph from The House of Dolls. A 2008 article by music writer Jon Savage in The Guardian newspaper noted that Curtis’ songs “such as ‘Novelty’, ‘Leaders of Men’ and ‘Warsaw’ were barely digested regurgitations of their sources: lumpy screeds of frustration, failure, and anger with militaristic and totalitarian overtones”.
Deborah Curtis (Ian’s wife) also remembered that her husband had a book by John Heartfield that included photomontages of the Nazi Period and that graphically documented the spread of Hitler’s ideals. The cover artwork of the band’s first record, the ‘An Ideal For Living’ EP, also featured a boy member the Hitler Youth drawn by guitarist Barney Sumner banging on a drum. Much of the flirtation with Nazi symbolism was arguably juvenile fascination and playful naivety. It’s also been noted that Joy Division’s early music concentrated on the nihilistic provocations of industrial music’s pioneers Throbbing Gristle (whose music I also examined at length in a previous blog). An interesting 2010 article by Mateo on the A View From The Annex website defended Joy Division’s use of Nazi imagery and lyrics:
“The Labour government´s betrayal of the working class during the 1970s and the rise of Thatcherism at the end of the 1970s heralded a future of mass unemployment, government repression and decaying industry. The perspective taken by Ian Curtis, the band´s sole lyricist, towards this growing authoritarianism and despair is crucial to understand if one is to place the references to fascism found in the band´s album art in the context intended by the artist, that is, a despairing anti-Nazism…Punk at that time was a unique music scene in which battles between anti-racists and neo-nazis were being thrashed out at concerts as the skinheads tried to appropriate the punk aesthetic and hijack the following of alienated, disillusioned working class youth who gravitated towards such a sub-culture in places like Manchester at the beginning of the 1980s…The lyrics of Ian Curtis made it clear that this was a presence suffered and feared as opposed to tolerated or toyed with by the band…Joy Division feared fascism, they did not flirt with it and the artwork and lyrics in ‘An Ideal for Living’ serves as a warning of growing fascistic tendencies in British society…For this, Curtis and his bandmates should be lauded for tackling such a controversial issue and expressing such a well-grounded fear and hostility towards such a veritable enemy of the working class during a swift turn to the right in Britain”.
By all accounts, Curtis was a voracious reader and read books by William Burroughs, Fyodor Dostoyevsky, Franz Kafka, Friedrich Nietzsche, Nikolai Gogol, Jean-Paul Sartre, Hermann Hesse and J.G. Ballard, many of which made their way into various Joy Division songs (an obvious example being their song ‘Interzone’ taken directly from a collection of short stories by William Burroughs). As Jon Savage noted:
“Curtis’s great lyrical achievement was to capture the underlying reality of a society in turmoil, and to make it both universal and personal. Distilled emotion is the essence of pop music and, just as Joy Division are perfectly poised between white light and dark despair, so Curtis’s lyrics oscillate between hopelessness and the possibility, if not need, for human connection. At bottom is the fear of losing the ability to feel”.
J.G. Ballard was a particular inspiration to Curtis (particularly the books High Rise and Crash, the latter of which was about the suffering of car accident victims and sexual arousal, and which I wrote about in a previous blog on symphorophilia). One of Joy Division’s best known songs (the opening ‘Atrocity Exhibition’ from their second LP Closer) took its’ name from Ballard’s collection of ‘condensed novels’ (and given its focus on mental asylums is of great psychological interest). So distinct is Ballard’s work that it gave rise to a new adjective (‘Ballardian’) and defined by the Collins English Dictionary as “resembling or suggestive of the conditions described in J.G. Ballard’s novels and stories, especially dystopian modernity, man-made landscapes and the psychological effects of technological, social or environmental developments”. Given this definition, many of Joy Division’s songs are clearly Ballardian as they examine the emotional and psychological effects of everything around them (including personal relationships on songs such as their most well known and most covered song, and only British hit ‘Love Will tear Us Apart’).
The overriding psychology and underlying philosophy of both Ian Curtis and Joy Division are both contradictory and complex but ultimately the band members were a product of the environment they were brought up in and the sum of their musical and literary influences. At the age of 24 years, Curtis’ suicide was undoubtedly tragic and like many other literary and musical ‘artists’, his death has been somewhat romanticized by the mass media. Although he didn’t quite make it into the infamous ‘27 Club’ of ‘rock martyr’ musicians that died when they were 27 years (e.g., Dave Alexander [The Stooges], Chris Bell [Big Star], Kurt Cobain [Nirvana], Richey Edwards [Manic Street Preachers], Pete Ham [Badfinger], Jimi Hendrix, Robert Johnson, Brian Jones [Rolling Sones], Janis Joplin, Jim Morrison [The Doors], Amy Winehouse) he is surely a candidate for being a prime honorary member (along with Jeff Buckley). Retrospectively looking at his lyrics (“In the shadowplay, acting out your own death, knowing no more” from ‘Shadowplay’, you can’t help but wonder (given that many of them were autobiographical) whether Curtis’ death could have been prevented by those closest to him.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Curtis, D. (1995). Touching From A Distance. London: Faber and Faber.
Curtis, I., Savage, J. & Curtis, D. (2015). So This Is Permanence: Joy Division Lyrics and Notebooks. London: Faber and Faber.
Gleason. P. (2015). This Is the Way: “So This Is Permanence” by Ian Curtis. Located at: http://stereoembersmagazine.com/way-permanence-ian-curtis/
Hook, P. (2013). Unknown Pleasures: Inside Joy Division. London: Simon and Schuster.
Kennedy, J. (2006). Joy Division and the Making of Unknown Pleasures. London: Omnibus.
Mikies, D. (2012). Holocaust pulp fiction. The Tablet, April 19. Located at: http://www.tabletmag.com/jewish-arts-and-culture/books/97160/ka-tzetnik?all=1
Morley, P. (2007). Joy Division: Piece by Piece: Writing About Joy Division 1977-2007. London: Plexus Publishing.
Reynolds, S. (2006). Rip It Up and Start Again: Postpunk, 1978–1984. New York: Penguin.
Savage, J. (2008). Controlled chaos. The Guardian, May 10. Located at: http://www.theguardian.com/books/2008/may/10/popandrock.joydivision
Hoard focus: A brief overview of Diogenes Syndrome
In a previous blog on animal hoarding I made a passing reference to Diogenes Syndrome (DS) that is sometimes referred to as ‘senile squalor syndrome’ (as it typically occurs in elderly individuals – although it has occasionally been reported in young adults). According to a paper by Alberto Pertusa and colleagues in a 2010 issue of Clinical Psychology Review:
“Squalor has been defined in various ways including, ‘social breakdown of the elderly’, ‘Diogenes syndrome’ and ‘severe domestic squalor’…These definitions have usually encompassed both domestic neglect and a lack of personal hygiene…The majority of case observations and studies on squalor have focused on elderly populations recruited from nursing or disability services…These studies initially suggested that those living in squalor were likely to be over the age of 60, primarily female, living alone and unmarried…Hypotheses on the etiology of squalor have moved from the phenomenon possibly being uni-dimensional to having heterogeneous causes such as physical disabilities, brain damage, psychiatric conditions, and personality disorders…A study on squalor reported the prevalence to be 0.005% in the United Kingdom”.
Hoarding is often a consequence of having DS but is associated with self-neglect and much of the items excessively hoarded are typically items of trash with little or no value. Like animal hoarders, those with DS often live on their own in severe domestic squalor and unsanitary conditions. As I noted in my previous blog, DS is characterized by extreme self-neglect, apathy, domestic squalor, social withdrawal, compulsive hoarding of rubbish, and lack of shame. Most sufferers refuse help of others and the onset of DS may sometimes be initiated by a stressful event in their lives (such as death of a loved one). According to a 2013 paper on DS by Dr. Projna Biswas and colleagues in the journal Case Reports in Dermatological Medicine:
“DS is named after the Greek Philosopher “Diogenes of Sinope” (4th century BC) who taught about cynicism philosophy. He kept his need for clothing and food to a minimum by begging. He used to follow some ideas like ‘life according to nature’, ‘self-sufficiency’, ‘freedom from emotion’, ‘lack of shame’, ‘outspokenness’, and ‘contempt for social organization’…The approximate annual incidence of Diogenes is 0.05% in people over the age of 60 [years]. Affected individuals come from any socioeconomic status, but are usually of average or above-average intelligence…It is often associated with other mental illnesses, such as schizophrenia, mania, and frontotemporal dementia…While no clear etiology exists, it is hypothesized that it may be due to a stress reaction in people with certain pre-morbid personality traits, such as being aloof, or certain personality disorders, such as schizotypal or obsessive compulsive personality disorder. There are suggestions that an orbitofrontal brain lesion may lead to such behaviours…while others state that chronic mania symptoms, such as poor insight, can lead to such a condition”.
DS was not included separately in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) although hoarding (syllogomania) is included as a genuine psychiatric diagnosis. Because of deliberate self-isolation, physical neglect and poor eating, DS mortality rates are high with close to half of sufferers dying within five years of DS onset. Biswas and colleagues also note:
“Diogenes syndrome is also known as dermatitis passivata. The term Diogenes syndrome was coined in 1975 by [Clark and colleagues]…DS has been classified as primary or pure which is not associated with mental illness and secondary or symptomatic. Secondary DS is related to mental illness like schizophrenia, depression, and dementia…Alcohol abuse has been identified as a cofactor…Multiple deficiency states have been associated with DS including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium…Skin lesions are mainly due to uncleanliness which may result in various infestations and infections. These are ignored by the patient. Dirt, dust, bacterial, fungal, and parasitic debris conglomerate to form thick crusts and scales over various parts of the body”.
The paper by Biswas and colleagues’ asserted that four symptoms have been reported as being in almost all DS sufferers. These are that they: (i) never ask for any help despite possessing nothing; (ii) are unusually fond of certain objects (including rubbish); (iii) display unusual behavior with other people (misanthropy) and (iv) display extreme self-neglect. Although hoarding is often present in those with DS, there have been some cases reported where no hoarding was present. In their 2010 review paper, Dr. Pertusa and colleagues noted:
“Research on hoarding has rarely included assessments of severe domestic squalor. Winsberg et al. (1999) noted that clutter inhibited normal activities of daily living – including personal hygiene. A few studies have provided more direct indications of squalor in hoarding. [one study in 2000] surveyed health department officers in Massachusetts who reported that 38% of their hoarding cases were ‘heavily cluttered with filthy environment, overwhelming’. [Another study] focused on cleanliness ratings of the personal appearance and the homes of 62 elderly hoarding individuals. In their sample, 17% of individuals were described as ‘extremely filthy’ and 33% of residences were rated as ‘extremely filthy and dirty’. For 32% of the residences, there was an overpowering odor from rotten food or animal or human feces. Many subjects could not use their refrigerator (45%), kitchen sink (42%), bathtub (42%), or toilet (10%). Lack of standardized instruments to measure squalor have prevented researchers from understanding squalor in compulsive hoarding”.
Dr. Pertusa and his colleagues claim the data on DS is scarce and that the clinical picture between hoarding and DS needs more clinical research. They do conclude that hoarding within a DS diagnosis is clinically different from other types of hoarding (for instance, compulsive hoarders do not display the same core features as those with DS such as squalor and self-neglect). Like many other clinical conditions, Pertusa’s team assert that longitudinal studies will best help uncovering the natural history and link (if any) between both DS and compulsive hoarding.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Biswas, P., Ganguly, A., Bala, S., Nag, F., Choudhary, N., & Sen, S. (2013). Diogenes syndrome: a case report. Case reports in dermatological medicine, http://dx.doi.org/10.1155/2013/595192
Clark, A. N., Mankikar, G. D., & Gray, I. (1975). Diogenes syndrome. A clinical study of gross neglect in old age. Lancet, 1(7903), 366−368.
Drummond, L.M., Turner, J., Reid, S. (1996). Diogenes’ syndrome – a load of old rubbish? Irish Journal of Psychiatric Medicine, 14(3), 99–102.
Greve, K.W., Curtis, K.L., & Bianchini, K.J. (2004). Personality disorder masquerading as dementia: A case of apparent Diogenes syndrome. International Journal of Geriatric Psychiatry, 19, 703–705
Irvine, J. D., & Nwachukwu, K. (2014). Recognizing Diogenes syndrome: a case report. BMC Research Notes, 7(1), 276.
Pertusa, A., Frost, R.O., Fullana, M.A., Samuels, J., Steketee, G., Tolin, D., Saxena, S., Leckman, J.F., Mataix-Cols, D. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30, 371-386.
Rosenthal, M., Stelian, J., & Wagner, J. (1999). Diogenes syndrome and hoarding in the elderly: Case reports. Israel Journal of Psychiatry and Related Sciences, 36, 29–34.
Meditate to medicate: Mindfulness as a treatment for behavioural addiction
Please note: A version of the following article was first published on addiction.com and was co-written with my research colleagues Edo Shonin and William Van Gordon
Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, a ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience.
Throughout the last two decades, Buddhist principles have increasingly been employed in the treatment of a wide range of psychological disorders including mood and anxiety disorders, substance use disorders, bipolar disorder, and schizophrenia-spectrum disorders. The emerging role of Buddhism in clinical settings appears to mirror a growth in research examining the potential effects of Buddhist meditation on brain neurophysiology. Such research forms part of a wider dialogue concerned with the evidence-based applications of specific forms of spiritual practice for improved psychological health.
Within mental health and addiction treatment settings, mindfulness-based interventions (MBIs) are generally delivered in a secular eight-week format and often comprise the following: (i) weekly sessions of 90-180 minutes duration, (ii) a taught psycho-education component, (iii) guided mindfulness exercises, (iv) a CD of guided meditation to facilitate daily self-practice, and (v) varying degrees of one-to-one discussion-based therapy with the program instructor. Examples of MBIs used in behavioural addiction treatment studies include Mindfulness-Based Cognitive Therapy, Mindfulness-Enhanced Cognitive Behaviour Therapy, Mindfulness-Based Relapse Prevention, Mindfulness-Based Stress Reduction, and Meditation Awareness Training.
Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on problem and/or pathological gambling. These studies have shown that levels of dispositional mindfulness in problem gamblers are inversely associated with gambling severity, thought suppression, and psychological distress. Recent clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change in problem gambling individuals. Published case studies include: (i) a male in his sixties addicted to offline roulette playing, (ii) a 61-year old female (with comorbid anxiety and depression) addicted to slot machine gambling (treated with a modified version of Mindfulness-Based Cognitive Therapy), and (iii) a 32-year old female (with co-occurring schizophrenia) addicted to online slot-machine playing (treated with a modified version of Meditation Awareness Training). Also, a recent study showed that problem gamblers that received Mindfulness-Enhanced Cognitive Behaviour Therapy demonstrated significant improvements compared to a control group in levels of gambling severity, gambling urges, and emotional distress.
Outside of gambling addiction, case studies have investigated the applications of mindfulness for treating addiction to work (i.e., workaholism) and sex. In the case of the workaholic, a director of a blue-chip technology company in his late thirties was successfully treated for his workaholism utilizing Meditation Awareness Training. Significant pre-post improvements were also observed for sleep quality, psychological distress, work duration, work involvement during non-work hours, and employer-rated job performance. However, as with any case study, the single-participant nature of the study significantly restricts the generalizability of such findings.
Key treatment mechanisms that have been identified and/or proposed in this respect (several of which overlap with mechanisms identified as part of the mindfulness-based treatment of chemical addictions) include:
- A perceptual shift in the mode of responding and relating to sensory and cognitive-affective stimuli that permits individuals to objectify their cognitive processes and to apprehend them as passing phenomena.
- Reductions in relapse and withdrawal symptoms via substituting maladaptive addictive behaviours with a ‘positive addiction’ to mindfulness/meditation (particularly the ‘blissful’ and/or tranquil states associated with certain meditative practices).
- Transferring the locus of control for stress from external conditions to internal metacognitive and attentional resources.
- The modulation of dysphoric mood states and addiction-related shameful and self-disparaging schemas via the cultivation of compassion and self-compassion.
- Reductions in salience and myopic focus on reward (i.e., by undermining the intrinsic value and ‘authenticity’ that individuals assign to the object of addiction) due to a better understanding of the ‘impermanent’ nature of existence (e.g., all that is won must ultimately be lost, an attractive body will age and wither, a senior/lucrative occupational role must one day be relinquished, etc.).
- Growth in spiritual awareness that broadens perspective and induces a re-evaluation of life priorities.
- ‘Urge surfing’ (the meditative process of adopting an observatory, non-judgemental, and non-reactive attentional-set towards mental urges) that aids in the regulation of habitual compulsive responses.
- Reduced autonomic and psychological arousal via conscious-breathing-induced increases in prefrontal functioning and vagal nerve output (breath awareness is a central feature of mindfulness practice).
- Increased capacity to defer gratitude due to improvements in levels of patience.
- A greater ability to label and therefore modulate mental urges and faulty thinking patterns.
Although preliminary findings indicate that there are applications for MBIs in the treatment of behavioural addictions, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed. Despite this, both the classical Buddhist meditation literature and recent scientific findings appear to agree that when correctly practised and administered, mindfulness meditation is a safe, non-invasive, and cost-effective tool for treating behavioural addictions and for improving psychological health more generally.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, in press.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.
Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research and Therapy, 5: e122. doi: 10.4172/2155-6105.1000e122.
Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Current trends in mindfulness and mental health. International Journal of Mental Health and Addiction, 12, 113-115.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.
Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.
Shonin, E., Van Gordon W., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.
Disfigure it out: A brief look at post-mortem mutilation in murder cases
“A body of an adult female of about 25 years old was found dead in a naked condition in a reserved forest area in South Delhi in June, 2006 by police. There was information to [the] police via public call as 2-3 people had killed one lady after [having] sex [with her] and [then running] away. Further enquiry, revealed that they all had consumed alcohol along with the lady. They also had sexual intercourse with her using condom…Following the quarrel they killed her by hitting her head with a heavy stone. After killing her, they also tried to destroy her identity by burning her face with wooden stick and twigs and her clothes. One of them also introduced a wine bottle inside [her] vagina. There were multiple postmortem injuries in particular pattern over left side lower part of chest, abdomen and inguinal regions including upper part of left thigh. All [the] accused were subsequently arrested by the police”.
This shocking account of a brutal murder was the opening paragraph in a paper by Dr. B.L. Chaudhary and his colleagues in a 2007 issue of the Journal of Indian Academy of Forensic Medicine (JIAFM). Although an increasingly common theme in television and film homicides, post-mortem mutilation of a dead person’s body by perpetrators is arguably much rarer than the incidence in fictionalized drama. The JIAFM paper noted that the majority of such cases typically involve body “dismemberment for the purpose of disposing or hiding a body or of preventing identification”.
A national study carried out in Sweden by Dr. Jovan Rajs and colleagues in the Journal of Forensic Sciences found that only 22 deaths over a 30-year period (1961-1990) had been criminally mutilated and/or dismembered. These were then classified into one of three types: (i) defensive, (ii) offensive (i.e., lust murder) and (iii) necromanic mutilation. They reported that the perpetrators of the defensive and aggressive post-mortem mutilation were typically “disorganized” (i.e., alcoholics, drug abusers, mentally disordered) whereas the lust murderers were typically “organized” with a long history of violent crimes. The JIAFM paper summarized the findings of Raus and colleagues:
“The characteristics of the mutilations were diverse. In cases of murder committed in association with sexual deviation, wounding is usually limited to the breasts and sexual organs. Corpse mutilation can also be of a symbolic nature as in cases of mafia murders (revenge punishment) and then it is associated with torturing the victim and with the motive of destruction of identify of victim”.
In the case of the female victim reported by Chaudhary and colleagues, they reported that it was the victim’s head, face, and chest that were burned, destroyed, and mutilated post-mortem. They speculated that this was done to either (i) to prevent identification of the victim, (ii) to make it difficult to determine the cause of death, or (iii) as an act of depersonalization as it is often seen “when the murder is disorganized and has a close relation to his victim or offensive mutilation as general act of frustration”. Why the men had inserted a foreign object into the woman’s vagina was less clear. The authors speculated that it may have been because of (i) frustration of a non-performing sexual partner because of heavy intoxication, (ii) an extortion demand by victim, (iii) blackmail by the victim, or (iv) psychopathic tendencies of the perpetrators can carried out for sadistic pleasure. However, they also added that:
“In this case as there was alleged history of consensual sexual activity which could be or could not be as body had injuries so it could be non-consensual activity also. Apparently there was no smell in the [gastric] contents but samples were sent for alcohol screening/concentration estimation. In [the medical] literature, various materials and objects like chilly powder, corrosives, metal or wooden sticks are introduced into genitalia as a part of punishment for unfaithfulness or infidelity. Males suffering from depression due to erectile dysfunctions, premature ejaculation and impotency may indulge in extreme frustration cases. In this psychological profiling of the accused can also be helpful in knowing for such abnormal instincts. At times, provocative words by female partner about their malehood could trigger such impulsive murder and mutilation”
Post-mortem mutilation while extreme can sometimes border on the almost unbelievable. For instance, Dr. J. Kunz and Dr. A. Gross published a paper in a 2001 issue of the American Journal of Forensic and Medical Pathology which as Ronseal would claim “does exactly what it says on the tin” as it was entitled “Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation”. The paper reported that:
“After killing his father, the son decapitated his body and dissected the scalp free, forming a mask of the father’s head and neck. The young man wore the scalp-mask over his own head to imitate the father. The motive of the murder was revenge, and the postmortem mutilation was the realization of the perpetrator’s fantasies, symbolically representing a penalty for the reprehensible past life of his father”.
Another extreme case of postmortem mutilation following murder was reported by Dr. Tomasz Konopka and his colleagues in a 2006 issue of the Journal of Forensic Medicine and Pathology. In this instance, a Polish man cut up the corpse and dismembered the body into 850 fragments. He “employed various tools to divide the body into fragments and subsequently boiled the pieces to reduce their volume”. This reduced the body volume by 30kg. The murderer then placed all the body fragments into two large pots in a space under his stairwell and then plastered over the wall to hide the body. Another paper by Dr. Konopka and colleagues in a 2007 issue of Legal Medicine examined 23 cases of dismembered bodies in the 1968-2005 period at the Cracow Department of Forensic Medicine. Of these, 17 were cases of defensive mutilation, three were offensive mutilation and two were dismemberment (decapitation, and direct cause of death). One case remained unclassified where the murderer dissected free skin from the whole torso. They concluded that:
“Apart from rare cases of necrophilia, the victim of dismemberment is always a victim of homicide. Homicides ending with corpse dismemberment are most commonly committed by a person close to, or at least acquainted with the victim and they are performed at the site of homicide, generally in the place inhabited by the victim, the perpetrator or shared by both. Such instances are generally not planned by the perpetrator and rarely serial in character”.
Finally, I came across an interesting 2009 paper by a Finnish team led by Dr. Häkkänen-Nyholm in the Journal of Forensic Sciences. The authors noted that research relating to mutilation of bodies by murderers was “sparse”. They estimated the rate of mutilation of the victim’s body in Finnish homicides. To do this they examined all crime and forensic reports of homicide offenders from 1995–2004 (n = 676). Only 13 murders (2.2%) involved postmortem mutilation. They concluded that:
“Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Chaudhary, B.L., Murty, O.P. & Singh, D. (2007). Foreign objects in genitalia: Homicide with destruction of identity – A case report. Journal of Indian Academy of Forensic Medicine, 29(4), 135-137.
Häkkänen-Nyholm, H., Weizmann‐Henelius, G., Salenius, S., Lindberg, N., & Repo-Tiihonen, E. (2009). Homicides with mutilation of the victim’s body. Journal of Forensic Sciences, 54(4), 933-937.
Hladík, J., Štefan, J., Srch, M., & Pilin, A. (2000). A rare case of evisceration. International Journal of Legal Medicine, 113(2), 107-109.
Konopka, T., Bolechala, F., & Strona, M. (2006). An unusual case of corpse dismemberment. The American Journal of Forensic Medicine and Pathology, 27(2), 163-165.
Konopka, T., Strona, M., Bolechała, F., & Kunz, J. (2007). Corpse dismemberment in the material collected by the Department of Forensic Medicine, Cracow, Poland. Legal Medicine, 9(1), 1-13.
Kunz, J. & Gross, A. (2001). Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation. American Journal of Forensic and Medical Pathology, 22(3), 327-31.
Rajs, J., Lundstrom, M., Broberg, M., Lidberg, L., & Lindquist, O. (1998). Criminal mutilation of the human body in Sweden: A thirty year medico-legal and forensic psychiatric study. Journal of Forensic Sciences, 43(3), 563-80.
Simonsen, J. (1989). A sadistic homicide. The American Journal of Forensic Medicine and Pathology, 10(2), 159-163.
Türk, E. E., Püschel, K., & Tsokos, M. (2004). Features characteristic of homicide in cases of complete decapitation. The American Journal of Forensic Medicine and Pathology, 25(1), 83-86.
