CensoredScribe

If Astro Boy is the Japanese Superman, Black Jack is the Japanese Batman. Everyone knows him, even far outside the comics world, and when people think of him people think of his fierce critique of the medical world. ~ Ada Palmer in Cian O'Luanaigh, "Osamu Tezuka: Father of manga and scourge of the medical establishment", The Guardian, (21 July, 2010).

When we start to write, we’re under the assumption that everyone knows racism is bad. If you don’t know that, you’re a moron. ~ Hayden Schlossberg in "Mining Post-9/11 America for Laughs" by Dennis Lim, New York Times, (April 20, 2008)

You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist's circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. [If he is unplugged from you now, he will die; but] in nine months he will have recovered from his ailment, and can safely be unplugged from you. - Judith Jarvis Thomson, A Defense of Abortion 1971: 48–49.

Do you really believe ... that everything historians tell us about men – or about women – is actually true? You ought to consider the fact that these histories have been written by men, who never tell the truth except by accident.” ~ Moderata Fonte

The intellectual, the moral, the religious seem to me all naturally bound up and interlinked together in one great and harmonious whole. - Ada Lovelace, in a letter to Andrew Crosse, as quoted in Eugen Kölbing's Englische Studien, Volume 19 (1894), Leipzig; O.R. Reisland, "Byron's Daughter", p. 158.

Although it is impossible accidentally for the past not to have been, if one considers the past thing itself, as, for instance, the running of Socrates; nevertheless, if the past thing is considered as past, that it should not have been is impossible, not only in itself, but absolutely since it implies a contradiction. Thus, it is more impossible than the raising of the dead; in which there is nothing contradictory, because this is reckoned impossible in reference to some power, that is to say, some natural power; for such impossible things do come beneath the scope of divine power. - Thomas Aquinas, Summa Theologica, Question 25 Article 6.

Women have long been props for war-making. Invasions are often justified in part by pointing to the suffering of women in the countries targeted for attack. “Only the terrorists and the Taliban threaten to pull out women’s fingernails for wearing nail polish,” Laura Bush said when she took over her husband’s weekly radio address, in 2001, to urge Americans to support the war in Afghanistan. Like McMaster’s miniskirt photograph, Bush’s speech exemplifies the kind of pseudo-feminism sometimes used to justify invasion. The literary theorist and postcolonial feminist Gayatri Spivak calls it “white men saving brown women from brown men,” an imperial logic that ignores sexism at home to fight sexism abroad, and which disregards brown women’s agency and self-understanding. How women make sense of the situations in which they live—whether, for instance, they see the veil as oppressive or as a symbol of resistance or simply as an important religious practice—is irrelevant. Instead, imperialism is presented as a necessary act of deliverance. They don’t know how to treat their women; our job—really, our moral obligation—is liberation. ~ Sarah Sentilles, "Colonial Postcards and Women as Props for War-Making", The New Yorker, (October 5, 2017).

Yet this defence of unborn life is closely linked to the defence of each and every other human right. It involves the conviction that a human being is always sacred and inviolable, in any situation and at every stage of development. Human beings are ends in themselves and never a means of resolving other problems. Once this conviction disappears, so do solid and lasting foundations for the defence of human rights, which would always be subject to the passing whims of the powers that be. Reason alone is sufficient to recognize the inviolable value of each single human life, but if we also look at the issue from the standpoint of faith, “every violation of the personal dignity of the human being cries out in vengeance to God and is an offence against the creator of the individual”.
Precisely because this involves the internal consistency of our message about the value of the human person, the Church cannot be expected to change her position on this question. ~ Pope Francis, Evangelii Gaudium · The Joy of the Gospel, (November 24, 2013), sections 214-215.

The ownership of land is an odd thing when you come to think of it. How deep, after all, can it go? If a person owns a piece of land, does he own it all the way down, in ever narrowing dimensions, till it meets all other pieces at the center of the earth? Or does ownership consist only of a thin crust under which the friendly worms have never heard of trespassing? - Natalie Babbit, Tuck Everlasting

The word Nephilim is derived from the Hebrew word Naphal which literally means “fall or drop”. The commentators explain that these giants were called Nephilim since the hearts of those that saw them would “drop” as a result of seeing these awesome beings.
Of course, any mention of fallen angels who in essense became humans, begs a deeper understanding. Recall that these fallen angels are mentioned in the same context as the intense immorality which pervaded mankind. The actions of mankind have repercussions far beyond the physical world we find ourselves in. All our actions, whether positive or negative impact the spiritual worlds as well. ~ Rabbi Yoel Spotts

Feet, what do I need them for If I have wings to fly. - Frida Kahlo dated 1953, preceding a foot amputation in August of that year.

Among those nations like my own that hold nuclear stockpiles, we must have the courage to escape the logic of fear and pursue a world without them. - President Barack Obama’s Speech in Hiroshima, Japan

If I were not an atheist, I would believe in a God who would choose to save people on the basis of the totality of their lives and not the pattern of their words. I think he would prefer an honest and righteous atheist to a TV preacher whose every word is God, God, God, and whose every deed is foul, foul, foul.
I would also want a God who would not allow a Hell. Infinite torture can only be a punishment for infinite evil, and I don't believe that infinite evil can be said to exist even in the case of Hitler. Besides, if most human governments are civilized enough to try to eliminate torture and outlaw cruel and unusual punishments, can we expect anything less of an all-merciful God?
I feel that if there were an afterlife, punishment for evil would be reasonable and of a fixed term. And I feel that the longest and worst punishment should be reserved for those who slandered God by inventing Hell. - Isaac Asimov, Asimov: A Memoir (1994).

As long as an heir is underage, he is no different from a slave, although he owns the whole estate. The heir is subject to guardians and trustees until the time set by his father. So also, when we were underage, we were in slavery under the elemental spiritual forces of the world. - Paul, Epistle to the Galatians 4:1-7 NIV

Narrated 'Aisha: I used to play with the dolls in the presence of the Prophet, and my girl friends also used to play with me. When Allah's Apostle used to enter (my dwelling place) they used to hide themselves, but the Prophet would call them to join and play with me. (The playing with the dolls and similar images is forbidden, but it was allowed for 'Aisha at that time, as she was a little girl, not yet reached the age of puberty.) ~ Aisha Sahih Bukhari 8:73:151 Sahih Bukhari.

Wealth converts a strange land into homeland and poverty turns a native place into a strange land. - Ali as quoted by Nahj al-Balagha, translations by Askari Jafri

In fact, the thickness of the Earth's atmosphere, compared with the size of the Earth, is in about the same ratio as the thickness of a coat of shellac on a schoolroom globe is to the diameter of the globe. That's the air that nurtures us and almost all other life on Earth, that protects us from deadly ultraviolet light from the sun, that through the greenhouse effect brings the surface temperature above the freezing point. (Without the greenhouse effect, the entire Earth would plunge below the freezing point of water and we'd all be dead.) Now that atmosphere, so thin and fragile, is under assault by our technology. We are pumping all kinds of stuff into it. You know about the concern that chlorofluorocarbons are depleting the ozone layer; and that carbon dioxide and methane and other greenhouse gases are producing global warming, a steady trend amidst fluctuations produced by volcanic eruptions and other sources. Who knows what other challenges we are posing to this vulnerable layer of air that we haven't been wise enough to foresee? - Carl Sagan in Wonder and Skepticism, Skeptical Inquirer (Jan-Feb 1995), 19, No. 1.

The surplus of basic knowledge of the atomic nucleus was largely used up during the war with the atomic bomb as the dividend. We must, without further delay restore this surplus in preparation for the important peacetime job for the nucleus - power production. ... Many of the proposed applications of atomic power - even for interplanetary rockets - seem to be within the realm of possibility provided the economic factor is ruled out completely, and the doubtful physical and chemical factors are weighted heavily on the optimistic side. ... The development of economic atomic power is not a simple extrapolation of knowledge gained during the bomb work. It is a new and difficult project to reach a satisfactory answer. Needless to say, it is vital that the atomic policy legislation now being considered by the congress recognizes the essential nature of this peacetime job, and that it not only permits but encourages the cooperative research-engineering effort of industrial, government and university laboratories for the task. ... We must learn how to generate the still higher energy particles of the cosmic rays - up to 1,000,000,000 volts, for they will unlock new domains in the nucleus. - Chauncey Guy Suits Addressing the American Institute of Electrical Engineering, in New York (24 Jan 1946). In Schenectady Gazette (25 Jan 1946)

Societies with a high incidence of rape . . . tolerate violence and encourage men and boys to be tough, aggressive, and competitive. Men in such cultures generally have special, politically important gathering spots off limits to women, whether they be the Mundurucu men's club or the corner tavern. Women take little or no part in public decision making or religious rituals: men mock or scorn women's practical judgment. They also demean what they consider women's work and remain aloof from childbearing and rearing. These groups usually trace their beginnings to a male supreme being. - B.L. Benderly, 1982, "Rape free or rape prone", Science 82, vol. 3, no. 8. p.42-43.

Last year, Vice President Biden said that with a new moonshot, America can cure cancer. Last month, he worked with this Congress to give scientists at the National Institutes of Health the strongest resources they’ve had in over a decade. Tonight, I’m announcing a new national effort to get it done. And because he’s gone to the mat for all of us, on so many issues over the past forty years, I’m putting Joe in charge of Mission Control. - Barrack Obama State of the Union (Jan 12th 1016) as quoted 8 Key Quotes Last Obama's State of the Union State of the Union (Jan 12th 1016)

When the last tree is cut, the last fish is caught, and the last river is polluted; when to breathe the air is sickening, you will realize, too late, that wealth is not in bank accounts and that you can’t eat money. - Alanis Obomsawin, Who is the Chairman of This Meeting?: A Collection of Essays (1972), edited by Ralph Osborne, as quoted in “Conversations with North American Indians” by Ted Poole, Page 43, Neewin Publishing Company, Toronto.

Our planet is bigger than the reed bundles that have carried us across the seas, and yet small enough to run the same risks unless those of us still alive open our eyes and minds to the desperate need of intelligent collaboration to save ourselves and our common civilization from what we are about to convert into a sinking ship. - Thor Heyderdahl Open Letter to the UN Secretary-General Kurt Waldheim

In ancient times writings and inscriptions were generally made on tablets of bamboo or on pieces of silk called chih. But silk being costly and bamboo heavy, they were not convenient to use. Tshai Lun Cai Lun then initiated the idea of making paper from the bark of trees, remnants of hemp, rags of cloth, and fishing nets. He submitted the process to the emperor in the first year of Yuan-Hsing [+105] and received praise for his ability. From this time, paper has been in use everywhere and is universally called 'the paper of Marquis Tshai'. - Tsien, Tsuen-Hsuin; Needham, Joseph (1985). Science and Civilization in China: Volume 5: Chemistry and Chemical Technology, Part 1: Paper and Printing.

A bewildering assortment of (mostly microscopic) life-forms has been found thriving in what were once thought to be uninhabitable regions of our planet. These hardy creatures have turned up in deep, hot underground rocks, around scalding volcanic vents at the bottom of the ocean, in the desiccated, super-cold Dry Valleys of Antarctica, in places of high acid, alkaline, and salt content, and below many meters of polar ice. ... Some deep-dwelling, heat-loving microbes, genetic studies suggest, are among the oldest species known, hinting that not only can life thrive indefinitely in what appear to us totally alien environments, it may actually originate in such places. - David Darling, In Life Everywhere: the Maverick Science of Astrobiology (2002), xi.

Each Party undertakes not to develop, test, or deploy: (...) (c) systems for placing into Earth orbit nuclear weapons or any other kind of weapons of mass destruction, including fractional orbital missiles. - SALT II treaty

The factors governing the actual pattern of global incidence for any particular extraterrestrial invasion could be complex. If bacteria or viruses are dispersed in a diffuse cloud of small particles, the incidence of disease may well be global. On the other hand, a smaller disintegrating aggregate of infective grain clumps falling over a limited area of the Earth's surface could provide a geographically more localized invasion….Our suggestion, if correct, would have profound biological, medical and sociological implications. A continual microbiological vigil of the stratosphere may well be necessary to eliminate the havoc which will ensue from extraterrestrial invasions in the future. - "Does Epidemic Disease Come From Space?," - N. Chandra Wickramasing, November 17, 1977 issue of New Scientist

It is also our view that there are no sound reasons for treating the early-stage human embryo or cloned human embryo as anything special, or as having moral status greater than human somatic cells in tissue culture. A blastocyst (cloned or not), because it lacks any trace of a nervous system, has no capacity for suffering or conscious experience in any form – the special properties that, in our view, spell the difference between biological tissue and a human life worthy of respect and rights. Additional biological facts suggest that a blastocyst should not be identified with a unique individual person, even if the argument that it lacks sentience is set aside. A single blastocyst may, until the primitive streak is formed at around fourteen days, split into twins; conversely, two blastocysts may fuse to form a single (chimeric) organism. Moreover, most early-stage embryos that are produced naturally (that is, through the union of egg and sperm resulting from sexual intercourse) fail to implant and are therefore wasted or destroyed. - The President's Council on Bioethics Washington, D.C. July 2002.

But if the same tests, the same foods are examined by an independent scientist, then it turns out that in almost every case there are quite serious harms done to the rats, the mice or the other poor unfortunate animals, particularly internal organs like liver and kidneys and things of that sort. - Jane Goodall, "Godall Says Animals Suffer From Genetically Modified Foods" (2015-04-28)

And the LORD spake unto Moses, saying, Avenge the children of Israel of the Midianites ... And they warred against the Midianites, as the LORD commanded Moses; and they slew all the males ... And the children of Israel took all the women of Midian captives, and their little ones ... And Moses was wroth with the officers ... And Moses said unto them, Have ye saved all the women alive? ... Now therefore kill every male among the little ones, and kill every woman that hath known man by lying with him. But all the women children, that have not known a man by lying with him, keep alive for yourselves. - Deuteronomy 20:10-14

Dans ses écrits, un sage Italien
Dit que le mieux est l'ennemi du bien.
(In his writings, a wise Italian
says that the better is the enemy of good.). ~ Voltaire, "Art Dramatique", 1770 edition of Dictionnaire philosophique

After a series of harmless punishments, each girl was led into a large room where all the Junior and Senior girls were assembled. There she was sentenced to go through various exhibitions, supposed to be especially suitable to punish each particular girls failure to submit to discipline imposed by the upper class girl. The sophomore girls carried long sticks with which to enforce, if necessary, the stunts which the freshmen were required to preform. While the programme did not call for a series of pre-arranged physical struggles between individual girls...frequent rebellion of the freshman against the commands of their captresses and guards furnished the most exciting portion of the entertainment according to the report of a majority of the class girls. Nearly all the sophomores reported excited pleasantness of captivation emotion throughout the party. - William Moulton Marston, as quoted in Wonder Woman: Bondage and Feminism in the Marston/Peter comics, 1941-1948 pp. 64-65 by Noah Berlatsky.

What it really means is pro-human-life. Abortion clinic bombers are not known for their veganism, nor do Roman Catholics show any particular reluctance to have their suffering pets 'put to sleep'. In the minds of many confused people, a single-celled human zygote, which has no nerves and cannot suffer, is infinitely sacred, simply because it is 'human'. No other cells enjoy this exalted status. But such 'essentialism' is deeply un-evolutionary. If there were a heaven in which all the animals who ever lived could frolic, we would find an interbreeding continuum between every species and every other. For example I could interbreed with a female who could interbreed with a male who could ... fill in a few gaps, probably not very many in this case ... who could interbreed with a chimpanzee. We could construct longer, but still unbroken chains of interbreeding individuals to connect a human with a warthog, a kangaroo, a catfish. - Richard Dawkins, Richard Dawkins Chimpanzee Hybrid? The Guardian, Jan 2009.

They (Native Americans) didn't have any rights to the land, and there was no reason for anyone to grant them rights which they had not conceived and were not using. What was it that they were fighting for, when they opposed white men on this continent? For their wish to continue a primitive existence, their 'right' to keep part of the earth untouched, unused and not even as property, but just keep everybody out so that you will live practically like an animal, or a few caves above it. Any white person who brings the element of civilization has the right to take over this continent. - Ayn Rand, Q and A session following her address to the graduating class of The United States Military Academy at West Point, New York, March 6, 1974 - found in Endgame: Resistance, by Derrick Jensen, Seven Stories Press, 2006, pg 220.

We believed that the often ridiculed mass audience is sick of this world's petty nationalism and all it ís old ways and old hatreds, and that people are not only willing but anxious to think beyond most petty beliefs that have for so long kept mankind divided. So you see that the formula, the magic ingredient that many people keep seeking and many of them keep missing is really not in Star Trek. It is in the audience. There is an intelligent life form out on the other side of that television too. Star Trek was an attempt to say that humanity will reach maturity and wisdom on the day that it begins not just to tolerate, but take a special delight in differences in ideas and differences in life forms. […] If we cannot learn to actually enjoy those small differences, to take a positive delight in those small differences between our own kind, here on this planet, then we do not deserve to go out into space and meet the diversity that is almost certainly out there. - Gene Roddenberry as quoted by Socialism in One Galaxy, Socialist Worker.org, [1].

The things we can do with life—have relationships, be creative, create knowledge—are what give life meaning. We don't need death to give time a purpose. We rationalize this great tragedy and convince ourselves that death is a blessing, but it's a tragedy. It's a profound loss of knowledge and skill and humanity and relationships. It is a loss of the things that give life significance. - Ray Kurzweil as quoted in "Google Engineer Ray Kurzweil Thinks We'll Cheat Death In This Lifetime. Here's Why.", Prevention.com.

He who fights with monsters should look to it that he himself does not become a monster. And if you gaze long into an abyss, the abyss also gazes into you. ~ Friedrich Nietzsche, Beyond Good and Evil, Aphorism 146

Kai: I killed mothers with their babies. I've killed great philosophers, proud young warriors, and revolutionaries. I've killed the evil, the good, the intelligent, the weak, and the beautiful. I have done this in the service of His Divine Shadow and his predecessors, and I have never once shown any mercy. ~ Lex Gigeroff, Lexx, I Worship His Shadow

Man in a state of society, more especially where there is an inequality of condition and rank, is very often the creature of leisure. He finds in himself, either from internal or external impulse, a certain activity. He finds himself at one time engaged in the accomplishment of his obvious and immediate desires, and at another in a state in which these desires have for the present been fulfilled, and he has no present occasion to repeat those exertions which led to their fulfilment. This is the period of contemplation. This is the state which most eminently distinguishes us from the brutes. Here it is that the history of man, in its exclusive sense, may be considered as taking its beginning. - William Godwin Lives of the Necromancers (1834)

I don’t want to ever say that anything that I’m doing with these fantasy pictures has anything to do with real heroics. I admire those men and women in the service and I know that they risk a lot for our country and for our freedom. They have my thanks and my admiration. These are simple comic book fantasy stories, but they have their importance, too. They’re much lower level. I’m very lucky to be an American and to be able to tell these stories and live in Los Angeles protected. But that having been said, I think the value of any story of a hero is that it reminds us of the good we can do in the world. And it reminds of what we’re capable of. Like myths, or stories of old. They have us identify with characters, they show them coming upon terrible conflicts and problems, and they show these characters, if they’re heroic stories, rising above those conflicts – exhibiting qualities that they probably didn’t even think that they had. Maybe it’s a growth of responsibility, like in this film. Or maybe it’s the ability to withstand more than they thought they could for the ones they love, or to risk something for an ideal they believe in, that’s greater than themselves. And when we see these stories, and when we see these characters overcome these conflicts and grow as human beings, we’re uplifted because we’re reminded – yes, we’re capable of that. I’m capable of that goodness too. And we feel touched and stirred when it works right. And that’s the value of these heroic stories. They show us the way and remind us what we should be. ~ Sam Raimi, "Interview: Director Sam Raimi on Spider-Man 2", SuperHeroHype, (Jun 23, 2004).

The Joker: So... I see you received the free ticket I sent you. I'm glad. I did so want you to be here. You see it doesn't matter if you catch me and send me back to the asylum... Gordon's been driven mad. I've proved my point. I've demonstrated there's no difference between me and everyone else! All it takes is one bad day to reduce the sanest man alive to lunacy. That's how far the world is from where I am. Just one bad day. You had a bad day once, am I right? I know I am. I can tell. You had a bad day and everything changed. Why else would you dress up as a flying rat? You had a bad day, and it drove you as crazy as everybody else... Only you won't admit it! You have to keep pretending that life makes sense, that there's some point to all this struggling! God you make me want to puke. I mean, what is it with you? What made you what you are? Girlfriend killed by the mob, maybe? Brother carved up by some mugger? Something like that, I bet. Something like that... Something like that happened to me, you know. I... I'm not exactly sure what it was. Sometimes I remember it one way, sometimes another... If I'm going to have a past, I prefer it to be multiple choice! Ha ha ha! But my point is... My point is, I went crazy. When I saw what a black, awful joke the world was, I went crazy as a coot! I admit it! Why can't you? I mean, you're not unintelligent! You must see the reality of the situation. Do you know how many times we've come close to World War Three over a flock of geese on a computer screen? Do you know what triggered the last World War? An argument over how many telegraph poles Germany owed its war debt creditors! Telegraph poles! Ha ha ha ha HA! It's all a joke! Everything anybody ever valued or struggled for... it's all a monstrous, demented gag! So why can't you see the funny side? Why aren't you laughing? ~ Alan Moore, Batman: The Killing Joke, (1988)

It's impossible for a white person to believe in capitalism and not believe in racism. You can't have capitalism without racism. ~ Malcolm X, Speech, May 29, 1964, The Harlem Hate-Gang-Scare, p. 69 as quoted in Malcolm X Speaks (1965)

It is easy to kill someone with a slash of a sword. It is hard to be impossible for others to cut down. ~ Yagyū Munenori, as quoted in Behold the Second Horseman (2005), by Joseph Lumpkin, p. 53

Art is subjective; it’s in the eye of the beholder. I think video games can be fun. They can teach eye-hand coordination and strategy and they can introduce children to computer technology. And there is no doubt they are intricate and sophisticated technologically. I’m not in any way trying to do away with video games. I’m strictly concerned with a small subset of games that are harmful to children — those that are excessively violent and sexually explicit. I want to make sure children can’t obtain these games without their parents’ consent. ~ Hillary Clinton as quoted in Senator Clinton on Violent Video Games, CBS, (Aug 2, 2005)] Youtube.

We always think of the road not taken, of something in the past. 'Wow, what would have happened if I married so and so, or took that job in San Diego…' But you rarely think that each and every second that goes by is one of those moments. Like this second that just happened. And that one. And the one that's going to happen in a second." Potentially, each of these seconds could alter a game in a profound way. Just as they can in life. The easiest thing for us to imagine is that our lives, and the story we are playing, are pre-designed, solid. But neither gaming nor life has to be like that. In both, we can alter and decide in a way that is surprising, ultimately freeing. ~ Ken Levine, "Ken Levine Bioshok Interview", The Guardian, 14 January 2014

I think girls tend to like RPGs, like Final Fantasy. Girls who play games like that seem to get more of a desire to work in this field. I usually don't think to make games strictly for a female audience, myself, but I think my RPGs attract a larger female audience. Violent, war-themed titles seem to attract an overwhelmingly male audience. I think if companies want to get more girls to play their games, they should keep this in mind. ~ Reiko Kodama "Interview Reiko Kodama", The-nextlevel.com

Needless to say, adventure characters should be just one facet of videogaming. In the same way a painting allows us to gaze upon the faces and souls of people from another age, or a book permits us to linger on the thoughts of great figures from history and fiction, videogames can expand our awareness of the world as it is, was, or might be. ~ Adam West, "The Keyboard: Guest Editorials", Videogaming Illustrated July 1983, p. 6

J.D.: You probably wondered why I didn't show up before, huh? I know you wanted me to, even though you'd never admit it. Normally I would kill to get into this apartment, and you'd try and keep me out... I say "try", because at your Super-Bowl party, which I was not invited to, I was lucky enough to be able to watch the second half from right over there. I was the bearded Dominoe's employee you invited in because I said I was a fan of Jerome Bettis, whoever the hell that is. Anyway, I tried to convince myself the reason I didn't come earlier was because of you coming into work drunk; but that's not it. I was scared. I guess after all this time I still think of you as like this superhero that'll help me out of any situation I'm in. I needed that. But that's my problem, you know, and I'll deal with that. I guess I came over here to tell you... how proud of you I am. Not because you did the best you could for those patients; but because after twenty years of being a doctor, when things go badly, you still take it this hard. And I gotta tell you man, I mean... that's the kind of doctor I want to be. ~ Scrubs, My Fallen Idol, (May, 2006), Bill Lawrence (created by), Bill Callahan

Big Boss: The nightmares? They never go away, Snake. Once you've been on the battlefield, tasted the exhilaration, the tension... it all becomes part of you. Once you've awakened the warrior within... it never sleeps again. You crave ever bigger tensions, ever bigger thrills. As a mercenary, I'd think you would have realized that by now. You care nothing for power, or money, or even sex. The only thing that satisfies your cravings is war! All I've done is give you a place for it. I've given you a reason to live. ~ Hideo Kojima, Metal Gear II: Solid Snake, (July 20, 1990)

Every culture has such myths and theories about the creation of their worlds, and it can be beneficial and entertaining to examine them in detail, for they often affect the present day social structure. ~ “The Legend of Zelda: Link to the Past”, Kensuke Tanabe, Yoshiaki Koizumi, Nintendo, (1992), p.3

Dune was aimed at this whole idea of the infallible leader because my view of history says mistakes made by a leader (or made in a leader's name) are amplified by the numbers who follow without question. That's how 900 people wound up in Guyana drinking poison Kool-Aid. That's how the U.S. said "Yes, sir, Mister Charismatic John Kennedy!" and found itself embroiled in Vietnam. That's how Germany said "Sieg Heil!" and murdered more than six million of our fellow human beings. ~ Frank Herbert, Introduction to Eye, (1987)

I imagine that as population continues to increase—and as the available resources decrease—there will be less energy and food, so we'll all enter a stage of scrounging. The average person's only concerns will be where he or she can get the next meal, the next cigarette, the next means of transportation. In such a universal scramble, the Earth will be just plain desolated, because everyone will be striving merely to survive regardless of the cost to the environment. Put it this way: If I have to choose between saving myself and saving a tree, I'm going to choose me. Terrorism will also become a way of life in a world marked by severe shortages. Finally, some government will be bound to decide that the only way to get what its people need is to destroy another nation and take its goods ... by pushing the nuclear button. And this absolute chaos is going to develop—even if nobody wants nuclear war and even if everybody sincerely wants peace and social justice—if the number of mouths to feed continues to grow. Nothing will be able to stand up against the pressure of the whole of humankind simply trying to stay alive! ~ Isaac Asimov, "Science, Technology and Space: The Isaac Asimov Interview" Pat Stone, Mother Earth News (October 1980)

Jack Harkness: There you go! I can taste it! Oestrogen. Definitely oestrogen. You take the pill, flush it away, and it enters the water cycle. Feminizes the fish. Goes all the way up into the sky then falls all the way back down onto me. Contraceptives in the rain. Love this planet. Still, at least I won't get pregnant. Never doing that again. ~ Russell T Davies, "Everything Changes", Torchwood, (22 October 2006).

The Gothic tradition concerns things lurking in the beyond and monsters that often represent ourselves. It’s traditionally looked at how big institutions like the church and state are in fact fundamentally corrupt. That idea of the evil within is a very X-Files thing. Both Gothic literature and The X-Files are about taking that walk into the dark woods and facing what we can’t define. That’s essentially what Mulder does in the show. ~ Sharon R. Yang, "Can The X-Files exist in a post-9/11 world?", Andrew Harrison, New Statesmen, (29 December 2015).

You express amazement at my statement that 'civilized' men try to justify their looting, butchering and plundering by claiming that these things are done in the interests of art, progress and culture. That this simple statement of fact should cause surprize, amazes me in return. People claiming to possess superior civilization have always veneered their rapaciousness by such claims... Your friend Mussolini is a striking modern-day example. In that speech of his I heard translated he spoke feelingly of the expansion of civilization. From time to time he has announced; 'The sword and civilization go hand in hand!' 'Wherever the Italian flag waves it will be as a symbol of civilization!' 'Africa must be brought into civilization!' It is not, of course, because of any selfish motive that he has invaded a helpless country, bombing, burning and gassing both combatants and non-combatants by the thousands. Oh, no, according to his own assertions it is all in the interests of art, culture and progress, just as the German war-lords were determined to confer the advantages of Teutonic Kultur on a benighted world, by fire and lead and steel. Civilized nations never, never have selfish motives for butchering, raping and looting; only horrid barbarians have those. ~ Robert E. Howard from a letter to H. P. Lovecraft (5 December 1935)

I should regard them [the Elves interested in technical devices] as no more wicked or foolish (but in much the same peril) as Catholics engaged in certain kinds of physical research (e.g. those producing, if only as by-products, poisonous gases and explosives): things not necessarily evil, but which, things being as they are, and the nature and motives of the economic masters who provide all the means for their work being as they are, are pretty certain to serve evil ends. For which they will not necessarily be to blame, even if aware of them. ~ J. R. R. Tolkien; in a letter to Peter Hastings (Sep 1954); in Humphrey Carpenter (ed.) assisted by Christopher Tolkien, The Letters of J.R.R. Tolkien (1995, 2014), 190, Letter No. 153.

They were meant to emphasize the conflict between people who felt that we've got to all work together and find a way to get along, and people who feel, 'We're not treated well, therefore we're going to strike back with force!' ~ Stan Lee

Mutants are all around us. They could be your neighbors. They could be your co-workers. They could be related to you. ~ Chris Claremont

Games are all about mechanics. That’s what games are, at the heart. You can put a story on top of any mechanics, to string something together, but the game is about the mechanics. To me, one of the most powerful things about games is the story the player can put into the game. The more story you put into a game, the less ownership of the story you give to the player. The less story you put in a game, the more the player feels they can create their own story. ~ John Romero, "After 20 years, Doom co-creator John Romero looks back on the impact of a seminal (and Satanic) game (interview)" by Dean Takahashi, Venturebeat.com (December 11, 2013)

The trouble with animation today is that we’ve forgotten the basics. Every animator at Pixar can still draw. Good animation is driven by the craft not by the tools. ~ Steve Williams, "Steve "Spaz" Williams", Sheridancollege.ca

When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation. ~ Declaration of Independence

The Face of Boe: Everything has its time. You know that, old friend, better than most. ~ Russell T Davies, "Gridlock", Doctor Who, (14 April 2007).

Elizabeth Comstock: Some men dream of money, some men dream of love. My father dreamt of a flood of fire. We were given Eden, and we turned it into Sodom. ~ Ken Levine, BioShock Infinite, (March 26, 2013)

This was a period when we were experimenting with the atom bomb. People were wondering what the effects would be. Everybody worried ‘Would we all become mutants? We played around with this ‘mutation thing’ and I came up with the X-Men, who were associated with radiation and its effects on humanity. ~ Jack Kirby, “1993: Jack Kirby: The Hardest Working Man in Comics by Steve Pastis”, Happening Magazine, (1993) by Steve Pastin; as quoted by Rand Hoppe, The Kirby Effect The Journal of the Jack Kirby Museum & Research Center, (28 April 2018)

Naomi Hunter: The most we can say about DNA is that it governs a person's potential strengths... potential destiny. You mustn't allow yourself to be chained to fate... to be ruled by your genes. Humans can choose the type of life they want to live. ~ Hideo Kojima, Tomokazu Fukushima, Metal Gear Solid, (September 3, 1998)

As an adult, you may be more sensitive to some emotions than to others. What you learned about reading emotions in your own family might have great applicability to understanding others or relatively little, at least for some emotions. Through watching television, or movies, or a close friend, you may have improved upon and added to your knowledge of facial expressions. Although almost everyone correctly reads some facial expressions, few people realize when they make mistakes or why they make them.
The rules for translating a particular set of facial wrinkles into the judgement that a person is angry, afraid, etc. would be very hard for most people to describe. When you follow these rules you do so automatically, on the basis of habits established long so long ago that usually you don’t know how they operate, or even when they operate. In this sense, understanding facial expressions of emotion is like driving a car. You don’t think about what you are doing when you do it. Unlike driving a car, with facial expression there never was an earlier period in which you were specifically taught the skills. ~ Paul Ekman, Wallace V. Friesen, Unmasking the Face, Cambridge MA, (2003), p. 8.

Although nearly all fiction may provide a basis for simulated social experiences (Koopman & Hakemulder, 2015; Mar & Oatley, 2008), the present findings suggest that literary fiction is most likely to prompt readers to rely extensively on ToM, leading them to more fully recruit ToM-related processes, even beyond the immediate context of reading. This finding is consistent with prior research demonstrating short-term benefits to ToM performance caused by reading short works of literary fiction (Black & Barnes, 2015a; Kidd & Castano, 2013). We propose that these findings emerge because the implied (rather than explicit) sociocognitive complexity, or roundness of characters, in literary fiction prompts readers to make, adjust, and consider multiple interpretations of characters’ mental states (Zunshine, 2015). Though both prior experimental findings and the current results are consistent with this view, no direct evidence speaks to the precise mechanisms through which literary fiction affects ToM. Future research either focusing on the linguistic, syntactic, and other characteristics of literary texts, or that creates ad hoc texts that vary along specific dimensions, will provide valuable information about such mechanisms. ~ Kidd, D., & Castano, E., "Different Stories: How Levels of Familiarity With Literary and Genre Fiction Relate to Mentalizing", Psychology of Aesthetics, Creativity, and the Arts, (2016, August 8), p. 10.

You see all these white heroes, everybody is white, all the literature classes—your Shakespeare, your poetry — everybody’s white, and you start to feel less than. ~ John Leguizamo, "Broadway's John Leguizamo shares four favorite Latino heroes", Arturo Conde, NBC News, (Nov. 16, 2018).

All my heroes were either murdered by the government or… are registered sex offenders. ~ Dave Chappelle, The Bird Revelation, (November 2017)

Reference desk questions archive

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Quotes

• Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.
  • Martin Luther King, Jr. Speech to the Second National Convention of the Medical Committee for Human Rights – Chicago, (March 25, 1966).
• Now our struggle is for genuine equality, which means economic equality. ... What does it profit a man to be able to eat at an integrated lunch counter if he doesn't earn enough money to buy a hamburger and a cup of coffee?
  • Martin Luther King, Jr., in The Radical King, p. 249.
• There is something wrong with our world, something fundamentally and basically wrong. I don't think we have to look too far to see that. I'm sure that most of you would agree with me in making that assertion. And when we stop to analyze the cause of our world's ills, many things come to mind. We begin to wonder if it is due to the fact that we don't know enough. But it can't be that. Because in terms of accumulated knowledge we know more today than men have known in any period of human history. We have the facts at our disposal. We know more about mathematics, about science, about social science, and philosophy than we've ever known in any period of the world's history. So it can't be because we don't know enough. And then we wonder if it is due to the fact that our scientific genius lags behind. That is, if we have not made enough progress scientifically. Well then, it can't be that. For our scientific progress over the past years has been amazing. Man through his scientific genius has been able to dwarf distance and place time in chains, so that today it's possible to eat breakfast in New York City and supper in London, England. Back in about 1753 it took a letter three days to go from New York City to Washington, and today you can go from here to China in less time than that. It can't be because man is stagnant in his scientific progress. Man's scientific genius has been amazing. I think we have to look much deeper than that if we are to find the real cause of man's problems and the real cause of the world's ills today. If we are to really find it I think we will have to look in the hearts and souls of men.
  • Martin Luther King Jr., Rediscovering Lost Values, Sermon delivered at Detroit's Second Baptist Church (28 February 1954)
• We have genuflected before the God of Science only to find that it has given us the atomic bomb, producing fears and anxieties that science can never mitigate.
  • Martin Luther King Jr., Strength to Love, 1963.
• The history books, which had almost completely ignored the contribution of the Negro in American history, only served to intensify the Negroes' sense of worthlessness and to augment the anachronistic doctrine of white supremacy. All too many Negroes and whites are unaware of the fact that the first American to shed blood in the revolution which freed this country from British oppression was a black seaman named Crispus Attucks. Negroes and whites are almost totally oblivious of the fact that it was a Negro physician, Dr. Daniel Hale Williams, who performed the first successful operation on the heart in America. Another Negro physician, Dr. Charles Drew, was largely responsible for developing the method of separating blood plasma and storing it on a large scale, a process that saved thousands of lives in World War II and has made possible many of the important advances in postwar medicine. History books have virtually overlooked the many Negro scientists and inventors who have enriched American life. Although a few refer to George Washington Carver, whose research in agricultural products helped to revive the economy of the South when the throne of King Cotton began to totter, they ignore the contribution of Norbert Rillieuz, whose invention of an evaporating pan revolutionized the process of sugar refining. How many people know that multimillion-dollar United Shoe Machinery Company developed from the shoe-lasting machine invented in the last century by a Negro from Dutch Guiana, Jan Matzelinger; or that Granville T. Woods, an expert in electric motors, whose many patents speeded the growth and improvement of the railroads at the beginning of this century, was a Negro?
  Even the Negroes' contribution to the music of America is sometimes overlooked in astonishing ways. In 1965 my oldest son and daughter entered an integrated school in Atlanta. A few months later my wife and I were invited to attend a program entitled "Music that has made America great." As the evening unfolded, we listened to the folk songs and melodies of the various immigrant groups. We were certain that the program would end with the most original of all American music, the Negro spiritual. But we were mistaken. Instead, all the students, including our children, ended the program by singing "Dixie".
  • Martin Luther King Jr., as quoted in Carson, Clayborne. 2001. The Autobiography of Martin Luther King, Jr., Grand Central Publishing. Cap: Black Power.
• The poor folk go forth to war, to fight, and die for the delights, riches, and super fluities of others, and they are falseley called lords and rulers of the habitable world in that land where they have not so much as a single inch that they may call their own.
• The preservation of their wealth became the chief care of the ruling classes, who nearly always made common cause with the foreign invaders. During the Peloponnesian war the populace took the part of the Athenians, the rich that of the Spartans. Likewise, during the MAcedonian invasion, the rich-the "optimates" - were in favour of Philip of Macedon. Finally, later on, when the Roman legions appeared, the aristocrats again made terms with the invaders.
  • Plutarch, Parallel Lives, as quoted in From Serfdom to Socialism, James Keir Hardies, p. 115.
• It's simply a national acknowledgement that in any kind of priority, the needs of human beings must come first. Poverty is here and now. Hunger is here and now. Racial tension is here and now. Pollution is here and now. These are the things that scream for a response. And if we don't listen to that scream - and if we don't respond to it - we may well wind up sitting amidst our own rubble, looking for the truck that hit us - or the bomb that pulverized us. Get the license number of whatever it was that destroyed the dream. And I think we will find that the vehicle was registered in our own name.
  • Rod Serling, Commencement Address at the University of Southern California; (March 17, 1970).
• Nuclear weapons offer us nothing but a balance of terror, and a balance of terror is still terror.
  • George Wald from speech given at an anti-war teach-in at the Massachusetts Institute of Technology, (4 Mar 1969) 'A Generation in Search of a Future', as edited by Ron Dorfman for Chicago Journalism Review, (May 1969).
• We speak erroneously of “artificial” materials, “synthetics”, and so forth. The basis for this erroneous terminology is the notion that Nature has made certain things which we call natural, and everything else is “man-made”, ergo artificial. But what one learns in chemistry is that Nature wrote all the rules of structuring; man does not invent chemical structuring rules; he only discovers the rules. All the chemist can do is find out what Nature permits, and any substances that are thus developed or discovered are inherently natural. It is very important to remember that.
  • Buckminster Fuller, "The Comprehensive Man", Ideas and Integrities: A Spontaneous Autobiographical Disclosure (1963), 75-76.
• Pollution is nothing but resources we're not harvesting. We allow them to disperse because we've been ignorant of their value. But if we got onto a planning planning basis, the government could trap pollutants in the stacks and spillages and get back more money than this would cost out of the stockpiled chemistries they'd be collecting.
  Margaret Mead gets cross with me when I talk like this because she says people are doing some very important things because they're worried and excited and I'm going to make them relax and stop doing those things. But we're dealing with something much bigger than we're accustomed to understanding, we're on a very large course indeed. You speak of racism, for example, and I tell you that there's no such thing as race. The point is that racism is the product of tribalism and ignorance and both are falling victim to communications and world-around literacy.
  • Buckminster Fuller as quoted in "The View from the Year 2000" by Barry Farrell in LIFE magazine, (26 February 1971).
• We have got to make sure that every qualified American in this country who wants to go to college can go to college -- regardless of income. Further, it is unacceptable that 40 million Americans are drowning in more than $1.2 trillion in student loan debt. It is unacceptable that millions of college graduates cannot afford to buy their first home or their first new car because of the high interest rates they are paying on student debt.
  • Bernie Sanders Statement by Senator Bernard Sanders on the College for All Act (May 19, 2015).
• The stronghold of the determinist argument is the antipathy to the idea of chance...This notion of alternative possibility, this admission that any one of several things may come to pass is, after all, only a roundabout name for chance.
  • William James The Dilemma of Determinism, (1884), p. 153.
• My dynamite will sooner lead to peace than a thousand world conventions. As soon as men will find that in one instant, whole armies can be utterly destroyed, they surely will abide by golden peace.
  • Alfred Nobel as quoted in The Military Quotation Book (2002) by James Charlton, p. 114.
• A heart can no more be forced to love than a stomach can be forced to digest food by persuasion.

• Alfred Nobel, "Aphorisms by Alfred Nobel". Nobelprize.org. Nobel Media AB 2014.

• "Do unto others as you'd have them do unto you" is the greatest phrase ever written. If everyone followed that creed, this world would be a paradise.

• "Unlikely Saints Stan Lee Soupy Sales and the Golden Rule" Huffington Post, Stan Lee, (08/10/2010)

• I am afraid we must make the world honest before we can honestly tell our children that honesty is the best policy.
  • George Bernard Shaw, "Rungs of the Ladder", BBC Radio broadcast, 11 July 1932
• Imagine a room awash in gasoline, and there are two implacable enemies in that room. One of them has nine thousand matches. The other has seven thousand matches. Each of them is concerned about who's ahead, who's stronger. Well that's the kind of situation we are actually in. The amount of weapons that are available to the United States and the Soviet Union are so bloated, so grossly in excess of what's needed to dissuade the other, that if it weren't so tragic, it would be laughable. What is necessary is to reduce the matches and to clean up the gasoline.

• Carl Sagan, during a panel discussion in ABC News Viewpoint following the TV movie The Day After (20 Nov 1983). Misquoted as “The nuclear arms race is like two sworn enemies standing waist deep in gasoline, one with three matches, the other with five.”

• We have made a thing, a most terrible weapon, that has altered abruptly and profoundly the nature of the world. We have made a thing that, by all standards of the world we grew up in, is an evil thing. And by doing so, by our participation in making it possible to make these things, we have raised again the question of whether science is good for man, of whether it is good to learn about the world, to try to understand it, to try to control it, to help give to the world of men increased insight, increased power. Because we are scientists, we must say an unalterable yes to these questions; it is our faith and our commitment, seldom made explicit, even more seldom challenged, that knowledge is a good in itself, knowledge and such power as must come with it.
  • J. Robert Oppenheimer, Speech to the American Philosophical Society (Jan 1946). Atomic Weapons, printed in Proceedings of the American Philosophical Society, 90(1), 7-10. In Deb Bennett-Woods, Nanotechnology: Ethics and Society (2008), 23. Identified as a speech to the society in Kai Bird, Martin J. Sherwin, American Prometheus: the Triumph and Tragedy of J. Robert Oppenheimer‎ (2005), 323
• Science is not everything, but science is very beautiful.
  • J. Robert Oppenheimer, last published words With Oppenheimer on an Autumn Day, Look, Vol. 30, No. 26 (19 December 1966)
• Well — yes. In modern times, of course.
  • J. Robert Oppenheimer, answer to a student at Rochester University who asked whether the bomb exploded at Alamogordo was the first one to be detonated, as quoted in Doomsday, 1999 A.D. (1982) by Charles Berlitz, p. 129
• The aim of life is inquiry into the Truth, and not the desire for enjoyment in heaven by performing religious rites, Those who possess the knowledge of the Truth, call the knowledge of non-duality as the Truth, It is called Brahman, the Highest Self, and Bhagavan.
  • Bhagavata Purana 1.2.10-11, translated by Daniel Sheridan 1986, p. 23
• That swarm of ants that I observed, each one following the one ahead, have every one been Indra in the world of the gods by virtue of their own past action. And now, by virtue of their deeds done in the past, they have gradually fallen to the state of ants.
  • Krsna, Indra and the Ants Indra and the Ants, Classical Hindu Mythology: A Reader in the Sanskrit Puranas, by Cornelia Dimmitt, p. 321
• I grieve for you, Jonathan my brother; you were very dear to me. Your love for me was wonderful, more wonderful than that of women.
  • 2 Samuel 1:26 (NIV)
• Do not press me to leave you or to turn back from following you! Where you go, I will go; where you lodge I will lodge; your people shall be my people, and your God my God. Where you die, I will die — there will I be buried. May the Lord do thus and so to me, and more as well, if even death parts me from you!
  • (Ruth 1:16-17)
• Now behold, I have two daughters who have not had relations with man; please let me bring them out to you, and do to them whatever you like; only do nothing to these men, inasmuch as they have come under the shelter of my roof." But they said, "Stand aside." Furthermore, they said, "This one came in as an alien, and already he is acting like a judge; now we will treat you worse than them."
  • Genesis 19:9, New American Standard Bible
  • You are fifty years old and would worship a day old statue!
  • Abraham in Genesis Rabbah 38.13 R. Hiyya and the Idol Shop
• In the last heaven Moses saw two angels, each five hundred parasangs in height, forged out of chains of black fire and red fire, the angels Af, "Anger," and Hemah, "Wrath," whom God created at the beginning of the world, to execute His will. Moses was disquieted when he looked upon them, but Metatron embraced him, and said, "Moses, Moses, thou favorite of God, fear not, and be not terrified," and Moses became calm. There was another angel in the seventh heaven, different in appearance from all the others, and of frightful mien. His height was so great, it would have taken five hundred years to cover a distance equal to it, and from the crown of his head to the soles of his feet he was studded with glaring eyes. "This one," said Metatron, addressing Moses, "is Samael, who takes the soul away from man." "Whither goes he now?" asked Moses, and Metatron replied, "To fetch the soul of Job the pious." Thereupon Moses prayed to God in these words, "O may it be Thy will, my God and the God of my fathers, not to let me fall into the hands of this angel."
  • Louis Ginzberg, The Ascension of Moses, Chapter IV, "Aggadah: The Legend of the Jews"
• While God created Adam, who was alone, He said, 'It is not good for man to be alone. He also created a woman, from the earth, as He had created Adam himself, and called her Lilith. Adam and Lilith immediately began to fight. She said, 'I will not lie below,' and he said, 'I will not lie beneath you, but only on top. For you are fit only to be in the bottom position, while I am to be the superior one.' Lilith responded, 'We are equal to each other inasmuch as we were both created from the earth.' But they would not listen to one another. When Lilith saw this, she pronounced the Ineffable Name and flew away into the air.
  • Adam and Lilith in Alphabet of Sirach
• So ye shall not pollute the land wherein ye are: for blood it defileth the land: and the land cannot be cleansed of the blood that is shed therein, but by the blood of him that shed it.
  • Numbers 35:33.
• I have met people who have claimed to be satanists, who claimed to be involved with black magic...I warn all of you: never, never, never. You will not only lose your mind, you'll lose your soul.
  • Christopher Lee, University College Dublin interview, 2011.
• The more we learn of the true nature of non-human animals, especially those with complex brains and corresponding complex social behavior, the more ethical concerns are raised regarding their use in the service of man — whether this be in entertainment, as "pets," for food, in research laboratories, or any of the other uses to which we subject them.
  • Frans de Waal, Through a Window: My Thirty Years with the Chimpanzees of Gombe (2000), p. 245
• Economists are being indoctrinated into a cardboard version of human nature, which they hold true to such a degree that their own behavior has begun to resemble it. Psychological tests have shown that economics majors are more egoistic than the average college student. Exposure in class after class to the capitalist self-interest model apparently kills off whatever prosocial tendencies these students have to begin with. They give up trusting others, and conversely others give up trusting them.
  • Frans de Waal, Our Inner Ape: A Leading Primatologist Explains Why We Are Who We Are (2006), p. 243.
• Get it understood how dangerous these damaged, sick personalities are to ourselves - and above all, to our children, whose traits are taking form and we shall find ways to put an end to them.
  • Donald Ewen Cameron as quoted by Harvey Weinstein in Father, Son and CIA pg. 101
• That is the great thing about our movement--that these members are uniform not only in ideas, but even, the facial expression is almost the same!
  • Adolf Hitler, attributed by Jack Kirby in The Forever People #3, National Periodical Publications, (June-July 1971).
• Remember that time is money. He that can earn ten shillings a day by his labor, and goes abroad, or sits idle, one half of that day, though he spends but sixpence during his diversion or idleness, ought not to reckon that the only expense; he has really spent, rather thrown away, five shillings, besides.
  “Remember, that credit is money. If a man lets his money lie in my hands after it is due, he gives me interest, or so much as I can make of it during that time. This amounts to a considerable sum where a man has good and large credit, and makes good use of it.
  “Remember, that money is of the prolific, generating nature. Money can beget money, and its offspring can beget more, and so on. Five shillings turned is six, turned again it is seven and three pence, and so on, till it becomes a hundred pounds. The more there is of it, the more it produces every turning, so that the profits rise quicker and quicker. He that kills a breeding sow, destroys all her offspring to the thousandth generation. He that murders a crown, destroys all that it might have produced, even scores of pounds.”
  “Remember this saying, The good paymaster is lord of another man’s purse . He that is known to pay punctually and exactly to the time he promises, may at any time, and on any occasion, raise all the money his friends can spare. This is sometimes of great use. After industry and frugality, nothing contributes more to the raising of a young man in the world than punctuality and justice in all his dealings; therefore never keep borrowed money an hour beyond the time you promised, lest a disappointment shut up your friend’s purse for ever.
  “The most trifling actions that affect a man’s credit are to be regarded. The sound of your hammer at five in the morning, or eight at night, heard by a creditor, makes him easy six months longer; but if he sees you at a billiard table, or hears your voice at a tavern, when you should be at work, he sends for his money the next day; demands it, before he can receive it, in a lump. ‘It shows, besides, that you are mindful of what you owe; it makes you appear a careful as well as an honest man, and that still increases your credit.’
  “Beware of thinking all your own that you possess, and of living accordingly. It is a mistake that many people who have credit fall into. To prevent this, keep an exact account for some time both of your expenses and your income. If you take the pains at first to mention particulars, it will have this good effect: you will discover how wonderfully small, trifling expenses mount up to large sums, and will discern what might have been, and may for the future be saved, without occasioning any great inconvenience.
  “For six pounds a year you may have the use of one hundred pounds, provided you are a man of known prudence and honesty.
  “He that spends a groat a day idly, spends idly above six pounds a year, which is the price for the use of one hundred pounds.
  “He that wastes idly a groat’s worth of his time per day, one day with another, wastes the privilege of using one hundred pounds each day.
  “He that idly loses five shillings’ worth of time, loses five shillings, and might as prudently throw five shillings into the sea.
  “He that loses five shillings, not only loses that sum, but all the advantage that might be made by turning it in dealing, which by the time that a young man becomes old, will amount to a considerable sum of money.”

• Advice to a Young Tradesman, Written by an Old One (1748), as quoted by Max Weber, The Protestant Ethic and the Spirit of Capitalism, Chapter II: The Spirit of Capitalism, 1905. [5][6], [7]

• German: Arbeit macht frei"
• English: "Work brings freedom" or "work shall set you free/will free you" or "work liberates" and, literally in English, "work makes (one) free".

• Lorenz Diefenbach, Arbeit macht frei: Erzählung von Lorenz Diefenbach (1873). The slogan is also known for being placed at the entrances to a number of Nazi concentration camps.

• If today you can take a thing like evolution and make it a crime to teach it in the public school, tomorrow you can make it a crime to teach it in the private schools, and the next year you can make it a crime to teach it to the hustings or in the church. At the next session you may ban books and the newspapers. Soon you may set Catholic against Protestant and Protestant against Protestant, and try to foist your own religion upon the minds of men. If you can do one you can do the other. Ignorance and fanaticism is ever busy and needs feeding. Always it is feeding and gloating for more. Today it is the public school teachers, tomorrow the private. The next day the preachers and the lectures, the magazines, the books, the newspapers. After a while, your honor, it is the setting of man against man and creed against creed until with flying banners and beating drums we are marching backward to the glorious ages of the sixteenth century when bigots lighted fagots to burn the men who dared to bring any intelligence and enlightenment and culture to the human mind.
  • Clarence Darrow, Scopes Trial, Dayton, Tennessee (13 July 1925).
• Mutual understanding would be immensely facilitated by the use of one universal tongue. But which shall it be, is the great question. At present it looks as if the English might be adopted as such, though it must be admitted that it is not the most suitable. Each language, of course, excels in some feature.... A practical answer to that momentous question must perforce be found in times to come, for it is manifest that by adopting one common language the onward march of man would be prodigiously quickened. I do not believe that an artificial concoction, like Volapuk, will ever find universal acceptance, however time-saving it might be. That would be contrary to human nature. Languages have grown into our hearts.
• Our senses enable us to perceive only a minute portion of the outside world. Our hearing extends to a small distance. Our sight is impeded by intervening bodies and shadows. To know each other we must reach beyond the sphere of our sense perceptions. We must transmit our intelligence, travel, transport the materials and transfer the energies necessary for our existence. Following this thought we now realize, forcibly enough to dispense with argument, that of all other conquests of man, without exception, that which is most desirable, which would be most helpful in the establishment of universal peaceful relations is — the complete ANNIHILATION OF DISTANCE.
  To achieve this wonder, electricity is the one and only means. Inestimable good has already been done by the use of this all powerful agent, the nature of which is still a mystery. Our astonishment at what has been accomplished would be uncontrollable were it not held in check by the expectation of greater miracles to come. That one, the greatest of all, can be viewed in three aspects: Dissemination of intelligence, transportation, and transmission of power.
• Within a few years a simple and inexpensive device, readily carried about, will enable one to receive on land or sea the principal news, to hear a speech, a lecture, a song or play of a musical instrument, conveyed from any other region of the globe. The invention will also meet the crying need for cheap transmission to great distances, more especially over the oceans. The small working capacity of the cables and the excessive cost of messages are now fatal impediments in the dissemination of intelligence which can only be removed by transmission without wires.

• Nikola Tesla, A Means for Furthering Peace (1905), "The Transmission of Electrical Energy Without Wires as a Means for Furthering Peace" in Electrical World and Engineer (7 January 1905)

• Just as the commandment “Thou shalt not kill” sets a clear limit in order to safeguard the value of human life, today we also have to say “thou shalt not” to an economy of exclusion and inequality. Such an economy kills. How can it be that it is not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses two points? This is a case of exclusion. Can we continue to stand by when food is thrown away while people are starving? This is a case of inequality. Today everything comes under the laws of competition and the survival of the fittest, where the powerful feed upon the powerless. As a consequence, masses of people find themselves excluded and marginalized: without work, without possibilities, without any means of escape.

• Pope Francis, Evangelii Gaudium • The Joy of the Gospel, (November 24, 2013), section 53.

• By extending the working day, therefore, capitalist production . . . not only produces a deterioration of human labour-power by robbing it of its normal moral and physical conditions of development and activity, but also produces the premature exhaustion and death of this labour-power itself.
• Capital is dead labour which, vampire-like, lives only by sucking living labour, and lives the more, the more labour it sucks.
  • Karl Marx Capital, Volume 1 The Political Economy of the Dead: Marx's Vampires by Mark Neocleous
• Wikipedia founder Jimmy Wales underscores that Bomis, his dot-com search engine business, was not directly involved in pornography, pointing out that its content was R-rated rather than X-rated, like Maxim magazine rather than Playboy.
  • Jonathan Zittrain (2008). The Future of the Internet--And How to Stop It. Yale University Press. p. 289
• If I take the wages of everyone here, individually it means nothing, but collectively all of the earning power or wages that you earned in one week would make me wealthy. And if I could collect it for a year, I'd be rich beyond dreams. Now, when you see this, and then you stop and consider the wages that were kept back from millions of Black people, not for one year but for 310 years, you'll see how this country got so rich so fast. And what made the economy as strong as it is today. And all that slave labor that was amassed in unpaid wages, is due someone today. And you're not giving us anything when we say that it's time to collect.
  • Malcolm X, "Twenty million black people in prison," in Malcolm X: The Last Speeches, p. 51.
• Journalism is not a profession ... at its heart, it's just a craft. And that means that it can be practiced by anyone who is sensible and intelligent and thoughtful and curious ...
  • Sue Gardner, "Interview with Sue Gardner of the Wikimedia Foundation", Wikinews; (October 24, 2007).
• Everything about the games industry sends the signal: 'this is a space for men'. When players are repeatedly shown that women are sex symbols and damsels in distress, is it any surprise that players go on to treat women poorly in real life?. Gamergate feels like it owns the culture. Women and minorities are only welcomed if they keep their identity silent and don’t try to change the status quo. If I am a feminist, I am an outsider trying to steal their games – even if I am an avid gamer and a developer. I worry about becoming known to people outside the industry. As I gain experience in speaking, writing articles, publicising my game, I am increasing the risk of abuse. I stopped playing online games years ago. I couldn’t see why I was putting myself through the torrent of abuse, and sexual messages. Today, instead of them directing their abuse at a gamer tag, they will be contacting me directly, by email, Twitter, Facebook, and maybe anyone else that associates with me.
  • Briana Wu as quoted in James Batchelor, (November 10, 2014). "Games developers must fight internet abuse together". Develop. Archived from the original on November 10, 2014. Retrieved November 10, 2014.
• For each person there is a sentence — a series of words — which has the power to destroy him … another sentence exists, another series of words, which will heal the person. If you're lucky you will get the second; but you can be certain of getting the first: that is the way it works. On their own, without training, individuals know how to deal out the lethal sentence, but training is required to deal out the second.
  • Philip K. Dick, VALIS (1981).
• I remember some artists who said this world isn't worth anything, that it is a pigsty, that we are going nowhere, that God is dead, and all those things. Bad literature is this. To expose your navel, to tell how you drank your morning coffee amid general disgust, with everything around you rotting. While the world is dying, I drink my coffee. Or I perform my little sex acts. This is old-fashioned. One must cross this neurotic curtain.
  • Alejandro Jodorowsky, Psychomagic: The Transformative Power of Shamanic Psychotherapy, (2010).
• The framers of our Constitution firmly believed that a republican government could not endure without intelligence and education generally diffused among the people. The Father of his Country, in his Farewell Address, uses this language: Promote, then, as an object of primary importance, institutions for the general diffusion of knowledge. In proportion as the structure of a government gives force to public opinion, it is essential that public opinion should be enlightened.
  • Ulysses S. Grant, Message to the Senate and House of Representatives (1870)
• As the primary step, therefore, to our advancement in all that has marked our progress in the past century, I suggest for your earnest consideration, and most earnestly recommend it, that a constitutional amendment be submitted to the legislatures of the several States for ratification, making it the duty of each of the several States to establish and forever maintain free public schools adequate to the education of all the children in the rudimentary branches within their respective limits, irrespective of sex, color, birthplace, or religions; forbidding the teaching in said schools of religious, atheistic, or pagan tenets; and prohibiting the granting of any school funds or school taxes, or any part thereof, either by legislative, municipal, or other authority, for the benefit or in aid, directly or indirectly, of any religious sect or denomination, or in aid or for the benefit of any other object of any nature or kind whatever.
  • Ulysses S. Grant, Seventh State of the Union Address (1875)
• War is mankind's most tragic and stupid folly; to seek or advise its deliberate provocation is a black crime against all men. Though you follow the trade of the warrior, you do so in the spirit of Washington -- not of Genghis Khan. For Americans, only threat to our way of life justifies resort to conflict.
  • Dwight D. Eisenhower, Graduation Exercises at the United States Military Academy at West Pont, New York, USA at 3 June 1947
• Every gun that is made, every warship launched, every rocket fired, signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. The world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.
  • Dwight D. Eisenhower, 16 April 1953, Speech to the American Society of Newspaper Editors
• How does America find its way in this new, global economy? What will our place in history be? Like so much of the American story, once again, we face a choice. Once again, there are those who believe that there isn’t much we can do about this as a nation. That the best idea is to give everyone one big refund on their government—divvy it up by individual portions, in the form of tax breaks, hand it out, and encourage everyone to use their share to go buy their own health care, their own retirement plan, their own child care, their own education, and so on. In Washington, they call this the Ownership Society. But in our past there has been another term for it—Social Darwinism—every man or woman for him or herself. It’s a tempting idea, because it doesn’t require much thought or ingenuity. It allows us to say that those whose health care or tuition may rise faster than they can afford—tough luck. It allows us to say to the Maytag workers who have lost their job—life isn’t fair. It let’s us say to the child who was born into poverty—pull yourself up by your bootstraps. And it is especially tempting because each of us believes we will always be the winner in life’s lottery, that we’re the one who will be the next Donald Trump, or at least we won’t be the chump who Donald Trump says: “You’re fired!” But there is a problem. It won’t work. It ignores our history. It ignores the fact that it’s been government research and investment that made the railways possible and the internet possible. It’s been the creation of a massive middle class, through decent wages and benefits and public schools that allowed us all to prosper. Our economic dependence depended on individual initiative. It depended on a belief in the free market; but it has also depended on our sense of mutual regard for each other, the idea that everybody has a stake in the country, that we’re all in it together and everybody’s got a shot at opportunity. That’s what’s produced our unrivaled political stability.
  • Barack Obama, Knox College Commencement Address (4 June 2005)
• Look at what happened in New Orleans and along the Gulf Coast when Katrina hit. People ask me whether they thought race was the reason the response was so slow. I say, "well, no, this administration was colorblind in its incompetence." But, everyone here knows that the disaster and the poverty happened long before the hurricane hit.
• And so God is asking us today to remember the miracle of that baby and he's asking us, he says, "Take the bullet out!" If we have more black men in prison than in our colleges and universities, then it's time to take the bullet out. If we have millions of people goin' to the emergency room for treatable illnesses like asthma, it's time to take the bullet out. If too many of our kids don't have health insurance, it's time to take that bullet out. If we keep sending our kids to crumblin' school buildings, we keep fighting this war in Iraq, a war that should've never been authorized and should've never been waged, a war that costing us 20 cents — $275 million a day, that could have been invested in rebuilding communities all across this country, then it's time to take that bullet out!
• Now here's the thing, when 9-11 happened in New York City, they waived the Stafford Act — said, "This is too serious a problem. We can't expect New York City to rebuild on its own. Forget that dollar you gotta put in. Well, here's ten dollars." And that was the right thing to do. When Hurricane Andrew struck in Florida, people said, "Look at this devastation. We don't expect you to come up with y'own money, here. Here's the money to rebuild. We're not gonna wait for you to scratch it together — because you're part of the American family." What's happening down in New Orleans? "Where's your dollar? Where's your Stafford Act money?" Makes no sense! Tells me the bullet hasn't been taken out. Tells me that somehow, the people down in New Orleans they don't care about as much!
• We know that our faith sometimes has been used as a wedge to divide us, but we also know that with a big God, with a loving and forceful God, if we unite in his name, we can finish his work on Earth. In the face of impossible odds, people who love their country can change it. With a uniting faith, with a God powerful enough to empower us, we can take those bullets out.
• There was a team that took that bullet out of the baby, 15 years ago. She's got a scar on her arm, always will, but she will survive. Just like America will survive. Just like black folks will survive. We won't forget where we came from. We won't forget what happened 19 months ago, or 15 years ago, or 300 years ago. We know who the head surgeon is, we're on the case, we're going to pull bullet after bullet out.
  • Barack Obama, Hampton University, June 2007, referring to Jessica Evers, born with a bullet in her arm on 1992-04-30 during the Los Angeles riots
• The document they produced was eventually signed, but ultimately unfinished. It was stained by this nation's original sin of slavery, a question that divided the colonies and brought the convention to a stalemate until the founders chose to allow the slave trade to continue for at least twenty more years, and to leave any final resolution to future generations.
  Of course, the answer to the slavery question was already embedded within our Constitution - a Constitution that had at its very core the ideal of equal citizenship under the law; a Constitution that promised its people liberty, and justice, and a union that could be and should be perfected over time.
  And yet words on a parchment would not be enough to deliver slaves from bondage, or provide men and women of every color and creed their full rights and obligations as citizens of the United States. What would be needed were Americans in successive generations who were willing to do their part - through protests and struggles, on the streets and in the courts, through a civil war and civil disobedience, and always at great risk - to narrow that gap between the promise of our ideals and the reality of their time.
• The church contains in full the kindness and cruelty, the fierce intelligence and the shocking ignorance, the struggles and successes, the love and yes, the bitterness and bias that make up the black experience in America.
  And this helps explain, perhaps, my relationship with Reverend Wright. As imperfect as he may be, he has been like family to me. He strengthened my faith, officiated my wedding, and baptized my children. Not once in my conversations with him have I heard him talk about any ethnic group in derogatory terms, or treat whites with whom he interacted with anything but courtesy and respect. He contains within him the contradictions - the good and the bad - of the community that he has served diligently for so many years.
  I can no more disown him than I can disown the black community. I can no more disown him than I can my white grandmother - a woman who helped raise me, a woman who sacrificed again and again for me, a woman who loves me as much as she loves anything in this world, but a woman who once confessed her fear of black men who passed by her on the street, and who on more than one occasion has uttered racial or ethnic stereotypes that made me cringe.
  These people are a part of me. And they are a part of America, this country that I love.

• Barack Obama, A More Perfect Union (March 2008)

• People have a tendency to blame politicians when things don't work, but as I always tell people, you get the politicians you deserve. And if you don't vote and you don't pay attention, you'll get policies that don't reflect your interest.
  • Speaking at a summit on food innovation in Milan, Italy on May 9, 2017. Source: Conway, Madeline (9 May 2017). "Obama: 'You get the politicians you deserve'". Politico. Archived from the original on 13 May 2017. Retrieved 13 May 2017.
• Democracy cannot be imposed on any nation from the outside. Each society must search for its own path, and no path is perfect.
  • United Nations, General Debate of the 64th Session (2009), United States of America, H.E. Mr. Barack Obama, President p. 6, 23 September 2009
• If I become so convinced that ‘I’m always right,’ the logical conclusion of that often ends up being great cruelty and great violence.
  • Barack Obama, speaking during a discussion at "Kirchentag," a multi-day meeting sponsored by the Protestant church in Germany in Berlin, Germany on May 25, 2017. Source: Dovere, Edward-Isaac (25 May 2017). "Obama in Berlin: 'We can’t hide behind a wall'". Politico. Archived from the original on 2 June 2017. Retrieved 2 June 2017.
• Here's the advice I give everyone about marriage-is she someone you find interesting? You will spend more time with this person than anyone else for the rest of your life, and there is nothing more important than always wanting to hear what she has to say about things. Does she make you laugh? And I don’t know if you want kids, but if you do, do you think she will be a good mum? Life is long. These are the things that really matter over the long term.
  • Barack Obama, marriage advice to Dan Pfeiffer in Yes We Still Can, chapter 9, (June 19, 2018); as quoted in "Barack Obama says these are the three questions you must ask someone before you marry them", by Narjas Zatat, The Independent, (7/7/2018).
• When marrying, ask yourself this question: Do you believe that you will be able to converse well with this person into your old age? Everything else in marriage is transitory.
  • Friedrich Nietzsche in: William Safire, Leonard Safir, Words of Wisdom, Simon and Schuster, 15-Apr-1990, p. 237
• I probably could've done this earlier, if I was more ambitious.
  • Michael Keaton, The New York Times (2008).

Additions

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• (+4000 bytes): Louis C.K., Martin Luther, William Jennings Bryan, Clarence Darrow, Jane Goodall, Isaac Asimov, Rod Serling, Walt Disney, Michael Badnarik, Chanakya, Martin Luther King, Pythagoras, Georges Bataille, Ishmael, Muhammad, Malcolm X, Abu Musab Zarqawi, Abu Bakr al-Baghdadi, Osama bin Laden, Jesus, Edward Bernays, John C. Lily, Ali, Dan Savage, Albert Einstein, Adolf Hitler, Bernie Sanders (with Mdd), Thomas Jefferson, Jerusalem, Hollywood, Writing, Comics, Books, Science fiction, Internet, Video games, Film, Television, Graffiti, Fashion, Clothing, Language, Sculpture, Painting, Image, Copyright, Truth, Dreams, Reality, Fantasy, Lying, Insanity, Brain, Soul, Body, Medicine, Abortion, Birth, Babies, Mutant, Evolution, Learning, Intelligence, Memory, Education, Law, War, Prejudice, Forgiveness, Black people, Feminism, Masculinity, Weightlifting, Amazons, Women, Love, Marriage, Children, Animals, Animal rights, Arthopods, Feet, Pedophilia, Sadomasochism, Rape, Necromancy, Paranormal, Science, Chemistry, Organic chemistry, Genetics, Alien life, Space, Space Exploration, Sexuality, Prostitution, Sex, Sex offender, Heaven, Hell, God, Atheism, Anarchism, Buddhism, Buddha, Islamic law, Judaism, Christianity, Antichrist, Catholic Church, Free Masonry, Witch, Life, Death, Meaning of life, Lies, Censorship, Surveillance, Facial expression, Eating, Hunger, Darkness, Pain, Fear, Torture, Fighting, Power, Strength, Control, Mind control, Wisdom, Belief, Machine, Gun, War, Robot, Artificial Intelligence, Singularity, Freewill, Determinism, Future, Past, Small, World, Understanding, World view, World domination, World peace, Simian, Organic chemistry, Nuclear weapons, Nuclear power, Nuclear War, Botany, Wind, Volcano, Geology, Heavy metal music, Nikola Tesla, Filipino proverbs, Book of Leviticus, Eastern Orthodox Church, Misandry, Dungeons and Dragons, Benjamin Franklin, Protestantism, 14th Dalai Lama, Prayer, Moses, Homicide, Witnesses, Pornography, Envy, Theft, Sabbath, Capitalism, Vietnam War, Lyndon B. Johnson, History of Science, Technology, Mary Mother of Jesus, Sigmund Freud, John Calvin, Huldrych Zwingli, John Knox, Menno Simons, Thomas Cranmer, Destiny, Guns, Alexander Hamilton, Audience, Yahoo, Microsoft, Apple, Steve Jobs, Alan Moore, Unit cohesion, Trauma trigger, Morale, IBM, Nintendo, Hip hop, Marriage, Virginity, Batman, Drugs, Illusion, Heroes, Consent, Bullying, Companionship, Friendship, Romance, Pope Francis, Circumcision, Disability, Barack Obama, Abraham Lincoln, Education, Will Eisner, The Boondocks (comic strip), Human genome project, Pedophilia, Eleventh Doctor, Scientists, Consumerism, Globalism, Cloning, Michael Jackson, Horror, Torture, Mask, Memory, Medical malpractice.
• (+2000 bytes): Pope Alexander VI, Hakuin Ekaku, Ja'far al-Sadiq, Scheherazade, Homosexuality, Rumi, Ada Lovelace, Andrea Dwarkin, Richard Dawkins, Ayn Rand, Libertarianism, Masturbation, Dolphins, B. F. Skinner, William James, Relationship between religion and science, Intelligent Design, European colonization of the Americas (with Peter1c), Genetic engineering (with Y-S.Ko), Chemistry, Cancer, philosophy, Werner von Braun, Statue of Liberty, Hawaiian proverbs, Japan, Buckminster Fuller, Dragon, Common Place Book, Alexander the Great, Help, Talk, Sound, Weakness, Advertising, Screenwriting, White privilege, Heresy, Islam, Jihad, Black People, Apostasy, Al-Qaeda, Mankind, Richard Nixon, Antisemitism, Monuments, Greed, Vegetarianism, Fathers, Mothers, Parenting, Gene Roddenberry, Nazism, William Shatner, Astronomy, Machine, Civilization, Racism in the United States, Adam and Eve, David, Bigfoot, Acting, Schizoprehnia, Autism, LSD, Paranoia, Kawaii, Post Traumatic Stress Disorder, Depression, Anxiety, Alcoholism, Genetic engineering, Suicide, Obscenity, Blindness, Undead, Ulysses S. Grant, Duels, Sperm donation, Michael Moore, Universities, Terrorism, Journalism, Criminal justice, Robert E. Howard, Attention, Fascism, Hunting, Abraham, Social rejection, Economist.
• Pages Wonder Woman, William Moulton Marston, Regeneration, The Vision of Escaflowne, Animation, Young Sherlock Holmes, Crowdfunding, Iron Man (comics), Lilith, The Ark of the Covenant, Justice League Gods and Monsters, Charm, Grigori Rasputin, Moe Berg, Embryo, Zoophilia, Jack Kirby, Promethea, Noah, Experiment, Osamu Tezuka, Dead Man, Drones, Tibet, 6th Dalai Lama, Sodom and Gommorah, Democratic Republic of Congo, Voodoo, Andrew Vachss, Aisha, Botany, Heavy metal music, DC Comics, The Last House on the Left, Eastern Orthodox Church, Misandry, Dungeons and Dragons, Editorial cartoon, Oddworld: Abe's Oddysee, Gabriel, Ex Machina, The Maxx, Will Eisner, The Spectacular Spider-Man, Melvil Dewey, Dungeon, Obsolescence, Corey Feldman, Sexism, Occam's Razor, True Cross, Metatron, Scientific literacy, Eratosthenes, Black Jesus (TV series), Choir, Huldrych Zwingli, Thomas Cranmer, Samantha Bee, Unit cohesion, Pregnancy, Sonic the Hedgehog (Archie comics), Fantastic Four (comics), Ethnicity, Teamwork, Sexual harassment.
• Categories: sci-fi fantasy and crime video games; Sci-fi, fantasy, crime, horror and war comics; and films with elves, dwarves, fairies, dragons, robots, cyborgs, genetic engineering, cloning, dinosaurs, ninja's, simulated reality, altered memories, transhumanism, airplane, hijackings, rape, juvenile sexuality, wish fulfillment, Gods, personifications of death, heaven and hell, after life, authors, acting and horses. For media in general it is reincarnation, robots, time travel, post apocalyptic, biological warfare, nuclear weapons, superhero, hostage dramas, marionette films. For professions it is soldier. I also made the Births category but stopped creating categories when I started to questioning whether the lesson Wikipedia wanted me to learn from my ban was to make better categories or to stop making them entirely, no one provided much direction regarding the reasons for my ban the numerous times I contacted the arbitration committee, making it difficult to give them what they wanted to see me do.
• Intros: Oddworld, Metal Gear, Final Fantasy VII, Final Fantasy VIII, Final Fantasy IX, Spyro the Dragon, Frasier, Scrubs, Chrono Trigger, Crash Bandicoot 2:Cortex Strikes Back, Megaman, Halo, Jade Empire, Pokemon Red and Blue, Donkey Kong Country, Mario, Sonic the Hedgehog, The Legend of Zelda, The Elder Scrolls IV: Oblivion, Earthworm Jim, Psychonauts, The Elder Scrolls III: Morrowind, Chrono Cross, Tales of Symphonia, Doom, Castlevania, Portal, Crash Bandicoot 3: Warped, Spyro: Year of the Dragon‎, Paper Mario: The Thousand-Year-Door, Mega Man Legends, Spider-Man 2 (video game), Enter the Matrix, Ultimate Spider-Man (video game), Soul Calibur II, The Legend of Zelda: Twilight Princess, Spider-Man 2: Enter Electro, Spider-Man (2000 video game), The Legend of Zelda: Majora's Mask, The Legend of Zelda: Ocarina of Time, Contra III: The Alien Wars, Super Metroid, Gex 3: Deep Cover Gecko and Crash Bandicoot: The Wrath of Cortex. I've played a bit of other video games we have pages for, like Diablo, Legacy of Kain, Legend of Dragoon and Star Wars: Knights of the Old Republic, but have not actually finished them, that or the pages for them are for the entire series which I have not seen the first installment of; I haven't actually finished The Elder Scrolls IV: Oblivion or Super Metroid myself but have seen others. As such, there are no other games I'm familiar with for me summarize that don't already have them, contrary to what you may have heard from the incompetently conducted sock puppet investigations on Wikipedia which have ruined my username's credibility. Trust me, I'd be stealing more glory if I could, but I can't without spoiling the plots to a bunch of games I've never played.,I'm not very good at describing the premises of games I've played all of an hour of.
• Images: Noah, Weightlifting, Graffiti, Animation, Sculpture, Pornography, Dragons, Vampires, Lilith, Mary, mother of Jesus, Wishes, Gabriel, Aristotle, Small, Dungeon, Plants, Philip Moris, University of Phoenix, Bain Capital, Exxon mobile, American Apparel, Twitter, Facebook, Yahoo, Microsoft, Apple Inc., Steve Jobs, Nintendo, IBM, Paranoia, Obscenity, Paranoia, Heroes, Soldier, Kawaii, Hip hop, Guns, Destiny, Chaos theory, Virginity, Marriage, Pregnancy, Amazons, Obscenity, Homicide, Undead, Poverty, Art, Ulysses S. Grant, Threat, Cultural appropriation, Ethnicity, Teamwork, Disability, Genetic engineering, Human Genome, Superman, Batman, Wonder Woman, The Flash, Batman villains, The Joker, Selena Kyle, Spider-Man, X-Men, Hulk, Thor, Teenage mutant Ninja Turtles, Iron Man (comics), New York City, Duels, Star Wars, Star Trek: The Original Series, Cloning, Alien (franchise), Neon Genesis Evangelion, Death Note, Fullmetal alchemist (anime), Michael Jackson, Escape from L.A., Weapon, Sadomasochism, Torture, Masks, Chernobyl disaster, September 11 attacks, Berlin Wall, Afghanistan, Pitch Black, Point Break, Cliffhanger, Kill Bill, The Matrix, Delicatessen, Chess, Metal Gear, Flowers of War, The Promise, Exodus: Gods and Kings, Memory, Batman Begins, The Dark Knight, The Dark Knight Rises, Nuclear power, Nanotechnology, Videogames, Man of Steel, Wonder Woman (2017 film), World War I, Indiana Jones, Godzilla, Prostitution, Pornography, Child Pornography, James Bond, Harry Potter, Alice in Wonderland, Lex Luthor, Darkseid, Silver Surfer, Fantastic Four, Captain America, Batman (TV series), Star Trek, Klingon Proverbs, Vulcan Proverbs, Green Lantern, Science-fiction, Colonialism, European Colonization of the Americas, Radio, Deafness, Nuclear weapons, Nuclear war, Blade Runner 2049, Alien 3, Alien Resurrection, Figure skating, Ice hockey, Moon, Tennis, Cricket, Golf, Sports, Force-feeding, Fascism, Soldiers, Rod Serling, Tales from the Crypt, The Daleks, Mutant, Sperm donation, Gulf War, War in Afghnistan, Fire, Cold, Clouds, Monument, Batman and Robin, Brave New World, Cancer, Fantasy, Horror, Forest, Vietnam War, Korean War, Doll, Ocean, Puritanism, Video.

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• Live action films: 12 Monkeys, 2001: A Space Odyssey (film), 300 (film), Alien, Alien 3, Alien vs Predator, The Avengers (2012 film), Back to the Future, Batman, Batman Begins, Batman Returns, Batman & Robin (film), Batman Forever, Batman: Under the Red Hood, Battle Royale (film), Beetlejuice, Blade, Blade 2, Blade Runner, Captain America: The First Avenger, Cliffhanger, A Clockwork Orange (film), The Crow, Daredevil (film), Dark City (1998 film), The Dark Knight, The Dark Knight Rises, Dawn of the Dead (1978), Dawn of the Dead (2004), The Day the Earth Stood Still (1951 film), Delicatessen, District 9, E.T. the Extra-Terrestrial, Elektra (film), Escape from New York, Escape from L.A., Fantastic Four (2005 film), Fantastic Four: Rise of the Silver Surfer, Fight Club, Flowers of War, Ghost Busters, Good Will Hunting, Gravity, Grindhouse (film), Green Lantern, Harold and Kumar, Harold & Kumar Go to White Castle, Harold & Kumar Escape from Guantanamo Bay, Her (film), The Hunger Games (film), The Incredible Hulk (film), Independence Day, Indiana Jones and the Kingdom of the Crystal Skull, Indiana Jones and the Last Crusade, Interstellar, Iron Man (2008 film), Iron Man 2, E.L. James, Jurassic Park, Kill Bill, Kill Bill Volume 1, Kill Bill Volume 2, King Kong (2005 film) Man of Steel (film), Pirates of the Caribbean: The Curse of the Black Pearl, Pitch Black, Planet of the Apes (1968 film), Point Break, Predator, The Promise, Red Dragon, RoboCop, The Silence of the Lambs, Sin City (film), Small Soldiers, Spider-Man (2002 film), Spider-Man 2, Spider-Man 3, The Spirit (film), Starship Troopers, Star Trek II, Star Trek V, Star Trek VI, Star Wars I-VI, Superman (1978 film), Superman IV: The Quest for Peace, Superman Returns, Superman vs. The Elite, Suzanne Collins, Team America: World Police, Teenage Mutant Ninja Turtles (1991 film), Teenage Mutant Ninja Turtles II: The Secret of the Ooze, Terminator, Terminator 2, Thor (film), Transformers, Tron Legacy, Twilight (film), The Twilight Saga: New Moon, War of the Worlds (2005 film), Watchmen (film), Willow, Wonder Woman (film), X-Men (2000 film), X2 (film), X Men: The Last Stand.
• Animated films: 9 (2009 film), Aladdin, Alpha and Omega, Alvin and the Chipmunks: Chipwrecked, Antz, Arthur Christmas, Brave, The Black Cauldron (film), Cinderella, Chicken Little, Cloudy with a Chance of Meatballs, Cool World, The Croods, Despicable Me, Despicable Me 2, Everyone's Hero, The Emperor's New Groove, Final Fantasy VII: Advent Children, Finding Nemo, Frozen, Garfield: The Movie, Garfield: The Tale of Two Kitties, The Good Dinosaur, Happy Feet, Horton Hears a Who, Inside Out, The Lion King, The Lorax (film), Meet the Robinsons, Megamind, Princess Mononoke, Monster House, Monsters University, Monsters vs. Aliens, Open Season, The Peanuts Movie, Rango, Ratatoullie, The Road to El Dorado, The Secret of Nimh, Sleeping Beauty, Snow White, Strange Magic, Stuart Little, Surfs Up, Titan AE, TMNT, Toy Story, Turbo, Valiant, WALL-E, The Wild (film).
• Live action television: Batman (TV series), Battle Star Galactica (1978), Battlestar Galactica (2003), Black Jesus (TV series), Doctor Who, Firefly, Fringe, Heroes (TV show), Lexx, Lost (TV show), Mad Men, Mighty Morphin Power Rangers, The Prisoner, Quantum Leap, Scrubs, Star Gate SG-1, Star Trek: Deep Space Nine, Star Trek: Enterprise, Star Trek: The Next Generation, Star Trek: The Original Series, Star Trek: Voyager, The Twilight Zone (1959 series), Xena: Warrior Princess, The X-Files.
• Animated television: Batman: The Animated Series, The Big O, Card Captor Sakura, Cowboy Bebop, Death Note, Dragon Ball, Full Metal Alchemist, Gargoyles, InuYasha, The Jetsons, Lupin III, Mobile Suit Gundam‎, Neon Genesis Evangelion, Sailor Moon, Samurai X, Star Trek: The Animated Series, Spiderman: The Animated Series, SpongeBob SquarePants, Trigun, X-Men (TV show), Yu-Gi-Oh!
• Video Games: Bioshock, Doom, Halo, Fallout, Metal Gear, Where in the World is Carmen Sandiego?
• Literature: Carrie, The Dark Tower, Book of Deuteronomy, Ender's Game, Book of Genesis, Harry Potter and the Philosopher's Stone, Harry Potter and the Goblet of Fire, Book of Leviticus, Mass (liturgy), The Wizard of Oz, World War Z.
• Fictional characters/disambiguation pages: Albus Dumbledore, Batman, Barbara Gordon, Captain America, Dalek, Darkseid, DC comics, Godzilla, Green Lantern, Harry Potter, Hulk, Indiana Jones, Iron Man, James Bond, Jason Todd, Kill Bill, Lex Luthor, Pokemon, Silver Surfer, Star Trek, Star Wars, Spider-Man, Thor, Wonder Woman, X-Men.
• Historical/mythological figures: Aisha, David, Noah, Ja'far al-Sadiq, Scheherazade, William Howard Taft, John Calvin

Work on other wikis

Wikipedia

• Censored Scribe
• Cassandra Truth
• Robopsychologist
• Amateur Encyclopedist
• Exiled Encyclopedist
• Bullets and Bracelets
• An Inconvenient Truth The edit history on this one seems slightly off. I don't deny it when I sockpuppet and someone realizes it, but they normally ban me without asking any questions so I don't get the opportunity. I turn myself in or I don't get caught, I'm actually very good at it even though I don't do it a lot and my success is why I'm a bad role model to other editors. I also don't ask what to do when my edits get reverted, the reverted good edits on my other accounts got restored because I do good work editing Wikis, and with the exception of some subjective categories that I argued about and reverted other editors over, my edits were all good. I might break the rules, but I do have a code. That's why other people are occasionally willing to help me by undoing an edit for me, because the easiest way to get blocked is to keep reverting a page; we can't agree on much as a community, but we all agree edit wars are annoying and those that fight them are to be punished as edit war criminals. (The term edit war is offensive to soldiers and civilians impacted by real wars, however it's the term still used by some admins rather than wheel revert, I believe the use of this term is an implied threat of violence against other editors and as a threat of violence should result in a block.) Discussions with other editors would be the easiest pages to alter the record of as they have fewer views compared to the main space pages. I don't think that kind of historical revisionism would even be a crime, so having evidence doesn't really matter. None of us have any legal recourse if someone changes our edit history.

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• Exiled Encyclopedist
• X-Factor
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Curiosities

Science/Medicine/Economics/Environment

• It is a commonly held view that genetically homogenous host populations are more vulnerable to infection than genetically diverse populations. The underlying idea, known as the ‘monoculture effect,' is well documented in agricultural studies. Low genetic diversity in the wild can result from bottlenecks (that is, founder effects), biparental inbreeding or self-fertilization, any of which might increase the risk of epidemics. Host genetic diversity could buffer populations against epidemics in nature, but it is not clear how much diversity is required to prevent disease spread.
  • K C King and C M Lively, “Does genetic diversity limit disease spread in natural host populations?”, Heredity, (Edinb). 2012 Oct; 109(4): 199–203.

• Following bites, protective immune responses are induced, just like a conventional vaccination but with no pain and no cost. What's more, continuous exposure to bites will maintain high levels of protective immunity, through natural boosting, for a life time. So the insect shifts from being a pest to being beneficial.
  • Shigeto Yoshida in "Genetically modified mosquitos could be used to spread vaccine for malaria", Richard Alleyne, The Telegraph, (19 Mar 2010).

• Scientists have discovered that insects from cockroaches to caterpillars all emit the same stinky blend of fatty acids when they die, and this sinister stench sends bugs of all kinds running for their lives.
  • Hadley Leggett, "UNIVERSAL 'DEATH STENCH' REPELS BUGS OF ALL TYPES" WIRED, 2009/09.

• Miniaturization doesn't actually make sense unless you miniaturize the very atoms of which matter is composed. Otherwise a tiny brain in a man the size of an insect, composed of normal atoms, is composed of too few atoms for the miniaturized man to be any more intelligent than the ant. Also, miniaturizing atoms is impossible according to the rules of quantum mechanics.
  • Isaac Asimov Peary, D ed. (1984). Omni's Screen Flights, Screen Fantasies Doubleday

• You can drop a mouse down a thousand-yard mine shaft; and, on arriving at the bottom, it gets a slight shock and walks away, provided that the ground is fairly soft. A rat is killed, a man is broken, a horse splashes.
  • J.B.S. Haldane, On Being the Right Size, (1923)

• With the end of the Second World War, the Soviet Union was now high on the list of tyrannical enemies of democracy, and American nuclear weapons development and strategic theory were fashioned with that enemy foremost in mind. Oppenheimer’s sympathy for Communism, his enthusiasm for world government as the ultimate arbiter of nuclear technology, and his qualms about the proposed second generation of nuclear weapons, played a critical role in the history of the Cold War and in the precipitous course of his subsequent career. Already, in the fall of 1945, when Edward Teller was pressing for immediate development of the hydrogen bomb (the “Super,” as it was called), Oppenheimer responded coldly and tersely: “I neither can nor will do so.” Oppenheimer regarded the Super as a genocidal weapon: its only conceivable purpose would be the destruction of civilian populations by the millions — and ideally in the tens or hundreds of millions. The sole end of war with H-bombs would be annihilation. The peace that such a war would bring would be that of the mass grave; and if there were any survivors, they would likely prefer to have been among the dead. Civilization would have to be reconstituted from radioactive ash.
  And yet the undeniable perfidy of the Stalinist Soviet Union convinced even Oppenheimer that the Atomic Energy Commission (AEC), created to oversee the use of atoms for peace, would be above all the instrument of war. In 1947, Oppenheimer declared that the agency’s main job was to “provide atomic weapons and good atomic weapons and many atomic weapons.” And Oppenheimer wanted to be the moving force in this work, despite his ever-deepening moral qualms.
  But Oppenheimer was never of one mind for long. The Soviets’ test of an atomic bomb in 1949 propelled him back to the internationalist position he had taken just after the war, believing that a single world organization should govern the nuclear policies of every individual nation. While Edward Teller insisted that the Super was needed now more than ever, Oppenheimer huffed, “Keep your shirt on.” He joined Enrico Fermi and other eminent physicists in lobbying Roosevelt’s former vice-president Henry Wallace to stop H-bomb development, “primarily because we should prefer defeat in war to victory obtained at the expense of the enormous human disaster that would be caused by its determined use.” To possess a weapon of incalculable potency — some theoreticians feared it could ignite the atmosphere in an explosive chain reaction and destroy the earth — would pose graver dangers than not to have one at all.
• While Oppenheimer was making the case for tactical nuclear weapons, useful on the battlefield, the Strategic Air Command’s war plan emphasized a massive and decisive nuclear first strike in the event of a conventional Soviet attack on Western Europe. According to Bird and Sherwin, the H-bomb advocates were so obsessed with the threat of Communism that they believed “Oppenheimer’s championing of tactical nuclear weapons was a ploy to block the Super Bomb.” Teller went so far as to spread the word that in trying to block the H-bomb Oppenheimer was acting on “direct orders from Moscow.” Teller may have been out of control, the Strategic Air Command may have been defending its turf, and Strauss may have been seeking personal revenge against Oppenheimer, but all the same, the gravest matters were at stake. The Soviet Union was a real threat that needed to be confronted with sobriety; seeing the defenders of the H-bomb as fanatics and conspiracy theorists foolishly belittles the existential challenge America was then just beginning to face.
• Machiavelli, so widely considered the founding father of modern political morality, or immorality, understood prudence, or the ability to choose among possible courses of action, as the sine qua non of the conqueror. But in the atomic age, the foremost aim of prudence among more or less decent nations is no longer to conquer but to avoid annihilation, while also avoiding the evil of annihilating the enemy — i.e., nuclear genocide. In October 1949, the General Advisory Committee to the AEC recommended that “a super bomb should never be produced” — that it “might become a weapon of genocide.” Oppenheimer was one of the signatories. To assume that the Soviet enemy would share this American scrupulousness was the committee’s fallacy; and to make such an assumption of Stalin was the depth of folly.

• Algis Valiunas, "The Agony of Atomic Genius", The New Atlantis, Number 14, Fall 2006, pp. 85-104.

• Allan Childers: Before you left the base, they gave you some codes that gave you access to the complex. You would read the code to the commander and then you would take a lighter, set the codes on fire and drop them down into a box so they would burn up and no one else could use those codes.
• Allan Childers: We never new what our specific targets were, becatuse you didn't really want to know who you were going to destroy.
• Allan Childers: You had to be prepared to destroy an entire civilization, and we were trained on that. As heartless as it sounds, I never had a problem with it, I was doing it for my country, I was doing it to protect my country.
• Eric Schlosser: At one point we only thought we needed 50 to 200 nuclear weapons to annihalate the Soviet Union, and by the 1960's we had 32,000.
• Eric Schlosser: One of the weapons in particular went through all of its arming steps to detonate, and when that weapon hit the ground, a firing signal was sent. And the only thing that prevented a full-scale detonation of a powerful hydrogen bomb in North Carolina was a single safety switch.
• Eric Schlosser: During a fire, solder might melt on a circuit board. It created all kinds of new electrical pathways that could completely circumvent a safety device.

• "Command and Control", American Experience, PBS, April 25, 2017

• 3,000: Tons of chemical weapons in the U.S. stockpile, mostly consisting of mustard gas and various nerve agents.

1,000: Tons of chemical weapons that Syria is believed to have.

• $500 million: Amount spent by the United States each year to assist other countries in destroying their stores of chemical, biological, and nuclear weapons.
• 2,150: Operational U.S. nuclear warheads assigned to land-based missiles, nuclear submarines, and bombs ready for deployment in military aircraft.

4,650: Operational nuclear warheads in Russia.

• "America's weapons of mass destruction: By the numbers", Keith Wagstaff, The Week, September 13, 2013

• Alan Turing was the first to make a careful analysis of the potential capabilities of machines, inventing his famous "Turing machines" for the purpose. He argued that if any machine could perform a computation, then some Turing machine could perform it. The argument focuses on the assertion that any machine's operations could be simulated, one step at a time, by certain simple operations, and that Turing machines were capable of those simple operations. Turing's first fame resulted from applying this analysis to a problem posed earlier by Hilbert, which concerned the possibility of mechanizing mathematics. Turing showed that in a certain sense, it is impossible to mechanize mathematics: We shall never be able to build an "oracle" machine that can correctly answer all mathematical questions presented to it with a "yes" or "no" answer. In another famous paper Turing went on to consider the somewhat different question, "Can machines think?." It is a different question, because perhaps machines can think, but they might not be any better at mathematics than humans are; or perhaps they might be better at mathematics than humans are, but not by thinking, just by brute-force calculation power. These two papers of Turing lie near the roots of the subjects today known as automated deduction and artificial intelligence.
  • Michael J. Beeson, "The Mechanization of Mathematics," in Alan Turing: Life and Legacy of a Great Thinker (2004).

• Hannah Devlin: In your book you describe a nightmare you had involving Hitler wearing a pig mask, asking to learn more about your “amazing technology”. Do you still have anxiety dreams about where Crispr might leave the human race?

Jennifer Doudna: I had the Hitler dream and I’ve had a couple of other very scary dreams, almost like nightmares, which is quite unusual for an adult. Not so much lately, but in the first couple of years after I published my work, the field was moving so fast. I had this incredible feeling that the science was getting out way ahead of any considerations about ethics, societal implications and whether we should be worrying about random people in various parts of the world using this for nefarious purposes.

• Hannah Devlin: In 2015, you called for a moratorium on the clinical use of gene editing. Where do you stand on using Crispr to edit embryos these days?

Jennifer Doudna: It shouldn’t be used clinically today, but in the future possibly. That’s a big change for me. At first, I just thought why would you ever do it? Then I started to hear from people with genetic diseases in their family – this is now happening every day for me. A lot of them send me pictures of their children. There was one that I can’t stop thinking about, just sent to me in the last 10 days or so. A mother who told me that her infant son was diagnosed with a neurodegenerative disease, caused by a sporadic rare mutation. She sent me a picture of this little boy. He was this adorable little baby, he was bald, in his little carrier and so cute. I have a son and my heart just broke.

• Jennifer Doudna, "Jennifer Doudna: ‘I have to be true to who I am as a scientist’", Hannah Devlin, The Guardian, (July 2, 2017).

• If we combine the benefits of a human physiology maintained at the level of effectiveness possessed by our bodies when we were children (e.g., dechronification), along with the ability to deal with almost any form of severe trauma (via nanosurgery), then there are very few diseases or conditions that cannot be cured using nanomedicine. The only major class of incurable illness which nanorobots can’t handle is the case of brain damage in which portions of your brain have been physically destroyed. This condition might not be reversible if unique information has been irrevocably lost (say, because you neglected to make a backup copy of this information). There are several other minor “incurable” conditions, but all of these similarly relate to the loss of unique information.
• The key issue for enabling full-immersion reality is obtaining the necessary bandwidth inside the body, which should be available using the in vivo fiber network I first proposed in Nanomedicine, Vol. I (1999). Such a network can handle 1018 bits/sec of data traffic, capacious enough for real-time brain-state monitoring. The fiber network has a 30 cm3 volume and generates 4-6 watts waste heat, both small enough for safe installation in a 1400 cm3 25-watt human brain. Signals travel at most a few meters at nearly the speed of light, so transit time from signal origination at neuron sites inside the brain to the external computer system mediating the upload are ~0.00001 millisec which is considerably less than the minimum ~5 millisec neuron discharge cycle time. Neuron-monitoring chemical sensors located on average ~2 microns apart can capture relevant chemical events occurring within a ~5 millisec time window, since this is the approximate diffusion time for, say, a small neuropeptide across a 2-micron distance. Thus human brain state monitoring can probably be “instantaneous,” at least on the timescale of human neural response, in the sense of “nothing of significance was missed.
  • Robert Freitas, "Interview with Robert A. Freitas Jr. Part 2" Kurzweilai.net, (2 February 2006).

• Poverty is an important social determinant of health and contributes to child health disparities. Children who experience poverty, particularly during early life or for an extended period, are at risk of a host of adverse health and developmental outcomes through their life course. Poverty has a profound effect on specific circumstances, such as birth weight, infant mortality, language development, chronic illness, environmental exposure, nutrition, and injury. Child poverty also influences genomic function and brain development by exposure to toxic stress, a condition characterized by “excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships.” Children living in poverty are at increased risk of difficulties with self-regulation and executive function, such as inattention, impulsivity, defiance, and poor peer relationships. Poverty can make parenting difficult, especially in the context of concerns about inadequate food, energy, transportation, and housing.
• The economic cost of child poverty to society can be estimated by anticipating future lost productivity and increased social expenditure. A study compiled before 2008 projected a total cost of approximately $500 billion each year through decreased productivity and increased costs of crime and health care, nearly 4% of the gross domestic product.
• Demographics have a profound influence on the likelihood that a family or community will experience poverty or low income. For example, African American, Hispanic, and American Indian/Alaska Native children are 3 times more likely to live in poverty than are white and Asian children. Infants and toddlers more commonly live in poverty than do older children.
• During the recovery of the Great Recession, income inequality in the United States accelerated, with 91% of the gains going to the top 1% of families.
• In 1935, the US Congress passed the Social Security Act and in 1965 enacted Medicare. Together, these 2 pieces of legislation have greatly reduced and nearly eliminated poverty in the elderly. It is time to enact similar reforms to eliminate child poverty.

• “Poverty and Child Health in the United States”, James H. Duffee, Alice A. Kuo, Benjamin A. Gitterman, Pediatrics, March 2016, from the American Academy of Pediatrics Policy Statement.

• On average, 24,000 children under the age of five die every day, most from preventable causes, with undernutrition contributing to about one-third of these deaths. Millions of children are denied primary education, and hundreds of millions have no access to safe drinking water or decent sanitation facilities.
  • "The Convention on the Rights of a Child", Ernest C. Madu, UNICEF

• Two buckets of safe water a day – 20 litres – is the bare minimum a child needs to live. This is enough for drinking and eating, washing and basic sanitation. But some 4000 children die every day, because they simply don’t have access to an adequate supply of clean water.
  • "World Water Day 2005: 4,000 children die each day from a lack of safe water" March 20, 2005

• Among the multiple symptoms revealing the current system’s drawbacks, two are arguably amongst the most striking: our analysis indicates (i) that 95% of the value of plastic packaging material, worth $80-120 billion annually, is lost to the economy, and (ii) that, on the current track, there could be more plastics than fish in the ocean (by weight) by 2050.
  • "The New Plastics Economy: Rethinking the future of plastics, Background to key statistics from the report" , World Economic Forum, Ellen MacArthur Foundation and McKinsey & Company, (February 2016) as quoted in "Plastic Island: How our throwaway culture is turning paradise into a graveyard" Nick Paton Walsh, Ingrid Formanek, Jackson Loo and Mark Phillips, CNN (December, 2016)

• Are we going to let the ocean take a state-sized bite out of America? If we make extreme efforts to cut carbon, we can avoid that.
  • Benjamin Strauss, "Too late: 400 cities in America, including Miami and New Orleans, will likely be submerged by rising sea waters", Ruth Sherlock, The Telegraph, (Oct. 15, 2015, 8:32 AM)

• Earth's oceans and land cover are doing us a favor. As people burn fossil fuels and clear forests, only half of the carbon dioxide released stays in the atmosphere, warming and altering Earth's climate. The other half is removed from the air by the planet's vegetation ecosystems and oceans.
  As carbon dioxide levels in the atmosphere continue their rapid, human-made rise past levels not seen for hundreds of thousands of years, NASA scientists and others are confronted with an important question for the future of our planet: How long can this balancing act continue? And if forests, other vegetation and the ocean cannot continue to absorb as much or more of our carbon emissions, what does that mean for the pace of climate change in the coming century?
• "Today and for the past 50 to 100 years, the oceans and land biosphere have consistently taken up about half of human emissions," said Dave Schimel of NASA's Jet Propulsion Laboratory, Pasadena, California. "If that were to change, the effect of fossil emissions on climate would also change. We don't understand that number, and we don't know how it will change in the future."

• Buis, Alan; Ramsayer, Kate; Rasmussen, Carol (12 November 2015). "A Breathing Planet, Off Balance". NASA. Retrieved 13 November 2015.

• The danger is that global warming may become self-sustaining, if it has not done so already. The melting of the Arctic and Antarctic ice caps reduces the fraction of solar energy reflected back into space, and so increases the temperature further. Climate change may kill off the Amazon and other rain forests, and so eliminate once one of the main ways in which carbon dioxide is removed from the atmosphere. The rise in sea temperature may trigger the release of large quantities of carbon dioxide, trapped as hydrides on the ocean floor. Both these phenomena would increase the greenhouse effect, and so global warming further. We have to reverse global warming urgently, if we still can.
  • Stephen Hawking, ABC News interview "Changes in Our Solar System: Is Trouble Coming? " August 16, 2006

• This may surprise you, because it surprised me when I found out, but the single biggest thing that an individual can do to combat climate change is to stop eating animals. Because of the huge, huge carbon footprint of animal agriculture. I was shocked to find out that animal agriculture directly or indirectly accounts for 14.5% of all greenhouse gas emissions, compared to all transportation – every ship, car, truck, plane on the planet only accounts for 13%. Less than animal agriculture. So most people think that buying a Prius is the answer, and it’s certainly not wrong, but it’s not the biggest agent of climate change.
  • James Cameron, from an "Ask Me Anything" session on Reddit; as quoted in "Director James Cameron on Vegan Diet: Like I've Set the Clock Back 15 Years", in Ecorazzi (12 April 2014).

• To an outsider, the most significant innovation in the global warming controversy is the overt reliance that is being placed on models. Back in the days of nuclear winter, computer models were invoked to add weight to a conclusion: “These results are derived with the help of a computer model.” But now, large-scale computer models are seen as generating data in themselves. No longer are models judged by how well they reproduce data from the real world—increasingly, models provide the data. As if they were themselves a reality. And indeed they are, when we are projecting forward.
• This fascination with computer models is something I understand very well. Richard Feynmann called it a disease. I fear he is right.
• What is clear, however, is that on this issue [global warming], science and policy have become inextricably mixed to the point where it will be difficult, if not impossible, to separate them out.

• Michael Crichton, lecture at the California Institute of Technology, (January 17, 2003).

• Bitcoin uses about 32 terawatts of energy every year, enough to power about three million U.S. households, according to the Bitcoin Energy Consumption Index published by Digiconomist, a website focused on digital currencies.
  By comparison, processing the billions of Visa (V) transactions that take place each year consumes the same amount of power as just 50,000 American homes, according to Digiconomist.
• Without a significant change in how transactions are processed, bitcoin could be consuming enough electricity to power the U.S. by the middle of 2019.
  Six months later, that demand could equal the world's power consumption.

• “Bitcoin boom may be a disaster for the environment”, Daniel Shane, CNN, December 7, 2017

• Kidney transplantation is the treatment of choice for patients with end-stage kidney disease (ESKD). Rising ESKD prevalence has substantially increased numbers of kidney transplants performed. Maintenance immunosuppression is long-term treatment to prevent acute rejection and deterioration of graft function. Although immunosuppressive treatment using drugs such as calcineurin inhibitors (CNIs, such as cyclosporin A (CsA) or tacrolimus) reduce acute rejection rates, long-term allograft survival rates are not significantly enhanced. CNI-related adverse effects contribute to reduced quality of life among kidney transplant recipients. Adjuvant immunosuppressive therapies that could offer a synergetic immunosuppressive effect, while minimising toxicity and reducing side effects, have been explored recently. Cordyceps sinensis, (Cordyceps) a traditional Chinese medicine, is used as an adjuvant immunosuppressive agent in maintenance treatment for kidney transplantation recipients in China, but there is no consensus about its use as an adjuvant immunosuppressive treatment for kidney transplantation recipients.
  • "Cordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients." Hong T1, Zhang M, Fan J.,Cochrane Database Syst Rev. 2015 Oct 12;(10),

• The Porto Ricans (sic) are the dirtiest, laziest, most degenerate and thievish race of men ever to inhabit this sphere… I have done my best to further the process of extermination by killing off eight and transplanting cancer into several more… All physicians take delight in the abuse and torture of the unfortunate subjects.
  • Cornelius Rhoads as quoted by Truman R. Clark. 1975. Puerto Rico and the United States, 1917-1933, pp. 151-154

• A scorpion-venom concoction that makes tumors glow sounds almost too outlandish to be true. In fact, Olson explains, that’s what troubled the big grant-­making organizations when he came to them for funding. But when those organizations dismissed his ideas as too bizarre, Olson started accepting donations from individuals—particularly the families of current and former patients—quickly raising $5 million for his research. It was a bold and unprecedented tactic: Though patients and their families are often asked to donate to foundations with broad goals, Olson raised money for one specific, untested technology—a much riskier gamble. But thanks to his efforts, Olson’s fluorescent scorpion toxin is now in Phase I clinical trials, an impressive accomplishment for a compound with such a peculiar lineage. The University of Washington students are clearly awed by the work.
  • "One Doctor’s Quest to Save People by Injecting Them With Scorpion Venom", Brendan I. Koerner, WIRED, 06.24.14.

• Currently there is no good treatment for autoimmune disorders; the challenge has been suppressing inflammatory attacks by the immune system on body tissues without generally suppressing immune function (thereby increasing risk of infections). The main treatment is antibodies that neutralize cytokines, chemical messengers produced by T cells that regulate immune function and inflammatory responses. However, antibodies are expensive, must be given intravenously and don't address the root cause of disease, simply sopping up cytokines rather than stopping their production; patients must therefore receive frequent intravenous infusions to keep inflammation in check. Powerful immune-suppressing drugs are sometimes used as a last resort, but patients are left at risk for life-threatening infections and other serious side effects.
  Through a series of experiments, the researchers show that halofuginone prevents the development of Th17 cells in both mice and humans, halts the disease process they trigger, and is selective in its effects. It also has the potential to be taken orally. "This is really the first description of a small molecule that interferes with autoimmune pathology but is not a general immune suppressant," says Mark Sundrud, PhD, of the PCMM/IDI, the study's first author.
  • "New Lead For Autoimmune Disease From Chinese Medicine", Children's Hospital Boston, Science Daily, June 8, 2009

• The X-men are frequently referred to as the “next step” in human evolution (X-Men: First Class 2011; Gresh and Weinberg 2002, 133). According to Darwin, in order for evolution to occur, an individual must exhibit a variation that makes it better suited to its environment and then that variation must be selected for and passed down to future generations. When that variation has accumulated throughout the species, the species is considered to have evolved. Playing by Darwin’s rules, then, in order for the X-men to be the “next step” in human evolution, they must have a variation, that variation must prove useful in their environment, and that variation must be passed down to offspring. The genetic variation that the X-men have is called the x-gene; presumably the same gene, shared among the X-men but not among normal humans. There are huge problems with this, not the least of which is that an identical gene has appeared simultaneously in individuals who otherwise share very few genes. Furthermore, while Richard Dawkins, celebrated author of The Selfish Gene and authority on genetics, talks at length in about genes for various physical traits and sets of genes for various behaviors, he never once in his body of work mentions the possibility of a gene that has the same protein structure in each individual, but manifests itself in each individual in a radically different way. There is a gene for blue eyes and a gene for brown eyes, but the blue-eye gene will never produce brown eyes. Yet the x-gene is capable of producing invisibility, scales, telepathy, and wings, all with the same protein structure. Even epigenetics, which can account for different physiological manifestations of the same genetic code, cannot produce such a wide variety of traits.
  • Jocelyn D. Pickreign. “Science Fiction and the Myth of Trajectory Evolution”. The Macalester Review, Vol. 3 [2013], Iss. 2, Art. 1, (6-2-2013), pp. 8-9.

• For the reader who isn't convinced that writing a book (no matter how highly acclaimed) makes up for exterminating a race, Card offers an alternative, albeit rather contradictory, excuse for his genocide's actions -- genetic determinism. Although this "science" has been shown to represent such an oversimplification that it's a downright distortion, Card makes it the foundation of the biology of his universe. From the very beginning, authorities can breed geniuses more easily than you or I could establish a strain of purebred blue budgies, and never mind that breeding for color and size involves at most a few genes, while breeding for intelligence would require a total understanding of the complicated interactions between whole chromosomes. In Card's strange world, children can inherit advanced qualities like a talent for xenobiology -- a bizarre combination of genetic determinism and Lamarckianism since these characteristics were presumably artificially acquired at some point in the past. (Or does Card imagine that there is literally a gene for xenobiological talent that we can breed for? How could such a thing evolve? Surely our genes would have to be macroscopic to carry all the information he assumes they do.) In any case, his pseudo-science serves primarily as an excuse for ugly actions running the gamut from genocide to vivisection.
  • Elaine Radford. "Ender and Hitler: Sympathy for the Superman (20 Years Later)". (2007-03-26).

• I have watched the #metoo campaign as avidly as anyone. I have gone to bed each night wondering who will be outed as a sexual harasser in the morning, whether it will be another one of my political heroes or someone we all recognize from mainstream media or Hollywood. We’ve seen many of these perpetrators lose jobs, be forced to resign, and face economic difficulty because of their abhorrent behaviors.
  But I have not gone to bed a single night in all these months wondering what scientist would be sacked in the morning because of his transgressions—let alone be publicly outed—because scientist-harassers rarely lose their jobs.
• Are people who engage in sexual misconduct actually making scientific advances that would not be made without them? I’d say it’s more likely that swifter, greater advances would have occurred if there were fewer perpetrators limiting opportunities for their victims. When part of your brain has to be occupied with workplace stress—from unwanted sexual advances to witnessing abuse between colleagues—you have less to give to your science.
  If we punish these perpetrators, especially by taking away their funding, won’t their trainees suffer? I wonder how many grad students would be better off, relieved of the pressures of working for a predator. As federal funding agencies grapple with this problem, they have begun to figure out solutions, such as assigning a new principal investigator if the original one can’t continue. It doesn’t kill the project or leave students and staff out of their jobs. Removing the perpetrator from a project also saves the pedigree of the trainees; few want their published work tainted with the name of a known sexual harasser.
  The last concern is the trickiest: Why don’t we do anything when we know about the perpetrators in our midst? So far, consequences for scientist-harassers are few and far between. In academia it’s common to get sanctions like “no more female grad students” or “no more undergraduate teaching” or “please work at home for now.” These are mild punishments at best, but departments are unsure what other options they have—and universities don’t make it easy to fire professors. The institutions know that perpetrators generally have more resources than victims and are more likely to sue if they are fired. It is a good financial decision, then, to do nothing about a perpetrator, even if they are guilty.
  So this is where we find ourselves today: In many professions sexual misconduct is now cause for dismissal. In the sciences, not so much. What’s more, many science workplaces use legal definitions of sexual harassment to set the standard for workplace conduct. If that is the bar that has to be met for a disgusting behavior to be considered actionable by a university, research institute, or field station, it is a high one. An enormous range of disrespectful and even frightening behavior can slip under that bar, even though it damages the careers of victims and bystanders, holding back scientific advancement.

• Kathryn B. H. Clancy, "Have the Sciences Had a #MeToo Moment? Not So Much.", National Geographic, (05/2018).

• The drug war has nothing to do with making communities livable or creating a decent future for black kids. On the contrary, prohibition is directly responsible for the power of crack dealers to terrorize whole neighborhoods. And every cent spent on the cops, investigators, bureaucrats, courts, jails, weapons, and tests required to feed the drug-war machine is a cent not spent on reversing the social policies that have destroyed the cities, nourished racism, and laid the groundwork for crack culture.
  • Ellen Willis, "Hell No, I Won't Go: End the War on Drugs", The Village Voice (September 19, 1989).

• The centerpiece of the cultural counterrevolution is the snowballing campaign for a "drug-free workplace" — a euphemism for "drug-free workforce," since urine testing also picks up for off-duty indulgence. The purpose of this '80s version of the loyalty oath is less to deter drug use than to make people undergo a humiliating ritual of subordination: "When I say pee, you pee." The idea is to reinforce the principle that one must forfeit one's dignity and privacy to earn a living, and bring back the good old days when employers had the unquestioned right to demand that their workers' appearance and behavior, on or off the job, meet management's standards.
  • Ellen Willis, "Hell No, I Won't Go: End the War on Drugs," The Village Voice (September 19, 1989).

• Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the well-being of nurses. Survey data from nurses in four states showed that more than 80 percent of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care. Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted.
• Traditional eight-hour shifts for hospital nurses are becoming a thing of the past: Nurses increasingly work twelve-hour shifts. This schedule gives nurses a three-day work week, potentially providing better work-life balance and flexibility. However, actual shift lengths are often unpredictable because of fluctuations in patient needs and unanticipated staffing changes. As a result, nurses often must put in unplanned overtime beyond the scheduled shift length.
• When we examined the hospital characteristics by shift length category, we found that nurses working shifts of twelve hours or longer were more numerous in teaching and high-technology hospitals.
• The odds of burnout and job dissatisfaction were up to two and a half times higher for nurses who worked longer shifts than for nurses who worked shifts of 8–9 hours.
• Nurses working shifts that were twelve hours or longer were disproportionately male and nonwhite; their mean age was also lower than that of nurses in other categories of shift length.
• One possible explanation for the findings is that nurses underestimate the impact of working long shifts because the idea of working three days a week instead of five seems appealing. Working longer but fewer shifts may also attract nurses who work a second job. However, the strain of those three long work days and the rest and recovery time needed may offset any perceived benefit, if our survey results are any indication. When a three-day week turns into more days or additional, unplanned-for overtime, nurses’ satisfaction appears to decrease.

• “The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction”, Amy Witkoski Stimpfel, Douglas M. Sloane, and Linda H. Aiken, Health Aff (Millwood). 2012 Nov; 31(11): 2501–2509.

• A growing body of evidence suggests that long working hours adversely affect the health and wellbeing of workers. Studies have associated overtime and extended work schedules with an increased risk of hypertension, cardiovascular disease, fatigue, stress, depression, musculoskeletal disorders, chronic infections, diabetes, general health complaints, and all-cause mortality. Several reviews and meta-analyses have been published summarising these research findings. Systematic reviews generally have concluded that long working hours are potentially dangerous to workers’ health. However, existing research is sparse and inconsistent in many areas.
• This study of nationally representative data from the United States adds to the growing body of evidence indicating that work schedules involving long hours or overtime substantially increases the risk for occupational injuries and injuries. Unlike previous studies, our investigation had the advantage of covering a large variety of jobs, and controlling for the potential confounding affect of age, gender, occupation, industry, and region. We analysed nearly 100 000 job records extending over a 13 year period, and employed several statistical techniques for quantifying the extent of risk. The results of this study suggest that jobs with long working hours are not more risky merely because they are concentrated in inherently hazardous industries or occupations, or because of the demographic characteristics of employees working those schedules. Our findings are consistent with the hypothesis that long working hours indirectly precipitate workplace accidents through a causal process, for instance, by inducing fatigue or stress in affected workers.
• Our study found that overtime schedules had the greatest incremental risk of injury, with overtime workers having a 61% higher injury hazard rate compared to workers in jobs without overtime, after controlling for age, gender, occupation, industry, and region. This finding is consistent with other studies that have identified overtime work as particularly hazardous.
• In the USA, approximately 19–33% of overtime work is mandatory (also called “compulsory”, “forced”, or “involuntary”). Mandatory overtime is overtime work required by employers, often under the threat of job loss or other penalty if the worker fails to comply. Several studies have suggested that mandatory overtime is especially hazardous with respect to its affect on worker fatigue, stress, impaired performance, and the potential for accidents, especially in the nursing and healthcare professions.
• This analysis found that, after adjusting for those factors, jobs with extended hours per day have a 37% higher injury hazard rate compared to jobs without that exposure. Similarly, working in a job with extended hours per week was associated with a 23% higher injury hazard rate, working in a job with overtime was associated with a 61% higher injury hazard rate, and working in a job with any overtime or extended hours schedule was associated with a 38% higher injury hazard rate. No association was detected between working in a job with extended commute time and the injury hazard rate.

• “The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States”, A E Dembe, J B Erickson, R G Delbos, S M Banks, Occupational and Environmental Medicine, Volume 62, Issue 9.

• From next year, workers at many of Germany's top engineering firms -- such as Mercedes-Benz owner Daimler (DDAIF) -- can opt to work 28 hours a week for up to two years, before returning to the standard 35-hour week.
• IG Metall said the flexibility would help employees who want to care for children or relatives. Pay will be reduced to reflect the shorter working week. The deal also gives workers the option to work 40 hours to earn more.

• “German workers win right to 28-hour week”, Alanna Petroff, CNN, (February 7, 2018).

• World Game finds that 60 percent of all the jobs in the U.S.A. are not producing any real wealth—i.e., real life support. They are in fear-underwriting industries or are checking-on-other-checkers, etc.
  • R. Buckminster Fuller, "Critical Path", (1982), p. 223.

• "It's a hotly debated area, because there are still people who want to separate humans from other animals," said Marc Bekoff, professor emeritus of ecology and evolutionary biology at the University of Colorado, Boulder, and co-founder (with primatologist Jane Goodall) of Ethologists for the Ethical Treatment of Animals. "So if you're doing fieldwork and you see something in the animal's communication system that looks like syntax, they're going to say it isn't."
  • "When Will We Learn To Speak Animal Languages?", Natalie Wolchover, (August 17, 2012).

• At the time, I was interested in reconciliation after fights, and I wanted to know how bonobos did it compared to chimpanzees. Very soon I discovered that they were much more sexual in everything they did, and that interested me—not so much for the sex part, even though that became a very hot topic, the peacemaking-through-sex thing—but much more how they have such a peaceful society, because they are much less violent than chimpanzees.
  • Jane Goodall, "The Bonobo in All of Us" NOVA, PBS, (1 January 2007).

Psychology/Psychiatry

• Whereas abandonment and personal identity trauma (e.g., sexual abuse) have direct negative effects, secondary trauma (e.g., parents' involvement in war or combat) has a positive effect on IQ. Collective identity trauma (e.g., oppression) did not have either negative or positive effects on IQ. The PTSD components re-experiencing and arousal generally mediated some of the negative effects of traumas on IQ; avoidance and emotional detachment/dissociation generally mediated positive effects. In conclusion, trauma type differentially impacts IQ.
  • "The effects of trauma types, cumulative trauma, and PTSD on IQ in two highly traumatized adolescent groups.", Kira, I., Lewandowski, L., Somers, C. L., Yoon, J. S., & Chiodo, L. (2012), Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 128-139.

• War does not develop the virtues of peace. . .It is not a school that teaches respect for the person or property of others.
• When the rules of civilized society are suspended, when killing becomes a business and a sign of valor and heroism, when the wanton destruction of peaceable women and. children becomes an act of virtue, and is praised as a service to God and country, then it seems almost useless to talk about crime in the ordinary sense.
• [There is] an obliteration of all the religious, moral and legal habits which acted as a barrier against acts of murder or of aggression against personal inviolability.
• There was a marked increase in juvenile delinquency and it was found to be due to the disturbance of home conditions, the absence of the father and elder brother, the employment of the mother in other than domestic pursuits and the interruption of school attendance. There was an increase in the number of women offenders, both actually and, of course, tremendously more, proportionally. There was a marked decrease in adult male offending and a corresponding falling off in prison population, traceable, of course, to the fact that a large proportion of the male population was occupied in war.

• "Relationship Between War and Crime in the United States", Betty B. Rosenbaum, Journal of Criminal Law and Criminology, Volume 30, Issue 5, January-February, 1940.

• In the fantasies they committed to paper, the men associated the women they despised with floods of liquid and slime, and with dirt – substances that would threaten to overwhelm the defences of their ill-formed psyches. The solider male felt that he could only guarantee “his own survival, his self-preservation and self-regeneration”, through acts of violence against such women. (Another way of maintaining their fragile sense of self is by slotting themselves into enveloping external structures like the armed forces or fascist youth organisations.)
  In the soldier males’ journals we see them taking great pleasure, and building fraternal camaraderie, by murdering women, pairs of lovers and leftists of all genders. We also see that many of them cannot reconcile acts of physical love with the nature of their own desires. When it came to these men, their murderous acts and their sexual problems were not coincidental, they were interrelated.
  In explaining how, Theweleit takes exception with the left’s then-dominant explanation of fascism – that it was a result of pure irrationality, or repressed homosexuality. Some said it could be countered by the left mounting a renewed defence of progress and reason, or by beefing up alternative institutions that mirrored those of the fascists.
  For Theweleit, this misses the central dynamic that propels the fascist male towards violence. Fascism derives its power from channelling the protean, potentially liberating force of human desire towards hatred, distorting it into a desire for death and blood. All of its institutions, its rituals, and the (male) bonds it promotes are bent to this purpose. We cannot beat fascists by aping their structures, any more than we can hope to rationally persuade them. The problem goes deeper.
  On this theme, he says that classical fascism was not as distinct as we might want it to be from the culture surrounding it. It is not a departure from European history, but an intensification of some of its more pervasive traits.
  At one point he asks, “Can we not draw a straight line from the witch to the sensuous Jewish woman? Is the persecution of the sensuous woman not a permanent reality, one that is not economic in origin, but which derives from the specific social organisation of gender relations in patriarchal Europe?”
  Later, more succinctly, he comments that his soldier males are “equivalent to the tip of the patriarchal iceberg, but it’s what lies beneath the surface that really makes the water cold”.
• Too many people have taken the incels’ explanation of their own virulent misogyny at face value, and repeated the comfortable line that these men stand apart from all others. Along with influential columnists, even economists have endorsed the idea of “sexual marketplace”, wherein women are figured as a commodity, and some men have inadequate buying power to procure. (Most have been too polite to mention many incels’ accompanying belief that the world, and women, are so corrupted that sex is beneath them.)
  • Jason Wilson, "What do incels, fascists and terrorists have in common? Violent misogyny", The Guardian, (4, May 2018)

• Other factors theorised to have contributed include the media and public fascination with serial murder creating a snowball effect; the development of an interstate highway system, which gave some killers a wider geography to roam and kill; and, related to the overall increase in crime, lead exposure from petrol.
  Vronsky has another hypothesis to add to the list: he believes the rise of the North American serial killer in the late 20th century can be traced to the ravages of World War Two, which lasted from 1939 to 1945, and the children of men returning from battlefields in Europe and the Pacific.
• He said there was a less pronounced but noticeable increase in serial killings from 1935 to 1950, following World War One, and hopes sociologists and criminologists look more closely at the war experiences of the fathers of these killers, and their paternal relationships.
  Vronsky also pointed to popular culture of the post-war era as a contributing factor, specifically the pulp fiction and true crime magazines that were widely sold across North America with covers that often depicted violent sexualised imagery.
• A report from the FBI's behavioural unit notes that "there is no single identifiable cause or factor that leads to the development of a serial killer. Rather, there are a multitude of factors that contribute to their development.
  "The most significant factor is the serial killer's personal decision in choosing to pursue their crimes".

• Jessica Murphy, "Why were there so many serial killers in the 1980s?", BBC News, (August 31, 2018).

• Claus Lamm summarizes the findings as follows: "Based on their neural responses, stressed participants had a stronger emotional reaction to the pictures. However, this implies that they also ignored complex information about the actual situation the shown person was in. Our results thus support the hypothesis that humans show more empathy and are more prone to helping others when they are under stress, but that their perspective taking skills might deteriorate. In some circumstances, the stronger emotional response might thus result in aid that is uncalled for or inappropriate, for example when one's first impression of another's mental state does not match their actual emotion -- e.g. when someone is crying out of joy. Hence, depending on the context and situation, stress can be either beneficial or detrimental in social situations."
  • "Stress can increase empathy", University of Vienna, ScienceDaily, April 11, 2017

• BYU School of Family Life professor Laura Padilla-Walker, in a longitudinal study she coauthored with a former student (Xinyuan Fu, Central University of Finance and Economics, China) in the Journal of Adolescence, found that adolescents who exhibited prosocial behavior -- such as helping, sharing and comforting -- toward strangers had higher self-esteem a year later. The same was not true for those in the study who exhibited prosocial behavior solely to friends and family.
  • "Teens who help strangers have more confidence: Get your kids involved in service to strangers in this season of giving, researchers suggest.", Brigham Young University, ScienceDaily, 18 December 2017

• The work was done by the late Dr. Yuin Cameron and involved extensive use of potentially dangerous drugs, excessive electric shock treatment, and endless tape recorded messages to sleeping patients. Some heard the same message a quarter-of-a-million times.
• The United States, the CIA, was doing what the Nuremberg laws say you can't do, take experiments on human beings when in fact they're not told that these are experiments. They thought they were getting treatment. They were paying for treatment.

• "Mind Experiments" NBC Nightly News, September 15, 1984

• MK-Ultra and its successor program, MK-SEARCH, were terminated in part because the drugs and other techniques proved "too unpredictable in their effect on human beings."
  • “Lawsuit Forces CIA confession On MK-ULTRA", Jack Anderson, Washington Post 28 August 1982.

• MK-Ultra wanted to know if the drug actually could induce loss of willpower and memory. Another documented case involves two suspected Russian CIA agents which the agency feared might have been compromised. Both agents were drugged, then hypnotized. They relived past incidents in their lives, the documents report. Interrogations were very successful.
  Among the MK-Ultra documents produced today was a 1949 letter outlining ways of killing a person without leaving evidence of murder.

• "CIA Revelations: Behavior Control", ABC Evening News, July 20, 1977

• It is one of those drugs with a rich backstory. It is said to be one of the first “truth serums”. In the early 20th century, it was administered by some doctors as a pain-relief drug – or rather a drug that led to the forgetting of pain – in childbirth until one obstetrician noticed how women who had been given it answered candidly to questions; he later wondered if it could be used when questioning people charged with crimes. It was used as evidence in some trials, but dubiously.
  Then there are stories of it being used in Nazi Germany as an interrogation tool, and also in the middle ages by witches. “The degree to which any of this stuff is true is unknown,” says Curran. “There’s a lot of myth.”
  • "Devil's Breath' Aka Scopolamine: Can It Really Zombify You?", Emine Saner, The Guardian, 2 September 2015

• What action does salamander brandy have on human consciousness? Ogorevc says it definitely has hallucinogenic effects which I would compare, according to his description, more to the reactions elicited by muscimole, ibogaine or strychnine than to the effects of classic psychedelics like LSD, mescaline and psilocybin. Under its influence visual reality starts to be illuminated by colourful flashes and is contorted in a specific way. Auditory phenomena may accompany visual changes, but the subject is not sure if they are real or not.
  Above all, it has been said that it has a strong effect on the sex drive. It purportedly produces a temporary sexual disorientation, but nonetheless the sexuality of the consumer can be promoted from the commonest banality into metaphysical play. It is said to be a powerful libidinous agent that can turn everything in the environment into an erotically charged being or object. If there is any symbolism that should be ascribed to the salamander, it is not ethereal chastity but fiery passion. It is no surprise then that some consumers take the brandy in order to enhance their sexual imagination and modify their reactions to sexual stimuli.
  The consumer can fall asleep from time to time and lose his or her sense for how much time has elapsed in between as well as from the beginning of the trip. It is possible to have partial amnesia. After-effects have not been reported, yet an adept in psychedelic movement avers that salamander brandy is a bad drug, because it contains, along with psychoactive substances, also spiritually negative emanation caused by the suffering of salamanders in mortal agony.
  • "Salamdander Brandy: A Psychadelic Drink Made In Slovenia", Ivan Valenčič

• It is not a case of awakening the dead, but a matter of the semblance of death induced by some drug known to a few: some secret probably brought from Africa and handed down from generation to generation. The bocors know the effect of the drug and the antidote. It is evident that it destroys that part of the brain which governs speech and willpower. The victim can move and act but cannot formulate thought.
  • Zora Hurston, as quoted by Wade Davis, in "The Pharmacology of Zombies" Harpers, (April 1984).

• APA has a long history of prohibiting torture. Since 1985, APA has issued numerous policies condemning torture, which have been reaffirmed and refined over the years. APA’s policies draw upon international human rights instruments and have expressly adopted the definitions of torture and cruel, inhuman or degrading treatment or punishment in the U.N. Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. APA’s policy prohibits psychologists from participating in national security interrogations at detention settings operating in violation of the U.S. Constitution or international law. Jessen was never a member of APA. Mitchell resigned his APA membership in 2006.

• American Psychological Association, "APA Reaction to Settlement of Torture Case Against Psychologists", (August 17, 2017)

• Particularly where it is associated with the more prosperous countries, or those that see themselves as bringers of civilization, torture may wear a humane, almost kindly face. It goes under euphemisms such as 'pressure', 'shock', 'stress' and 'duress'; and the perpetrators themselves will see a distinction between what they do and what they consider to be torture. However, this is as vicious a form of torture as any: it can leave people mentally and physically disabled—indeed, the practitioners acknowledge the potential to render people psychotic, in hours or days.
  The victim is typically subjected to physical punishments that do not leave obvious scars, and this means that, should the case ever come under legal scrutiny, physical evidence of torture may be lacking. However, many ways of causing extreme pain remain possible. The subject will be tightly handcuffed and restrained, often in a way that damages nerves and muscles; he may be suspended in painful postures, or forced to assume them himself, with damage to muscles and joints; he may be subjected to electric shocks. Typically, he will be kept in a small, dark, bedless cell, with inadequate food and variable toilet facilities, so that his own filth stains the floor and dampens his clothes. He may be exposed to extreme heat or cold, and perhaps forced to stare at the sun. Beatings with rifle butts and kicking with military boots can cause lasting damage; lashing on the soles of the feet can make walking painful for years. A doctor may well be present, persuading the prisoner that he is in the wrong and that all he must do is recant. The doctor may even provide medication—as a symbol of civilization, or to keep the patient alive (deaths in custody can be inconvenient), or to cause pain or disability.
• How can people do this to one another? In society, few people are actively sadistic or psychopathic. To impose one's will on another, particularly with brutality, is possible only if one views oneself as wiser or more valuable; and this notion is fostered by creeds that exalt certain groups and denigrate others. People torture in the name of ideals that, in their culture, would be held to be unassailable—democracy, freedom, Islam. What counts is the label, not the reality of these doctrines. Milgram demonstrated the power of labels when, in his experiment, men in white coats persuaded volunteers to deliver what they thought were lethal electric shocks to screaming individuals (who were acting the part). The quiet priestly authority of 'progress' outweighed the volunteers' own consciences.
• Human beings, regrettably, are easily conditioned to the notion that other sorts of people are different, inferior, intrinsically dangerous. Education is no protection against such conditioning—indeed, the leaders and propagators of political violence are commonly from among the well educated. But an intrinsic feeling of superiority, or necessity, is not enough: the torturer must be placed in an appropriate role. Zimbardo demonstrated the importance of this when he placed students in a mock jail, some as prisoners, others as guards. Within a few days the experiment had to be stopped, such was the treatment meted out to the prisoners by the guards. The torturer may see himself as a defender of humanity, when all the while his conduct is dominated by brutality and corruption. In areas where torture is well established, people are swept up off the streets on a suspicion or a word; bribery secures release, and maladministration results in detention or even execution of the innocent.

• "Healing in survivors of torture", Athar Yawar, J R Soc Med. 2004 Aug; 97(8): 366–370.

• Using a white-noise-aggression paradigm, we found that sadists, psychopaths, narcissists, and those low in empathy and perspective taking aggressed against an innocent person when aggression was easy. Of those with dark personalities, however, only sadists increased the intensity of their attack once they realized that the innocent person would not fight back. Sadists were also the only dark personalities willing to work (i.e., expend time and energy) to hurt an innocent person. Together, these results suggest that sadists possess an intrinsic appetitive motivation to inflict suffering on innocent others a motivation that is absent in other dark personalities. Inflicting suffering on the weak is so rewarding for sadists that they will aggress even at a personal cost.
  In the present research, we investigated whether every-day sadism is a viable personality construct. Two questionnaire measures of sadistic personality converged with two overtly sadistic behaviors. In Study 1, sadistic personality predicted a preference for killing bugs. In Study 2, sadistic personalities were willing to hurt innocent others, and, importantly, to incur personal costs for the opportunity. In both studies, sadism remained a unique predictor of sadistic choice when we controlled for over-lap with the Dark Triad.
  These findings support the call to incorporate sadism into a new Dark Tetrad of personality (Chabrol et al., 2009; Furnham et al., 2013). Our results advance the literature on sadism by show-ing that (a) it can be studied in a laboratory setting and (b) the Short Sadistic Impulse Scale and the Varieties of Sadistic Tendencies are valid measures of sadistic personality. To our knowledge, there is no prior behavioral evidence for the validity of these measures. Admittedly, the enjoyment of killing bugs may not extend to the enjoyment of hurting human beings. However, the same sadistic personalities went out of their way to hurt human victims in Study 2. By contrast, participants with low sadism scores would rather endure the pain of ice water than hurt another living entity.

• “Behavioral Confirmation of Everyday Sadism”, Erin E. Buckels, Daniel N. Jones, and Delroy L. Paulhus, Psychological Science, September 10, 2013

• In two online studies (total N = 1215), respondents completed personality inventories and a survey of their Internet commenting styles. Overall, strong positive associations emerged among online commenting frequency, trolling enjoyment, and troll identity, pointing to a common construct underlying the measures. Both studies revealed similar patterns of relations between trolling and the Dark Tetrad of personality: trolling correlated positively with sadism, psychopathy, and Machiavellianism, using both enjoyment ratings and identity scores. Of all personality measures, sadism showed the most robust associations with trolling and, importantly, the relationship was specific to trolling behavior. Enjoyment of other online activities, such as chatting and debating, was unrelated to sadism. Thus cyber-trolling appears to be an Internet manifestation of everyday sadism.
  • “Trolls just want to have fun”, Personality and Individual Differences, Volume 67, September 2014, Pages 97-102

• "Some players feel they can intimidate other players by getting into their heads," says Katz, who has worked with the New Jersey Nets and several college basketball teams. "But many athletes are putting time and energy into something that distracts them from playing their best. Playing well is the most intimidating factor."
  Still, sports history is filled with famous trash talkers. One well-known athlete, a young man named David, was able to use a verbal attack to his benefit in a battle with a heavily favored foe. "I will strike you down and cut off your head," David proclaims to his much larger enemy, Goliath, in the first chapter of the biblical book of Samuel. And the rest is trash-talking history.
  • "The Art of Trash Talk", Jason Silverman, Psychology Today, September 1, 1999

• Bullying at work is not only about aggressive behavior. The covert nature of workplace bullying behavior can destroy a target’s health, ability to work, emotional well-being, self-worth, and financial condition. This research is one of the first studies on workplace bullying in the United States. Workplace bullies have a serious negative impact upon the organizations for which they work (Namie & Namie, 2003; Prentice, 2005). Once the bullying atmosphere begins to pervade an organization, morale is destroyed and productivity is affected. The workplace often includes distorted personality types that seem to have just one purpose: to find somebody else to attack, to belittle, to criticize, and to destroy (Prentice). Bully behavior, whether committed by men 94 or women, should be further examined due to the long-term costs for both employees and the organizations for which they work. Many leaders and managers either fail to recognize the problem or are themselves the problem. Early studies on bullying focused on the behavior of the bully, the target, or the bully-target pairing (Olweus, 1999). Recent approaches have adopted an ecological perspective that examines the broader context in which bullying can occur and especially the many interrelated systems of the environment, such as the workplace and its leadership (Namie, 2003). This study presents methods of aggression employed by bullies that leaders must recognize and cease.
  • Fisher-Blando, Judith Lynn. "Workplace Bullying: Aggressive Behavior and its effect on Job Satisfaction and Productivity", Archived from the original (PDF) on 2016-10-19. Retrieved 2013-04-18, p. 93-94

• Bullying bosses, studies find, differ in significant ways from the Blutos of childhood. In the schoolyard, particularly among elementary school boys, bullies tend to pick on smaller or weaker children, often to assert control in an uncertain social environment in which they feel uncomfortable. But adult bullies in positions of power are already dominant, and they are just as likely to pick on a strong subordinate as a weak one, said Dr. Gary Namie, director of the Workplace Bullying and Trauma Institute, an advocacy group based in Bellingham, Wash. Women, Dr. Namie said, are at least as likely as men to be the aggressors, and they are more likely to be targets. In leadership positions that require the exercise of sheer violent will- on the football field or the battlefield- this approach can be successful: consider Vince Lombardy or George Patton. But in an office or on a factory floor, different rules apply, and bullying usually has more to do with the boss's desires than with the employee's needs.
  • Benedict Carey, New York Times journalist, in the article "Fear in the Workplace: The Bullying Boss", published June 22, 2004.

• Definitions of bullying at work further emphasize two main features: repeated and enduring aggressive behaviours that are intended to be hostile and/or perceived as hostile by the recipient (Einarsen and Skogstad, 1996; Leymann, 1990b; Zapf et al., 1996). In other words, bullying is normally not about single and isolated events, but rather about behaviours that are repeatedly and persistently directed towards one or more employees. Leymann (1990b, 1996) suggested that to be called 'mobbing' or bullying, such events should occur at least once a week, which characterises bullying as a severe form of social stress. In many cases this criterion is difficult to apply because not all bullying behaviors are strictly episodic in nature. For example, a rumour can circulate that may be harmful or even threaten to destroy the victim's career or reputation. However, it does not have to be repeated every week. In cases we have been made aware of, victims had to work in basement rooms without windows and telephone. Here, bullying consists of a permanent state rather than a series of events. Hence, the main criterion is that the behaviours or their consequences are repeated on a regular as opposed to an occasional basis.
  • Stale Einarsen, Helge Hoel, Dieter Zapf, and Cary L. Cooper, "The Concept of Bullying at Work: The European Tradition"; in Bullying and Emotional Abuse in the Workplace: International Perspectives and Research, pp. 7-8.

• Parents who are intimidated by texting and social-networking sites view cyberbullying as a terrifying new form of bullying, but the truth is that cyberbullying is just a continuation of existing adolescent behavior, played out in a new arena. Approximately 20-25 percent of kids have been bullied online, and this is a conservative estimate. Bullies and victims can trade places at the click of a mouse, and things move so fast online that it is difficult to process information rationally before acting. For unfortunate kids who find themselves on the receiving end of massive cyberbullying attacks, the relentless barrage of cruelty can create a sensation of sinking into a black hole of pain.
  • Dr. Dorothy Espelage, in the Introduction for Bullied: What Every Parent, Teacher, and Kid Needs to Know About Ending the Cycle of Fear (2012) by Carrie Goldman, p. xiii

• How exactly does the pain of severe bullying affect the most vulnerable kids? Studies investigating the neuroscience of bullying have found that bullying victims experience anxiety, depression, post-traumatic stress, difficulty concentrating, headaches, and stomach pain as a result of being bullied. Studies of early social deprivation show that human beings are hardwired to belong, and nowhere is this more evident than in kids jockeying for social position. And the old adage- sticks and stones may break my bones but words will never hurt me? Not true. Neuroimaging studies have shown that parts of the cortical brain network are also activated when a person is socially excluded. This goes not just for adults but for children as well. The brain of a child as young as thirteen has been shown to react to pain as if the child were being physically injured. Taunting and bullying hurts, and we have the brain scans to prove it. Even worse, repeatedly being victimized by peers- which is the very nature of bullying, the repetitiveness of it- actually alters brain functioning, which increases the victim's sensitivity to future attacks, even causing the person to perceive an ambiguous situation as threatening. Years after the bullying has ceased, victims are left picking up the wreckage.
  • Dr. Dorothy Espelage, in the Introduction for Bullied: What Every Parent, Teacher, and Kid Needs to Know About Ending the Cycle of Fear (2012) by Carrie Goldman, p. xiii

• Bullying is a learned behavior. Children are not born cruel. Babies in diapers do not assess each other as too fat, too poor, too dark-skinned, to nerdy, too conceited. Born innocent, they start learning stereotypes as soon as they understand language, and we see bullying behavior in children as young as toddlers. Since preschoolers who display marked aggressiveness have a higher likelihood of being bullies in older grades, the earlier intervention begins, the better the results. It is much easier to inculcate kindness and acceptance into a five-year-old who acts like a bully than a fifteen-year-old who acts like a bully.
  • Dr. Dorothy Espelage, in the Introduction for Bullied: What Every Parent, Teacher, and Kid Needs to Know About Ending the Cycle of Fear (2012) by Carrie Goldman, p. xiii-xiv

• The problem than arises of when to define operationally the duration of bullying behaviours. Leymann (1990b, 19960=) suggested exposure for more than six months as an operational definition of bullying at work. Others have used repeated exposure to negative behaviours within a six-month period as the proposed timeframe (Einarsen and Skogstad, 1996). Leymann's strict criterion has been argued to be somewhat arbitrary, as bullying seems to exist on a continuum from occasional exposure to negative behaviours to severe victimisation resulting from frequent and long-lasting exposure to negative behaviours at work (Mattiesen et al., 1989). Yet, the criterion of about six months has been used in many studies in order to differentiate between exposure to social stress at work and victimisation from bullying (e.g. Einarsen and Skogstad, 1996; Mikkelsen and Einarsen, 2001; Niedl, 1995; Varita, 1996; Zapf et al. 1996). The reason for this criterion for Leymann (1993, 1996) was to argue that mobbing leads to severe psychiatric and psychosomatic impairment, stress effects which would not be expected to occur as a result of the normal occupational stressors such as time-pressure, role-conflicts or everyday social stressors. Hence, the period of 6 months was chosen by Leymann because it is frequently used in the assessment of various psychiatric disorders.
  • Ibid, p. 8

• The duration of the bullying seems to be closely related to the frequency of bullying, with those bullied regularly reporting a longer duration of their experience than those bullied less frequently (Einarsen and Skogstad, 1996). This seems to be in line with a model of bullying highlighting the importance of conflict-escalation, with the conflict becoming more intense and more personalised over time (Zapf and Gross, 2001).
  The negative and unwanted nature of the behaviour involves is essential to the concept of bullying. Victims are exposed to persistent insults or offensive remarks, persistent criticism, personal or, even in some few cases, physical abuse (Einarsen, 200b). Others experience social exclusion and isolation; that is they are given the 'silent treatment' or 'sent to Coventry' (Williams, 1997). These behaviours are 'used with the aim or at least the effect of persistently humiliating, intimidating, frightening or punishing the victim' (Einarsen, 2000b, p. 8).
  • Ibid, p. 8-9

• Based on both empirical and theoretical evidence, Zapf (1999a) categorised five main types of bullying behaviour:
  
  1 work-related bullying which may include changing the victim's work tasks in some negative way or making them difficult to perform;
  2 social isolation by not communicating with somebody or excluding someone from social events;
  3 personal attacks or attacks on someone's private life by ridicule or insulting remarks or the like;
  4 verbal threats in which somebody is criticised, yelled at or humiliated in public;and
  5 spreading rumors.
  • Ibid, p.9

• Bullies are typically attempting to promote or assert an identity rather than defend one. Their behavior is typicvally predatory rather than dispute related. Bullies prey on vulnerable targets, usually in the presence of third parties, in order to show how tough they are (see Olweus, 1978). For the bully, dominating the victim is ana ccomplishment, a way of demonstrating power to himself and others.
  In case of jealousy, a person may intentionally harm another person who has not attacked or wronged them in any way. Both justice and self-image concerns can produce an aggressive response when someone is jealous. When people think that someone has recieved an unfair share of some reward, they may attempt to restore equity by harming the person, even when that person is not held responsible for the injustice. We have referred to this behaviour as "redistributive justice" (to distinguish it from "retributive justice"). Thus, an employee may blame the supervisor who gives a raise to someone else but attempt to produce unfavorable outcomes for the coworker who recieved a raise. Jealous people may also attempt to harm the object of jealousy for purposes of downward comparison (Wills, 1981). They may engage in aggressive behavior that lowers the standing of the target on some dimension, thereby providing a faborable comparison for the actor. They put themselves"up" by putting other "down." Wills (1981) suggested that downward comparison was an alternative explanation for the displacement effects obtained in experiments testing frustration-aggression theory. He noted that investigations of displaced aggression, scapegoating, and hostility generalization all involve some challenge to the participants' identities.
  • Ibid, pp. 20-21

• Adult bullying at work is a shocking, frightening, and at times shattering experience, both for those targeted and for onlookers. Workplace bullying, mobbing, and emotional abuse essentially synonymous phenomena*are persistent, verbal, and nonverbal aggression at work that include personal attacks, social ostracism, and a multitude of other painful messages and hostile interactions. Because this phenomenon is perpetrated by and through communication, and because workers’ principal responses are communicative in nature, it is vital that communication scholars join the academic dialogue about this damaging feature of worklife. The harm to workers runs the gamut of human misery including ‘‘anxiety, depression, burnout, frustration, helplessness, ... difficulty concentrating, alcohol abuse (Richman, Flaherty, & Rospenda, 1996), and posttraumatic stress disorder (Leymann & Gustafsson, 1996; Mikkelsen & Einarsen, 2002). Witnessing co-workers experience increased fear, emotional exhaustion, hypervigilance, stress, and intentions to leave (Jennifer, Cowie, & Anaiadou, 2003; Vartia, 2001, 2003). Bullying also hinders group communication, cohesion, and performance by creating hostile environments marked by apprehension, distrust, anger, and suspicion (Frost, 2003; Lockhart, 1997; Vartia, 2003). What makes this communicative phenomenon especially grave is its elevated prevalence in US workplaces. From 28% to 36% of US workers report persistent abuse at work (Keashly & Neuman, 2005; Lutgen-Sandvik, Tracy, & Alberts, 2005; Neuman, 2004), and nearly 25% of US companies report some degree of bullying (Blosser, 2004). Furthermore, over 80% of workers say they have witnessed bullying sometime during their work histories (Keashly & Neuman, 2005; Lutgen-Sandvik, 2003a; Namie, 2003b). Given its prevalence and negative consequences, bullying warrants the attention of communication scholars, particularly those studying power and oppression.
  • Pamela Lutgen-Sandvik , “Take This Job and ... : Quitting and Other Forms of Resistance to Workplace Bullying”, Communication Monographs Vol. 73, No. 4, December 2006, pp. 406-407

• On the other hand, witnesses were also deeply disturbed by their experiences. Similar to target-witnesses, they spoke of how the workplace experience took over their entire lives, they worried about it at and away from work, they talked about it continually to family and friends, they spent large segments of work time speaking with others or figuring out how to deal with or avoid being abused. Witnesses and targets reported that their experiences and failure of organizational authorities to stop abuse stripped away their beliefs that good prevails over evil.
  • Ibid, p. 421

• Resistance to abuse at work is a complex, dynamic process in which workers fight to have a voice and are often punished for their efforts. If and when organizational authorities finally intervene, many have already left the organization or suffered years of abuse. The human cost is staggering and workers’ stories heartbreaking. Neither is resistance straightforward; worker dissent is easily reframed as deviant behavior by those for whom the resistance is threatening. Nonetheless, workers faced with bullying at work say they have a moral imperative to act against the injustice and in some cases actually alter their situations. Furthermore, workers often collectively organize against abusers, even in the absence of formal unions. Organizations would be well-informed to heed these voices. Resistance and the emotional communication that springs from it are warning signs that "act as signaling devices when expected appropriate norms of communication are violated" (Waldron, 2000, p.72). These should not be ignored. Organizational authorities must learn to "read the traces" of resistance to bullying, diagnose the problem early, and construct effective interventions.
  • Ibid, p. 429

• More than 90% of adults experience workplace bullying—that is, psychological and emotional abuse—at some time during the span of their work careers (Hornstein, 1996). The supervisors who inflict psychological abuse on subordinates represent one of the most frequent and serious problems confronting employees in today’s workforce (Yamada, 2000). Although the television news is quick to report the rare but sensational incidents of disgruntled employees returning to their former workplaces seeking revenge (e.g., “Office Rampage,” 1999), rarely do we see stories of employee humiliation and psychological violence perpetrated by more powerful organizational members. Research indicates a link between workplace abuse and workplace violence as the aggressor becomes increasingly more threatening to targeted employees (Namie & Namie, 2000). In addition to increased threats of violence from abusers (Leymann, 1990), employees who feel unfairly treated may express their anger and outrage in subtle acts of retaliation against their employers, including work slowdown or covertly sabotaging the abuser (Skarlicki & Folger, 1997). As reported in a government study, “The cost to employers is untold hours and dollars in lost employee work time, increased health care costs, high turnover rates, and low productivity” (Bureau of National Affairs [BNA], 1990, p. 2). Employee emotional abuse (EEA) is a repetitive, targeted, and destructive form of communication directed by more powerful members at work at those less powerful.
  • Pamela Lutgen-Sandvik, "The Communicative cycle of Employee Emotional Abuse", Management Communication Quarterly, Vol. 16, No. 4, May 2003, p. 472

• For the purposes of this article, EEA is defined as targeted, repetitive workplace communication that is unwelcome and unsolicited, violates standards of appropriate conduct, results in emotional harm, and occurs in relationships of unequal power (Keashly, 2001). EEA has also been labeled workplace mistreatment (Price Spatlen, 1995), workplace aggression (Baron & Neuman, 1998), workplace harassment (Bjorkqvist et al., 1994), verbal abuse (Cox et al., 1991), psychological abuse (Sheenan et al., 1990), and chological violence (Institute for Workplace Trauma and Bullying, 2002).
  • Ibid, pp. 474-5

• Emotional abusers appear to be particularly skilled at appearing to provide constructive feedback because the organization formally requires it. The extremes to which managers go to build a verbal and written case against the target suggest that this is done to “make . . . action appear justifiable and reasonable to all parties” (Fairhurst et al., 1986, p. 569). They are inclined to systematically distort these communicative processes if they want to get rid of an employee (author’s experience), and because the more powerful member creates the documenting language, they author the formal record of “what occurred.” Rather than improve performance, this form of chronic criticism more often unnerves targets (Lockhart, 1997) and results in further poor performance that substantiates the abuser’s initial claims of incompetence (Wyatt & Hare, 1997).
  • Ibid, p. 482

• "So what was the outcome with the student who found the bullet in his locker?" With the principal's permission, he called a school meeting in their auditorium, where he boldly shared with his classmates his thoughts and feelings about finding the bullet on his book, in his locker. This morphed into a student led conscientious pro peace and anti violence movement in the school community. For a while I continued to get on his case about not revealing who he believed the culprit to be, but then I realized that with the level of awareness he had helped spread amongst his peers, knowing who his antagonist might be didn't matter. Especially since the harassment had ended. My client had found a silver lining in a dark cloud and he was now more confident and accepting of who he was as a person, with more friends.
  In the aftermath of the tragedy that unfolded this weekend here in Tucson, I have heard all sorts of responses and suggestions, from banning guns, to regulation of ammunition magazine sizes, to encouraging or scaring every citizen to begin arming themselves in public. As a US. Army veteran and veteran of the war in Afghanistan, I can vouch that simply being armed, doesn't increase anyone's safety or make a threat (real or perceived) any less likely.
  • “Effective Behavioral Responses to Threats (Real or Perceived): The Best Way To Deal With A Threat Of Gun Violence”, Ugo Uche, Psychology Today, Jan 11, 2011

• Five years ago, while still a faculty member, I deliberately looked for provocative ways to engage students who, by age 18, seemed blasé (having already been exposed to all manner of sex, violence, and ‘depravities’ via news-stories and popular films). Not only did I regularly screen “A Clockwork Orange,” “The Rapture,” and “Girl, Interrupted,” I had been known to open my Social Problems course with “BumFights." The issues raised by each of these offerings always got my student’s attention—generating stunned silences and lively discussion—which was the intended outcome. The agenda of the protagonist in each of these offerings—and the circumstances of the ‘victims’—needs to be digested, questioned, probed, pushed, and responded to. Their content needs to be negotiated—especially if it triggers an emotional response. To my mind, it seemed irresponsible to let students come to these issues (or the films that showcase them) on their own, without the context of a classroom to support engagement with the topics.
  But today, showing such films might make me a bully—an insensitive faculty member abusing her power/authority over students. While I would hardly wish to re-traumatize a student, exempting everyone who 'self-identifies' from engaging difficult material—especially if it calls up shame—is troublesome.

• "Trigger Warnings, Micro-aggressions and Bullying: Where do we draw the line?", Laura Martocci, Psychology Today, Dec 18, 2015

• Indeed, a review of the psychiatric literature shows no studies that link trigger warnings to either short-term or long-term mental health outcomes. As such, trigger warnings are not an evidence-based intervention and are not supported by the scientific literature.
  On the contrary, related studies indicate that avoiding phobic experiences can be detrimental to individual mental health. Avoidance can increase sadness and worry, which in turn can constrain everyday behaviour and prevent personal growth.
  In fact, evidence suggests that the best way to tackle undue fear is through exposure, rather than avoidance. Hence this is the basis for many evidence-based interventions for phobia and anxiety.
• Associating the word "trigger" with mental health perpetuates damaging myths that people with mental illness are constantly on the verge of "snapping." Indeed a culture of trigger warnings can contribute to common misperceptions that people with mental illnesses such as PTSD are akin to Pavlovian dogs, lacking self-control and prone to emotional outbursts at the least provocation. This can contribute to the considerable stigma already experienced by people with mental illness.
  Trigger warnings can also contribute to patronizing stereotypes that emerging adults are part of a pampered "snowflake generation." They imply that young adults are overgrown fragile children who need protection from hard and cold reality. This could theoretically lead to discrimination in the job-market, with young people passed over in favor of (perceived) tougher older people.
• Instead of giving a trigger warning, I took a more old fashioned approach. I acknowledged to the class that the session may be disturbing. I told them that I had lost friends to suicide, using these tragedies as fuel to try and help address the problem. Finally, I stated that anyone who feels disturbed at the end of the class could join my assistant and I in a local café for chat, comfort and moral support. This approach may be more meaningful than a trite one-second trigger warning.

• "Trigger Warnings and Mental Health: Where Is the Evidence?: Examining whether trigger warnings protect mental health.", Psychology Today, Mar 23, 2017

• Something strange is happening at America’s colleges and universities. A movement is arising, undirected and driven largely by students, to scrub campuses clean of words, ideas, and subjects that might cause discomfort or give offense. Last December, Jeannie Suk wrote in an online article for The New Yorker about law students asking her fellow professors at Harvard not to teach rape law—or, in one case, even use the word violate (as in “that violates the law”) lest it cause students distress.
• For example, some students have called for warnings that Chinua Achebe’s Things Fall Apart describes racial violence and that F. Scott Fitzgerald’s The Great Gatsby portrays misogyny and physical abuse, so that students who have been previously victimized by racism or domestic violence can choose to avoid these works, which they believe might “trigger” a recurrence of past trauma.
• These same children grew up in a culture that was (and still is) becoming more politically polarized. Republicans and Democrats have never particularly liked each other, but survey data going back to the 1970s show that on average, their mutual dislike used to be surprisingly mild. Negative feelings have grown steadily stronger, however, particularly since the early 2000s. Political scientists call this process “affective partisan polarization,” and it is a very serious problem for any democracy. As each side increasingly demonizes the other, compromise becomes more difficult. A recent study shows that implicit or unconscious biases are now at least as strong across political parties as they are across races.
• These first true “social-media natives” may be different from members of previous generations in how they go about sharing their moral judgments and supporting one another in moral campaigns and conflicts. We find much to like about these trends; young people today are engaged with one another, with news stories, and with prosocial endeavors to a greater degree than when the dominant technology was television. But social media has also fundamentally shifted the balance of power in relationships between students and faculty; the latter increasingly fear what students might do to their reputations and careers by stirring up online mobs against them.
  We do not mean to imply simple causation, but rates of mental illness in young adults have been rising, both on campus and off, in recent decades. Some portion of the increase is surely due to better diagnosis and greater willingness to seek help, but most experts seem to agree that some portion of the trend is real. Nearly all of the campus mental-health directors surveyed in 2013 by the American College Counseling Association reported that the number of students with severe psychological problems was rising at their schools. The rate of emotional distress reported by students themselves is also high, and rising. In a 2014 survey by the American College Health Association, 54 percent of college students surveyed said that they had “felt overwhelming anxiety” in the past 12 months, up from 49 percent in the same survey just five years earlier. Students seem to be reporting more emotional crises; many seem fragile, and this has surely changed the way university faculty and administrators interact with them. The question is whether some of those changes might be doing more harm than good.

• "The Coddling of the American Mind", Greg Lukianoff, Jonathan Haidt, The Atlantic, September 2016

• Individuals primarily seek social relationships to fulfill their need for belonging (Baumeister and Leary 1995; Lee and Robbins 1998). Human beings are social animals and because ‘no man (woman) is an island’ (Donne 1975), people are naturally inclined to make social connections to satisfy their need for belonging (Maslow 1954; Brewer 2005). Baumeister and Leary (1995) described belonging, the need to form and maintain interpersonal bonds, as one of the fundamental motivations behind human behavior. Most research indicates a common definition of what loneliness is – it is an aversive psychological state due to a person’s perception of lacking satisfactory social relationships. Quantity of social relationship is a contributing factor to lonely feeling: people will feel ‘lonely’ when there are too few people around them (Russell, Peplau and Cutrona 1980), as opposed to the ‘crowded’ feeling when individuals are surrounded by too many people. However, quality may be more important than quantity at times. As the sufficient number of relationships varies among individuals (Jones 1982), loneliness has also been understood as the perception that one’s existing interpersonal relationships do not meet one’s expectations (Weiss 1973; Gordon 1976; Peplau and Caldwell 1978; 4266 L.W. Lam and D.C. Lau Downloaded by [University of Macau Library] at 00:54 22 September 2012 Newcomb 1990; Green, Richardson, Lago and Schatten-Jones 2001). Other scholars describe loneliness as painful feelings and emotional distress due to insufficient or unsatisfactory social connections or relationships (Rook 1984; Cacioppo et al. 2006; Cacioppo and Patrick 2008; Rotenberg et al. 2010).
  • Lam, Long W.; Lau, Dora C. (2012-11-01). "Feeling lonely at work: investigating the consequences of unsatisfactory workplace relationships". The International Journal of Human Resource Management. 23 (200): p.4266-67

• The most widely-accepted theory regarding supervisor–subordinate relationship quality is Leader–Member Exchange (LMX) Theory (Graen & Scandura, 1987). According to LMX theory, supervisors form different types of relationships with their various employees and these relationships vary with respect to quality (Graen, Dansereau, & Minami, 1972; Graen & Schiemann, 1978). In general, higher quality supervisor–subordinate relationships (also known as “in-group” relationships) are characterized by higher levels of mutual trust, respect and obligation among the relationship partners. In such relationships, leaders and members learn they can count on one another for support and encouragement. As a result, higher quality relationships function more as “partnerships” where “members move beyond their own self-interests to focus on larger mutual interests” (Graen & Uhl-Bien, 1995). Leader–member relationship quality is associated with a variety of important individual and organizational outcomes. For example, employees in higher quality relationships report higher levels of job satisfaction (Graen, Novak, & Sommerkamp 1982) and commitment to the organization (Nystrom, 1990) than do employees in lower quality relationships. In addition, research indicates leader–member relationship quality is negatively related to employee turnover (Graen, Liden, & Hoel, 1982). Focusing largely on such outcomes, LMX research has given only limited attention to the communication that occurs between leaders and members (e.g., Fairhurst, 1993). This work provides some direction for speculation regarding how leader–member relationship quality might be associated with employee information experiences. High quality LMX relationships tend to be characterized by high levels of trust and self-disclosure (Duchon, Green, & Taber, 1986). As a consequence, supervisors and subordinates may communicate more openly (i.e., more frequently and about more 378 P. M. Sias issues) in high quality relationships than in low quality relationships. Thus, employees in high quality relationships likely receive more information from their supervisors, than those in low quality relationships
  • Sias, Patricia M. (2005-01-01). "Workplace Relationship Quality and Employee Information Experiences". Communication Studies. 56 (4): pp.377-378.

• Peer relationships, also referred to as “equivalent status” relationships (Sias, Krone, & Jablin, 2002), are relationships between co-workers with no formal authority over one another. These relationships represent the bulk of workplace relationships, as employees typically have only one supervisor but several peer co-workers. Peer relationships perform a variety of important functions in the workplace. Peer co-workers are the most likely, and most important, source of emotional and instrumental support for employees, primarily because co-workers possess knowledge and understanding about the workplace experience that external sources do not (Ray, 1987). Moreover, peers act as a second “set of eyes and ears” for one another, sharing important organizational information and gossip that may otherwise be unobtainable (Rawlins, 1994). Kirby and Krone (2002) note the powerful influence peer co-workers have on one another with respect to workplace attitudes and behavior. Thus, peer relationships are of great consequence to organizational functioning. Peer relationships, like supervisor–subordinate relationships, vary with respect to quality. Kirby and Krone (2002), for instance, noted the ways in which peer co-workers cluster into sub-groups based upon the employees’ family status (e.g., married/unmarried; children/childless). They found that interaction among these groups of employees differed and had significant impact on the employees’ attitudes toward, and use of, the organization’s work–family policies. Sias and Cahill (1998) examined the ways employees form different types of relationships with their co-workers ranging from acquaintance, to friend, to very close or best friend. Interaction among these various relationship types differed in fundamental ways. Specifically, friends engaged in much more frequent, intimate, and open communication than did acquaintances. In addition, communication between co-workers became increasingly broad and intimate as their friendships grew closer.
  • Ibid, p. 379.

• When I hear the word “rape,” especially when it is used out of context, it makes me extremely uncomfortable. Often, it can be a trigger, causing fragments of my assaults to come flooding back. The stale cigarette breath, the smeared Halloween makeup, or the sickly sweet White Russians will become so visceral, I am transported back. It can make me feel unsafe — either physically or emotionally — in the company of the people who’ve said it. It is painful; it makes me feel ashamed, used, and violated all over again.
  Now, when I read stories about women who try to report their rape and get laughed at and forced to clean up the blood dripping from them because of said rape, I seethe with rage. It boils up from my gut and my face gets hot. I want to scream out for these women, for myself, and for everyone who has had to go through the experience of being violated.
  To feel solidarity, compassion, and rage for these fellow survivors so strongly and then hear the word “rape” thrown around in a casual, joking, or completely unrelated manner is just something I can no longer reconcile. It is not okay. Rape is not something you get to laugh about. Rape is not something that can describe any other thing but sexual violence. To continue to do so is to dishonor these women (and men) who have already had so much taken away from them. Their agency. Their innocence. Their natural sexual desire.
  Many people who say things like this don’t have bad intentions. I’m not here to shame these people and make them feel bad. I’m here to educate them. Misuse of this word comes from either ignorance or cruelty. Most people who use the word out of context are not cruel. I think ignorance is completely surmountable. So let’s move forward. Let’s elevate our language. Let’s stop minimizing the suffering of so many people.

• "Stop Saying ‘Rape’ Out of Context", Amelia Shroyer, Huffpost, 04/16/2014

• As long as you want to keep playing whack-a-mole from hell, it is my solemn promise that I will keep picking up the metaphorical hammer to slam you back down and remind you that you have not yet done anything to earn our forgiveness. So take your millions of dollars and pay a therapist to care about how tough it’s been to get caught being an abuser because honestly, I don’t give a shit.
  • Samantha Bee, Full Frontal, May 9, 2018, as quoted in "Samantha Bee Checks in With #MeToo, This Time With Zero F***s Left to Give for These Men", by Vivian Kane, The Mary Sue, May 10th, 2018

• Stop telling those fucking jokes! You’re a hack and everybody knows it. But here’s the good news: Lots of things are funny that aren’t rape!

• Terry Crews, Full Frontal, Aug 1, 2018, as quoted in "Samantha Bee and Terry Crews Share a Friendly Reminder: Your Prison-Rape Joke Isn’t Funny", by Megh Wright, The Mary Sue, Aug 2, 2018

• Another recent survey from Pew Research Center revealed that divisions along party lines have reached record levels since Trump became president (after already reaching all-time highs during the Obama years). “Across 10 measures that Pew Research Center has tracked on the same surveys since 1994,” the authors write, “the average partisan gap has increased from 15 percentage points to 36 points.” On issues like immigration, the environment and racial discrimination, partisan disagreement has only gotten sharper over the past 25 years, while antipathy between the two parties has grown even more intense. It is not surprising, then, that a record high 77 percent of Americans perceive the nation as divided, according to a Gallup survey taken shortly after last year’s election.
  Perhaps no issue captures our hyper-partisan age better than gun control, which was once again thrust into the national spotlight after last week’s mass shooting in Las Vegas. Shortly after the massacre, the polling company Survey Monkey published two maps based on 2016 exit polls that reveal just how much of a partisan issue guns have become in 2017. Gun ownership is now one of the best indicators of whether one will vote Democratic or Republican, and in 2016, gun-owning households voted overwhelmingly for Trump, while the majority of non-gun owning households voted for Hillary Clinton.

• “America may be more divided now than at any time since the Civil War”, Conor Lynch, 10.14.2017 Salon.

• “The analogy here is infectious disease,” says Barry Krisberg, a UC-Berkeley criminologist who has advised Boggan. For years, crime fighters had combated epidemics of violence by quarantining criminals in prison. Boggan took what he’d seen in other cities and adopted a new course of treatment: By inoculating the carriers of violence, perhaps you can protect an entire community.
  • "Did This City Bring Down Its Murder Rate by Paying People Not to Kill?", Mother Jones, Tim Murphy July/August, 2014

• You know, the interesting thing is the FBI did a very intensive study of 160 mass shootings over the period from 2000 to 2013. And what they found was that over that period, in the 160 cases, there was only one incidence of a private citizen who was not security personnel or a police officer who effectively intervened in the mass shooting, and that individual was an active duty Marine. On the other hand, 22 unarmed citizens intervened to stop those mass shootings, typically when the individual was reloading. And so it gives you a sense of the relative effectiveness of relying on someone with a gun to intervene in an active shooting scenario.
  • "Does Increased Gun Ownership Help Decrease Crime?" John Donohue, "All Things Considered", NPR, Nov 7, 2017.

• One area in which political beliefs do have an impact is the kinds of scientists that liberals and conservatives are likely to trust. A 2013 study of 798 participants found that conservatives put more faith in scientists involved in economic production – food scientists, industrial chemists and petroleum geologists, for instance – than in scientists involved in areas associated with regulation, such as public health and environmental science. The opposite was true for liberals. Again, this suggests that it’s not simply a matter of conservatives being skeptical of science in general; there’s a much more nuanced relationship between political leanings and trust in scientific expertise.
  • "Why do science issues seem to divide us along party lines?", October 16, 2016, Lauren Griffin, The Conversation

• Your class background shapes how you want to go about your daily life, and it does so in really systematic ways. Strangers who have never met yet who share a class background often have more in common with each other than spouses with whom they share their life if they came from different classes.
  • Jessi Streib in "If you grew up far richer than your spouse, it will likely change your marriage" Danielle Kurtzleben, Vox, Mar 23, 2015; as quoted in "The Truth About "Mixed-Collar" Dating — From the People Who Make These Relationships Work" by Kate Hakala, Mic, Mar 23, 2015.

• Isolate: Therapists spend a large portion of their day hidden under a legally mandated shroud of secrecy. The answer to a simple “How was your day?” must omit any detail from the hours you spent in session. The hard work you spend maintaining a functional relationship with clients, including all the challenges and victories, remains unknown. Unless you have supervision, a consultation group, or your own therapy, that is. Also, if all your friends and hobbies outside of work are therapy related, you will become a jargon-filled, myopic mess mumbling quotes from In Treatment to yourself.
  • "Seven Mistakes Therapists Makes", Ryan Howes, Psychology Today, Jul 30, 2012.

• "Some people have become so cynical that they don't believe in anything any more. In them, healthy scepticism has been replaced by a total breakdown in trust, the belief that everybody lies.
• Only the severe end was even considered. There was no sense of spectrum. Paranoia was very much seen as inexplicable, un-understandable, if anything some kind of biological system that had gone wrong. I remember thinking that seemed very reductionalist, that there must be some kind of psychology to it. Once I started looking at it as a spectrum, once you make the connection to things such as depression and anxiety, it really opens it up. People with depression have higher levels of paranoia because of a sense of vulnerability and low self-esteem.
  Anxiety is linked too. But whereas anxiety may lead to fearing harm from a spider, or of being humiliated in a social situation, it doesn't lead to a belief that the spider or others intend to humiliate or hurt us. It's the attribution of intent that distinguishes paranoia.
• This is another main reason why I believe paranoia is on the increase. Because we are constantly reminded, in the press, of threats from other people, we overestimate the chances of these events happening to us. There is a lot of research on this. It is what is known as the 'availability heuristic'. We make an estimate of the likelihood of a particular event simply by how easily we bring it to mind. Our children are getting fat because we aren't letting them out to play enough. We're scared they will be run over or abducted by strangers. In fact, the risks to the health from obesity are much higher than the risks of either of those events.

• David Freeman, "Suspicious minds" Sabine Durrant, The Guardian, (Mon 9, 2009).

• The London Sperm Bank recently came under public scrutiny for rejecting a prospective sperm donor because he’s dyslexic. Aside from dyslexia, this repository also screens out men seeking to donate sperm if they have ADHD, dyspraxia, Asperger’s and other neurological conditions, many of which have a demonstrated genetic link. On the company’s website, these traits were listed as “neurological diseases,” along with Cerebral Palsy, Parkinson’s, Alzheimer’s, Epilepsy, Tourette Syndrome and Multiple Sclerosis.
• Screening policies in the human gamete industry reflect larger cultural assumptions that pathologize difference. In my research on both sperm donation in the 1990s up to my current work on egg donation, I have discovered there are a number of reasons a prospective sperm or egg provider may be rejected: too short, too tall, overweight “socially inappropriate,” not having the “right motivations,” not attractive enough, a variety of “health reasons,” possibly even religion or ethnicity, and so on. The reasons for rejecting a potential donor are often unspoken.
• Are there genetic predispositions to coffee drinking? Highly unlikely.
  I referred to this kind of donor selection process as grass roots eugenics—where people select donors based upon fuzzy interpretations of genetics, imagining a prototype perfect donor whose desired traits will be passed down to their child. People choose donors with whom they feel they have a connection. If they plan to tell the child how they were conceived, they also want to be able to say good things about the donor who helped create them.

• "Designer Genes: ADHD, Dyslexia, and the Quest for Perfect Donors", Diane Tober, Psychology Today, January 21, 2016

• Everyday experience suggests that highly emotional events are often the most memorable, an observation supported by psychological and pharmacological studies in humans. Although studies in animals have shown that nondeclarative emotional memory (behaviors associated with emotional situations) may be impaired by lesions of the amygdala, little is known about the neural underpinnings of emotional memory in humans, especially in regard to declarative memory (memory for facts that can be assessed verbally). We investigated the declarative memory of two rare patients with selective bilateral amygdala damage. Both subjects showed impairments in long-term declarative memory for emotionally arousing material. The data support the hypothesis that the human amygdala normally enhances acquisition of declarative knowledge regarding emotionally arousing stimuli.
  • Adolphs R.; Cahill L.; Schul R.; Babinsky R. (1997). "Impaired declarative memory for emotional material following bilateral amygdala damage in humans". Learning & Memory. 4 (3): 291–300. doi:10.1101/lm.4.3.291.

• For more than a century, scientific investigators and clinicians have noted the potential for memory distortions associated with hypnosis. Moll, a noted nineteenth-century authority, commented that "Retroactive hallucinations are of great importance in law. They can be used to falsify testimony. People can be made to believe that they have witnessed certain scenes, or even crimes." (Moll 1889/1958, pp. 345-346). The pioneer hypnosis practitioner, Bernheim, observed, "I have shown how a false memory can cause false testimony given in good faith, and how examining magistrates can unwittingly cause false testimony by suggestion" (Bernheim, 1891/1980, p. 92). Similar findings have been observed by later legal commentators, as will be noted in the following discussion.
  • Deirdre Barrett, “Hypnosis and Hypnotherapy”, (2010), p.53.

• Historically, infants and very young children were thought incapable of explicit memory. As a result of changes in theoretical perspective and methodological developments, this assumption was challenged in the latter part of the 20th century. Substantial progress was made in describing age-related changes in explicit memory in the first two years of life. These developments permitted the first steps toward construction of a neuro-developmental account of the changes. By considering the timing and course of development of the neural substrate responsible for explicit memory we are able to bring greater specificity to the question “what develops?” Thus far, behavioral and electrophysiological methods (event-related potentials: ERPs) have revealed both individual and age-related variability in encoding and in consolidation and storage processes; the variability is systematically related to variability in long-term explicit memory. Suggestions are made for additional research to further our understanding of relations between brain and behavioral development in the first years of life.
  • Bauer P.J. (2004). "Getting explicit memory off the ground: Steps toward construction of a neuro-developmental account of changes in the first two years of life". Developmental Review. 24 (4): 347–373. doi:10.1016/j.dr.2004.08.003.

• "The horror of that moment," the King went on, "I shall never, never forget!"
  "You will, though," the Queen said, "if you don't make a memorandum of it."
  - Lewis Carroll, from Through the Looking Glass and What Alice Found There (1872/1982, p. 94, emphasis in original)
  In his brief dialogue between the King and the Queen - two of the chess piece sovereigns of the Looking Glass House - Lewis Carroll captured the complementary sides of the coin we term memory The King, having experienced a "horrifying" event (being set on a table by Alice, a relative giant whom the King could neither see nor hear), expresses absolute faith in the durability of memory. The Queen, in contrast, presents a less flattering view of the capacity: that without some intervention (a memorandum), even a salient event will be forgotten. In a rare instance, the reality experienced by the King and Queen on their side of the looking glass is reflected on the drawing room side as well. Memory is at times seemingly and at other times frustratingly fallible. What is at times seemingly indelible and at other times frustratingly fallible. What is more, in true looking glass fashion, the same past experience can at one moment impinge on consciousness unbidden and at another elude deliberate attempts to recollect it.
  • Bauer, Patricia J. (2007). Remembering the times of our lives: memory in infancy and beyond. Hillsdale, N.J: Lawrence Erlbaum Associates. ISBN 0-8058-5733-8. OCLC 62089961., p. 3.

• One of the more consistent predictors of later recall of events is their uniqueness or distinctiveness. Specifically, events that are unique tend to be better remembered, relative to single episodes of events that occur more frequently (e.g., Brewer, 1988; Wagenaar, 1986). For example, in White's (1982, 1989, 2002) examinations of how own memories from the year 1979, the uniqueness of an event t the time it was experienced was strongly related to how well it was remembered: The less unique the event, the worse was White's recall of it. This pttern may be accounted for by interference schematization, or both. Interference from other, similar experiences makes it more difficult to retrieve the features of any specific experience. Similarly, schematization occurs as the features that are common across experiences are abstracted and the representation condensed to include only the common elements. The result is that, "...repeated encounters of similar kinds blend and the details of any single event may be forgotten..." (Barclay % DeCooke, 1988, p. 106).
• The affective intensity of an event is another predictor of later recall: Events that are "affectively charged," or have high levels of emotionality associated with them, either positive or negative, tend to be well recalled (e.g., Brewer, 1988; Thompson, 1998; Wagenaar, 1986; White, 2002).
  • Ibid, p.36

• The precise nature of the engram, the physical substrate of memory, remains uncertain. Here, it is reported that RNA extracted from the central nervous system of Aplysia given long-term sensitization training induced sensitization when injected into untrained animals; furthermore, the RNA-induced sensitization, like training-induced sensitization, required DNA methylation. In cellular experiments, treatment with RNA extracted from trained animals was found to increase excitability in sensory neurons, but not in motor neurons, dissociated from naïve animals. Thus, the behavioral, and a subset of the cellular, modifications characteristic of a form of nonassociative long-term memory in Aplysia can be transferred by RNA. These results indicate that RNA is sufficient to generate an engram for long-term sensitization in Aplysia and are consistent with the hypothesis that RNA-induced epigenetic changes underlie memory storage in Aplysia.
  • Alexis Bédécarrats, Shanping Chen, Kaycey Pearce, Diancai Cai and David L. Glanzman “RNA from Trained Aplysia Can Induce an Epigenetic Engram for Long-Term Sensitization in Untrained Aplysia”, eNeuro 14 May 2018, ENEURO.0038-18.2018; DOI: https://doi.org/10.1523/ENEURO.0038-18.2018

• It is possible for one with a well-trained memory to compose clearly in an organized fashion on several different subjects. Once one has the all-important starting-place of the ordering scheme and the contents firmly in their places within it, it is quite possible to move back and forth from one distinct composition to another without losing one's place or becoming confused.
  • Mary Carruthers, (1990). The Book of Memory (first ed.). Cambridge University Press. ISBN 978-0-521-38282-3. (limited preview on Google Books), p.7

• The ability to recall information about the past is thought to emerge in the 2nd half of the 1st year of life. Although there is evidence from both cognitive neuroscience and behavioral psychology to support this hypothesis, there is little longitudinal evidence with which the question can be addressed. Infants' memory abilities were tested between the ages of 9 and 16 months using elicited and deferred imitation. Infants' memory for events was tested after delays ranging from 1 to 6 months. The results suggest that at 9 months of age, infants are able to store and retrieve representations over delays of as many as 4 weeks but not over long delays. In contrast, 10-month-olds have at their disposal a system that allows encoding and retrieval of event representations over delays of up to 6 months. These results support the idea that the system that underlies long-term ordered recall emerges near the end of the 1st year of life.
  • Carver, L.J.; Bauer, P.J. (December 2001). "The dawning of a past: the emergence of long-term explicit memory in infancy". J Exp Psychol Gen. 130 (4): 726–45. CiteSeerX 10.1.1.130.4890. doi:10.1037/0096-3445.130.4.726. PMID 11757877.

• The purpose of this review is to evaluate the effects of chronic stress on hippocampal-dependent function, based primarily upon studies using young, adult male rodents and spatial navigation tasks. Despite this restriction, variability amongst the findings was evident and how or even whether chronic stress influenced spatial ability depended upon the type of task, the dependent variable measured and how the task was implemented, the type and duration of the stressors, housing conditions of the animals that include accessibility to food and cage mates, and duration from the end of the stress to the start of behavioral assessment. Nonetheless, patterns emerged as follows: For spatial memory, chronic stress impairs spatial reference memory and has transient effects on spatial working memory. For spatial learning, however, chronic stress effects appear to be task-specific: chronic stress impairs spatial learning on appetitively motivated tasks, such as the radial arm maze or holeboard, tasks that evoke relatively mild to low arousal components from fear. But under testing conditions that evoke moderate to strong arousal components from fear, such as during radial arm water maze testing, chronic stress appears to have minimal impairing effects or may even facilitate spatial learning. Chronic stress clearly impacts nearly every brain region and thus, how chronic stress alters hippocampal spatial ability likely depends upon the engagement of other brain structures during behavioral training and testing.
  • Conrad C.D. (2010). "A critical review of chronic stress effects on spatial learning and memory". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 34 (5): 742–755. doi:10.1016/j.pnpbp.2009.11.003. PMID 19903505.

• Attentional focus on one coherent scene does not in itself explain how a complex sequence can be recalled. To understand that, one must take into account that the focus of attention can shift from one level of analysis to another. Cowan: The magical number 4 BEHAVIORAL AND BRAIN SCIENCES (2001) 24:1 93 McLean and Gregg (1967, p. 459) described a hierarchical organization of memory in a serial recall task with long lists of consonants: “At the top level of the hierarchy are those cueing features that allow S to get from one chunk to another. At a lower level, within chunks, additional cues enable S to produce the integrated strings that become his overt verbal responses.”
  • Cowan, N (February 2001). "The magical number 4 in short-term memory: a reconsideration of mental storage capacity"(PDF). Behav Brain Sci. 24 (1): 87–114, discussion 114–85. doi:10.1017/S0140525X01003922. PMID 11515286 p.93

• Broadbent (1975) noted that the ability to recall items from an array grows with the visual field duration: “for the first fiftieth of a second or so the rate of increase in recall is extremely fast, and after that it becomes slower.” He cites Sperling’s (1967) argument that in the early period, items are read in parallel into some visual store; but that, after it fills up, additional items can be recalled only if some items are read (more slowly) into a different, perhaps articulatory store. Viewed in this way, the visual store would have a capacity of three to five items, given that the performance function rapidly increases for that number of items. However, the “visual store” could be a central capacity limit (assumed here to be the focus of attention) rather than visually specific as the terminology used by Sperling seems to imply.
  • Ibid, p.96

• The ability to apprehend a small number of items at one time in the conscious mind can be distinguished from the need to attend to items individually when a larger number of such items are presented. This point is one of the earliest to be noted in psychological commentaries on the limitations in capacity. Hamilton (1859) treated this topic at length and noted (vol. 1, p. 254) that two philosophers decided that six items could be apprehended at once, whereas at least one other (Abraham Tucker) decided that four items could be apprehended. He went on to comment: “The opinion [of six] appears to me correct. You can easily make the experiment for yourselves, but you must be aware of grouping the objects into classes. If you throw a handful of marbles on the floor, you will find it difficult to view at once more than six, or seven at most, without confusion; but if you group them into twos, or threes, or fives, you can comprehend as many groups as you can units; because the mind considers these groups only as units, – it views them as wholes, and throws their parts out of consideration. You may perform the experiment also by an act of imagination.” When the experiment actually was conducted, however, it showed that Hamilton’s estimate was a bit high. Many studies have shown that the time needed to count a cluster of dots or other such small items rises very slowly as the number of items increases from one to four, and rises at a much more rapid rate after that. Jevons (1871) was probably the first actual study, noting that Hamilton’s conjecture was “one of the very few points in psychology which can, as far as we yet see, be submitted to experiment.” He picked up handfuls of beans and threw them into a box, glancing at them briefly and estimating their number, which was then counted for comparison. After over a thousand trials, he found that numbers up to four could be estimated perfectly, and up to five with very few errors
  • Ibid, p.102.

• Other theorists (Hummel & Holyoak 1997; Shastri & Ajjanagadde 1993) have applied this neural synchronization principle in a way that is more abstract. It can serve as an alternative compatible with Halford et al.’s (1998) basic notion of a limit on the complexity of relations between concepts, though Halford et al. instead worked with a more symbolically based model in which “the amount of information that can be represented by a single vector is not significantly limited, but the number of vectors that can be bound in one representation of a relation is limited” (p. 821). Shastri and Ajjanagadde (1993) formulated a physiological theory of working memory very similar to Lisman and Idiart (1995), except that the theory was meant to explain “a limited-capacity dynamic working memory that temporarily holds information during an episode of reflexive reasoning” (p. 442), meaning reasoning that can be carried out “rapidly, spontaneously, and without conscious effort” (p. 418). The information was said to be held as concepts or predicates that were in the form of complex chunks; thus, it was cautioned, “note that the activation of an entity together with all its active superconcepts counts as only one entity” (p. 443). It was remarked that the bound on the number of entities in working memory, derived from facts of neural oscillation, falls in the 7 6 2 range; but the argument was not precise enough to distinguish that from the lower estimate offered in the present paper. Hummel and Holyoak (1997) brought up similar concepts in their theory of thinking with analogies. They defined “dynamic binding” (a term that Shastri & Ajjanagadde also relied upon to describe how entities came about) as a situation in which “units representing case roles are temporarily bound to units representing the fillers of those roles” (p. 433). They estimated the limit of dynamic binding links as “between four and six” (p. 434). In both the approaches of Shastri and Ajjanagadde (1993) and Hummel and Holyoak (1997), these small limits were supplemented with data structures in long term memory or “static bindings” that appear to operate in the same manner as the long-term working memory of Ericsson and Kintsch (1995), presumably providing the “active superconcepts” that Shastri and Ajjanagadde mentioned.
  • Ibid, pp. 109-110

• Infants devote more visual fixation to novel than to previously exposed targets, thereby indicating both discriminative ability and recognition memory. Since the earliest demonstrations of infants' preferences for novel visual stimulation (Fantz 1964; Saayman, Ames, & Moffett 1964), a number of explorations of infant recognition memory have been conducted. Variables studied have included age (Fagan, Fantz, & Miranda 1971; Wetherford & Cohen 1973), dcegree and type of stimulus variation (Cohen & caron 1968; Fagan 1970, 1971, 1973; Pancratz & Cohen 1970), sources of forgetting (Fagan 1973), and conceptual development (Caron, Caron, Caldwell, & Weiss 1973; Fagan 1972).
  • Fagan, J.F. (June 1974). "Infant recognition memory: the effects of length of familiarization and type of discrimination task". Child Dev. 45 (2): 351–356. PMID 4837713. 

• We ought, then, to set up images of a kind that can adhere longest in memory. And we shall do so if we establish similitudes as striking as possible; if we set up images that are not many or vague but active; if we assign to them exceptional beauty or singular ugliness; if we ornament some of them, as with crowns or purple cloaks, so that the similitude may be more distinct to us; or if we somehow disfigure them, as by introducing one stained with blood or soiled with mud and smeared with red paint, so that its form is more striking, or by assigning certain comic effects to our images, for that, too, will ensure our remembering them more readily.
  • Rhetorica Ad Herrenium, III, xxii (1st century BCE)

• Our memory changes every single time it's being 'recorded'. That's why we can incorporate new information into old memories and this is how a false memory can form without us realising it.
  • Xu Liu in "Scientists can implant false memories into mice", by Melissa Hogenboom, BBC News, (July 25, 2013).

• What happens when people witness an event, say, a crime or accident, and are later exposed to new information about the event? Two decades of research have been devoted to the influence of new information on the recollections of such witnesses. An all-too-common finding is that after receipt of new information that is misleading in some way, people make errors when they report what they saw. New, postevent information often becomes incorporated into a recollection, supplementing or altering it, sometimes in dramatic ways. New information invades us, like a Trojan horse, precisely because we do not detect its influence. Understanding how we become tricked by revised data about a witnessed event is a central goal of this research.
  Current research showing how memory can become skewed when people assimilate new data utilizes a simple paradigm. Participants first witness a complex event, such as a simulated violent crime or automobile accident. Subsequently, half the participants receive new, misleading information about the event. The other half do not get any misinformation. Finally, all participants attempt to recall the original event. In a typical example of a study using this paradigm, participants saw a simulated traffic accident. They then received written information about the accident, but some people were misled about what they saw. A stop sign, for instance, was referred to as a yield sign. When asked whether they originally saw a stop or a yield sign, participants given the phony information tended to adopt it as their memory; they said they saw a yield sign. In these and many other experiments, people who had not received the phony information had much more accurate memories. In some experiments, the deficits in memory performance following receipt of misinformation have been dramatic, with performance differences as large as 30% or 40%.
• A growing body of studies reveals the conditions that make people particularly susceptible to the influence of misinformation. For example, people are particularly prone to having their memories modified when the passage of time allows the original memory to fade. Put another way, with a long interval between the event and the misinformation, the injection of misinformation becomes relatively easy. In its weakened condition, memory - like the disease-ridden body-becomes especially vulnerable to repeated assaults on its very essence. This finding leads up to a principle, the discrepancy detection principle for determining when changes in recollection will occur:
  Recollections are more likely to change if a person does not immediately detect discrepancies between postevent information and memory for the original event.
  • Loftus GR (1992). "When a lie becomes memory's truth: Memory distortion after exposure to misinformation". Current Directions in Psychological Science. 1 (4): 121–123. doi:10.1111/1467-8721.ep10769035. p.121

• Counterfactual imaginings are known to have far-reaching implications. In the present experiment, we ask if imagining events from one's past can affect memory for childhood events. We draw on the social psychology literature showing that imagining a future event increases the subjective likelihood that the event will occur. The concepts of cognitive availability and the source-monitoring framework provide reasons to expect that imagination may inflate confidence that a childhood event occurred. However, people routinely produce myriad counterfactual imaginings (i.e., daydreams and fantasies) but usually do not confuse them with past experiences. To determine the effects of imagining a childhood event, we pretested subjects on how confident they were that a number of childhood events had happened, asked them to imagine some of those events, and then gathered new confidence measures. For each of the target items, imagination inflated confidence that the event had occurred in childhood. We discuss implications for situations in which imagination is used as an aid in searching for presumably lost memories.
  • Garry M, Manning CG, Loftus EF, Sherman SJ, "Imagination inflation: Imagining a childhood event inflates confidence that it occurred". Psychonomic Bulletin & Review. 3(2): 208–214. doi:10.3758/bf03212420. PMID 24213869. (1996).

• In two experiments, subjects heard simple action statements (e.g., “Break the toothpick”), and, in some conditions, they also performed the action or imagined performing the action. In a second session that occurred at a later point (10 min, 24 h, 1 week, or 2 weeks later), subjects imagined performing actions one, three, or five times. Some imagined actions represented statements heard, imagined, or performed in the first session, whereas other statements were new in the second session. During a third (test) phase, subjects were instructed to recognize statements only if they had occurred during the first session and, if recognized, to tell whether the action statement had been carried out, imagined, or merely heard. The primary finding was that increasing the number of imaginings during the second session caused subjects to remember later that they had performed an action during the first session when in fact they had not (imagination inflation). This outcome occurred both for statements that subjects had heard but not performed during the first session and for statements that had never been heard during the first session. The results are generally consistent with Johnson, Hashtroudi, and Lindsay’s (1993) source monitoring framework and reveal a powerful memory illusion: Imagining performance of an action can cause its recollection as actually having been carried out.
  • Goff LM, Roediger HL, "Imagination inflation for action events: Repeated imaginings lead to illusory recollections". Memory and Cognition. 26: 20–33. doi:10.3758/bf03211367, (1998).

• 'The method of loci', an imaginal technique known to the ancient Greeks and Romans and described by Yates (1966) in her book The Art of Memory as well as by Luria (1969). In this technique the subject memorizes the layout of some building, or the arrangement of shops on a street, or any geographical entity which is composed of a number of discrete loci. When desiring to remember a set of items the subject 'walks' through these loci in their imagination and commits an item to each one by forming an image between the item and any feature of that locus. Retrieval of items is achieved by 'walking' through the loci, allowing the latter to activate the desired items. The efficacy of this technique has been well established (Ross and Lawrence 1968, Crovitz 1969, 1971, Briggs, Hawkins and Crovitz 1970, Lea 1975), as is the minimal interference seen with its use.
  • O'Keefe, John; Nadel, Lynn (December 7, 1978). The Hippocampus as a Cognitive Map. Oxford: Oxford University Press. ISBN 978-0198572060.

• Demonstrations of limitations in the way humans process and store information have generated much controversy among researchers in the cognitive sciences. A major theme concerns the capacity of working memory. Separate verbal, spatial, and visual object working memory systems can be distinguished (1-3), but similar estimates of their capacities have been established. These estimates have sometimes been made in terms of “magical numbers,” which have ranged from seven to about four words, numbers, or locations (4). In line with these results, recent studies suggest that it is possible to retain information of up to four objects in visual working memory (5-9).
  • Olsson Henrik, Poom Leo, Treisman Anne (2005). "Visual memory needs categories". Proceedings of the National Academy of Sciences of the United States of America. 102(24): 8776–8780. doi:10.1073/pnas.0500810102. PMC 1150822. PMID 15937119.

• Young and old participants were evaluated on tests of frontal lobe function, recognition memory, and memory for temporal and spatial information. Older participants showed significant impairments on memory for temporal order, and this impairment was found to correlate with deficits on frontal lobe tests measuring spontaneous flexibility but not reactive flexibility. However, spatial memory showed no evidence of an age effect. An interpretation of this latter finding based on the differential availability of contextual cues is ruled out because similar results were obtained when spatial memory was assessed in a different context to that used during learning. The researchers concluded that memory for temporal order and spatial memory are affected differentially by age. Theoretical interpretations of this difference are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Parkin A.J.; Walter B.M.; Hunkin N.M. (1995). "Relationships between normal aging, frontal lobe function, and memory for temporal and spatial information". Neuropsychology. 9 (3): 304–312. doi:10.1037/0894-4105.9.3.304.

• All people have a natural curiosity about their own memory. This curiosity was tweaked severalyears ago by reports in the popular press of recoered memories from early childhood. These reports also renewed a long-standing debate bout whether infants can actually remember for any length of time. Some resedarchers argue that infants possess only a primitive memory system that cnanot encode specific events (Mandler, 1998), that early development is characterized by "infantile amnesia" (the absense of enduring memories; Pillemer & White, 1989), that children cannot remember events until they can rehearse them by talking about them (Nelson, 1990), and that children younger than 18 months are incapable of representation (Piaget, 1952); others argue that the behavior of older infants and children is shaped by their earlier experiences (Watson, 1930) and that adult personality is shaped by memories of events that occurred in infancy (Freud, 1935). Surprisingly, this debate has been waged in the absence of date from infants themselves.
  This article reviews new evidence that infants' memory processing does not fundamentally differ from that of older children and adults, not only can older children remember an event that occured before they could talk, but even very young infants can remember an event over the entire infantile-amnesia period if they are periodically reminded.
  • Rovee-Collier, Carolyn (1999). "The Development of Infant Memory". Current Directions in Psychological Science. 8 (3): 80–85. doi:10.1111/1467-8721.00019. ISSN 0963-7214. P.80

• Converging lines of evidence indicate that stress either before or after learning influences memory. Surprisingly little is known about how memory is affected when people learn while they are stressed. Here, we examined the impact of learning under stress in 48 healthy young men and women. Participants were exposed to stress (socially evaluated cold pressor test) or a control condition while they learned emotional words and neutral words that were either conceptually associated with or unrelated to the stressor. Memory was assessed in free recall and recognition tests 24h after learning. Learning under stress reduced both free recall and recognition performance, irrespective of the emotionality and the stress context relatedness of the words. While the effect of stress was comparable in men and women, women outperformed men in the free recall test. These findings show a memory impairing effect of learning under stress in humans and challenge some assumptions of current theories about the impact of stress around the time of learning on memory formation.
  • Schwabe, L.; Wolf, O.T. (2010). "Learning under stress impairs memory formation". Neurobiology of Learning and Memory. 93 (2): 183–188. doi:10.1016/j.nlm.2009.09.009. PMID 19796703.

• Stress before retention testing impairs memory, whereas memory performance is enhanced when the learning context is reinstated at retrieval. In the present study, we examined whether the negative impact of stress before memory retrieval can be attenuated when memory is tested in the same environmental context as that in which learning took place. Subjects learned a 2-D object location task in a room scented with vanilla. Twenty-four hours later, they were exposed to stress or a control condition before memory for the object location task was assessed in a cued-recall test, either in the learning context or in a different context (unfamiliar room without the odor). Stress impaired memory when assessed in the unfamiliar context, but not when assessed in the learning context. These results suggest that the detrimental effects of stress on memory retrieval can be abolished when a distinct learning context is reinstated at test.
  • Schwabe, L.; Wolf, O.T. (2009). "The context counts: Congruent learning and testing environments prevent memory retrieval impairment following stress". Affective & Behavioral Neuroscience. 9 (3): 229–236. doi:10.3758/CABN.9.3.229. PMID 19679758.

• To conclude, our results suggest that stress can interfere with our ability to integrate context information into a memory trace. These findings might improve our understanding of the pathogenesis of psychiatric disorders, such as the post-traumatic stress disorder in which the failure to connect the traumatic event with the appropriate (temporal and spatial) contextual information is a common pathological hallmark (Rauch et al. 2006).
  • Schwabe, L.; Bohringer, A.; Wolf, O.T. (2009). "Stress disrupts context-dependent memory". Learning and Memory. 16 (2): 110–113. doi:10.1101/lm.1257509. PMID 19181616.

• A model for visual recall tasks was presented in terms of visual information storage (VIS), scanning, rehearsal, and auditory information storage (AIS). It was shown first that brief visual stimuli are stored in VIS in a form similar to the sensory input. These visual “images” contain considerably more information than is transmitted later. They can be sampled by scanning for items at high rates of about 10 msec per letter. Recall is based on a verbal receding of the stimulus (rehearsal), which is remembered in AIS. The items retained in AIS are usually rehearsed again to prevent them from decaying. The human limits in immediate-memory (reproduction) tasks are inherent in the AIS-Rehearsal loop. The main implication of the model for human factors is the importance of the auditory coding in visual tasks.
  • Sperling, G (1963). "A Model for Visual Memory Tasks". hfs.sagepub.com. 5 (1): 19–31.

• Converging evidence and new research methodologies from across the neurosciences permit the neuroscientific study of the role of sleep in off-line memory reprocessing, as well as the nature and function of dreaming. Evidence supports a role for sleep in the consolidation of an array of learning and memory tasks. In addition, new methodologies allow the experimental manipulation of dream content at sleep onset, permitting an objective and scientific study of this dream formation and a renewed search for the possible functions of dreaming and the biological processes subserving it.
  • R. Stickgold, J.A. Hobson, R. Fosse, M. Fosse1 (November 2001). "Sleep, Learning, and Dreams: Off-line Memory Reprocessing". Science. 294 (5544): 1052–1057. doi:10.1126/science.1063530. PMID 11691983. http://science.sciencemag.org/content/294/5544/1052.long

• Some researchers have reported that high levels of stress are associated with improved memory in the laboratory (Goodman et al. 1991b; Warren & Swartwood, 1992), some have reported that high levels of stress are associated with poorer memory (Bugental et al., 1992; Merritt, Ornstein, & Spicker, 1994). For example, Howe, Courage, & Peterson (1994) found no relationship between the amount of stress (reported by the parents) and the amount of information recalled by their children either 3-5 days or 6 months after an emergency room procedure. By contrast, Goodman et al. (1991b) found that children who showed higher levels of arousal during a medical procedure reported the incident more accurately than children who simply had a washable tattoo applied.
  • Teti D.M. (2005). Handbook of research methods in developmental science: New developments in the study of infant memory. San Francisco: Blackwell Publishing., p.500

• Within what we might call “classical cognitive science” (Piattelli-Palmarini, 2001) it has always been understood that the mind/brain is to be considered a computational-representational system. Yet, not all cognitive scientists have ever (fully) agreed with this assessment (e.g., Rumelhart et al., 1986). Actually, as of today, large parts of the field have concluded, primarily drawing on work in neuroscience, that neither symbolism nor computationalism are tenable and, as a consequence, have turned elsewhere. In contrast, classical cognitive scientists have always been critical of connectionist or network approaches to cognitive architecture (e.g., Fodor and Pylyshyn, 1988), and recent work on memory (e.g., Gallistel and King, 2009; Gallistel and Matzel, 2013; Gallistel and Balsam, 2014) has been adding fuel to the fire. Recent work in neuroscience (Chen et al., 2014; Johansson et al., 2014; Ryan et al., 2015) has now provided first tentative neurobiological evidence for the cognitive scientists' doubts about the synapse as the locus of memory in the brain.
• If we believe that memories are made of patterns of synaptic connections sculpted by experience, and if we know, behaviorally, that motor memories last a lifetime, then how can we explain the fact that individual synaptic spines are constantly turning over and that aggregate synaptic strengths are constantly fluctuating? (Bizzi and Ajemian, 2015, p. 91)
  • Trettenbrein, P. C. (2016-01-01). "The Demise of the Synapse As the Locus of Memory: A Looming Paradigm Shift?",. Frontiers in Systems Neuroscience. 10 (88): 88. doi:10.3389/fnsys.2016.00088. PMC 5112247. PMID 27909400.

• …episodic memories are the only ones with direct reference to the past. As Tulving (1999, p.15) points out: “episodic memory is the only form of memory that, at the time of retrieval, is oriented toward the past: retrieval in episodic memory means ‘mental time travel’ through and to one’s past. All other forms of memory, including semantic, declarative and procedural memory, are, at retrieval oriented to the present”
  • Ofengenden Tzofit (2014). "Memory formation and belief" (PDF). Dialogues in Philosophy, Mental and Neuro Sciences. 7 (2): p.37-38

• “Not only is it impossible to compare our memories with the events of which they are the memories; but because the present is, as it were, always slipping away from us into the past we cannot even compare our memories with what purport to be the effects of the original events (or, more properly, with our inferences from those ‘effects’). For what I am comparing must always be, not the memory itself but my memory of that memory. Suppose that today I remember building, a short while ago, a castle in the sand. Tomorrow I go to the beach and there it is. I say ‘Yes just as I remembered it yesterday’. But how do I then know it is just as I remembered it yesterday? The sight of the sand castle itself may well influence my memory of my previous remembering” (Brian Smith, 1966, p.27, italics original)
  • Ofengenden Tzofit (2014). "Memory formation and belief" (PDF). Dialogues in Philosophy, Mental and Neuro Sciences. 7 (2): p.38

• Thomas Suddendorf and Michael Corballis (2007, p. 301-302) write: “The fact that episodic memory is fragmentary and fragile suggests that its adaptiveness may derive less from its role as an accurate record of personal history than from providing a “vocabulary” from which to construct planned future events (and perhaps to embellish events of the past). It may be part of a more general toolbox that allowed us to escape from the present and develop foresight, and perhaps create a sense of personal identity. Indeed, our ability to revisit the past may be only a design feature of our ability to conceive of the future”
  • Ibid, p.43

• Hypnotic dreams have long been a method by which hypnosis is utilized in psychotherapy;however, the research on their characteristics in comparison to nocturnal dreams is sparse.Physiological correlates of hypnotic dreams have been clearly established as resembling those of a relaxed waking state much more closely than they resemble any stage of sleep(Brady & Rosner, 1966; Tart, 1964), the one exception being the observation of rapid eyemovements (REM) during some hypnotic dreams (Brady & Rosner, 1966; Schiff, Bunney, & Freedman, 1961).
  The content of hypnotic dreams has been less methodically tested. Some psycho-therapists describe using hypnotic dreams inthe same manner they would nocturnal dreams and believe their content to be virtually identical (Fromm, 1965; Sacerdote, 1968;Schneck, 1953). Other authors describe havingobserved differences between two categories(Gill & Brenman, 1959; Tart, 1966). The most empirical articles to date have indicated some possible differences, such as hypnoticdreams being shorter, having fewer characters,having more " Alice-in-Wonderland" size dis-tortions (Hilgard & Nowlis, 1972), and beingless vivid, less fearful, and more plausible(Spanos & Ham, 1975). Tart (1966) found acorrelation between depth of trance andvividness of hypnotic dreams. Some authorssuch as Barber (1962) and Walker (1974)assert that hypnotic dream content is identicalto that of waking fantasy and quite differentfrom nocturnal dreams. Obviously there aremany contradictions in the literature of this area.
  • Barrett, D. L. (1979). "The Hypnotic Dream: Its Content in Comparison to Nocturnal Dreams and Waking Fantasy". Journal of Abnormal Psychology. 88: 584–591. doi:10.1037/0021-843x.88.5.584. p.584

• Freud also asserted that "a reference to the events of the day just past is to be discovered in every dream," but five detailed studies demonstrate that only about half of dreams contain even the slightest "day residue" that can be identified by the dreamer (Botman & Crovitz, 1989; Harlow & Roll, 1992; Hartmann, 1968; Marquardt, Bonato, & Hoffmann, 1996; Nielsen & Powell, 1992). As part of his emphasis on the large role of specific memories in shaping dream content, Freud believed that all significant speeches in dreams can be traced to memories of speeches heard or sentences read, but the analysis of hundreds of speech acts in dreams collected in sleep laboratories shows they are usually new constructions appropriate to the unfolding dream context, not reproductions (Meier, 1993). Indeed, speech acts are so appropriate to the dream context that bi-lingual participants in one sleep study reported that they spoke in the language understood by the dream character with whom they were talking(Foulkes, Meier, Strauch, & Kerr, 1993).
• Freud's most famous and important claim was that "wish-fulfillment is the meaning of each and every dream." Although this hypothesis was based on his work with adult patients, he began his argument with several simple wishful dreams that he overheard from his pre-school children or learned of through the parents of the dreamers. However, a five-year longitudinal study in the sleep laboratory of 14 children ages 3-5 reveals on the basis of dozens of awakenings that young children have static and bland dreams, not at all like Freud's anecdotal examples (Foulkes, 1982; Foulkes, 1999).
  • Domhoff, G. W. (2000). "Moving Dream Theory Beyond Freud and Jung". Paper presented to the symposium Beyond Freud and Jung?, Graduate Theological Union, Berkeley, CA, 9/23/2000.

• If dreaming was selected for because of its adaptive function, the general content of dreams should certainly reflect this, and consist of situations that allow the rehearsal of scenarios that ultimately lead toward increased fitness. This is exactly what is seen, with studies indicating that dream content is biased toward negative elements reflecting threat, as opposed to positive elements. Data collected from over 500 dream reports by Hall and Van de Castle (1966) indicate that about 80% contained negative emotions, while only about 20% contained positive emotions. These negative dreams are also disproportionably likely to contain threatening elements such as animals and male strangers in threatening encounters. The evidence points towards the overrepresentation of threatening events in dreams, which should not occur if dream content is random. Through appropriating and learning to deal with these threats in dreams, it is proposed here that an animal could increase its overall evolutionary fitness.
  • Franklin, M; Zyphur, M (2005). "The role of dreams in the evolution of the human mind" (PDF). Evolutionary Psychology. 3: Archived (PDF) from the original on 2011-08-11, p.66

• Another example of a skill that has arguably played a pivotal role in other functional aspects of the human intellect and could serve to be shaped by dreaming is that of interpretation. As discussed by Bogdan (1997, p.108), “…key advances in interpretation, such as the recognition of belief, were accelerated by increased opportunities to interact with or manipulate subjects and slowed down by a lack of such opportunities.” As such, via teasing, play, mental rehearsal/imagery, or dreaming, the individual is given the opportunity to utilize successful strategies in dealing with these situations and further develop interpretive skills. In fact, studies of children’s dream-reports indicate that their dreams more often contain family members and close friends than adults’ dreams (Hobson, 1988), possibly due to the fact that it is more important for younger children to be practicing close interpersonal skills than it is for adults.
  • Ibid, p.69-70

• The latent content of dreams consists of:
  1. Dynamically unconscious wishes (id impulses) prevented by the censorship (the defences of the ego) from reaching consciousness or even the system preconscious during waking life. Several wishes may be present in the same dream:
  'Dreams frequently seem to have more than one meaning. Not only, as our examples have shown, may they include several wishfulfilments one alongside the other; but a succession of meanings or wish-fulfilments may be superimposed on one another, the bottom one being the fulfilment of a wish dating from earliest childhood. And here again the question arises whether it might not be more correct to assert that this occurs "invariably" rather than "frequently".
  • (1900a) The Interpertation of Dreams, S.E., Vol. 4, p. 219; as quoted in Nagera, Humberto, ed. (2014) [1969]. "Latent dream-content (pp. 31ff.)". Basic Psychoanalytic Concepts on the Theory of Dreams. Abingdon-on-Thames: Routledge. ISBN 1-31767048-5. ISBN 978-1-317-67048-3., p.31

• The majority of these impulses are sexual in nature, and most of them stem from the infantile period of life: 'a dream might be described as a substitute for an infantile scene modified by being trnsferred on to a recent experience. The infantile scene is unable to bring about its own revival and has to be content with returning as a dream.'
  • 1900a) The Interpertation of Dreams, S.E., Vol. 5, p. 546; as quoted in Nagera, Humberto, ed. (2014) [1969]. "Latent dream-content (pp. 31ff.)". Basic Psychoanalytic Concepts on the Theory of Dreams. Abingdon-on-Thames: Routledge. ISBN 1-31767048-5. ISBN 978-1-317-67048-3., p.31

• Dreaming has fascinated and mystified humankind for ages: the bizarre and evanescent qualities of dreams have invited boundless speculation about their origin, meaning and purpose. For most of the twentieth century, scientific dream theories were mainly psychological. Since the discovery of rapid eye movement (REM) sleep, the neural underpinnings of dreaming have become increasingly well understood, and it is now possible to complement the details of these brain mechanisms with a theory of consciousness that is derived from the study of dreaming. The theory advanced here emphasizes data that suggest that REM sleep may constitute a protoconscious state, providing a virtual reality model of the world that is of functional use to the development and maintenance of waking consciousness.
  • Hobson, J.A. (2009). "REM sleep and dreaming: towards a theory of protoconsciousness". Nature Reviews Neuroscience. 10 (11): 803–813. doi:10.1038/nrn2716. PMID 19794431.

• We were able to reveal dream content from brain activity during sleep, which was consistent with the subjects' verbal reports.
• All of this would have to be done within individual subjects. So you would never be able build a general classifier that could read anybody's dreams. They will all be idiosyncratic to the individual, so the brain activity will never be general across subjects.
  • Yukiyasu Kamitani, in "Scientists 'read dreams' using brain scans – BBC News". BBC News. Archived from the original on 2016-04-27. Retrieved 2016-04-24.

• This research investigated laypeople's interpretation of their dreams. Participants from both Eastern and Western cultures believed that dreams contain hidden truths (Study 1) and considered dreams to provide more meaningful information about the world than similar waking thoughts (Studies 2 and 3). The meaningfulness attributed to specific dreams, however, was moderated by the extent to which the content of those dreams accorded with participants' preexisting beliefs--from the theories they endorsed to attitudes toward acquaintances, relationships with friends, and faith in God (Studies 3-6). Finally, dream content influenced judgment: Participants reported greater affection for a friend after considering a dream in which a friend protected rather than betrayed them (Study 5) and were equally reluctant to fly after dreaming or learning of a plane crash (Studies 2 and 3). Together, these results suggest that people engage in motivated interpretation of their dreams and that these interpretations impact their everyday lives. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Morewedge, Carey K.; Norton, Michael I. "When dreaming is believing: The (motivated) interpretation of dreams". Journal of Personality and Social Psychology. 96(2): 249–264. doi:10.1037/a0013264. PMID 19159131.

• The dream censorship functions to preserve sleep by controlling the expression of unconscious wishes, and reventing the generation of unpleasant affect. The inhibition of affect...must be considered as the second consequence of the censorship of dreams, just as dream-distortion is its first consequence' It should be noted that while it is the censorship that necessitates dream distortion, the censorship itself does not actually carry out the distortion, This is done by the dream-work. The work of the censorship is merely to prevent unconscious wishes from entering the preconscious, or from linking up with preconscious wishes. Only if the unconscious wishes can be sufficiently disguised by the dream-work will the censorship permit the compromise formation to be experienced as part of the dream.
  • Nagera, Humberto, ed. "Manifest content" "Basic Psychoanalytic Concepts on the Theory of Dreams". Abingdon-on-Thames: Routledge. ISBN 1-31767047-7. ISBN 978-1-317-67047-6. p.57, (2014) [1969]

• Several theories claim that dreaming is a random by-product of REM sleep physiology and that it does not serve any natural function. Phenomenal dream content, however, is not as disorganized as such views imply. The form and content of dreams is not random but organized and selective: during dreaming, the brain constructs a complex model of the world in which certain types of elements, when* compared to waking life, are underrepresented whereas others are over represented. Furthermore, dream content is consistently and powerfully modulated by certain types of waking experiences. On the basis of this evidence, I put forward the hypothesis that the biological function of dreaming is to simulate threatening events, and to rehearse threat perception and threat avoidance. To evaluate this hypothesis, we need to consider the original evolutionary context of dreaming and the possible traces it has left in the dream content of the present human population. In the ancestral environment human life was short and full of threats. Any behavioral advantage in dealing with highly dangerous events would have increased the probability of reproductive success. A dream-production mechanism that tends to select threatening waking events and simulate them over and over again in various combinations would have been valuable for the development and maintenance of threat-avoidance skills. Empirical evidence from normative dream content, children's dreams, recurrent dreams, nightmares, post traumatic dreams, and the dreams of hunter-gatherers indicates that our dream-production mechanisms are in fact specialized in the simulation of threatening events, and thus provides support to the threat simulation hypothesis of the function of dreaming.
  • Revonsuo, A. (2000). "The reinterpretation of dreams: an evolutionary hypothesis of the function of dreaming". Behavioral and Brain Sciences. 23 (6): 877–901. doi:10.1017/S0140525X00004015. PMID 11515147.

• Although the variability of dream content is large, typical dream themes that occur quite often and are reported by many people can be identified (e.g., being chased, falling, flying, failing an examination, being unable to find a toilet or restroom). The present study is an investigation of the stability of the rank order of the dream themes and of gender differences in the content of dreams. The authors administered A. L. Zadra and T. A. Nielsen's (1997) Typical Dream Questionnaire to 444 participants. The findings indicated that most of the 55 dream themes occurred at least once in most of the participants' lifetimes. In addition, the correlation coefficients for the rank order of the themes were very high; that is, the relative frequencies were stable. The gender differences in the present study were in line with content analytic findings; for example, men reported dreams about physical aggression more often than did women. Overall, previous research and the present data indicate that available research results of the measurement of typical dream themes are reliable and valid. The question of the meaning of these themes or the relationship between typical dream contents and waking life experiences, however, has not yet been answered and is open to future research.
  • Michael Schredl; Petra Ciric; Simon Götz; Lutz Wittmann (November 2004). "Typical Dreams: Stability and Gender Differences". The Journal of Psychology. 138 (6): 485–94. doi:10.3200/JRLP.138.6.485-494. PMID 15612605.

• In the past, daydreaming was often considered a failure of mental discipline, or worse. Freud labeled it infantile and neurotic. Psychology textbooks warned it could lead to psychosis. Neuroscientists complained that the rogue bursts of activity on brain scans kept interfering with their studies of more important mental functions.
  But now that researchers have been analyzing those stray thoughts, they’ve found daydreaming to be remarkably common — and often quite useful. A wandering mind can protect you from immediate perils and keep you on course toward long-term goals. Sometimes daydreaming is counterproductive, but sometimes it fosters creativity and helps you solve problems.
  • John Tierney, "Discovering the Virtues of a Wandering Mind". , The New York Times. (June 28, 2010).

• When the brain in not functioning properly during dreams of aggression, sleepwalkers have been able to commit murder. In several cases sleepwalkers did not recognize their victims. For example, one man drove 15 kilometers to his mother-in-law’s house, which means that his motor skills were intact. Then he stabbed her with a knife and did not respond to her screams. He acted as if he was under threat and initiated a fatal attack. This man had a genetic and personal history of awakening abruptly from the first cycle of sleep into a confused state and never entered REM sleep (Cartwright, 2000). The REM sleep is necessary to prevent waking hallucinations and mental illness (Siegel, 2001).
  Since aggression is prominent in most dreams, it is likely that our enemies cause this aggression. In a study by Hall and Van de Castle, animals and male strangers are the primary enemies in both male and female dreams. When a animal enters a dream it is almost always going to pose some threat or danger to the dreamer. The reason for this was thought to be because in ancestral times humans lived in an environment full of dangerous animals. There was also a constant threat from other humans. These ever-present dangers made behavioral strategies to avoid contact with these things and was of a high survival value. Dreaming simulates these strategies in order to maintain efficiency; otherwise, one failure to respond to these threats in waking life could mean death. Dreams are biased towards simulating threats that were common in our ancestral environment (Revonsuo, 2000).

• Tubo, J. "The evolution of dreaming". Archived from the original on 2011-09-28.

• Each day for 14 weeks, 193 college students indicated whether or not they remembered a dream from the previous evening; they also recorded their sleep schedules and noted whether they had (1) exercised and (2) consumed alcohol and caffeine. In addition, the students completed measures of dissociation, schizotypy, sleep-related experiences, and the five-factor model of personality (N=169). Analyses of these data indicated that individual differences in dream recall were strongly stable over a 2-month interval. Dream recall was specifically associated with openness and was unrelated to the other Big Five traits. Subsequent analyses indicated that individuals who are prone to absorption, imagination and fantasy are particularly likely to remember their dreams and to report other vivid nocturnal experiences. These results are consistent with a salience model of dream recall and a continuity model of human consciousness.
  • Watson, David (2003). "To dream, perchance to remember: Individual differences in dream recall". ‘’Personality and Individual Differences’’. 34 (7): 1271–1286. doi:10.1016/S0191-8869(02)00114-9.

• Our standards for beauty are not arbitrary. The presence of genes that impact health and viability makes itself known by impairing symmetry of face and figure. An extreme genetic impediment, such as those that cause mental retardation, may present with gross facial stigmata, such as eyes that are too close or too far apart, or skulls that are misshapen—pointy or enlarged, or too small. When such children are born, their features are not always diagnostic of a particular genetic syndrome. They are referred to sometimes in their medical charts, cruelly, as FLK—“funny looking kids”—in the way that doctors and other medical personnel are often inclined to make light of conditions that are otherwise too terrible to contemplate. It is not known what particular genetic defects cause the more familiar minor physical irregularities, such as a too-long nose, or protuberant ears, or a crooked smile; but it is thought that these too are an indication of a subtle deficiency of some sort.
• An interesting experiment has been conducted numerous times in which the faces of a number of women picked arbitrarily are averaged by means of a computer program. The resultant portrait is of a beautiful woman. She never appears as some sort of bland composite. She seems real and distinctive—and beautiful. So, in a very real sense, being physically attractive is to approach as closely as possible an average appearance: a nose that is straight and of average length, eyes and mouth that are not unusual in any particular way, and other features that are unobtrusive. This conflicts with our usual understanding of beauty—namely, an appearance that is special in some way. But the particular attractiveness of a movie star, for example—however, distinctive and extraordinary she may appear to be—is only a subtle variation of average.

• "The Elements of Beauty: Not entirely in the eye of the beholder", Fredric Neuman, Psychology Today, Sep 06, 2013

• It is difficult to overestimate the importance of determinism in the behavioral sciences. Discovering the determinants of socialization, learning, group dynamics, abnormality, and effective management is the goal in most behavioral science disciplines. What if, for example, the determinants of depression were discovered? Although some behavioral scientists might claim that they already know what determines depression, current knowledge is more an educated guess than an exact understanding. What if we knew precisely the determinants of depression? Knowledge of this sort would surely provide a clear-cut comprehension of the phenomenon as well as suggest a surefire treatment of its harmful effects. In other words, we would know the cause of depression.
  • Brent D. Slife & Richard N. Williams, (1995). What’s behind the research? Discovering hidden assumptions in the behavioral sciences, Thousand Oaks, CA: Sage, ch.4, p.94.

William Moulton Marston

• Not even the church is so powerfully equipped to serve the public psychologically as is the motion picture company.
  • William Moulton Marston, Henry W. Levy, "Professor to Cure Scenarios with Wrong Emotional Content: Dabbled in Movies While at Harvard; Now Sought By Hollywood with Offer of Favorable Contract", New York University News January 1929; in Jill Lepore, The Secret History of Wonder Woman (2014), p. 137.

• A motion picture must be true to life. If a picture portrays a false emotion a false emotion it trains people seeing it to react abnormally.
  • Jill Lepore, The Secret History of Wonder Woman (2014), p. 136.

• There are one or two rules of thumb which are useful in distinguishing sadism from exciting adventure in the comics. Threat of torture is harmless, but when the torture it’s self is shown it becomes sadism. When a lovely heroine is show bound to the stake, comics followers are sure that the rescue will arrive just in the nick of time. The readers wish is to save the girl, not to see her suffer. A bound or chained person does not suffer even embarrassment in the comics, and the reader, therefore is not being taught to enjoy suffering.
  • As quoted in Olive Richard Bryne's, "Don't laugh at the comics", Family Circle, (Oct 25, 1940).

• I have the good Sergeant’s letter in which he expresses his enthusiasm over chains for women—so what? Some day I’ll make you a list of all the items about women that different people have been known to get passionate over—women’s hair, boots, belts, silk worn by women, gloves, stockings, garters, panties, bare backs. You can’t have a real woman character in any form of fiction without touching off a great many readers’ erotic fancies. Which is swell, I say.

• As quoted in "The Surprising Origin Story of Wonder Woman", Jill Lepore, Smithsonian Magazine, (October 2014).

• The picture story fantasy cuts loose the hampering debris of art and artifice and touches the tender spots of universal human desires and aspirations. Comics speak, without qualm or sophistication to the innermost ears of the wishful self.
  • "Why 100,000,000 Americans Read Comics", The American Scholar, 13.1 (1943): pp 35-44. as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, p.9; in the essay "William Marston's Feminist Agenda" by Michelle R. Finn

• If you conclude, as I do, that the only hope of a permanent peace and happiness for humanity on this planet is an increased expression of love, and that women are the primary carriers of this great force, one of the problems we face is to provide women with more opportunity for using their love powers. The last six thousand years have demonstrated quite conclusively, I believe, that woman under the domination of man can increase but meagerly the world's total love supply. Our obvious goal, than must be to devise social mechanisms whereby man is brought under the love domination of woman.
  • Women: Servants for Civilization, p.44, as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, p.9; in the essay "William Marston's Feminist Agenda" by Michelle R. Finn,

• If children will read comics [...] isn't it advisable t o give them some constructive comics to read? [...] The wish to be super strong is a healthy wish, a vital compelling, power-producing desire. The more the Superman-Wonder Woman picture stories build this innner compulsion by stimulating the child's natural longing to battle and overcome obstacles, particularly evil ones, the better the better chance your child has for self-advancement in the world. Certainly there can be no arguement about the advisability of strengthening the fundamental human desire, too often buried beneath stultifying divertissments and disguises, to see god overcome evil.
  • "Why 100,000,000 Americans Read Comics", The American Scholar, 13.1 (1943): p 40, as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, pp. 9-10; in the essay "William Marston's Feminist Agenda" by Michelle R. Finn, as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, p.9; in the essay "William Marston's Feminist Agenda" by Michelle R. Finn.

• The creation of children is not justifiable in a majority of unions between the sexes; but when the creation responses are justifiably undertaken, there is sound psychological ground for advising the woman to provide, beforehand, sufficient funds of her own to carry both herself and the child through the period of her physical incapacity for appetitive work. There is sound psychological ground, also, for requiring the male to share equally at least, in the home work and the care of children.
  • The Emotions of Normal People, 395 as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, p.18 in the essay "William Marston's Feminist Agenda" by Michelle R. Finn.

• Nearly all the sophomores reported excited pleasantness of captivation emotion throughout the party. The pleasantness of captivation response appeared to increase when they were obliged to overcome rebellious freshmen physically, or to preform the actions from which the captive girls strove to escape....

Female behavior also contains still more evidence than male behavior that captivation emotion is not limited to inter-sex relationships. The person of another girls seems to evoke from female subjects, under appropriate circumstances, filly as strong captivation response as does that of a male.

• The Emotions of Normal People as quoted in Wonder Woman: Bondage and Feminism in the Marston/Peter comics, 1941-1948 pp. 64-65 by Noah Berlatsky.

• In the majority of cases which are brought to me as a consulting psychologist for love and marital adjustment, there are self-deceptions to be uncovered as well as attempts to deceive other people. Beneath such love conflicts there is almost always a festering psychological core of dishonesty.
  • Lie Detector Test, p. 119.

• The only hope for civilization is the greater freedom, development and equality of women in all fields of human activity.
  • "Noted Psychologist Revealed as Author of Best-Selling "Wonder Woman, Children's Comic," press release, typescript [June 1942], WW Letters, Smithsonian

• Give men an alluring woman stronger than themselves to submit to and they'll be proud to become her willing slaves.
  • Are Comics Fascist?, as quoted in The Ages of Wonder Woman: Essays on the Amazon Princess in Changing Times, edited by Joeph J Darowski, p.7 in the essay "William Marston's Feminist Agenda" by Michelle R. Finn, p.14.

• The next 100 years will see the beginning of an American matriarchy—a nation of amazons in the psychological rather than the physical sense. In 500 years there will be a serious sex battle. And in 1000 years women will definitely rule this country.
  • "Neglected Amazons to Rule Men in 1000 yrs., Says Psychologist"; Washington Post, November 11, 1937.

• Tolerant people are the happiest, so why not get rid of prejudices that hold you back?
  • Your Life What are your prejudices? (1939).

• This noted scientist is the most genuine human being I’ve met. He isn’t fat—that is, in the ordinary way. He’s just enormous all over. We walked through the garden and about the grounds. The doctor asked me about my work and myself, and I told him more in 15 minutes than I’d tell my most intimate friend in a week. He’s the kind of person to whom you confide things about yourself you scarcely realize.
  • Olive Richard Bryne, Family Circle 1935 as quoted in "Last Amazon" New Yorker, (09/22/2014).

• If, as psychologists, we follow the analogy of the other biological sciences, we must expect to find normalcy synonymous with maximal efficiency of function. Survival of the fittest means survival of those members of a species whose organisms most successfully resist the encroachments of environmental antagonists, and continue to function with the greatest internal harmony. In the field of emotions, then, why would we alter this expectation? Why should we seek the spectacularly disharmonious emotions, the feelings that reveal a crushing of ourselves by environment, and consider these affective responses as our normal emotions? If a jungle beast is torn and wounded during the course of an ultimately victorious battle, it would be a spurious logic indeed that attributed its victory to its wounds. If a human being be emotionally torn and mentally disorganized by fear or rage during a business battle from which, ultimately, he emerges victorious, it seems equally nonsensical to ascribe his conquering strength to those emotions symptomatic of his temporary weakness and defeat. Victory comes in proportion as fear is banished. Perhaps the battle may be won with some fear still handicapping the victor, but that only means that the winner's maximal strength was not required.
  • The Emotions of Normal People, (1928), p.2

• What does the average teacher of psychology mean when he glibly rattles the words "fear", "rage", "anger", and "sex-emotion"? Almost any literary light of the Victorian era, if asked to define these words, would have answered, readily enough : "They are names for emotions possessing distinctive conscious qualities, experienced by everybody, every day. These easily recognized, primitive emotions constitute the very backbone of literature." I submit that the backbone of literature has been transplanted intact into, psychology, where it has proved pitifully inadequate. The whole structure of our recently christened "science", in consequence, remains spineless in its attempted descriptions of human behaviour. Most teachers of psychology, it would seem, are still unable to define these time-worn emotional terms with greater exactness or scientific meaning than that employed by literary men of the last century.
  Nor can the average teacher be blamed. Theorists and researchers upon whom the teacher must depend for his scientific, concepts have written many hundreds of thousands of words on the subject of emotions, without attempting definite, psycho-neural descriptions of a single basic, or primary emotion. On the other hand, nearly all writers seem to accept the old, undefined literary names of various "emotions" without question ; each writer then giving these terms such connotation as they may happen to hold for him, individually.

• Ibid, pp. 3-4.

• But a person who calls himself a psychologist is in a peculiar position these days. Before he can write about the psychology of emotion, or intelligence, or, in fact, about the psychology of any human behaviour, he must define what he means by psychology. The introspectionistic psychologists, now considered unscientific, regarded any exposition as psychological which described its phenomena in subjective or introspective terms. Now the introspectionists are pushed into the background. In their place we find a great variety of teachers and researchers all naming their diverse methods and observations "psychology". We have, for instance, in the field of emotions, the physiologists the neurologists the physiological psychologists, the behaviorists, the endocrinologists, the mental-tester-statisticians, the psycho-analysts, and the psychiatrists. Each of these types of worker confesses himself to be a psychologist, and, moreover, each maintains that his are the only psychologically worth-while results. Psychology to-day, like Europe in the Middle Ages, is being fought over by feudal barons who have little in common save tacit acceptance of the rule that spoils shall be taken whenever and however possible.

• Ibid, pp. 5-6.

• Our problem is : What are the underlying desires or wishes, that lead some scientists to insist upon mechanistic conceptions, and others equally eminent, to espouse some form of scientific vitalism ? For in psychology, as in other sciences, a materialistic or vitalistic bias may be found at the root of nearly all factional schools, or contentious groups. Sometimes, of course, the underlying desire relates solely to the advancement of the personal fortunes of the workers concerned ; and such purely egoistic motives probably play a considerable part in the evolution of every scientific doctrine. In addition to this, however, originators and promulgators of conceptual systems of thought, nearly always possess hidden desires to push science in this direction or that, " for science's own sake ". The goal selected is the one that accords most closely with the basic emotional set of the scientific agitator. And the emotional sets of scientists may be classified, broadly, into two elementary groups, materialistic and vitalistic.

• William Moulton Marston, The Emotions of Normal People, (1928), p. 7.

Wilhelm Reich

• It is the mechanistic-mystical character of modern man that produces fascist parties, and not vice versa.
  The result of erroneous political thinking is that even today fascism is conceived as a specific national characteristic of the Germans or the Japanese.
  • Wilhelm Reich, in his Preface (August 1942), to the Third Edition of The Mass Psychology of Fascism (1933), p. xiii.

• If, by being revolutionary, one means rational rebellion against intolerable social conditions, if, by being radical, one means "going to the root of things," the rational will to improve them, then fascism is never revolutionary. True, it may have the aspect of revolutionary emotions. But one would not call that physician revolutionary who proceeds against a disease with violent cursing but the other who quietly, courageously and conscientiously studies and fights the causes of the disease. Fascist rebelliousness always occurs where fear of the truth turns a revolutionary emotion into illusion.
  In its pure form, fascism is the sum total of all irrational reactions of the average human character. To the narrow-minded sociologist who lacks the courage to recognize the enormous role played by the irrational in human history, the fascist race theory appears as nothing but an imperialistic interest or even a mere 'prejudice.' The violence and the ubiquity of these "race prejudices" show their origin from the irrational part of the human character. The race theory is not a creation of fascism. No: fascism is a creation of race hatred and its politically organized expression. Correspondingly, there is a German, Italian, Spanish, Anglo-Saxon, Jewish and Arabian fascism. Race ideology is a pure biopathic expression of the character structure of the orgastically impotent man.
  The sadistically perverse character of race ideology is also betrayed in its attitude towards religion. Fascism is supposed to be a reversion to paganism and an archenemy of religion. Far from it - fascism is the supreme expression of religious mysticism. As such, it comes into being in a peculiar social form. Fascism countenances that religiosity that stems from sexual perversion, and it transforms the masochistic character of the old patriarchal religion of suffering into a sadistic religion. In short, it transposes religion from the ‘other-worldliness’ of the philosophy of suffering to the ‘this worldliness’ of sadistic murder.
  • Wilhelm Reich, in his Preface (August 1942), to the Third Edition of The Mass Psychology of Fascism (1933), p. xiv.

• The structure of fascism is characterized by metaphysical thinking, unorthodox faith, obsession with abstract ethical ideals, and belief in the divine predestination of the fuhrer. These basic features are linked with a deeper layer, which is characterized by a strong authoritarian tie to the fuhrer-ideal or the nation. The belief in a ‘master race’ became the principal mainspring of the tie to the ‘fuhrer’ on the part of the National Socialist masses, as well as the foundation of their voluntary acceptance of slavish submission.
  • Wilhelm Reich, The Mass Psychology of Fascism (1933), p. 80.

• Fascism grew out of the conservatism of the Social Democrats on the one hand and the narrow-mindedness and senility of the capitalists on the other hand. It did not embody those ideals that had been advocated by its predecessors in a practical way, but solely in an ideological way (and this was the only thing that mattered to the masses of people whose psychic structures were ridden with illusions). It included the most brutal political reaction, the same political reaction that had devastated human life and property in the middle Ages. It paid tribute to so-called native tradition in a mystical and brutal way, which had nothing to do with a genuine feeling for one’s native country and attachment to the soil. By calling itself’ socialist’ and ‘revolutionary’, it took over the unfulfilled functions of the socialists. By dominating industrial magnates, it took over capitalism. From now on, the achievement of ‘socialism’ was entrusted to an all-powerful fuhrer who had been sent by God. The powerlessness and helplessness of the masses of people gave impetus to this fuhrer ideology, which had been implanted in man’s structure by the authoritarian school and nourished by the church and compulsive family. The ‘salvation of the nation’ by an all-powerful fuhrer who had been sent by God was in complete accord with the intense desire of the masses for salvation. Incapable of conceiving of themselves as having a different nature, their subservient structure eagerly imbibed the idea of man’s immutability and of the ‘natural division of humanity into the few who lead and the many who are led’. Now the responsibility rested in the hands of a strong man. In fascism or wherever else it is encountered, this fascist fuhrer ideology rests upon the mystical hereditary idea of man’s immutable nature, upon the helplessness, craving for authority, and incapacity for freedom of the masses of people. Admitted that the formula, ‘Man requires leadership and discipline’, ‘authority and order’, can be justified in terms of man’s present anti-social structure, the attempt to eternalize this structure and to hold it to be immutable is reactionary. The fascist ideology had the best of intentions. Those who did not recognize this subjective honesty failed altogether to comprehend fascism and its attraction for the masses. Since the problem of the human structure was never brought up or discussed, let alone mastered, the idea of a non authoritarian, self-regulatory society was looked upon as chimerical and Utopian.
  • Wilhelm Reich, The Mass Psychology of Fascism (1933), p. 234.

Disorders

• The study of human personality or ‘character’ (from the Greek charaktêr, the mark impressed upon a coin) dates back at least to antiquity. In his Characters, Tyrtamus (371-287 bc)—nicknamed Theophrastus or ‘divinely speaking’ by his contemporary Aristotle— divided the people of the Athens of the 4th century BC into thirty different personality types, including 'arrogance', 'irony', and 'boastfulness'. The Characters exerted a strong influence on subsequent studies of human personality such as those of Thomas Overbury (1581-1613) in England and Jean de la Bruyère (1645-1696) in France.
• While personality disorders may differ from mental disorders like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. They are estimated to affect about 10 per cent of people, although this figure ultimately depends on where clinicians draw the line between a ‘normal’ personality and one that leads to significant impairment. Characterizing the ten personality disorders is difficult, but diagnosing them reliably is even more so. For instance, how far from the norm must personality traits deviate before they can be counted as disordered? How significant is ‘significant impairment’? And how is ‘impairment’ to be defined?

• "The 10 Personality Disorders: A short, sharp look into the 10 personality disorders.", Neel Burton, Psychology Today, May 29, 2012

• Patients who have been diagnosed with DID tend to possess extreme sensitivity to interpersonal trust and rejection issues, and this makes brief treatment in a managed care setting difficult.14 Therapists who commonly treat patients with DID see them as outpatients weekly or biweekly for years, with the goal of fusion of the personality states while retaining the entire range of experiences contained in all of the alters.
  Patients tend to switch personality states when there is a perceived psychosocial threat. This switching allows a distressed alter to retreat while an alter who is more competent to handle the situation emerges. The alter system may replicate the DID patient’s experience of the relationships and circumstances that prevailed in the family of origin.3 In Kluft’s view,3 alternate identities or personality states are the core phenomena of DID. Kluft does not view the alters as obstacles, distractions, or artifacts to be bypassed or suppressed. In fact, he argues that he has found no evidence of improvement if the therapist does not work with these alternate personality states.

• Paulette Marie Gillig, "Dissociative Identity Disorder A Controversial Diagnosis", Psychiatry (Edgmont). 2009 Mar; 6(3): 24–29.

• Although previously the monoamine systems were considered to be responsible for the development of major depressive disorder (MDD), the available evidence to date does not support a direct causal relationship with MDD. There is no simple direct correlation of serotonin or norepinephrine levels in the brain and mood. In other words, after a half-century of research, the chemical-imbalance hypothesis as promulgated by the drug companies that manufacture SSRIs and other antidepressants is not only without clear and consistent support, but has been disproved by experimental evidence.
  • Irving Kirsch (2010). The Emperor's New Drugs: Exploding the Antidepressant Myth. p. 92.

• Three-phase drug studies with FDA approval will also have to be completed before these types of drugs can be removed from the list of substances with no medical purpose. Safety and quality control are always important and will also need much more research.
  The problem is that pharmaceutical companies are not interested in researching an inexpensive substance that has been around for a long time. There is no money to be made with a non-patentable drug that is given only once or twice in a lifetime.
  • "Can Psilocybin Mushrooms Help Cure Mental Illness?", Constance Scharff, Psychology Today, Jul 02, 2014

• Did you know that of the 14 states with the highest number of painkiller prescriptions per person, they all went for Trump?

• Bill Maher Real Time with Bill Maher, January 20th 2017

• Ibogaine is a psychoactive alkaloid naturally occurring in the West African shrub iboga. While ibogaine is a mild stimulant in small doses, in larger doses it induces a profound psychedelic state. Historically, it has been used in healing ceremonies and initiations by members of the Bwiti religion in various parts of West Africa. People with problem substance use have found that larger doses of ibogaine can significantly reduce withdrawal from opiates and temporarily eliminate substance-related cravings.
  • Multidisciplinary Association For Psychedelic Studies

• People with PTSD are afflicted with three primary types of symptoms.
  The first type of symptoms involves all manner of intrusive memories of the event that often come with startling clarity via flashbacks and nightmares. Along with anything else that reminds a person of the trauma, these intrusive memories produce profound psychological distress and physical symptoms, such as a pounding heart.
  The second type of symptoms revolves around avoidance and emotional numbing.
  Bedeviled as they are by unwanted memories, images, nightmares and flashbacks that keep the terrifying reality of their experience emotionally alive for them, people with PTSD often go to heroic lengths to avoid anything in the personal or physical environment that reminds them of the trauma.
  They often also report feeling emotionally deadened, unable to love and disinterested in things others find pleasurable. Often they feel like they will die young or have less of a future than other people.
  The third and final symptom domain of PTSD is known as hyperarousal. Hyperarousal symptoms include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, being hypervigilant and finally, demonstrating an exaggerated startle response.
  These PTSD symptoms usually don't travel alone, unfortunately, but are frequently accompanied by depression and difficulties with drugs and alcohol.
• There is another symptom of acute trauma that can be easily missed if you are not on the lookout for it that strongly predicts the development of later PTSD. In layman's parlance, we might call it "being spaced out." More technically, we call it dissociation.
  When people dissociate, things come apart in a variety of ways.
  Often they feel separated from themselves, as if they are watching themselves from some outside vantage point. Frequently they feel that there is some type of invisible wall between themselves and the rest of the world. Sometimes they will feel that everything in the world, including themselves, is somehow unreal.
  I've heard patients describe this experience as being like looking at the world through the wrong end of a telescope, so that everything seems smaller and distorted. In extreme instances, people so thoroughly lose track of things that they develop amnesia.

• Charles Raison, "PTSD: Know the symptoms and when to get help", CNN, (August 24, 2012).

• People with mood disorders, including those who are unresponsive to conventional therapies, might be able to ditch their antidepressants and antianxiety medications. Those with terminal illness could enjoy their remaining days without the fear of death looming over them, while people with PTSD could return to a normal life unobstructed by paralyzing flashbacks. And rehab centers for substance use and eating disorders could empty out as more people turn to psychedelics.
• In 2016, for instance, a Johns Hopkins study and a concurrent New York University study found that about 80 percent of cancer patients showed clinically significant decreases in depressed mood and anxiety even six months after receiving one to two psilocybin treatments.
  Psilocybin also appears to be an effective treatment for addiction. Echoing past research with LSD, scientists recently showed decreased cravings for and increased abstinence from alcohol after psilocybin treatment in a proof-of-concept study — and the benefits were still in evidence nine months later.
  Psilocybin seems especially promising as a tool for smoking cessation.
  In a preliminary study of smokers conducted in 2014, 80 percent of participants remained nicotine-free six months after receiving three psilocybin sessions. And 60 percent of the participants remained nicotine-free an average of 30 months after treatment.
• "Normally, when someone [with PTSD] would be instructed to relive the traumatic experience, they would be overwhelmed with fear, anxiety, and despair," Grob says. "But while under the influence of the MDMA, it's as if they can navigate the experience more safely."
  In recent clinical trials, 61 percent of 107 participants no longer had PTSD symptoms two months after MDMA-assisted psychotherapy. Sixty-eight percent were still PTSD-free a year later. In light of findings like these, the FDA recently deemed MDMA a "breakthrough therapy," putting it on the fast track for approval.

• “Will Psychedelic Therapy Transform Mental Health Care?”, Joseph Bennington-Castro , NBC News, Sep.28.2017

• As our experience with drug education has developed and been charted, it has become apparent that effective efforts need to be comprehensive. A classroom teacher's efforts must be reinforced by school wide drug abuse prevention activities, and these must in turn be supported by interventions in all aspects of community life. Furthermore, it is not enough merely to address the surface issue of drug use behavior; we must also address the environmental circumstances that contribute to such problems. This complex issue presents a great challenge to drug educators, but it also calls for a restructuring, sometimes called a paradigm shift, of many of our social institutions and the way they interact.
  For example, faith-based organizations are generally uninvolved in drug abuse prevention, except to condemn drug abuse. For them to have an organized and planned role in prevention will require a shift in their thinking about their goals and what type of programs they should sponsor. Establishing referral networks, service linkages, and collaborative relationships among community agencies and individuals is a difficult hurdle.
  Whether or not this is done, drug education professionals often do not know the long-term results of their work because the outcome occurs in the future, when educators no longer have contact with the objects of their efforts. Satisfaction may come from reviewing data trends as the years unfold, but this is not as gratifying as the immediate results that may come from participating in drug treatment of other kinds of human service work in which success is more immediately apparent. Of course, the flip side is that failure also is not recognized. Prevention efforts are repeated because they are well received or because of the inherent satisfaction of doing them. The fact that they have no impact may not be realized without careful evaluation.
  There has been a new push by the U.S. government to demand that state and local prevention programs, wen funded by state and federal dollars, be "science based." The expectation is that programs should show some evidence, prior to implementation, that they will actually affect youth drug use. The background to this effort is that enthusiasm and genuine concern for preventing adolescent drug abuse have often been translated into activities that are enjoyable but not carefully examined and tested. Schools have used funds to purchase t-shirts and ribbons, hire expensive motivational speakers, and to acquire videotapes and untested curriculum material without any assurance that such expenditures have led in the past, or will lead in the future, to decreases in youth drug use.
  • Richard W. Wilson; Cheryl A. Kolander. (2003). Drug abuse prevention: a school and community partnership, Sudbury, Mass.: Jones and Bartlett, p.5.

• In a release, Green commented that CBD could provide direct neurological support for a range of conditions affecting the brain, from schizophrenia to dementia. “From this review, we found that CBD will not improve learning and memory in healthy brains, but may improve aspects of learning and memory in illnesses associated with cognitive impairment, including Alzheimer’s disease, as well as neurological and neuro-inflammatory disorders," including hepatic encephalopathy, meningitis, sepsis, and cerebral malaria.
• “We found that CBD was able to restore recognition and working memory, as well as social behavior, to normal levels,” Osborne said in a release. "These findings are interesting because they suggest that CBD may be able to treat some of the symptoms of schizophrenia that are seemingly resistant to existing medications. In addition, CBD treatment did not alter body weight or food intake, which are common side effects of antipsychotic drug treatment.”
  Osborne also explained to ABC News Australia, "This is really important because current antipsychotic drugs don't address the cognitive deficits, which approximately 80% of patients with schizophrenia experience."
• A preliminary study published this year provided a retrospective evaluation of cannabis' effectiveness and tolerability in treating adults with Tourette Syndrome. Conducted by researchers at the University of Toronto with support from the Tourette Association of America, the study found that 18 of 19 participants were at least "much improved" after a regimen of inhaled cannabis, while tics scores for the whole group decreased by 60%.

• "Cannabis Shows Promise In Treating Schizophrenia And Tourette Syndrome", Janet Burns, Forbes, August 28, 2017.

• In a study 36 children in the 8-10 year age group were selected for a double blind, randomized trial. Nineteen were given 50 mg of Bacopa twice daily, 17 others received placebo. After 12 weeks of treatment, the children were subjected to a battery of specialized tests. The data revealed a significant improvement in the areas of sentence repetition, logical memory and pair associative learning (matching things that go together; e.g. “test” and “grade”) in all 19 ADHD children who took Bacopa.
  Also demonstrated a significant memory promoting effect in animal models of Alzheimer's disease.
• In a study, 61 subjects of both sex with an age range of 62-75 years were selected. Twenty-eight aged had cognitive deficits particularly the memory loss. Whereas 33 were normal aged. The subject of both group were treated with organic extract of BM in effective doses continuously for 6 months and evaluated on various neuropsychological parameters. The results obtained at the end of 6 months revealed beneficial effect in improving memory and attention span and also associated behavioral problems among demented elderly people. The neurochemical loss was checked and enhanced in senile dementia cases. The test drug has potentiality to improve memory and other cognitive deficits among the aged suffering from dementia and associated behavioral problems.
• In an experimental study, daily administration of Ashwagandha root extract (50,100 and 200 mg/kg orally) for 6 days significantly improved memory-consolidation in mice receiving chronic electroconvulsive shock (ECS) treatment. Ashwagandha administered on day 7, also attenuated the disruption of memory consolidation, produced by chronic treatment with ECS. On the elevated plus maze Ashwagandha reversed the scopolamine (0.3 mg/kg) induced delay in transfer latency on day 1. On the basis of these findings it is suggested that Ashwagandha exhibits a nootropic-like effect in naive and amnesic mice
• Drugs mentioned as Medhya (intellect promoting) and those indicated to improve cognitive functions can be used successfully in cases of dyslexia.
  The review indicates the Ayurvedic drugs like Brahmi, Mandookaparni, Shankhapushpi, Jyotishmati, Ashwagandha, Jatamansi, Madhuyashti and Guduchi have the potential to provide a significant improvement in children suffering from dyslexia. All these drugs improve the brain functions and also the sensory and motor systems as a result of their medhya properties and thereby can help in management of various areas of dyslexic child's malfunctioning.
  This is only a conceptual study, but the information provided can be utilized in clinical researches.

• "Dyslexia: A solution through Ayurveda evidences from Ayurveda for the management of dyslexia in children: A review", Anita Sharma, Vinod K. Gothecha, and Nisha K. Ojha, An International Quaterly Journal of Research in Ayuvedra, v.33(4);, Oct-Dec 2012

• “In the past 20 years, I’ve not seen anything like this,” says Dr. Cristina Cusin, a clinician and researcher who runs the ketamine clinic at Massachusetts General Hospital. Studies have shown that 60% to 70% of people with treatment-resistant depression respond to ketamine.
  • "New Hope for Depression" Mandy Oaklander, TIME, July 27, 2017

• Marital status was a consistently significant correlate of MDE. Being separated was associated with increased risk of MDE in twelve countries, with odds ratios varying from < 4.0 in five countries to > 8.0 in India (OR = 8.2), Japan (OR = 10.8) and Lebanon (OR = 19.3). Being divorced was associated with MDE in seven of the ten developed and four of the eight developing countries, with unusually high ORs in Japan (OR = 5.1), China (OR = 6.2) and Ukraine (OR = 4.2). Being widowed was less consistently and more modestly associated with MDE with the exception of Ukraine, where widows were eight times as likely as married men and women to have MDE. In the high-income countries, there was a significantly increased OR of MDE among the never married. However, India and South Africa were the only two low- to middle-income samples with significant ORs, and in these countries never being married was associated with low risk. Overall, the association between marital status and MDE differed significantly between high and low- to middle-income countries (χ2 3 = 124.4, P < 0.001), due to stronger associations of being separated and never married with depression in high-income countries, and stronger associations of being divorced and widowed with depression in low- to middle-income countries.
• The poorest respondents in France, Germany, New Zealand and the USA had an approximately twofold increased odds of MDE compared with those in the highest income group. In the low- to middle-income countries, in comparison, income was not significantly related to MDE. This stronger association between income and MDE in higher-income countries was significant overall (χ2 3 = 19.3, P < 0.001). Similarly, among the non-Asian countries, low education was significantly associated with MDE only in Israel, the USA, Mexico and Ukraine. The findings for the Asian countries were more complex. In India, respondents with the lowest education were 14 times as likely to have MDE as those with the highest education. In Japan and China, the reverse pattern was found, with the least educated having the lowest risk of MDE.
• On one level, it seems counterintuitive that people in high-income countries should experience more stress than those in low- to middle-income countries. However, it has been suggested that depression is to some extent an illness of affluence. A related argument is that income inequality, which is for the most part greater in high than low- to middle-income countries, promotes a wide variety of chronic conditions that includes depression.

• “Cross-national epidemiology of DSM-IV major depressive episode”, Evelyn Bromet, Laura Helena Andrade, Irving Hwang, Nancy A Sampson, Jordi Alonso,Giovanni de Girolamo, Ron de Graaf, Koen Demyttenaere, Chiyi Hu, Noboru Iwata, Aimee N Karam, Jagdish Kaur, Stanislav Kostyuchenko, Jean-Pierre Lépine, Daphna Levinson, Herbert Matschinger, Maria Elena Medina Mora, Mark Oakley Browne, Jose Posada-Villa, Maria Carmen Viana, David R Williams and Ronald C Kessler, BMC Medicine, June 2011

• Even suicidal behavior might serve a design function. A small minority of researchers believe that we may have evolved to, under the right conditions, try to kill ourselves. Edward Hagen, an anthropologist at Washington State University, is one of the most vocal supporters of this idea, and he presented fresh support for it in the May 2016 issue of Evolution and Human Behavior. He and two WSU collaborators, Kristen Syme and Zachary Garfield, set out to find evidence for two models of suicidal behavior, each of which cast suicide as a strategic behavior.
  The first model is called inclusive fitness, and it relies on the notion of the “selfish gene”: The most basic unit of reproduction in natural selection is not the individual organism but the gene. Your genes don’t care if you survive to reproduce, as long as they do, and they exist in more people than just you. So they might lead you, their host organism, to sacrifice yourself if it sufficiently benefits your family members, who share many of your genes. Hence, people seek to maximize not only their own fitness but, inclusively, that of their kin too. Most parents would decide in an instant to jump in front of a bus to save their children. And in studies of suicidal thinking, people frequently speak about not wanting to be a burden.
  The second strategic model of suicidality is the bargaining model, which relies on the notion of “costly signaling.”6 A colorful example of costly signaling is the peacock. Managing a big, eye-catching tail is costly, in that it wastes energy and draws predators. But the fitter a peacock, the less costly a big tail, and so big tails have evolved to signal genetic fitness to peahens. They are attractive not despite their costliness but because of it. In addition to communicating fitness, costly signals can also communicate need. Consider baby birds. They don’t need to chirp for food if their mother is right there, and chirping attracts predators, making it costly. But the more hungry or sickly a chick is, the less it has to lose by being eaten, and the more it has to gain by being fed. So chirping louder is an honest signal of greater need for food, and the mother responds. (Anthropologists and psychiatrists have long framed suicide attempts as cries for help, but considered them pathological forms of pleading rather than the results of context-sensitive and evolved cost-benefit analyses.) Whereas the goal of suicidality in the inclusive fitness model is death, the goal in the bargaining model is help. Crucially, the vast majority of suicide attempts are not fatal.
  • Matthew Hutson,"Does Depression Have an Evolutionary Purpose?", Nautilus, (February 9, 2017).

• So what could be so useful about depression? Depressed people often think intensely about their problems. These thoughts are called ruminations; they are persistent and depressed people have difficulty thinking about anything else. Numerous studies have also shown that this thinking style is often highly analytical. They dwell on a complex problem, breaking it down into smaller components, which are considered one at a time.
• Analysis requires a lot of uninterrupted thought, and depression coordinates many changes in the body to help people analyze their problems without getting distracted.
• But depression is nature’s way of telling you that you’ve got complex social problems that the mind is intent on solving. Therapies should try to encourage depressive rumination rather than try to stop it, and they should focus on trying to help people solve the problems that trigger their bouts of depression. (There are several effective therapies that focus on just this.) It is also essential, in instances where there is resistance to discussing ruminations, that the therapist try to identify and dismantle those barriers.
  • Paul W. Andrews, J. Anderson Thomson Jr., "Depression's Evolutionary Roots" Scientific American, (August 25, 2009).

• My profession of psychiatry still views depression purely as an illness. Insurance limitations have pushed many psychiatrists away from talk therapy and toward the more efficient prescription pad. So “there’s a lot of institutional and scientific investment in the exclusively disease model of depression. I’m basically telling colleagues they’re medicating people when they shouldn’t be. That’s not going to be welcome news.
  • J. Anderson Thomson, "Does Depression Have an Evolutionary Purpose?" Matthew Hutson, Nautilus, (February 9, 2017).

• The Centers for Disease Control first attempted to tally ADHD cases in 1997 and found that about 3 percent of American schoolchildren had received the diagnosis, a number that seemed roughly in line with past estimates. But after that year, the number of diagnosed cases began to increase by at least 3 percent every year. Then, between 2003 and 2007, cases increased at a rate of 5.5 percent each year. In 2013, the CDC released data revealing that 11 percent of American schoolchildren had been diagnosed with ADHD, which amounts to 6.4 million children between the ages of four and seventeen—a 16 percent increase since 2007 and a 42 percent increase since 2003. Boys are more than twice as likely to be diagnosed as girls—15.1 percent to 6.7 percent.
• The United States government first collected information on mental disorders in 1840, when the national census listed two generally accepted conditions: idiocy and insanity.
• One of the most shocking studies of the rise in ADHD diagnoses was published in 2012 in the Canadian Medical Association Journal. It was called "Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children." Nearly one million children between the ages of six and twelve took part, making it the largest study of its kind ever. The researchers found that "boys who were born in December"—typically the youngest students in their class—"were 30 percent more likely to receive a diagnosis of ADHD than boys born in January," who were a full year older. And "boys were 41 percent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January."
• Children with ADHD often get more time to take tests, and in some school districts, tests taken by ADHD kids do not even have to be included in the overall average.

• "The Drugging of the American Boy" Ryan D'Agostino, Esquire, Mar 27, 2014

• Researchers at the University of Heidelberg in Germany randomly assigned 19 children with ADHD either to yoga for children or traditional exercise. The researchers found that the yoga group had significant improvement in ADHD symptoms including attention problems, compared to the exercise group. Furthermore, yoga was effective for children undergoing drug treatment.
  • "Kids Yoga May Help Relieve ADHD" by Elaine Gavalas Huffington Post, 09/20/2013

• Women with eating disorders often report a lack of sexual interest during the course of their eating disorder. Several solid studies, including one, which assessed 242 women, found that issues with physical intimacy, libido, sexual anxiety, and difficulty in romantic relationships are present among this population.
  The results found that: Intercourse (55.3%), having a partner (52.7%), decreased sexual desire (66.9%), and increased sexual anxiety (59.2%) were common. Women with restricting and purging anorexia nervosa had a higher prevalence of loss of libido than women with bulimia nervosa and eating disorder not otherwise specified (75%, 74.6%, 39%, and 45.4%, respectively). Absence of sexual relationships was associated with lower minimum lifetime body mass index (BMI) and earlier age of onset; loss of libido with lower lifetime BMI, higher interoceptive awareness and trait anxiety; and sexual anxiety with lower lifetime BMI, higher harm avoidance and ineffectiveness. Sexual dysfunction in eating disorders was higher than in the normative sample.
• Only 25 percent of women are consistently orgasmic during vaginal intercourse. Orgasm for female patients with eating disorders is significantly reduced due to medical and psychological factors.
• Food, like sex, is a pleasure. Helping patients work toward emotional and physical intimacy in relationships is an important and life sustaining goal. Usually, when a patient is well on her way toward recovery and trust is deeply established and maintained with the therapist opportunities for frank conversations about sex can occur.

• Sexual Satisfaction and Eating Disorders, Judy Scheel, Psychology Today, Jun 19, 2014.

• Fifty percent of both our anorectic and bulimic patients reported a history of sexual abuse while only 28% of a non-anorexic, non-bulimic control population reported similar problems (p less than 0.01).
• Forty six percent of the bulimic women seen in our study exhibited some promiscuous behavior, using sex either as a gauge of their own self worth or as a means of punishing men. It is essential that sexual issues be addressed early in the treatment of patients with eating disorders.

• "Sexual abuse in patients with eating disorders.", Tice L, Hall RC, Beresford TP, Quinones J, Hall AK, Psychiatr Med., 1989; 7(4):257-67.

• A 2012 study published in the Journal of the Academy of Nutrition and Dietetics found that women suffering from eating disorders are four times more likely to be vegetarian than women without eating disorders. More than half (52 percent) of women with a history of eating disorders had been vegetarians at one point in their lives.
• In Project EAT, an ongoing study that assessed eating and weight-related behaviors in adolescents from 31 Minneapolis schools, about 6 percent of students reported being vegetarians. Of those, 35 percent did so to lose weight. Vegetarians also were more likely to be involved in unhealthy weight control behaviors, such as binge eating, vomiting, and using laxatives or diet pills.

• "Vegetarianism and Eating Disorders", Carolyn C. Ross, Psychology Today, Nov 1, 2012.

• Vegetarian adolescents in both Turkey and Australia show greater concern over their appearance and engage in more extreme eating behaviors than meat-eaters.
  Finnish vegetarian women have higher levels of depression and lower levels of self-esteem than non-vegetarians.
  College students who avoid meat are more obsessed with their weight and diet more often than meat eaters. They are also more inclined to agree with the statement, "If given the opportunity to eliminate all my nutritional needs safely and cheaply by taking a pill, I would."
• According to the Humane Research Council, there are twice as many female than male vegetarians. Several years ago, I reviewed the scientific literature on sex differences in the treatment of animals. You will not be surprised to find that, as a rule, women are more concerned about animal suffering than men. I am sure most female vegetarians give up meat out of concern for animals and the environment, not from a pathological desire to lose weight.
• However, there is no denying that meat-avoidance can be associated with eating problems, especially in women. (Rory and Kim even allude to the dangers of the Skinny Bitch diet, telling readers, "Don't be a fat pig anymore...But don't go anorexic on us, either.") The fact is that women are much more susceptible to eating disorders than men. Indeed, one recent study reported a female to male ratio of 9 to 1 for anorexia nervosa and 30 to 1 for bulimia nervosa.

• "Eating Disorders: The Dark Side of Vegetarianism", Hal Herzog, Psychology Today, Sep 07, 2010.

• These findings help to clarify the mechanisms through which hormone treatment might be able to improve eating disorder symptoms in this population. They suggest that hormones primarily improves body dissatisfaction, which in turn reduces levels of perfectionism and symptoms of anxiety, and increases self-esteem. In combination, these factors then appear to alleviate eating disorder symptoms.
  This is the first study with transgender people that has been able to indicate how cross-sex hormones alleviate eating disorder symptoms, although this finding needs to be replicated with more longitudinal research.
  • "Hormone therapy may reduce eating disorder symptoms in transgender people", Jon Arcelus, University of Nottingham, January 11, 2018

• For a long time, eating disorders were considered as culture-bound syndromes, specific to Western countries. This theory has been refuted for anorexia, but few transcultural studies have been carried out on bulimia nervosa. As a result, knowledge concerning this disorder is limited.
  • "Case Study of An Adopted Chinese Woman with Bulimia Nervosa: A Cultural and Transcultural Approach", Marion Vu-Augier de Mongremier, Liangliang Chen, Jue Chen, Marie Rose Moro; Shanghai Arch Psychiatry, 2017 Aug 25; 29(4): 243–246.

• In phase 2 clinical trials sponsored by MAPS, 61 percent of the 107 participants with chronic, treatment-resistant PTSD no longer had the disorder after two months of MDMA-assisted psychotherapy treatment. At a 12-month follow up, 68 percent no longer had PTSD.
  • "FDA designates MDMA as "breakthrough therapy" for PTSD", Ashley Welch, CBS News, August 31, 2017

• This group of boys showed considerable: and consistent effects from medication with UML or LSD daily for two to eleven months. Their behavior, ward management, school-room adjustment and progress at home changed favorably with less acting out and less disturbed behavior. They not only needed no other tranquilizing, sedative, or antidepressant medication, but furthermore, unlike the tranquilizers which made them sleepy and groggy, they were generally cheerful and alert. Personnel and families noted the difference. Repeated psychiatric inter-views revealed a change in fantasy material which was loss bizarre, personalized or disturbing. Depressive, anxious and paranoid attitudes were focused on real objective problems. Insight was impressive. Intellectual changes, as seen in psychometric tests, indicated improved maturity, better organization and motivation with a rise in IQ which was reflected in improved school work. The Rorschach and drawing tests also showed increased maturity and control with clearer thinking. Studies of the autonomic functions were not made.
• It was hoped that these drugs might prove effective in breaking through autistic defenses, improving autonomic nervous system functioning, and modifying distorted perceptual experiences.
  There were some differences in results in the various groups. In general, the younger autistic children became less anxious, less autistic and plastic, more aware and responsive, with some changes in verbalization and qualitative improvement, on the Vineland Social Maturity Scale. The girls and older autistic boys showed similar results, but much less marked and persistent. Verbal children showed improvement in general behavior, with marked changes in fantasy and bizarre ideation to more insightful, reality-oriented, though often anxious and depressive attitudes, and improved maturity and organization.
  There were no major side effects, though a few patients on UML had muscular spasms and vasomotor changes in the legs, generally of a temporary nature. It is significant to note that while most of these patients had required tranquilizing or, other medications, they could all now be maintained only on the LSD or UML. A few patients received reserpine to control excessive activity, aggression, or biting.
• We do not use it as a psychoanalytic tool. Our idea was to give it as a daily drug. It is our general experience that frequently the children respond to many drugs that affect the central nervous system differently than adults. This is common knowledge; at least, to those of us using drugs with children. So we were not surprised to find, in our early initial studies, that if the children were near puberty or in puberty they responded to the first dose with anxiety and disturbance, just as the adolescent boys did. But even these children could be maintained on high doses of the drug, just as the adolescent boys were, so that the drugs can be given to these children in continuing doses. What tolerance means, I don't know. Tolerance may be established in our patients. The chemical studies suggest this, and even our psychological studies indicate a slight change later on, a leveling off of response as compared to initial reaction, but the long-term reaction is still the most valuable reaction to the drug.

• "The Treatment of Childhood Schizophrenia with LSD and UML", L. Bender, L. Cobrinik, G. Faretra, D.V. Siva Sankar, Biological Treatment of Mental Illness, Proceedings II of the International Conference of the Manfred Sakel Foundation 10/31-11/3/1962, 1966; 2(4):463-91

• With regard to the purpose of these studies, all were to some extent exploring the therapeutic potential of psychedelic drugs rather than their psychotomimetic properties. This was least true of Freedman and his coworkers (1962) who viewed LSD primarily as a means of studying the schizophrenic process by "intensifying pre-existing symptomology." This orientation contrasted sharply with Bender's view. Noting that withdrawn children became more emotionally responsive while aggressive children became less so, she hypothesized that psychedelic drugs "tend to 'normalize' behavior rather than subdue or stimulate it." This basic difference in expectations seems at least partially responsible for Bender's extremely favorable outcomes and Freedman's rather poor results. Regarding all forms of psychotherapy, it has become a truism that " where there is no therapeutic intent, there is no therapeutic result" (Charles Savage in Abramson, 1960, p. 193).
• Consistent with their explicit therapeutic intent, Bender, Fisher, and Simmons each offer essentially the same hypothesis based on a psychological interpretation of childhood schizophrenia: " The working hypothesis of this study is that the psychosis is a massive defensive structure in the service of protecting and defending the patient against his feelings and affectual states" (Fisher & Castile, 1963). Psychedelic drugs were viewed as a powerful means of undermining an intractable defense system and thereby making the patient more receptive to contact and communication with others.
• Although Freedman was prompted to use LSD primarily as an experimental device to study psychosis, he did mention that he was influenced to some extent by the dramatic improvement in autistic children reported by Peck and Murphy (in Abramson, 1960) and by the apparent success of Cholden, Kurland, and Savage (1955) in their work with adult mute catatonic patients. As will become apparent in the discussion of results, a partial and often transient alleviation of mutism by LSD treatment has been one of the most consistent effects reported in the children studies.
• "...the vocabularies of several of the children increased after LSD or UML; several seemed to be attempting to form words or watched adults carefully as they spoke; many seemed to comprehend speech for the first time or were able to communicate their needs... Very few of these changes in communication had been noted previously in such a large number of children, and at such a relatively rapid rate" (1963, p. 91).
• "They appeared flushed, bright eyed, and unusually interested in the environment... They participated with increasing eagerness in motility play with adults and other children. . . They seek positive contacts with adults, approaching them with face uplifted and bright eyes, and responding to fondling, affection, etc." (1962, pp. 172- 3). "There is less stereotyped whirling and rhythmic behavior. . . They became gay, happy, laughing frequently... Some showed changes in facial expression in appropriate reactions to situations for the first time" (1963, pp. 90-91).

• The Use of Psychedelic Agents with Autistic Schizophrenic Children, Robert E. Mogar and Robert W. Aldrich, Behavioral Neuropsychiatry 1969 Nov; 1(8):44-50

• "Schizophrenic children receiving d-lysergic acid or a derivative in daily adequate doses are without toxicity, side effects or gross emotional reactions. They show alterations in mood, appearance of physical well being, responsiveness, habit patterning, soft neurological signs, sympathetic nervous system stability, integrated perception, reality testing, thought processes, fantasy content and intellectual and personality maturity.
  "There are concurrent biochemical changes in the binding of serotonin and freeing of epinephrine. Some of these alterations occur in the first few days, others in the first few weeks and tend to level off, others continue for many months and are integrated into a more healthy and mature level in the development of the child."
• Comparatively large doses of LSD-25 and Sansert may be safely administered to autistic schizophrenic children for extended periods of time. Brain damage was not observed. Rather, improvement is reported.

• The Use of LSD-25 in the Therapy of Children, Harold A. Abramson, M.D., Journal of Asthma Research, 5: 139-143 (1967)

• Compared with non psychiatric subjects and neurotic subjects, the psychopath is responsive to "fewer cues which have the capacity to elicit the autonomic components of fear and anxiety." In their sensory responsiveness, these individuals are found to evidence higher detection thresholds for stimuli in general, this is that is hyposensitivity to low intensity stimulation. In a subgroup of primary psychopaths this hyposensitivity was found to be correlated significantly with a minimal tolerance for pain stimulation; in secondary psycopaths the correlation was reversed.
• Kast has suggested several effects of LSD on the experience of pain: (1) it temporarily interferes with a patient's concentration on one specific sensory input; (2) minor sensations make a claim on the patient's attention: (3) it diminished cortical control of thoughts, concepts, or ideas and thus reduces their significance in relation to vegetative function; and (4) it diffuses body boundaries and this diffuses painful sensations in the body. In two large scale clinical studies of terminal patients, Kast reported significant reductions in their experienced intensity of pain for a ten-day period. Parallel to this change, sleep patterns improved for approximately 12 to 14 days and a definite lifting of mood also was noted during the same period.

• “Research With Psychedelics, Some Biopsychological Concepts and Possible Clinical Applications”, Julian Silverman, Arch Gen Psychiatry, Vol 25, Dec 25, 1971(6), pp. 506-507

• We then gave LSD in the same doses to non-autistic schizophrenic boys 6 to 12 years osocif age. They were intelligent and verbal and could be tested psychologically and in psychiatric interviews (Bender et al., 1963). They were selected because they had typical schizophrenic psychosis, with flying fantasies and identification and body image difficulties, loose ego boundaries, introjected objects and voices and bizarre ideologies. They had obvious anxiety and labile vaso-vegetative functions. After administering LSD to these children we found results contrary to those reported in adults. These children became more insightful, more objective, more realistic; and in a short time they became frankly depressed for reality reasons. They noted they were in the hospital, that they were away from their family, and that they had had "crazy" ideas before.
  • "Children's Reactions to Psychotomimetic Drugs", L. Bender, Psychotomimetic Drugs, 1970; pp. 265-273

• The adrenergic-cholinergic balance hypothesis of mania and depression suggests that depression may be due to an over-activity or a hypersensitivity to central acetylcholine. From this hypothesis, it is logical that scopolamine, a centrally acting antimuscarinic agent, would be useful as an antidepressant.
  • "Serendipity strikes again: scopolamine as an antidepressant agent in bipolar depressed patients", Janowsky DS, Curr Psychiatry Rep. 2011 Dec;13(6):443-5

• Treatment naïve and treatment resistant patients showed improved clinical symptoms following scopolamine, while those who were treatment naïve showed greater improvement. Scopolamine rapidly reduces symptoms in both treatment history groups, and demonstrates sustained improvement even in treatment resistant patients.
  • "Antidepressant treatment history as a predictor of response to scopolamine: clinical implications.", Ellis JS, Zarate CA Jr, Luckenbaugh DA, Furey ML, J Affect Disord. 2014 Jun; 162:39-42.

• Two double-blind randomized placebo-controlled crossover trials with intravenous scopolamine 4.0 μg/kg infusions showed a significant improvement in depressive symptoms seen as soon as 3 days after the first treatment. Further data analyses showed a greater antidepressant effect in women, significant improvements in bipolar depression, and 85% success rates predicting who will respond to treatment.
  • "Scopolamine as an antidepressant: a systematic review". Jaffe RJ1, Novakovic V, Peselow ED., Clin Neuropharmacol. 2013 Jan-Feb;36(1):24-6.

• Compulsions are defined as repetitive acts, behaviors, or thoughts that are designed to counteract the anxiety associated with an obsession. The key characteristic of a compulsion is that it reduces the anxiety associated with the obsession. Many compulsions are acts associated with specific obsessions, such as hand washing to counteract thoughts of contamination. Compulsions can also manifest as thoughts. Obsessions and compulsions must cause an individual marked distress, consume at least 1 hour/day of time, or interfere with functioning to be considered as OCD. During at least some point in the illness, adult patients must recognize symptoms of OCD as unreasonable, although there is great variability in the degree to which this is true, both across individuals and in a given individual over time. DSM-IV-TR recognizes a poor insight subtype of OCD in which individuals fail to recognize the irrational or unreasonable nature of their obsessions. OCD frequently co-occurs with other disorders such as major depression, panic disorder, phobias, attention –deficit/hyperactivity disorder (ADHD), eating disorders, and Tourette,s syndrome.
  ICD-10 emphasizes that a compulsive act must not be pleasurable. ICD-10 also stipulates that obsessions or compulsions must be present on most days for 2 weeks.
  Inflated responsibility is increasingly regarded a pathogenetic mechanism in obsessive– compulsive disorder. In seeming contrast, there is mounting evidence that latent aggression is also elevated in OCD. Building upon psychodynamic theories that an altruistic facade including exaggerated concerns for others is partly a defense against latent aggression. Evidence was recently obtained for high interpersonal ambivalence in (OCD) patients relative to psychiatric and healthy controls. Psychotic symptoms often lead to obsessive thoughts and compulsive behaviors.
• GAD is characterized by a pattern of frequent, persistent worry and anxiety that is disproportionate to the impact of the events or circumstances on which the worry focuses. These patients must be bothered by their degree of worry. This pattern must occur “more days than not” for at least 6 months. They find it difficult to control their worry and must report three or more of six somatic or cognitive symptoms, which include: feelings of restlessness, fatigue, muscle tension, or insomnia. Worry is a common characteristic of a variety of anxiety disorders: patients with panic disorder worry about panic attacks, patients with OCD worry about their obsessions. The worries in GAD must exceed in breath or scope the worries that characterize these other anxiety disorders. Children with marked and persistent worry can also be diagnosed with GAD; unlike adults, however, they must only meet one of the six somatic/ cognitive symptom criteria.
• Anti-anxiety medications including popular benzodiazepines such as alprazolam (Xanax) , clonazepam (klonopin), diazepam (Valium), and lorazepam (Ativan) are meant for shortterm use. However, many people take anti-anxiety drugs for long periods of time. This is risky because, when taken regularly, benzodiazepines quickly lead to physical dependence. Drug tolerance is also common, with increasingly larger doses needed to get the same anxiety relief as before. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use.

• "Anxiety Disorder and Its Types", M. Shiri, S. Akhavan and N. Geramian Vice-Chancellery for Health, Isfahan University of Medical Sciences, Isfahan, Iran.

• Sexual satisfaction can be jeopardized by dysfunction that occurs at any stage of the sexual response cycle: excitement (desire and arousal), plateau, orgasm, and resolution. Such problems occur in 43 percent of women and 31 percent of men. The most common dysfunction for women is sexual arousal disorder (10–20 percent), and for men it is premature ejaculation (about 30 percent).
• Interestingly, anxiety affects sexual arousal in different ways for different people. Researchers have found very different results between people with a history of sexual dysfunction and people with no history of sexual dysfunction. For those with no history of dysfunction, anxiety sometimes actually increases arousal. People with otherwise good autonomic nervous functioning can experience a sexual arousal response to threat. The study that tested this administered an electric shock to participants while they were viewing pornographic material. The researchers found that those who were threatened with or received the shock experienced greater physiological arousal than those who were left to watch pornography in peace.
• Having an anxiety disorder can cause people to develop sexual dysfunction. The reverse is also true that people with sexual disorders become more anxious. Men who experience premature ejaculation or inhibited sexual enjoyment are up to 2.5 times more likely to have an anxiety disorder that those who do not have these problems. Women with anxiety have an increased likelihood of arousal or orgasmic dysfunction up to 3.5 times more than non-anxious women. Looking at both men and women, anxiety is linked to a 2.6 times greater risk of orgasmic dysfunction, a 2.1 times greater risk for inhibited sexual excitement, and a 3.3 times greater risk of decreased sexual desire.

• "5 Effective Strategies to Help You Overcome Sexual Dysfunction", Christian Hahn, Anxiety.org, 08/16/2017.

• Carlo and his colleagues found that, on average, those individuals who carried the genotype associated with higher social anxiety were less likely to engage in prosocial behavior.
  "Previous research has shown that the brain's serotonin neurotransmitter system plays an important role in regulating emotions," said study co-author Scott Stoltenberg, an associate professor at the University of Nebraska-Lincoln. "Our findings suggest that individual differences in social anxiety levels are influenced by this serotonin system gene and that these differences help to partially explain why some people are more likely than others to behave prosocially. Studies like this one show that biological factors are critical influences on how people interact with one another."
  • "Those genetically predisposed to anxiousness may be less likely to volunteer, help others", University of Missouri-Columbia, ScienceDaily, 15 October 2013.

• Three reports have surfaced in the literature of individuals with long-standing OCD who experienced significant alleviation of their disorder after what was initially a “recreational” use of LSD, peyote, or Psilocybe mushrooms. The most recent of these relates that a 34-year-old man who had suffered from OCD since the age of 6 found that both peyote and Psilocybe mushrooms moderated his symptoms (which included incapacitating and compulsive counting, showering, and ritualistic washing of his clothes, hands, and body). He began a 4-year course of daily Psilocybemushroom ingestion, which resulted in improvement of his OCD symptoms, unaccompanied by any hallucinogenic effects because of his acquired tolerance. During a subsequent 2-year period, his OCD remained in control without the need for him to ingest Psilocybe, but then the symptoms gradually returned to their initial levels.
  Some beginnings have been made in studying the effects of psychedelic drugs for alleviating OCD. The potential benefits of these drugs in anorexia nervosa, a devastating and not infrequently life-threatening disorder with few or no fully successful treatment options, should likewise be studied.

• "Letter to the Editor: Hallucinogens and Obsessive-Compulsive Disorder", Daniel M. Perrine, American Journal of Psychiatry, Volume 156, Issue 7, July 1999, pp. 1123-1123.

• In a paper published this summer, Dr. Rafael dos Santos from the University of São Paulo in Brazil, along with his colleagues, sought to analyze and compile the research done on these drugs. Given the legal restrictions still placed on them, one difficulty in this area of research is identifying clinical trials conducted with the proper experimental methods and controls. Thus, of the 144 studies that the researcher found, only 6 made the cut for their analyses. Despite their small number, these studies reported consistent positive effects among their participants. For instance, psilocybin was found to improve symptoms of obsessive-compulsive disorder (OCD), reduce symptoms of anxiety and depression among terminally ill cancer patients, and decrease both alcohol and tobacco dependence among addicts. Likewise, LSD was reported to decrease anxiety symptoms associated with life-threatening diseases as well as help in the treatment of alcoholism. Crucially, the reported improvements lasted over the course of several days and, in some cases, months.
  • "Can Hallucinogens Treat Anxiety and Depression?", Samuel Hunley, Ph.D., Anxiety.org, 05/25/2017

• Scientific studies have looked at how individuals with autism spectrum disorder, childhood antisocial behaviors, schizophrenia, and other extreme social disorders affect how they perceive emotions. The failure to properly recognize and categorize emotions (i.e., recognize a smile as happy) is believed to be a root cause of many behaviors associated with these social disorders. When we discuss people not reading emotional facial expressions, we tend to assume that one of these social disorders is at work — most likely autism spectrum disorder. However, anxiety, anxiety disorders, and other mood disorders such as major depression also influence how we read emotional faces. Specifically, people who have high levels of anxiety or depression often categorize faces as fearful or angry.

• "High Levels of Anxiety Can Make You Misinterpret Facial Expressions", Arick Wang, M.A., Anxiety.org, 09/04/2017

• Women have a higher incidence of stress related disorders including depression and generalized anxiety disorder, and epigenetic mechanisms likely contribute to this sex difference. Evidence from preclinical research suggests that epigenetic mechanisms are responsible for both sexual dimorphism of brain regions and sensitivity of the stress response. Epigenetic modifications such as DNA methylation and histone modifications can occur transgenerationally, developmentally, or in response to environmental stimuli such as stress exposure.
• Stress-related disorders such as major depression and generalized anxiety affect over 20% of the American population within their lifetime, and have an annual prevalence approaching 10%. Currently available treatments for these disorders produce remission in only 40-60% of patients. Therefore, a clear need exists for novel therapeutic strategies that target the underlying biology involved with vulnerability to depression and anxiety. Within the clinical populations presenting for stress-related disorders, there is a higher incidence in women compared to men. One factor that may contribute to the low response to treatment has been the continued reliance on using male animals in preclinical research. A recent meta-analysis of publications indicated that 65% of studies in pharmacology and 55% of neuroscience papers used male subjects exclusively.

• "Sex, stress, and epigenetics: regulation of behavior in animal models of mood disorders", Georgia E Hodes, Biology of Sex Differences, 2013 4:1

• But what if you are constantly on the receiving end of threats like the ones above? Feelings of wanting to help soon turn to anger and resentment. Being constantly bombarded by comments from another person threatening to kill themselves is emotional blackmail. You never know what will come next, and as a result, feelings of anger, resentment, and fear all build up. It may feel like you have no choice but to do exactly what the person says in order to avoid a tragedy, but there are steps you can take to protect yourself and potentially save the other person’s life as well.
  • “Feeling Manipulated by Suicide Threats?”, Kate Thieda , Psych Central, (2011)

• The existence of alarm pheromones—chemosensory stress cues communicated between members of the same species—is well established in non-human mammals; when animals inhale odors secreted by acutely stressed conspecifics, they express neurobiological and behavioral changes consistent with heightened threat assessment ( Fanselow, 1985 ; Zalaquett and Thiessen, 1991 ; Dielenberg and McGregor, 2001 ; Dielenberg et al ., 2001 ; Kikusui et al ., 2001 ). In our fMRI experiment and its subsequent replication, we showed that humans also activate the amygdala during inhalation of sweat taken from an independent sample of emotionally stressed individuals, with exercise sweat as a control ( Mujica-Parodi et al ., 2009 ). Importantly, participants were unable to perceptually differentiate between the sweat odors, suggesting that the amygdala response was specific to emotional, rather than olfactory, discrimination. Psychophysiological and behavioral research have additionally demonstrated that inhalation of human stress sweat augments the defensive startle reflex ( Prehn et al ., 2006 ; Pause et al ., 2009 ) as well as enhancing perception and discrimination of fearful ( Zhou and Chen, 2009 ) and angry (Mujica-Parodi et al ., 2009 ) faces.
  • “Second-hand stress: inhalation of stress sweat enhances neural response to neutral faces”, Denis Rubin Yevgeny Botanov Greg Hajcak Lilianne R. Mujica-Parodi, Social Cognitive and Affective Neuroscience, Volume 7, Issue 2, 1 February 2012, Pages 208–212

• Frequent fear of nuclear war in adolescents seems to be an indicator for an increased risk for common mental disorders and deserves serious attention.
• Risks of war and terrorism are threatening our health, both directly in actual life and also indirectly by the increasingly violent content of video games and other forms of entertainment. How does this affect mental health? Earlier during the cold war period, fear of war was found to be common among adolescents, and more prevalent among girls than boys. Little is known about the influence of fear of war on mental health of adolescents. On one hand, it has been argued that worrying about nuclear war is related to positive aspects of mental health. On the other, fear of nuclear war has been found to associate with several measures of psychological distress in cross-sectional studies. To our knowledge, no follow-up studies have been published.
• Of the 400 women, 27.5% reported having feared nuclear war once a week or more often in 1990. The respective figures for men were 226 and 13.7%.
• The degree of perceived threat of nuclear war may depend on several factors, such as (i) actual presence and size of the nuclear weapon arsenal, (ii) actual political tensions and threats, (iii) media coverage of the former, (iv) mental, conscious and unconscious processing of information, and (v) psychological developmental influences specific to adolescence.
  Part of the fear may be based on realistic evaluation of the threat. Our baseline examination was carried out within two months before the outbreak of the Persian Gulf War in January 1991 and before the reductions in nuclear weapon arsenals in the United States and in Russia started. A quote from a novel describing the life experience of one teen-age girl during the pre-detente period may be illustrative:
• Widespread media coverage on any potential danger may bring about considerable increase in perceived fear.

• Fear of nuclear war increases the risk of common mental disorders among young adults: a five-year follow-up study Kari Poikolainen, Terhi Aalto-Setälä, Annamari Tuulio-Henriksson, Mauri Marttunen and Jouko Lönnqvist, BMC Public Health, 2004, 4:42

• Anxiety was a philosophical concept before it taken up by psychology and psychiatry. The Danish philosopher Kierkegaard (1813-1855) argued that anxiety is part of human nature. Anxiety arises where possibility and actuality come into contact and the present touches the future. Anxiety is a product of having the freedom to make choices and act, and by doing so make a commitment to one’s identity, ways of being in the world, and standing in relation to other people. For Kierkegaard, anxiety can be an avenue to stand in relation to God. This is why he wrote, “Whoever has learned to be anxious in the right way has learned the ultimate.”
  One can bracket out the God dimensions and still learn something valuable from Kierkegaard, namely that anxiety can cause inaction, which is, in its most basic sense, a loss of freedom. What is possible may never actualize and one may lose the present by tending to an imagined future. One becomes immobilized and unable to meet needs and realize goals and aspirations.
  • Peg O'Connor, "Anxiety Is a Part of Human Nature", Psychology Today, (Mar 24, 2017).

• The first time Faith-Ann Bishop cut herself, she was in eighth grade. It was 2 in the morning, and as her parents slept, she sat on the edge of the tub at her home outside Bangor, Maine, with a metal clip from a pen in her hand. Then she sliced into the soft skin near her ribs. There was blood–and a sense of deep relief. “It makes the world very quiet for a few seconds,” says Faith-Ann. “For a while I didn’t want to stop, because it was my only coping mechanism. I hadn’t learned any other way.”
  The pain of the superficial wound was a momentary escape from the anxiety she was fighting constantly, about grades, about her future, about relationships, about everything. Many days she felt ill before school. Sometimes she’d throw up, other times she’d stay home. “It was like asking me to climb Mount Everest in high heels,” she says.
• “The competitiveness, the lack of clarity about where things are going [economically] have all created a sense of real stress,” says Victor Schwartz of the Jed Foundation, a nonprofit that works with colleges and universities on mental-health programs and services. “Ten years ago, the most prominent thing kids talked about was feeling depressed. And now anxiety has overtaken that in the last couple of years.”
  • Susanna Schrobsdorff, "Teen Depression and Anxiety: Why the Kids Are Not Alright", Time, (Oct. 27, 2016).

• Male passersby were contacted either on a fear-arousing suspension bridge or a non-fear-arousing bridge by an attractive female interviewer who asked them to fill out questionnaires containing Thematic Apperception Test pictures. Sexual content of stories written by subjects on the fear-arousing bridge and tendency of these subjects to attempt post experimental contact with the interviewer were both significantly greater. No significant differences between bridges were obtained on either measure for subjects contacted by a male interviewer. A third study manipulated anticipated shock to male subjects and an attractive female confederate independently. Anticipation of own shock but not anticipation of shock to confederate increased sexual imagery scores on the Thematic Apperception Test and attraction to the confederate.
• Some evidence for the mechanics of the anxiety-sexual arousal link in the current research may be obtained from the fear ratings made by subjects in Experiment 3. When subjects anticipated receiving a strong shock and the female confederate was present during the anxiety manipulation, subjects re-ported significantly less fear than when no potential sexual object was present (t —2.17, d} = 19, p < .025). Since the questionnaires were filled out in private in both groups, it is unlikely that subjects' reporting merely reflects appropriate behavior in the presence of the opposite or same sex. One possible explanation for this result is that, having relabeled anxiety as sexual arousal, the subject is less likely to feel anxious. A more conclusive explanation of the mechanics of the anxiety-sexual arousal link must await the conclusion of present laboratory studies designed specifically to investigate this prob-lem. However, regardless of the interpretation of the mechanics of this link, the present re-search presents the clearest demonstration to date of its existence

• Donald G. Dutton, Arthur P. Aron, "Some Evidence For Heightened Sexual Attraction Under Conditions of High Anxiety", Journal of Personality and Social Psychology, 1974, Vol. 30, No. 4, pp. (510-517).

Eating disorders

• For females, bulimic symptoms increased from age 14 to 16 and declined slowly thereafter. For males, the symptoms decreased between ages 14 and 16 and returned in the early 20s. Females had higher levels of symptoms than males at every age. Age-associated trends in body mass index, appearance satisfaction, and symptoms of anxiety and depression were associated with some of the trends for both genders. For females, changes in alcohol consumption and cohabitation status functioned as predictors as well.
  • Abebe, D; Lein, L; von Soest (2012). "The development of bulimic symptoms from adolescence to young adulthood in females and males: A population‐based longitudinal cohort study", International Journal of Eating Disorders, 45 (6): 737–745. doi:10.1002/eat.20950. PMID 22886952.

• Of the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients-often females and aged younger and younger-seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement.
  • Abreu CN1, Cangelli Filho R1. "Anorexia nervosa and bulimia nervosa - a psychotherapeutic cognitive-constructivist approach", Int Rev Psychiatry. 2017 Jun;29(3):248-253. doi: 10.1080/09540261.2017.1285550. Epub 2017 Mar 2.

• Oxytocin is a peptide hormone important for social behavior and differences in psychological traits have been associated with variants of the oxytocin receptor gene in healthy people. We examined whether single nucleotide polymorphisms (SNPs) of the oxytocin receptor gene (OXTR) correlated with clinical symptoms in women with anorexia nervosa, bulimia nervosa, and healthy comparison (HC) women. Subjects completed clinical assessments and provided DNA for analysis. Subjects were divided into four groups: HC, subjects currently with anorexia nervosa (AN-C), subjects with a history of anorexia nervosa but in long-term weight recovery (AN-WR), and subjects with bulimia nervosa (BN). Five SNPs of the oxytocin receptor were examined. Minor allele carriers showed greater severity in most of the psychiatric symptoms. Importantly, the combination of having had anorexia and carrying either of the A alleles for two SNPS in the OXTR gene (rs53576, rs2254298) was associated with increased severity specifically for ED symptoms including cognitions and behaviors associated both with eating and appearance. A review of psychosocial data related to the OXTR polymorphisms examined is included in the discussion. OXTR polymorphisms may be a useful intermediate endophenotype to consider in the treatment of patients with anorexia nervosa.
  • Acevedo SF1, Valencia C1, Lutter M2, McAdams CJ3, "Severity of eating disorder symptoms related to oxytocin receptor polymorphisms in anorexia nervosa", Psychiatry Res. 2015 Aug 30;228(3):641-8. doi: 10.1016/j.psychres.2015.05.040. Epub 2015 Jun 11.

• An 18-year-old white woman had nausea, vomiting, weight loss, and a diagnosis of anorexia nervosa. Copper-colored skin was noted on physical examination, and serum chemistry values were normal. Subsequent fever, disorientation, and confusion led to the discovery of Addison's disease, which responded well to corticosteroid replacement therapy. Addisonian and anorexic patients exhibit clinical similarities, including nausea, vomiting, weight loss, abdominal pain, cold intolerance, hypothermia, and orthostasis. Other commonalities include prolongation of electrocardiographic PR and QT intervals and generalized slowing on electroencephalogram. Important differences include a brown color to the skin in Addison's disease instead of a yellowish color in anorexia. Addisonian patients also display hypocortisolism, hypoglycemia, and hyperkalemia, in contrast to the hypercortisolism, hyperglycemia, and hypokalemia seen in anorexia.
  • Adams, R; Hinkebein, MK; McQuillen, M; Sutherland, S (1998). "Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting". Southern Medical Journal. 91 (2): 208–11. doi:10.1097/00007611-199802000-00017. PMID 9496878.

• While cerebral atrophy has been shown in patients with anorexia nervosa, cerebellar atrophy has never been reported in these patients. We report a case of cerebral atrophy with marked cerebellar atrophy in a 20-year-old woman with anorexia nervosa admitted to our hospital for severe weight loss. Neuroradiological examinations of the patient showed morphological brain alteration without focal parenchymal lesions. Cranial computerized tomography (CCT) showed an enlargement of the external cerebrospinal fluid spaces, especially those close to the cerebellar cistern. A brain magnetic resonance imaging (MRI) study confirmed the results of the CCT and dynamic single-photon emission tomography (d-SPECT) showed a reduced perfusion of the left brain areas. The reported case shows that some forms of anorexia nervosa have a concomitant presence of cerebral and cerebellar morphological anomalies. At present, it is not possible to demonstrate the whole correlation between the imaging reports and the clinical or neurological symptomatology. Some forms of brain alteration could be secondary to undernutrition; on the other hand, cerebral and cerebellar atrophy and eating disorders are far from clear and may also be an expression of an unknown common denominator.
  • Addolorato, G; Taranto, C; Capristo, E; Gasbarrini, G (1998). "A case of marked cerebellar atrophy in a woman with anorexia nervosa and cerebral atrophy and a review of the literature". The International Journal of Eating Disorders. 24 (4): 443–7. doi:10.1002/(SICI)1098-108X(199812)24:4<443::AID-EAT13>3.0.CO;2-4. PMID 9813771.

• Because eating disorders (EDs) and obsessive compulsive disorder (OCD) co-occur at high rates and can have functionally similar clinical presentations, it has been suggested that both constructs might be part of a common spectrum of disorders. Identifying the relationship between EDs and OCD may lead to the discovery of important shared core disease processes and/or mechanisms for maintenance. The objective of this paper is to understand the relationship between EDs and OCD by systematically reviewing epidemiological, longitudinal and family studies guided by five models of comorbidity posited by Klein and Riso (1993) and others. Though this literature is relatively small, the preponderance of evidence from these studies largely suggests that OCD/ED co-occur because of a shared etiological relationship.
  • Altman SE1, Shankman SA, "What is the association between obsessive-compulsive disorder and eating disorders?", Clin Psychol Rev. 2009 Nov;29(7):638-46. doi: 10.1016/j.cpr.2009.08.001.

• It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.
  • American Dietetic Association (2006). "Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders". Journal of the American Dietetic Association. 106 (12): 2073–82. doi:10.1016/j.jada.2006.09.007. PMID 17186637.

• There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder.
• Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.
  • American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 329–354. ISBN 978-0-89042-555-8.

• Approximately two-thirds of the subjects with anorexia nervosa reported perfectionism and rigidity in childhood. This prevalence is consistent with that reported by Rastam (22) for premorbid obsessive-compulsive (or anankastic) personality disorder in anorexia nervosa. We are not aware of any similar studies conducted for patients with bulimia nervosa. However, previous findings that perfectionism, obsessionality, excessive concern about mistakes, and doubt about actions persist after recovery from both disorders suggest that they represent persistent traits (10, 13, 16).
• The findings suggest that childhood obsessive-compulsive personality traits are important risk factors for later development of eating disorders, particularly anorexia nervosa. Furthermore, the findings suggest that childhood perfectionism and rigidity may offer a more specific and homogenous phenotypic determination for genetic studies. Further studies are needed to determine whether these traits are specific for eating disorders or are also linked to other psychiatric disorders, such as depression or OCD. Personality traits may also act as maintaining factors and as such may have an important influence on the prognosis of the disorder. Studies of people who have recovered from an eating disorder would be needed to explore the influence of childhood obsessive-compulsive-personality traits on the length of illness and its severity. Female subjects were included in this study because the prevalence of eating disorders is approximately nine times higher in women than in men. However, further studies that include male subjects are needed to better understand the role of the assessed traits. To our knowledge, the interview scale described here is the first to measure these personality trait risk factors in a broad and comprehensive way. The finding that perfectionism and rigidity represent strong risk factors suggests that these items might also be also used to identify people at high risk for developing an eating disorder later in life. Prospective studies are needed to replicate these findings.
  • Anderluh, MB; Tchanturia, K; Rabe-Hesketh, S; Treasure, J (2003). "Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype". The American Journal of Psychiatry. 160(2): 242–7. doi:10.1176/appi.ajp.160.2.242. PMID 12562569.

• Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered
  • Arcelus, J; Witcomb, GL; Mitchell, A (March 2014). "Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis". European Eating Disorders Review. 22 (2): 92–101. doi:10.1002/erv.2271. PMID 24277724.

• At follow-up in girls, 3.6% (15 of 422) in control schools compared with 1.2% (4 of 327) in intervention schools reported engaging in disordered weight-control behaviors (P = .04). Multivariate analyses indicated that the odds of these behaviors in girls in intervention schools were reduced by two thirds compared with girls in control schools (odds ratio, 0.33; 95% confidence interval, 0.11-0.97). No intervention effect was observed in boys.
• Results add compelling support for the effectiveness of an interdisciplinary, school-based obesity prevention intervention to prevent disordered weight-control behaviors in early adolescent girls.
  • Austin SB1, Kim J, Wiecha J, Troped PJ, Feldman HA, Peterson KE, “School-based overweight preventive intervention lowers incidence of disordered weight-control behaviors in early adolescent girls.“, Arch Pediatr Adolesc Med. 2007 Sep;161(9):865-9.

• Several lines of evidence suggest that a disturbance of serotonin neuronal pathways may contribute to the pathogenesis of anorexia nervosa (AN) and bulimia nervosa (BN). This study applied positron emission tomography (PET) to investigate the brain serotonin 2A (5-HT(2A)) receptor, which could contribute to disturbances of appetite and behavior in AN and BN. To avoid the confounding effects of malnutrition, we studied 10 women recovered from bulimia-type AN (REC AN-BN, > 1 year normal weight, regular menstrual cycles, no binging, or purging) compared with 16 healthy control women (CW) using PET imaging and a specific 5-HT(2A) receptor antagonist, [18F]altanserin. REC AN-BN women had significantly reduced [18F]altanserin binding potential relative to CW in the left subgenual cingulate, the left parietal cortex, and the right occipital cortex. [18F]altanserin binding potential was positively related to harm avoidance and negatively related to novelty seeking in cingulate and temporal regions only in REC AN-BN subjects. In addition, REC AN-BN had negative relationships between [18F]altanserin binding potential and drive for thinness in several cortical regions. In conclusion, this study extends research suggesting that altered 5-HT neuronal system activity persists after recovery from bulimia-type AN, particularly in subgenual cingulate regions. Altered 5-HT neurotransmission after recovery also supports the possibility that this may be a trait-related disturbance that contributes to the pathophysiology of eating disorders. It is possible that subgenual cingulate findings are not specific for AN-BN, but may be related to the high incidence of lifetime major depressive disorder diagnosis in these subjects.
  • Bailer, UF; Price, JC; Meltzer, CC; Mathis, CA; Frank, GK; Weissfeld, L; McConaha, CW; Henry, SE; Brooks-Achenbach, S; Barbarich, NC; Kaye, WH (2004). "Altered 5-HT(2A) receptor binding after recovery from bulimia-type anorexia nervosa: relationships to harm avoidance and drive for thinness". Neuropsychopharmacology. 29 (6): 1143–55. doi:10.1038/sj.npp.1300430. PMC 4301578. PMID 15054474.

• Because recent limitations in health care coverage have resulted in shorter lengths of inpatient stay, many patients with anorexia nervosa are discharged while still underweight. The authors' goal was to determine whether anorectic patients who were underweight when they were discharged had a worse outcome and a higher rate of rehospitalization than those who had achieved normal weight at discharge.
• Anorectic patients who were discharged while severely underweight reported significantly higher rates of rehospitalization and endorsed more symptoms than those who had achieved normal weight before discharge.
• These data suggest that brief hospitalization for severely underweight women with anorexia may not be cost effective because the majority are rehospitalized.
  • Baran, SA; Weltzin, TE; Kaye, WH (1995). "Low discharge weight and outcome in anorexia nervosa". The American Journal of Psychiatry. 152 (7): 1070–2. doi:10.1176/ajp.152.7.1070. PMID 7793445.

• The latest studies and practice guidelines for the treatment of adolescent patients with anorexia nervosa agree in pointing out the key role played by parents in determining the young patients’ therapeutic possibilities and outcomes. Still family functioning has usually been studied using only self-reported instruments. The aim of the present study is therefore to investigate the triadic interactions within the families of adolescents with anorexia nervosa using a semi-standardized observational tool based on a recorded play session, the Lausanne Trilogue Play (LTP). Parents and adolescent daughters, consecutively referred to adolescent neuropsychiatric services, participated in the study and underwent the observational procedure (LTP). The 20 families of adolescent girls with anorexia nervosa (restricting type) were compared with 20 families of patients with internalizing disorders (anxiety and depression). The results showed different interactive patterns in the families of adolescents with anorexia nervosa: they had greater difficulties in respecting roles during the play, maintaining the joint attention and in sharing positive affect, especially in the three-together phase (third phase).
  • Laura Balottin, Stefania Mannarini, Martina M. Mensi, Matteo Chiappedi, and Michela Gatta “Triadic Interactions in Families of Adolescents with Anorexia Nervosa and Families of Adolescents with Internalizing Disorders”, Front Psychol. 2016; 7: 2046. [10.3389/fpsyg.2016.02046]

• Anorexia nervosa often begins in adolescence, and there is a growing body of quantitative literature looking at the efficacy of treatment for adolescents. However, qualitative research has a valuable contribution to make to the understanding of treatment and recovery. This paper aims to review qualitative studies on the experience of treatment and recovery for adolescents with anorexia nervosa. Key themes from the 11 studies identified the role of family, peers and professionals, family therapy, the inpatient setting, emphasis on physical versus psychological and conceptualisation of recovery. Future studies would benefit from relating their findings to adolescent theory and considering reflexivity.
• This literature search revealed only six randomised controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients. Due to the small sample sizes and the significant risk of bias (particularly information bias) in some of the studies the evidence in favour of family therapy over individual therapy is weak. In the future, larger randomised controlled trials with long term follow-up are required to assess whether family therapy is the most effective treatment for anorexia nervosa in adolescence.
  • Bezance J1, Holliday J., "Adolescents with anorexia nervosa have their say: a review of qualitative studies on treatment and recovery from anorexia nervosa", Eur Eat Disord Rev. 2013 Sep;21(5):352-60. doi: 10.1002/erv.2239. Epub 2013 Jun 13.

• Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n = 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9-26.5) of treatment, but only one patient went into remission while waiting for treatment (P = 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 > or = 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6-36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover.
  • Bergh, C; Brodin, U; Lindberg, G; Södersten, P (2002). "Randomized controlled trial of a treatment for anorexia and bulimia nervosa". Proceedings of the National Academy of Sciences of the United States of America. 99 (14): 9486–91. Bibcode:2002PNAS...99.9486B. doi:10.1073/pnas.142284799. PMC 123167. PMID 12082182.

• The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1-20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17-19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications.
  • Berman, MI; Boutelle, KN; Crow, SJ (2009). "A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa". European Eating Disorders Review. 17 (6): 426–34. doi:10.1002/erv.962. PMID 19760625.

• This review first identifies diseases with which eating disorders are often confused and then explores features in the history, physical examination, and laboratory studies, which can provide clues to the cause of the patient's symptoms. In addition, it discusses the recommended evaluation and treatments for the gastrointestinal diseases that most commonly mimic the presentation of eating disorders including Crohn disease (CrD), celiac disease, gastroesophageal reflux disease (GERD), and eosinophilic esophagitis (EoE).
• The ubiquitous nature of the gastrointestinal complaints requires the clinician to consider a broad differential diagnosis when evaluating a patient for an eating disorder.
  • Bern EM, O'Brien RF (Aug 2013). "Is it an eating disorder, gastrointestinal disorder, or both?". Curr Opin Pediatr (Review). 25 (4): 463–70. doi:10.1097/MOP.0b013e328362d1ad. PMID 23838835

• ADHD girls were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period compared to control females. Girls with eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder compared to ADHD girls without eating disorders. Girls with ADHD and eating disorders had a significantly earlier mean age at menarche than other ADHD girls. No other differences in correlates of ADHD were detected between ADHD girls with and without eating disorders.
  • Biederman, J; Ball, SW; Monuteaux, MC; Surman, CB; Johnson, JL; Zeitlin, S (2007). "Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study". Journal of Developmental and Behavioral Pediatrics: JDBP. 28(4): 302–7. doi:10.1097/DBP.0b013e3180327917. PMID 17700082.

• A randomized controlled trial of zinc supplementation in anorexia nervosa (AN) reported a two-fold increase of the rate of increase of body mass index (BMI) in the zinc group. Zinc is inexpensive, readily available and free of significant side effects. However, oral zinc supplementation is infrequently prescribed as an adjunctive treatment for AN. Understanding the mechanism of action of zinc may increase its use.
• Low zinc intake, which is very common in AN, adversely affects neurotransmitters in various parts of the brain, including gamma-amino butyric acid (GABA) and the amygdala, which are abnormal in AN. Zinc supplementation corrects these abnormalities, resulting in clinical benefit in AN.
• Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.
  • Birmingham, CL; Gritzner, S (2006). "How does zinc supplementation benefit anorexia nervosa?". Eating and Weight Disorders : EWD. 11 (4): e109–11. PMID 17272939.

• Social cognitive theory would warn that the high prevalence of interaction opportunities in the pro–eating disorder community has the potential to be extremely harmful if viewers are learning dangerous behaviors from one another, particularly if they are similar in age and gender. Other studies suggest that discussing techniques and perceived benefits may also have contagious effects on those not yet committed to the behaviors.5 The disclaimers included on pro–eating disorder Web sites may warn unsuspecting readers away from distressing content but also may entice vulnerable individuals to read further. Although there is no evidence as to the impact of warnings or disclaimers on pro–eating disorder sites, research on other media such as movies and video games with adult ratings suggests that labels might entice young viewers to want to see media that are not appropriate for them.
  Behavioral and communication theories, such as the social cognitive and cultivation theories mentioned earlier,8,9 would also suggest that the most deleterious components of these sites are the evocative images depicted coupled with constant social support encouraging extreme behaviors. On these Web sites, striving to be underweight is deemed not only as normative but as a signal of success. Only 13% of site maintainers offered an overt statement indicating that their own eating disorder was a problem. In addition, the Internet's easy accessibility allows users to tap into a site's features at any time of day or night.
  Social interaction is the most common reason young people use the Internet. This may be particularly relevant to the eating disorder online community, as research shows that individuals suffering from eating disorders have difficulty relating with same-age peers, attempt to hide their eating disorder behaviors, and often experience shame and isolation. Online venues for interaction with friends or strangers may seem like a safer and even appropriate place to disclose personal information. Furthermore, the Internet allows one to not only maintain relative anonymity but also easily retreat from criticism or uncomfortable situations.
  • Borzekowski, D; Schenk, S; Wilson, J; Peebles, R (2010). "E-Ana and e-mia: A content analysis of pro-eating disorder web sites". American Journal of Public Health. 100 (8): 1526–1534. doi:10.2105/AJPH.2009.172700. PMC 2901299. PMID 20558807.

• The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.
  • Braun, DL; Sunday, SR; Halmi, KA (1994). "Psychiatric comorbidity in patients with eating disorders". Psychological Medicine. 24 (4): 859–67. doi:10.1017/S0033291700028956. PMID 7892354.

• Findings indicate that women with BN and co-morbid APD may be characterized by interpersonal submissiveness and avoidance, affective instability, self-harm, behavioural inhibition in response to threat and lower sensitivity to serotonergic activation. These findings may indicate common, serotonergic factors, associated with social submissiveness, behavioural inhibition to threat and BN.
  • Bruce KR1, Steiger H, Koerner NM, Israel M, Young SN, "Bulimia nervosa with co-morbid avoidant personality disorder: behavioural characteristics and serotonergic function". Psychological Medicine. 34 (1): 113–24. doi:10.1017/S003329170300864X. PMID 14971632.

• Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism.
• Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.
  • Bulik, CM; Klump, KL; Thornton, L; Kaplan, AS; Devlin, B (2004). "Alcohol use disorder comorbidity in eating disorders: a multicenter study". The Journal of Clinical Psychiatry. 65 (7): 1000–6. doi:10.4088/JCP.v65n0718. PMID 15291691.

• Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals.
• Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism.
• Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.
  • Bulik CM1, Klump KL, Thornton L, Kaplan AS, Devlin B, Fichter MM, Halmi KA, Strober M, Woodside DB, Crow S, Mitchell JE, Rotondo A, Mauri M, Cassano GB, Keel PK, Berrettini WH, Kaye WH, “Alcohol use disorder comorbidity in eating disorders: a multicenter study.”, J Clin Psychiatry. 2004 Jul;65(7):1000-6.

• In a large study of psychiatric outpatients, their eating disorders were mainly classed as "not otherwise specified" (NOS) — rather than as bulimia, anorexia, or binge eating — and most patients failed to meet the full diagnostic criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ( DSM-IV).
  This suggests that DSM-IV diagnostic thresholds for eating disorders are too restrictive, the researchers, led by Mark Zimmerman, MD, from Brown University School of Medicine, in Providence, Rhode Island, write.
  Dr. Zimmerman told Medscape that their findings "strongly suggest that there are problems with the diagnostic criteria in the DSM category for eating disorders, because most individuals with an eating disorder don't meet the formal diagnostic criteria." He added that this contrasts with other categories of diagnosis — such as anxiety, personality, and depressive disorders — where "the overwhelming majority" of individuals meet the formal diagnostic criteria. "The conclusion is that there are significant problems with the eating-disorder diagnostic category in the DSM," he said.
  • Busko, Marlene. "DSM-IV Diagnostic Criteria for Eating Disorders May Be Too Stringent". Medscape. Archived from the original on 2012-05-13.

• Clinical signs of hypometabolism in anorexia nervosa may result from the "low triiodothyronine syndrome," in which thyroxine (T4) and thyroid stimulating hormone are usually normal, but triiodothyronine (T3) is in a range compatible with hypothyroidism. A case in which anorexia nervosa presented with unsuspected hyperthyroidism is reported.
  • Byerley, B; Black, DW; Grosser, BI (1983). "Anorexia nervosa with hyperthyroidism: case report". The Journal of Clinical Psychiatry. 44 (8): 308–9. PMID 6874653.

• Studies comparing PSH with GSH found no significant differences between treatment groups at end of treatment or follow-up. Comparison between different types of PSH/GSH found significant differences on eating disorder symptoms but not on bingeing/purging abstinence rates.
• PSH/GSH may have some utility as a first step in treatment and may have potential as an alternative to formal therapist-delivered psychological therapy. Future research should focus on producing large well-conducted studies of self-help treatments in eating disorders including health economic evaluations, different types and modes of delivering self-help (e.g. computerised versus manual-based) and different populations and settings.
  • Carter, JC; Olmsted, MP; Kaplan, AS; McCabe, RE (2003). "Self-help for bulimia nervosa: a randomized controlled trial". The American Journal of Psychiatry. 160 (5): 973–8. doi:10.1176/appi.ajp.160.5.973. PMID 12727703.

• The eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) are multifactorial syndromes of unknown origin which occur typically in female adolescents or young women. Nowadays, AN and BN are most often triggered by dietary restriction. Both are treatable conditions. As in other psychiatric disorders, a lower comorbidity, a shorter duration of illness, less familial psychopathology, and, in AN, a higher minimal weight have been shown to be associated with a better outcome. So far, no abnormalities specific to AN or BN that would shed light on their etiology have been identified. Controlled and uncontrolled studies testing antipsychotic, antidepressant, weight-promoting, and prokinetic drugs have demonstrated that the core symptoms of AN are refractory to currently available psychotropic medication. For relapse prevention, however, antidepressant medication may be useful. Renutrition, psychotherapy, and family therapy remain the cornerstones of treatment for AN. Placebo-controlled studies with antidepressant drugs have been far more promising for treating BN in the short term. Recent studies have found that lasting symptomatic improvement and remission require the addition of psychological treatments in the form of cognitive and interpersonal psychotherapy. The steady stream of newly identified peptides and other molecules involved in appetite and body weight control may ultimately provide cues to better targeted treatments of eating disorders.
  • Casper, RC (2002). "How useful are pharmacological treatments in eating disorders?". Psychopharmacology Bulletin. 36 (2): 88–104. PMID 12397843.

• Personality traits have been implicated in the onset, symptomatic expression, and maintenance of eating disorders (EDs). The present article reviews literature examining the link between personality and EDs published within the past decade, and presents a meta-analysis evaluating the prevalence of personality disorders (PDs) in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) as assessed by self-report instruments versus diagnostic interviews. AN and BN are both consistently characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant PD. Consistent differences that emerge between ED groups are high constraint and persistence and low novelty seeking in AN and high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline PD in BN. The meta-analysis, which found PD rates of 0 to 58% among individuals with AN and BN, documented that self-report instruments greatly overestimate the prevalence of every PD.
  • Cassin SE1, von Ranson KM, "Personality and eating disorders: a decade in review.", Clin Psychol Rev. 2005 Nov;25(7):895-916.

• BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs.
  • Caslini, M; Bartoli, F; Crocamo, C; Dakanalis, A; Clerici, M; Carrà, G (January 2016). "Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis". Psychosomatic Medicine. 78 (1): 79–90. doi:10.1097/psy.0000000000000233. PMID 26461853.

• Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder.
  • Casper, Regina C (1998). "Depression and eating disorders". Depression and Anxiety. 8 (Suppl 1): 96–104. doi:10.1002/(SICI)1520-6394(1998)8:1+<96::AID-DA15>3.0.CO;2-4. PMID 9809221. https://www.ncbi.nlm.nih.gov/pubmed/9809221

• We report the case of a 10-year-old girl with a mature teratoma in the hypothalamic region. The patient presented a 2-month history of anorexia, psychic disturbances and a 37% loss of body weight. These symptoms had led initially to a diagnosis of major depression and atypical anorexia nervosa. She also presented some signs and symptoms of diencephalic syndrome. This case illustrates the importance of considering a slow-growing mass as a rare but real possibility in the differential diagnosis of anorexia nervosa, mainly in atypical cases.
  • Chipkevitch, E; Fernandes, AC (1993). "Hypothalamic tumor associated with atypical forms of anorexia nervosa and diencephalic syndrome". Arquivos de Neuro-psiquiatria. 51 (2): 270–4. doi:10.1590/S0004-282X1993000200022. PMID 8274094..

• We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.
  • Conrad, R; Wegener, I; Geiser, F; Imbierowicz, K; Liedtke, R (2008). "Nature against nurture: calcification in the right thalamus in a young man with anorexia nervosa and obsessive-compulsive personality disorder". CNS Spectrums. 13 (10): 906–10. PMID 18955946.

• Obstetrical complications, based on parental recall, have been reported to be associated with development of anorexia nervosa. We used prospectively collected data about pregnancy and perinatal factors to examine the subsequent development of anorexia nervosa.
• Increased risk of anorexia nervosa was found for girls with a cephalhematoma (OR, 2.4; 95% CI, 1.4-4.1) and for very preterm birth (< or = 32 completed gestational weeks) (OR, 3.2; 95% CI, 1.6-6.2). In very preterm births, girls who were small for gestational age faced higher risks (OR, 5.7; 95% CI, 1.1-28.7) than girls with higher birth weight for gestational age (OR, 2.7; 95% CI, 1.2-5.8).
• Our results show that perinatal factors, possibly reflecting brain damage, had independent associations with anorexia nervosa. These risk factors may uncover the mechanisms underlying the development of the disorder, even if only a fraction of cases of anorexia nervosa may be attributable to perinatal factors.
  • Cnattingius, S; Hultman, CM; Dahl, M; Sparén, P (1999). "Very preterm birth, birth trauma, and the risk of anorexia nervosa among girls". Archives of General Psychiatry. 56 (7): 634–8. doi:10.1001/archpsyc.56.7.634. PMID 10401509

• CRT cognitive training was performed. Eating Attitudes Test 26 (EAT - 26), Beck Depression Inwentory (BDI), Child Yale - Brown Obsessive - Compulsive Scale (CY - BOCS), Eating Disorders Belief Questionnaire (EDBQ), Wisconsin Card Sorting Test (WCST), Temperament and Character Inventory (TCI) and also Child Heath Questionnaire (CHQ) - assessed by parents, were used before and after the programme.
  After CRT completion, an improvement on the level ofpsychopathological symptoms was observed (especially in the EAT- 26 and BDI scales), in WCST some improvement was noticed. In TCI, no significant changes were found. In comparison to the initial assessment, an increased level of dysfunctional beliefs was observed.

Cognitive Remediation Therapy can be used in adolescent patients with anorexia nervosa. This procedure may be related to cognitive and symptomatological improvement.

• • Cwojdzińska, A; Markowska-Regulska, K; Rybakowski, F (2009). "Cognitive remediation therapy in adolescent anorexia nervosa—case report". Psychiatria Polska. 43 (1): 115–24. PMID 19694406.

• The Stroop task has been adapted from cognitive psychology to be able to examine attentional biases in various forms of psychopathology, including the eating disorders. This paper reviews the research on the Stroop task in the eating disorders research area in both descriptive and meta-analytic fashions. Twenty-eight empirical studies are identified, which predominantly examine food and body/weight stimuli in bulimic, anorexic, or dieting/food-restricted samples. It is concluded that there is evidence of an attentional bias in bulimia for a range of stimuli but that the effect seems to be limited to body/weight stimuli in anorexia. The evidence to date is that there is no attentional bias in dieting samples.
  • Dobson KS1, Dozois DJ. "Attentional biases in eating disorders: a meta-analytic review of Stroop performance", Clin Psychol Rev. 2004 Jan;23(8):1001-22.

• Anorexia nervosa (AN), usually seen in young girls, is characterised by severe emaciation induced by self-imposed starvation. Enlargement of the ventricular system and sulci has been reported, as has high signal on T2-weighted images. We present a case with atrophic changes and high signal on T2-weighted images, which resolved completely following weight gain.
  • Drevelengas, A; Chourmouzi, D; Pitsavas, G; Charitandi, A; Boulogianni, G (2001). "Reversible brain atrophy and subcortical high signal on MRI in a patient with anorexia nervosa". Neuroradiology. 43 (10): 838–40. doi:10.1007/s002340100589. PMID 11688699.

• Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia.
• Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
  • Dukarm, CP (May 2005). "Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication". Journal of Women's Health. 14 (4): 345–50. doi:10.1089/jwh.2005.14.345. PMID 15916509.

• Anorexia nervosa, which primarily affects adolescent girls and young women, is characterized by distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat. The criteria have several minor but important changes: • Criterion A focuses on behaviors, like restricting calorie intake, and no longer includes the word “refusal” in terms of weight maintenance since that implies intention on the part of the patient and can be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the absence of at least three menstrual cycles, will be deleted. This criterion cannot be applied to males, pre-menarchal females, females taking oral contraceptives and post-menopausal females. In some cases, individuals exhibit all other symptoms and signs of anorexia nervosa but still report some menstrual activity.
  • DSMV "Archived copy" (PDF). Archived from the original(PDF) on 2015-05-01. Retrieved 2015-04-09. “Eating Disorders Fact Sheet”, p.2.

• Anorexia nervosa is originated from disturbances at various points of the cortico-hypothalamo-hypophyseal axis.
  • Ehle, G; Wahlstab, A; Ott, J (1982). "Psychodiagnostic findings in anorexia nervosa and post-pill amenorrhea". Psychiatrie, Neurologie, und Medizinische Psychologie. 34 (11): 647–56. PMID 7170321.

• Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.
  • Eisenberg, ME; Neumark-Sztainer, D; Story, M; Perry, C (2005). "The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls". Social Science & Medicine. 60 (6): 1165–73. doi:10.1016/j.socscimed.2004.06.055. PMID 15626514.

• This paper reports the results of a randomised treatment trial of two forms of outpatient family intervention for anorexia nervosa. Forty adolescent patients with anorexia nervosa were randomly assigned to "conjoint family therapy" (CFT) or to "separated family therapy" (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index. The design required therapists to undertake both forms of treatment and the distinctiveness of the two therapies was ensured by separate supervisors conducting live supervision of the treatments. Measures were undertaken on admission to the study, at 3 months, at 6 months and at the end of treatment. Considerable improvement in nutritional and psychological state occurred across both treatment groups. On global measure of outcome, the two forms of therapy were associated with equivalent end of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between parents increased.
  • Eisler, I; Dare, C; Hodes, M; Russell, G (2000). "Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions". ‘’Journal of Child Psychology and Psychiatry, and Allied Disciplines’’. 41 (6): 727–36. doi:10.1111/1469-7610.00660. PMID 11039685.

• The relationship between characteristics of self-soothing ability, the capacity for evocative memory, and aloneness was investigated in a clinical sample of 50 bulimia nervosa (BN) patients.
• Results suggest the need for a more comprehensive understanding of the role of affect regulation and the experience of aloneness in BN and the need to develop treatments to specifically address these features of the illness.
  • Esplen MJ1, Garfinkel P, Gallop R., “Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa”, Int J Eat Disord. 2000 Jan;27(1):96-100.

• The similarities between the mentalities of anorexia nervosa, bulimia, and sexual repression among young women are undeniable. Young women starve their bodies until they can no longer resist both physical and sexual hungers. But the guilt associated with indulging becomes overwhelming and purging and punishment ensues. Both biological and sexual hungers are natural. However the messages sent to young women by their culture are that neither of these hungers are normal and, in fact, are immoral and inexcusable.
  • Essick, Ellen (2006). "Eating Disorders and Sexuality". In Steinberg, Shirley R.; Parmar, Priya; Richard, Birgit. Contemporary Youth Culture: An International Encyclopedia. Greenwood. p.276

• Recent studies have hypothesized that perinatal complications might increase the risk of developing eating disorders. However, it is unclear which pathways might link obstetric complications and eating disorders. The present study aimed at exploring the relationship between obstetric complications and temperament in eating disordered subjects.
• The sample was selected among subjects who took part in a prevalence study carried out on a representative sample of the general population and from among people with anorexia and bulimia nervosa referred to an outpatient specialist unit. Subjects who were born in the two obstetric wards of Padua Hospital between 1971 and 1979 and who completed the Tridimensional Personality Questionnaire were included. A blind analysis of the obstetric records of the whole sample was performed. The final sample was composed of 66 anorexia nervosa, 44 bulimia nervosa, and 257 control subjects.
• Among the different groups of obstetric complications, only the group that included preterm birth and other signs of neonatal immaturity or dysmaturity displayed a significant relationship with harm avoidance. The use of a mediation path analytic model revealed a significant, but incomplete, mediation effect of harm avoidance in explaining the link between neonatal dysmaturity and the development of eating disorders. Maternal weight gain during pregnancy seemed to have a protective effect on harm avoidance.
• The presence of signs of neonatal dysmaturity at birth seems to influence the development of high levels of harm avoidance in eating disorders.
  • Favaro, A; Tenconi, E; Santonastaso, P (2006). "Perinatal factors and the risk of developing anorexia nervosa and bulimia nervosa". Archives of General Psychiatry. 63 (1): 82–8. doi:10.1001/archpsyc.63.1.82. PMID 16389201.

• Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use.
  • Fedorowicz VJ1, Falissard B, Foulon C, Dardennes R, Divac SM, Guelfi JD, Rouillon F., "Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders." Int J Eat Disord. 2007 Nov;40(7):589-95.

• Serum leptin levels in three groups of patients affected by severe eating disorders are not related to the specific pathology but are correlated with the individual BMI. The analysis of leptin values may be a useful index of assessing the adipose tissue stores in the clinical setting, but will be of no help for diagnosis nor prognosis of severe eating disorders.
  • Ferron, F; Considine, R; Peino, R; Lado; I (1997). "Serum leptin concentrations in patients with anorexia nervosa, bulimia nervosa, and non-specific eating disorders correlate with the body mass index but are independent of the respective disease". Clinical Endocrinology. 46 (3): 289–293. doi:10.1046/j.1365-2265.1997.1260938.x. PMID 9156037.

• Previously, we identified that a majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) as well as some control subjects display autoantibodies (autoAbs) reacting with alpha-melanocyte-stimulating hormone (alpha-MSH) or adrenocorticotropic hormone, melanocortin peptides involved in appetite control and the stress response. In this work, we studied the relevance of such autoAbs to AN and BN. In addition to previously identified neuropeptide autoAbs, the current study revealed the presence of autoAbs reacting with oxytocin (OT) or vasopressin (VP) in both patients and controls. Analysis of serum levels of identified autoAbs showed an increase of IgM autoAbs against alpha-MSH, OT, and VP as well as of IgG autoAbs against VP in AN patients when compared with BN patients and controls. Further, we investigated whether levels of these autoAbs correlated with psychological traits characteristic for eating disorders. We found significantly altered correlations between alpha-MSH autoAb levels and the total Eating Disorder Inventory-2 score, as well as most of its subscale dimensions in AN and BN patients vs. controls. Remarkably, these correlations were opposite in AN vs. BN patients. In contrast, levels of autoAbs reacting with adrenocorticotropic hormone, OT, or VP had only few altered correlations with the Eating Disorder Inventory-2 subscale dimensions in AN and BN patients. Thus, our data reveal that core psychobehavioral abnormalities characteristic for eating disorders correlate with the levels of autoAbs against alpha-MSH, suggesting that AN and BN may be associated with autoAb-mediated dysfunctions of primarily the melanocortin system.
  • Fetissov, SO; Harro, J; Jaanisk, M; Järv, A; Podar, I; Nilsson, I; Sakthivel, P; Lefvert, AK; et al. (2005). "Autoantibodies against neuropeptides are associated with psychological traits in eating disorders". ‘’Proceedings of the National Academy of Sciences of the United States of America’’. 102 (41): 14865–70. Bibcode:2005PNAS..10214865F. doi:10.1073/pnas.0507204102. PMC 1253594. PMID 16195379.

• With the apparent increase in prevalence of anorexic and bulimic eating disorders, the search for effective treatments for these disorders has been intensified in recent years. In this review the results of psychopharmacological studies of patients with anorexia or bulimia nervosa are presented and analysed. The focus of this review is on controlled studies. Although a variety of psychopharmacological substances has been tested in patients with anorexia nervosa, the outcome of controlled studies has been generally disappointing. A possible differential therapy effect of cyproheptadine needs replication: in one study it enhanced body weight gain in non-bulimic anorexics, while it appeared to hinder weight gain in bulimic anorexics. The issue of prophylaxis of osteoporosis in chronic low-weight anorexics has received increasing attention in recent years, and pharmacological prophylaxis appears indicated in this patient group. The results of psychopharmacological treatment studies of patients with bulimia nervosa have overall been more favourable than those of anorexic patients. Statistically significant effects concerning the reduction of bulimic or depressive symptoms in bulimia nervosa has been demonstrated for tricyclic antidepressants (imipramine, desipramine), serotonergic agents (fluoxetine, d-fenfluramine), non-selective monoamine-oxydase-inhibitors (isocarboxazide, phenelzine) and trazodone. The antibulimic effect appears not to be associated with the antidepressant effect. Theoretical, methodological and practical issues concerning pharmacological treatment of anorexic and bulimic eating disorders are presented and discussed.
  • Fichter MM, “Drug treatment of anorexia nervosa and bulimia nervosa. A review”, ‘’Nervenarzt’’.1993 Jan;64(1):21-35.

• Franko et al’s results are also very interesting as they found that suicide attempts were more frequent among people with anorexia than among people with bulimia. This finding may have implications for clinical practice, both for treatment and for seeking confirmation of this evidence. The generalisability of Franko et al’s results will depend on further longitudinal studies with similar features. One of the authors’ aims was to identify predictors of suicide and suicide attempts. This should also be the aim of all mental health professionals involved in the treatment of people with eating disorders. However, future studies would benefit from a careful consideration of the diagnostic tools used, the evaluation of suicide risk and the recognition of comorbid Axis I disorders or personality disorders that may increase suicide risk dramatically.
  • Franko, DL; Keel, PK; Dorer, DJ; Blais, MA; Delinsky, SS (2004). "What predicts suicide attempts in women with eating disorders?". Psychological Medicine. 34 (5): 843–53.

• Body dissatisfaction, disordered eating and depression differentially affect adolescent girls (compared to boys); however, these variables have not been examined in relation to ethnicity. A review of the literature finds that Black adolescent girls are more satisfied with their bodies than White adolescent girls and engage much less frequently in dieting or disordered eating than do White girls in the US. A central question raised by this review is whether body dissatisfaction and pubertal timing are as relevant to our understanding of the etiology of depression in Black girls as they appear to be in White girls. Based on the available data, it does not seem that a risk factor model supporting the role of early pubertal timing, weight increases and body dissatisfaction in the development of depression applies to Black adolescent girls. This review underscores the need for future research with a variety of ethnic minority groups to better understand the etiology of adolescent depression.
  • Franko DL1, Striegel-Moore RH, “The role of body dissatisfaction as a risk factor for depression in adolescent girls: are the differences Black and White?”, J Psychosom Res. 2002 Nov;53(5):975-83.

• Suicide is the third most frequent cause of death among teenagers and young adults. Reviews and meta-analyses have shown that suicidal behaviour is more frequent among people with eating disorders than in the general population. The course of illness and the follow up period is of great importance for the correct evaluation of suicidality in this class of patients.5 Suicide may occur not only in the late phases of the illness but in periods of symptomatic remission.
  Franko et al assessed suicidality every 6–12 months over 8.6 years. This is a most important and innovative contribution to the international literature. This approach should be implemented in everyday clinical practice, as it provides a greater opportunity to predict and prevent suicidal behaviour. However, such an approach may work only with certain resources and with increased staff motivation. We agree with the scales employed by the authors; however scales specifically designed for suicide risk assessment should be used in future studies. The evaluation of suicidality using tools that aim to recognise the possibility of committing suicide may contribute to the definition of a suicidal spectrum among people with eating disorders.
  Franko et al’s results are also very interesting as they found that suicide attempts were more frequent among people with anorexia than among people with bulimia. This finding may have implications for clinical practice, both for treatment and for seeking confirmation of this evidence. The generalisability of Franko et al’s results will depend on further longitudinal studies with similar features. One of the authors’ aims was to identify predictors of suicide and suicide attempts. This should also be the aim of all mental health professionals involved in the treatment of people with eating disorders. However, future studies would benefit from a careful consideration of the diagnostic tools used, the evaluation of suicide risk and the recognition of comorbid Axis I disorders or personality disorders that may increase suicide risk dramatically.
  • Franko, DL; Keel, PK; Dorer, DJ; Blais, MA; Delinsky, SS (2004). "What predicts suicide attempts in women with eating disorders?". Psychological Medicine. 34 (5): 843–53.

• Disturbances of volume-regulating mechanisms have already been implicated in the pathophysiology of eating disorders like anorexia or bulimia nervosa with the peptide hormones vasopressin and atrial natriuretic peptide (ANP) being of special interest. Aim of the present study was to investigate, whether the expression of the corresponding genes was altered and if so, if these changes could be explained by epigenetic mechanisms such as DNA methylation. We analyzed blood samples of 46 women suffering from anorexia (n=22) or bulimia nervosa (n=24) as well as of 30 healthy controls. Peripheral mRNA expression and DNA methylation of the vasopressin and the ANP precursor genes were assessed using real-time PCR. We found significantly lower levels of ANP mRNA in patients with eating disorders. This downregulation was accompanied by a hypermethylation of the ANP gene promoter in the bulimic subgroup. We did not find differences regarding expression or methylation of the vasopressin gene. ANP mRNA expression was inversely associated with impaired impulse regulation. We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders.
  • Frieling H1, Bleich S, Otten J, Römer KD, Kornhuber J, de Zwaan M, Jacoby GE, Wilhelm J, Hillemacher T., “Epigenetic downregulation of atrial natriuretic peptide but not vasopressin mRNA expression in females with eating disorders is related to impulsivity.” Neuropsychopharmacology. 2008 Oct;33(11):2605-9. doi: 10.1038/sj.npp.1301662. Epub 2008 Jan 2.

• The pathophysiology of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) has been linked to an impaired dopaminergic neurotransmission, still the origin of this disturbance remains unknown. The aim of the present study was, therefore, to evaluate whether the expression of dopaminergic genes is altered in the blood of patients suffering from eating disorders and if these alterations can be explained by changes in the promoter specific DNA methylation of the genes.
• Our study shows a disturbed expression of dopaminergic genes that is accompanied by a dysregulation of the epigenetic DNA methylation. Further studies are necessary to provide more insight into the epigenetic dysregulation of the dopaminergic neurotransmission in the pathophysiology of eating disorders.
  • Frieling, H; Römer, KD; Scholz, S; Mittelbach, F; Wilhelm, J; De Zwaan, M; Jacoby, GE; Kornhuber, J; Hillemacher, T; Bleich, S (2010). "Epigenetic dysregulation of dopaminergic genes in eating disorders". The International Journal of Eating Disorders. 43 (7): 577–83. doi:10.1002/eat.20745. PMID 19728374.

• Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders.
• Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child's body. The conveyance of these negative stereotypes also affects the child's own body image and satisfaction. Hilde Bruch, a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control.
  • Fox, John (July 2009). "Eating Disorders and Emotions". Clinical Psychology & Psychotherapy. 16 (237–239): 237–239. doi:10.1002/cpp.625. PMID 19639648.

• The media have been focusing on websites that are “pro-anorexic” to illustrate the pervasiveness of eating disorders in the US. This study focuses on the narratives of women who participate in “pro-ana” sites using Lyng’s (Am J Sociol 95:851–886, 1990) concept of edgework. Results indicate that women struggle with feelings of loss of control and through various skills are able to resume control. These data point to the intense emotive reactions fasting elicits, reactions which both reinforce and provide motivation to remain in the subculture. Findings contribute to the literature by focusing on women’s edgework and demonstrating the similarities between men and women edgeworkers.
  • Gailey, J (2009). "Starving is the most fun a girl can have: The Pro-Ana subculture as edgework". ‘’Critical Criminology’’. 17 (2): 93–108. doi:10.1007/s10612-009-9074-z.

• Anorexia nervosa is a mental health disorder characterised by deliberate weight loss (through restrictive eating, excessive exercise and/or purging), disordered body image, and intrusive overvalued fears of gaining weight. The National Institute for Clinical Excellence recommends that family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
• This literature search revealed only six randomised controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients. Due to the small sample sizes and the significant risk of bias (particularly information bias) in some of the studies the evidence in favour of family therapy over individual therapy is weak. In the future, larger randomised controlled trials with long term follow-up are required to assess whether family therapy is the most effective treatment for anorexia nervosa in adolescence.
  • Gardner J1, Wilkinson P, “Is family therapy the most effective treatment for anorexia nervosa?”, ‘’Psychiatr Danub’’. 2011 Sep;23 Suppl 1:S175-7.

• A population of professional dance (N = 183) and modelling (N = 56) students, who by career choice must focus increased attention and control over their body shapes, was studied. Height and weight data were obtained on all subjects. In addition, a questionnaire that is useful in assessing the symptoms of anorexia nervosa, the Eating Attitudes Test (EAT), was administered. Results of these tests were compared with those of normal female university students (N = 59), patients with anorexia nervosa (N = 68), and music students (N = 35). Anorexia nervosa and excessive dieting concerns were overrepresented in the dance and modelling students. Twelve cases (6.5%) of primary anorexia nervosa were detected in the dance group. All but one case developed the disorder while studying dance. Within the dance group those from the most competitive environments had the greatest frequency of anorexia nervosa. These data suggest that both pressures to be slim and achievement expectations are risk factors in the development of anorexia nervosa. The influence of socio-cultural determinants are discussed within the context of anorexia nervosa as a multidetermined disorder.
  • Garner, DM; Garfinkel, PE (2009). "Socio-cultural factors in the development of anorexia nervosa". ‘’Psychological Medicine’’. 10 (4): 647–56. doi:10.1017/S0033291700054945. PMID 7208724.

• While abnormalities in central norepinephrine regulation may contribute to abnormal eating patterns in bulimia nervosa, alterations in function of the peripheral sympathetic nervous system could contribute to the decreased metabolic rate and increased anxiety responses previously reported in these patients. To assess beta-adrenergic receptor sensitivity in bulimic patients, we studied cardiovascular and hormonal responses to acute pharmacological challenge with intravenously administered isoproterenol. In comparison to healthy controls, binge-abstinent bulimic patients had significantly reduced mean baseline plasma norepinephrine level, pulse rate, and systolic blood pressure, and significantly increased chronotropic responses to isoproterenol infusion. Decreased sympathoneural activity may contribute to a tendency for bulimic patients to maintain body weight despite low caloric intake.
  • George, DT; Kaye, WH; Goldstein, DS; Brewerton, TD; Jimerson, DC (July 1990). "Altered norepinephrine regulation in bulimia: effects of pharmacological challenge with isoproterenol". Psychiatry Res. 33 (1): 1–10. doi:10.1016/0165-1781(90)90143-S. PMID 2171006.

• Eating disorders, such as anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorders (BED), are described as abnormal eating habits that usually involve insufficient or excessive food intake. Animal models have been developed that provide insight into certain aspects of eating disorders. Several drugs have been found efficacious in these animal models and some of them have eventually proven useful in the treatment of eating disorders. This review will cover the role of monoaminergic neurotransmitters in eating disorders and their pharmacological manipulations in animal models and humans. Dopamine, 5-HT (serotonin) and noradrenaline in hypothalamic and striatal regions regulate food intake by affecting hunger and satiety and by affecting rewarding and motivational aspects of feeding. Reduced neurotransmission by dopamine, 5-HT and noradrenaline and compensatory changes, at least in dopamine D2 and 5-HT(2C/2A) receptors, have been related to the pathophysiology of AN in humans and animal models. Also, in disorders and animal models of BN and BED, monoaminergic neurotransmission is down-regulated but receptor level changes are different from those seen in AN. A hypofunctional dopamine system or overactive α2-adrenoceptors may contribute to an attenuated response to (palatable) food and result in hedonic binge eating. Evidence for the efficacy of monoaminergic treatments for AN is limited, while more support exists for the treatment of BN or BED with monoaminergic drugs.
  • Ivan Gestel MA1, Kostrzewa E, Adan RA, Janhunen SK, “Pharmacological manipulations in animal models of anorexia and binge eating in relation to humans”, Br J Pharmacol. 2014 Oct;171(20):4767-84. doi: 10.1111/bph.12789. Epub 2014 Sep 5.

• In three hospitals 81 female patients satisfying rigorous diagnostic criteria for anorexia nervosa were randomly allocated to one of four treatment combinations of cyproheptadine and placebo with behaviour therapy and no behaviour therapy. Cyproheptadine was found to be effective in inducing weight gain in a subgroup of anorexia nervosa patients who (a) had a history of birth delivery complications, (b) had lost 41-52 per cent weight from norm and (c) had a history of prior outpatient treatment failure. This subgroup may represent a more severe form of anorexia nervosa.
  • Goldberg, SC; Halmi, KA; Eckert, ED; Casper, RC; Davis, JM (1979). "Cyproheptadine in anorexia nervosa". ‘’The British Journal of Psychiatry’’. 134: 67–70. doi:10.1192/bjp.134.1.67. PMID 367480.

• The prevalence of body dysmorphic disorder in patients with anorexia nervosa is unknown. We hypothesized that body dysmorphic disorder would be underdiagnosed in patients with anorexia nervosa and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction.
• Sixteen (39%) of the 41 patients with anorexia nervosa were diagnosed with comorbid body dysmorphic disorder unrelated to weight concerns. The anorexia nervosa patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder.
• These preliminary results suggest that body dysmorphic disorder may be relatively common among patients with anorexia nervosa. The presence of comorbid body dysmorphic disorder may indicate a more severe form of illness.
  • Grant, JE; Kim, SW; Eckert, ED (November 2002). "Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image". The International Journal of Eating Disorders. 32 (3): 291–300. doi:10.1002/eat.10091. PMID 12210643.

• Thirty-one women (averaging at least one binge/purge episode per week) were randomly assigned to 20 weeks of dialectical behavior therapy or 20 weeks of a waiting-list comparison condition. The manual-based dialectical behavior therapy focused on training in emotion regulation skills.
• An intent-to-treat analysis showed highly significant decreases in binge/purge behavior with dialectical behavior therapy compared to the waiting-list condition. No significant group differences were found on any of the secondary measures.
• The use of dialectical behavior therapy adapted for treatment of bulimia nervosa was associated with a promising decrease in binge/purge behaviors.

• Gray, JJ; Hoage, CM (1990). "Bulimia nervosa: group behavior therapy with exposure plus response prevention". Psychological Reports. 66 (2): 667–74. doi:10.2466/PR0.66.2.667-674. PMID 1971954.

• The aim of this study is to obtain CRF (Corticotropin Releasing Factor) stimulation at a suprahypothalamic level with a psychological stressor and to evaluate its response in anorexia nervosa. CRF plays a major role in the mechanisms underlying the hypothalamo-pituitary-adrenal (HPA) system's response to stress. Animal studies clearly showed that CRF is involved both in the adaptation to a novel environment and the regulation of eating behaviour. CRF's staietogenic effect is mediated via the paraventricular nucleus. Three groups of age matched young women were studied: 8 patients meeting the DSM III-R criteria for anorexia nervosa, 8 underweight healthy volunteers and 10 normal weight volunteers. All subjects were submitted to an auditory stimulation test ("psychosocial stress test") consisting of an intellectual task in which maximal performance is impossible to achieve, the subjects being permanently disturbed by various meaningful noises. Subjects were asked to answer self-rating scales for anxiety and tension prior to and after the test. CRF reactivity was measured by salivary cortisol (RIA). After the test, anorexia nervosa patients exhibit a significantly higher salivary cortisol response compared to the normal weight volunteers. In most of cases, salivary cortisol response was not correlated with the psychological variables. The range of the response is very explosive in two anorectic patients. Our data are consistent with the hyperactivity of the corticotropic axis stress response in anorexia nervosa, but request further investigations to prove that.
  • Gross, MJ; Kahn, JP; Laxenaire, M; Nicolas, JP; Burlet, C (1994). "Corticotropin-releasing factor and anorexia nervosa: reactions of the hypothalamus-pituitary-adrenal axis to neurotropic stress". Annales d'Endocrinologie. 55 (6): 221–8. PMID 7864577.

• There is no one sign of an eating disorder, however there are red flags. These can include excessive “fat, weight or calorie talk,” a pattern of eating a limited choice of low-calorie food or a pattern of occasional binge eating of calorie-dense foods. People with anorexia nervosa may excessively exercise or excessively stand, pace or fidget. Affected individuals may severely limit the amount of calories they consume or may avoid weight gain following meals by inducing vomiting or abusing laxative, diuretic and diet pills. Feeling self-conscious about one’s eating behavior is common. Affected individuals often avoid social eating settings and eat alone.
• There is no single cause of an eating disorder. We know that genetics play a large role, but genetic vulnerability is only part of the story. Environment plays a role too, especially in triggering onset, which often occurs in adolescence. Pressure to diet or weight loss related to a medical condition can be the gateway to anorexia nervosa or bulimia. For those who are genetically vulnerable to anorexia nervosa, once they lose the first five to 10 lbs, dieting becomes increasingly compelling and rewarding. Looked at another way, if eating disorders were the result solely of social pressure for thinness we would expect eating disorder rates to have increased as obesity has in the past few decades, yet anorexia nervosa and bulimia remain relatively rare and often cluster in families.
• Treatment for an eating disorder is challenging. It involves interrupting behaviors that have become driven and compelling. Recovery takes a team, which includes family, friends and other social supports, as well as medical and mental health professionals. Be empathic, but clear. List signs or behaviors you have noticed and are concerned about. Help locate a treatment provider and offer to go with your friend or relative to an evaluation. Be prepared that the affected individual may be uncertain about seeking treatment. Treatment is effective, many are able to achieve full recovery and the vast majority will improve with expert care. Treatment assists affected individuals to change what they do. It helps them normalize their eating and reframe the irrational thoughts that sustain eating disordered behaviors. Food is central to many social activities and the practice of eating meals with supportive friends and family is an important step in recovery.
• Eating disorders do not discriminate and can affect anyone. Although they are most common in young women, it is not unusual for older women to have an eating disorder. Some have had one all their life, others were only mildly affected until some life event triggers clinical worsening – a stressor, physical illness or a co-occurring psychiatric illness, such as depression or anxiety. Recent evidence strongly suggests that anxiety disorders, especially social anxiety disorder, and obsessive compulsive personality traits increase individual vulnerability to an eating disorder. Eating disorders occur in men too. An estimated 10 percent of people with anorexia nervosa and bulimia and a third or more of people with binge eating disorder are male. More
  • Angela Guarda, M.D. "Eating Disorders". American Psychiatric Association. Archived from the original on 21 December 2014. Retrieved 4 December 2014.

• Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration.
• A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration.
• Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.

• Gueguen J1,2, Piot MA2,3, Orri M1,2, Gutierre A3, Le Moan J3, Berthoz S1,3, Falissard B1,2, Godart N1,3. “Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers”, PLoS One. 2017 Feb 2;12(2):e0170885. doi: 10.1371/journal.pone.0170885. eCollection 2017.

• Eating disorders have morbidity and mortality rates that are among the highest of any mental disorders and are associated with significant functional impairment. This article provides an up-to-date review on recent developments and expanding knowledge in adolescent anorexia nervosa, bulimia nervosa, and related disorders. It covers diagnoses and assessment, recognition of typical symptoms, medical and psychiatric comorbidities, and current trends in epidemiology.
  • Herpertz-Dahlmann B, “Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity”, Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):31-47. doi: 10.1016/j.chc.2008.07.005.

• A prospective, naturalistic, longitudinal design was used to map the course of AN and BN in 246 women. Follow-up data are presented in terms of full and partial recovery, predictors of time to recovery, and rates and predictors of relapse.

The full recovery rate of women with BN was significantly higher than that of women with AN, with 74% of those with BN and 33% of those with AN achieving full recovery by a median of 90 months of follow-up. Intake diagnosis of AN was the strongest predictor of worse outcome. No predictors of recovery emerged among bulimic subjects. Eighty-three percent of women with AN and 99% of those with BN achieved partial recovery. Approximately one third of both women with AN and women with BN relapsed after full recovery. No predictors of relapse emerged.

• The findings suggest that the course of AN is characterized by high rates of partial recovery and low rates of full recovery, while the course of BN is characterized by higher rates of both partial and full recovery.
  • Herzog, DB; Dorer, DJ; Keel, PK; Selwyn, SE; Ekeblad, ER (1999). "Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study". Journal of the American Academy of Child and Adolescent Psychiatry. 38 (7): 829–37. doi:10.1097/00004583-199907000-00012. PMID 10405500.

• The purpose of this review is to evaluate the recent literature on the incidence and prevalence of and mortality associated with eating disorders.
• General-practice studies show that the overall incidence rates of anorexia nervosa remained stable during the 1990s, compared with the 1980s. Some evidence suggests that the occurrence of bulimia nervosa is decreasing. Anorexia nervosa is a common disorder among young white females, but is extremely rare among black females. Recent studies confirm previous findings of the high mortality rate within the anorexia nervosa population.
• The incidence of anorexia nervosa is around eight per 100,000 persons per year. An upward trend has been observed in the incidence of anorexia nervosa in the past century till the 1970s. The most substantial increase was among females aged 15-24 years, for whom a significant increase was observed from 1935 to 1999. The average prevalence rates for anorexia nervosa and bulimia nervosa among young females are 0.3 and 1%, respectively. Only a minority of people with eating disorders, especially with bulimia nervosa, are treated in mental healthcare.
  • Hoek HW, “Incidence, prevalence and mortality of anorexia nervosa and other eating disorders”, Curr Opin Psychiatry. 2006 Jul;19(4):389-94.

• The authors report the case of a female patient who developed anorexia nervosa. A cavernoma, located on the frontal side of the right sylvian, was discovered by chance after a seizure.
• Surgical treatment of the lesion resulted in complete remission of the eating disorder at two years follow-up.
• Evidence for organic brain contribution to anorexia nervosa is strong and can be illustrated by this case report of anorexia nervosa associated with cerebral tumour.
  • Houy, E; Debono, B; Dechelotte, P; Thibaut, F (2007). "Anorexia nervosa associated with right frontal brain lesion". The International Journal of Eating Disorders. 40 (8): 758–61. doi:10.1002/eat.20439. PMID 17683096.

• We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.
  • Illing Vanessa A.; Tasca Giorgio; Balfour Louise; Bissada Hany (2010). "Attachment Insecurity Predicts Eating Disorder Symptoms and Treatment Outcomes in a Clinical Sample of Women". The Journal of Nervous and Mental Disease. 198 (9): 653–59. doi:10.1097/nmd.0b013e3181ef34b2. PMID 20823727.

• The aim of the article was an attempt to present selected theoretical motifs and moreover self experience in the adaptation of elements of psychodrama by Moreno in psychodynamic psychotherapy (individual and group psychotherapy) in a group of people with anorexia and bulimia nervosa. Psychodrama through own creativity, spontaneity and taking action on the "here and now" stage helps to attain and intensify therapeutic aims which concern the consciousness of inner conflict of persons with anorexia and bulimia nervosa, which is translocated on their body.
  • Izydorczyk B, “Adaptation of psychodrama in psychotherapy of patients with anorexia nervosa and bulimia nervosa”, Psychiatr Pol. 2011 Mar-Apr;45(2):261-75.

• Ninety-four female-female twins underwent a transabdominal ultrasound examination to detect polycystic ovaries. The scans of 52 individuals showed normal ovaries and 42 had evidence of polycystic ovaries. All the subjects were sent a bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behavior. A total of 74 responses was received (79%). Overall, 76% of women with polycystic ovaries had an abnormal BITE score and their mean BITE score showed a significant increase compared to those with normal ovaries. Also, model fitting analysis suggested a strong genetic effect for bulimia using the BITE scoring system, and it provided strong evidence of a significant influence of environmental factors in the severity score of bulimia.
  • Jahanfar, S; Eden, JA; Nguyent, TV (1995). "Bulimia nervosa and polycystic ovary syndrome". Gynecological Endocrinology. 9 (2): 113–7. doi:10.3109/09513599509160199. PMID 7502686.

• A wide range of childhood adversities were associated with elevated risk for eating disorders and problems with eating or weight during adolescence and early adulthood after the effects of age, childhood eating problems, difficult childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were found between specific childhood adversities and specific types of problems with eating or weight, and different patterns of association were obtained among the male and female subjects. Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior, childhood maltreatment, and other co-occurring childhood adversities were controlled statistically.
  Childhood adversities may contribute to greater risk for the development of eating disorders and problems with eating and weight that persist into early adulthood. Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring.
  • Johnson, JG; Cohen, P; Kasen, S; Brook, JS (2002). "Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood", The American Journal of Psychiatry. 159 (3): 394–400. doi:10.1176/appi.ajp.159.3.394. PMID 11870002.

• Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased.
  When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.
  • Jones, C; Harris, G; Leung, N (2005). "Parental rearing behaviours and eating disorders: the moderating role of core beliefs". Eating Behaviors. 6 (4): 355–64. doi:10.1016/j.eatbeh.2005.05.002. PMID 16257809.

• Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor.
  • Joyce, JM; Warren, DL; Humphries, LL; Smith, AJ; Coon, JS (1990), "Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation", Journal of Nuclear Medicine. 31 (3): p. 325.

• About 60% of eating disorder cases are attributable to biological and genetic components. Other cases are due to external reasons or developmental problems.
  • Kadison, Richard (2004). College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It. San Francisco: Jossey-Bass. p. 132. ISBN 9780787981143.

• Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.
• Kaye, WH; Bulik, CM; Thornton, L; Barbarich, N; Masters, K (2004). "Comorbidity of anxiety disorders with anorexia and bulimia nervosa". The American Journal of Psychiatry. 161 (12): 2215–21. doi:10.1176/appi.ajp.161.12.2215. PMID 15569892.

• Although many women diet, relatively few develop the extreme weight loss and the clinical symptoms of anorexia nervosa. An underlying biological diathesis and temperament may place someone at risk for developing anorexia nervosa. Certain traits, such as negative affect, behavioral inhibition, compliance, high harm avoidance, and an obsessive concern with symmetry, exactness, and perfectionism, persist after recovery from anorexia nervosa. These persistent symptoms raise the possibility that such traits exist premorbidly and contribute to the pathogenesis of this disorder. Such traits could be associated with increased brain serotonin activity. After recovery, anorexics have increased levels of 5-HIAA, the major metabolite of serotonin, in the cerebrospinal fluid (CSF). Low CSF 5-HIAA levels have been associated with impulsive and aggressive behaviors, which are opposite to those typically found in anorexia nervosa. Increased serotonin activity could contribute to many behavioral symptoms, such as increased satiety. Moreover, recent data suggest that selective serotonin reuptake inhibitor (SSRI)-type medication improves outcome and prevents relapse in people with anorexia nervosa. These theoretical issues have important clinical implications in this era of diminished support for treatment of eating disorders. Anorexia nervosa, like other major psychiatric disorders, has contributory pathophysiology and can benefit from and deserves appropriate treatment resources.
  • Kaye, WH (1997). "Anorexia nervosa, obsessional behavior, and serotonin". Psychopharmacology Bulletin. 33 (3): 335–44. PMID 9550876.

• Individuals with anorexia nervosa have a relentless preoccupation with dieting and weight loss that results in severe emaciation and sometimes death. It is controversial whether such symptoms are secondary to psychosocial influences, are a consequence of obsessions and anxiety or reflect a primary disturbance of brain appetitive circuits. New brain imaging technology provides insights into ventral and dorsal neural circuit dysfunction - perhaps related to altered serotonin and dopamine metabolism - that contributes to the puzzling symptoms found in people with eating disorders. For example, altered insula activity could explain interoceptive dysfunction, and altered striatal activity might shed light on altered reward modulation in people with anorexia nervosa.
• Premorbid, childhood personality and temperament traits, which are thought to be genetically-determined, are thought to contribute to a vulnerability to develop AN. These include negative emotionality, harm avoidance, perfectionism, inhibition, a drive for thinness, altered interoceptive awareness and obsessive-compulsive personality traits.
  Individuals with AN seem to have a paradoxical response to eating; they engage in dietary restraint in order to reduce anxiety, because eating stimulates dysphoric mood. Several lines of evidence raise the possibility that altered serotonin (5-HT) function contributes to anxiety in subjects with AN, and starvation is a means of diminishing 5-HT functional activity.
  Individuals with AN might have a trait towards an imbalance between serotonin and dopamine pathways, which may have a role in an altered interaction between ventral (limbic) neurocircuits, which are important for identifying the emotional significance of stimuli and for generating an affective response to these stimuli, and dorsal (cognitive) neurocircuits that modulate selective attention, planning and effortful regulation of affective states.
  Recent functional MRI studies support the possibility that individuals with AN might be less able to precisely modulate affective responses to immediately salient stimuli but have increased activity in neurocircuits concerned with planning and consequences.
  Coding the awareness of pleasant sensation from the taste experience through the anterior insula might be altered in individuals with AN, tipping the balance of striatal processes away from normal, automatic reward responses mediated by the ventral striatum and towards a more 'strategic' approach mediated by the dorsal striatum.
  Perfectionism and obsessional personality traits could be related to exaggerated cognitive control by the dorsal lateral prefrontal cortex (which may have excessive inhibitory activity and thus dampen information processing through reward pathways) or to compensation for primary deficits in limbic function. When there are deficits in emotional regulation, overdependence upon cognitive rules is a reasonable strategy of self-management. <br. The temperament and personality traits that create a vulnerability to develop AN also persist after recovery. After recovery, these traits tend to have positive aspects, including attention to detail, concern about consequences and a drive to accomplish and succeed.

• Kaye WH1, Fudge JL, Paulus M, “New insights into symptoms and neurocircuit function of anorexia nervosa”, Nat Rev Neurosci. 2009 Aug;10(8):573-84. doi: 10.1038/nrn2682. Epub 2009 Jul 15.

• Anorexia nervosa (AN) is a severe, usually relapsing, psychiatric disorder. It has the highest mortality rate of any psychiatric disorder with an estimated adult mortality rate of 5% per decade. It is most predominant among girls and young women with the average age at onset being 15 years. Estimated lifetime prevalence is approximately 2% in females and 0.3% in males although studies have reported rates of up to 4% in females. It is characterized by excessive weight loss due to self-starvation, body image distortion, and immense fear of gaining weight or being fat. There are two subtypes: (1) restricting (AN-R), characterized by restricting food intake with or without compulsive exercise, and (2) binge-eating/purging (AN-BP), characterized by episodes of consuming large portions of food (binging) followed by purging (eg, ipecac- or self-induced vomiting, and/or excessive use of laxatives, enemas, or diuretics). Comorbid psychiatric illnesses (eg, major depression, anxiety disorders, obsessive-compulsive disorder or behaviors) are common among individuals with AN.
• Anorexia nervosa can result in starvation status and nutritional deficiencies leading to reversible and irreversible medical complications of varying severity. These complications can affect nearly every body system and usually directly correlate to severity of the disease, degree of weight loss/starvation and/or purging.
• The use of antidepressants as the sole therapeutic intervention for AN is unsupported, and these agents should only be used as adjunctive treatment to nutritional restoration and psychotherapy. There is a general lack of evidence to support use of SSRIs or mirtazapine during the AN acute treatment phase in underweight individuals. As a result, clinicians should not use antidepressants during hospitalization while patients are undergoing initial weight and nutritional restoration. At this time, the data are inconclusive regarding the place of SSRIs and mirtazapine and for their benefits in individuals with AN during the maintenance treatment phase once the weight is at least partially restored. Health care professionals should use clinical judgment in recommending fluoxetine or possibly citalopram, sertraline, or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention and/or improvement of symptoms of depression and anxiety and/or obsessive-compulsive behaviors that did not to resolve with nutritional rehabilitation and psychotherapy. A combination of psychotherapy and different pharmacologic modalities may be used under the rationale that the efficacy of these treatments might be additive or perhaps synergistic to increase treatment success in weight-restored anorexic patients.

• Kaye WH1, Fudge JL, Paulus M, “New insights into symptoms and neurocircuit function of anorexia nervosa”, Nat Rev Neurosci. 2009 Aug;10(8):573-84. doi: 10.1038/nrn2682. Epub 2009 Jul 15.

• The prevalence of anxiety disorders in general and OCD in particular was much higher in people with anorexia nervosa and bulimia nervosa than in a nonclinical group of women in the community. Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.
  • Kaye, WH; Bulik, CM; Thornton, L; Barbarich, N; Masters, K (2004). "Comorbidity of anxiety disorders with anorexia and bulimia nervosa". The American Journal of Psychiatry. 161 (12): 2215–21. doi:10.1176/appi.ajp.161.12.2215. PMID 15569892.

• Individuals with anorexia nervosa (AN) demonstrate a relentless engagement in behaviors aimed to reduce their weight, which leads to severe underweight status, and occasionally death. Neurobiological abnormalities, as a consequence of starvation are controversial: evidence, however, demonstrates abnormalities in the reward system of patients, and recovered individuals. Despite this, a unifying explanation for reward abnormalities observed in AN and their relevance to symptoms of the illness, remains incompletely understood. Theories explaining reward dysfunction have conventionally focused on anhedonia, describing that patients have an impaired ability to experience reward or pleasure. We review taste reward literature and propose that patients' reduced responses to conventional taste-reward tasks may reflect a fear of weight gain associated with the caloric nature of the tasks, rather than an impaired ability to experience reward. Consistent with this, we propose that patients are capable of 'liking' hedonic taste stimuli (e.g., identifying them), however, they do not 'want' or feel motivated for the stimuli in the same way that healthy controls report. Recent brain imaging data on more complex reward processing tasks provide insights into fronto-striatal neural circuit dysfunction related to altered reward processing in AN that challenges the relevance of anhedonia in explaining reward dysfunction in AN. In this way, altered activity of the anterior cingulate cortex and striatum could explain patients' pathological engagement in behaviors they consider rewarding (e.g., self-starvation) that are otherwise aversive or punishing, to those without the eating disorder. Such evidence for altered patterns of brain activity associated with reward processing tasks in patients and recovered individuals may provide important information about mechanisms underlying symptoms of AN, their future investigation, and the development of treatment approaches.
  • Keating C1, Tilbrook AJ, Rossell SL, Enticott PG, Fitzgerald PB, “Reward processing in anorexia nervosa” Neuropsychologia. 2012 Apr;50(5):567-75. doi: 10.1016/j.neuropsychologia.2012.01.036. Epub 2012 Feb 13.

• The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.
  • Keel, PK; Klump, KL (2003). "Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology". Psychological Bulletin. 129 (5): 747–69. CiteSeerX 10.1.1.524.4493. doi:10.1037/0033-2909.129.5.747. PMID 12956542.

• Epidemiological, cross-cultural, and longitudinal studies underscore the importance of the idealization of thinness and resulting weight concerns as psychosocial risk factors for eating disorders. Personality factors such as negative emotionality and perfectionism contribute to the development of eating disorders but may do so indirectly by increasing susceptibility to internalize the thin ideal or by influencing selection of peer environment. During adolescence, peers represent self-selected environments that influence risk.
• Peer context may represent a key opportunity for intervention, as peer groups represent the nexus in which individual differences in psychological risk factors shape the social environment and social environment shapes psychological risk factors. Thus, peer-based interventions that challenge internalization of the thin ideal can protect against the development of eating pathology.
  • Keel PK1, Forney KJ., “Psychosocial risk factors for eating disorders”, Int J Eat Disord. 2013 Jul;46(5):433-9. doi: 10.1002/eat.22094.

• There is evidence for altered processing of taste in anorexia nervosa, particularly in the areas of reward processing and hedonic sensitivity. However, research on whether people with anorexia nervosa identify taste stimuli accurately, known as taste sensitivity, has yielded mixed findings
• The review of the findings suggest that individuals with AN may experience reduced taste sensitivity that may improve following recovery. However, there was a significant variability in results across studies, potentially reflecting methodological problems including low sample sizes, experimental designs, and uncontrolled confounding variables.
• This review suggests that altered taste sensitivity could represent a component in the wider altered taste processing observed in anorexia nervosa. However, the heterogeneity of findings highlight the need for future research to consider methodological issues raised by this review.
  • Kinnaird E1, Stewart C1,2, Tchanturia K1,2,3. “Taste sensitivity in anorexia nervosa: A systematic review”, Int J Eat Disord. 2018 Aug;51(8):771-784. doi: 10.1002/eat.22886. Epub 2018 Jul 8.

• Data described earlier are clear in establishing a role for genes in the development of eating abnormalities. Estimates from the most rigorous studies suggest that more than 50% of the variance in eating disorders and disordered eating behaviors can be accounted for by genetic effects. These high estimates indicate a need for studies identifying the specific genes contributing to this large proportion of variance. Twin and family studies suggest that several heritable characteristics that are commonly comorbid with AN and BN may share genetic transmission with these disorders, including anxiety disorders or traits, body weight, and possibly major depression. Moreover, some developmental research suggests that the genes involved in ovarian hormones or the genes that these steroids affect also may be genetically linked to eating abnormalities. Molecular genetic research of these disorders is in its infant stages. However, promising areas for future research have already been identified (e.g., 5-HT2A receptor gene, UCP-2/UCP-3 gene, and estrogen receptor beta gene), and several large-scale linkage and association studies are underway. These studies likely will provide invaluable information regarding the appropriate phenotypes to be included in genetic studies and the genes with the most influence on the development of these disorders.
  • Klump, KL; Kaye, WH; Strober, M (2001). "The evolving genetic foundations of eating disorders". The Psychiatric Clinics of North America. 24 (2): 215–25. doi:10.1016/S0193-953X(05)70218-5. PMID 11416922.

• Anorexia nervosa is an eating disorder defined by a symptomatic triad, anorexia, emaciation and amenorrhoea. This disease mainly affects young women. Besides these three symptoms, hyperactivity is often associated with anorexia nervosa. Hyperactivity can be considered as a strategy to lose weight, but studies on animal models have shown that it could be explained by more complicated mechanisms. Hyperactivity is defined by an excess of physical activity, which can induce social, professional and family consequences. Hyperactivity can take different forms, most striking is the restless one. Patients with anorexia nervosa are not all hyperactive. Brewerton et al. have compared patients with anorexia nervosa and hyperactivity to patients without hyperactivity. Hyperactive patients are more dissatisfied by their body image, they use less means of purging (laxatives, vomiting), and they start starving earlier than patients without hyperactivity. Many factors can promote the emergence and maintenance of hyperactivity, especially social and cultural requirements, sports environment, family influences. Various models can explain the links between excessive exercise and anorexia nervosa. Epling and Pierce have exposed a behavioural model which shows how hyperactivity can lead to starvation, creating a self-maintained cycle. Eisler and Le Grande have described four models to explain the links between hyperactivity and anorexia nervosa. First, excessive exercise can be considered as a symptom of anorexia nervosa. It can also promote the development of eating disorders. Anorexia nervosa and hyperactivity can be a manifestation of an other psychiatric disorder. At least, hyperactivity can be a variant of anorexia nervosa, which has the same effects, as weight loss. Hyperactivity can also be considered as a kind of obsessive compulsive disorder. Hyperactivity and obsessive compulsive disorders actually share some clinical and neurochemical characteristics. An other model consists in comparing excessive exercise in anorexia nervosa to an addictive behaviour. Self-starvation exacerbated by hyperactivity can be considered as an addiction to endogenous opioid. Few studies are carried out in order to estimate the prevalence of high level exercise in the eating disorders. Davis et al. have achieved a prevalence study. The results indicate that a large majority of patients with anorexia nervosa (80,8%) were exercising excessively during an acute phase of the disorder. Research on animals, specially on rats, brings us an interesting model explaining interactions between anorexia nervosa and hyperactivity. With animal models, we have noticed that, when rats with access to a running wheel, are restricted in their food intake, they become excessively active, and paradoxically reduce food consumption. Many searchers have tried to explain this phenomenon. Morse et al. have pointed from animal models that the level of hyperactivity was linked to the severity of food restriction. This result can be explained by a failure of a part of the brain involved in rest and activity regulation. Animal research brings us explanations about the effects of starvation on the endocrine system and the neurotransmitters. Broocks et al. have shown that corticosterone concentration in plasma was synergistically increased by semi starvation and exercise, and the reduction of triiodothyronine by semi starvation was significantly greater in the running wheel group. An other study of Broocks et al. has revealed an increased hypothalamic serotonin metabolism with the combined effect of hyperactivity and food restriction. Tryptophan, an amid acid involved in serotonin synthesis, can also play a role in the maintenance of anorexia nervosa. In starvation conditions, opioid releasing caused by physical exercise would decrease food intake. Exner's study and Adan's one have shown that leptin would be involved in semi starvation induced hyperactivity mechanisms. In spite of animal models can not be entirely generalized to human, they are useful to try to explain biological supports of hyperactivity. Hyperactivity is not only a strategy to lose weight, but also a specific symptom which completes the clinical triad. Animal studies have led to promising results; we might use medicine, such as serotonin reuptake inhibitors or opioid antagonists in the treatment of hyperactivity in anorexia nervosa.
  • Kohl M1, Foulon C, Guelfi JD, “Hyperactivity and anorexia nervosa: behavioural and biological perspective”, Encephale. 2004 Sep-Oct;30(5):492-9.

• The aim of this study was to describe patterns of personality disorders (PDs) in women with chronic eating disorders (EDs). An index group of nineteen women who have had EDs for an average of 8.5 years was compared with a control group of same-aged women from the general population. At the time of the study the index group received treatment at a tertiary treatment center in Stockholm. The PDs were assessed using the DSM-IV part of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). In the index group, eighteen of nineteen fulfilled the criteria for one or more PD. The number of PD diagnoses for each women ranged from zero (n = 1) to eight (n = 2) with a median of three. Among the controls, only one woman fulfilled the criteria for one or more PD. The most prevalent disorders in the index group were Borderline, Avoidant, and Obsessive-Compulsive. The index group had significantly higher DIP-Q dimensional scores than the controls in the Paranoid, Schizoid, Schizotypal, Borderline, Histrionic, Avoidant, and Dependent scales. Although the assessment of PD symptoms was limited to self-reports, the high prevalence of PD diagnoses and PD symptoms most probably reflects the severe psychiatric impairments in patients suffering from chronic ED.
  • Larsson, JO; Hellzén, M (2004). "Patterns of personality disorders in women with chronic eating disorders", Eating and Weight Disorders : EWD. 9 (3): 200–5. doi:10.1007/bf03325067. PMID 15656014.

• Exposure plus response prevention has been demonstrated to be effective in the treatment of bulimia nervosa. However, when done individually, it is labor intensive and cost-ineffective. In the present study exposure plus response prevention was used in the context of a 6-wk., 12-session behavioral group. In addition to the exposure plus response-prevention component, other techniques included self-monitoring, cognitive restructuring, eating-habit stabilization and problem-solving. Eight bulimic women, vomiting a minimum of five times per week for at least a year, participated in the group. At the end of treatment significant reductions in bingeing and vomiting behaviors were reported by all but one subject, substantiated by significantly lower depression scores (Beck Depression Inventory) and binge-eating scores (Binge Eating Scale). At 6 mo. and 1 yr. posttreatment, 6 of 8 subjects reported averaging less than one binge-purge episode per week, one subject continued unchanged, and one subject had relapsed. A group of wait-list control subjects reported essentially no change in binge-purge frequency over the treatment period. Exposure plus response prevention conducted in a behavioral group context appears to be a cost-effective alternative to individual treatment.
  • Latner, JD; Wilson, GT (2000). "Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating" Eating Behaviors. 1 (1): 3–21. CiteSeerX 10.1.1.578.4563. doi:10.1016/S1471-0153(00)00008-8. PMID 15001063.

• Studies examining the function of the hypothalamic-pituitary-adrenal (HPA) axis in anorexia nervosa are reviewed. A principal finding is that of hypercortisolism, associated with increased central corticotropin-releasing hormone levels and normal circulating levels of adrenocorticotropic hormone. Similarities between neuroendocrine findings in anorexia nervosa and in affective disorder are reviewed. The contribution of circadian rhythm disturbances and malnutrition to observed HPA axis abnormalities in anorexia nervosa is also considered. Directions for future research are discussed.
  • Licinio, J; Wong, ML; Gold, PW (1996). "The hypothalamic-pituitary-adrenal axis in anorexia nervosa". Psychiatry Research. 62 (1): 75–83. doi:10.1016/0165-1781(96)02991-5. PMID 8739117.

• This case suggests that an intracranial tumor near the hypothalamus should be included in the differential diagnosis of AN. Any male adolescent with the clinical impression of AN should receive periodic re-evaluation, including neurological, endocrinological and, if necessary, neuroimaging study.
  • Lin, L; Liao, SC; Lee, YJ; Tseng, MC; Lee, MB (2003). "Brain tumor presenting as anorexia nervosa in a 19-year-old man". Journal of the Formosan Medical Association, Taiwan Yi Zhi. 102 (10): 737–40. PMID 14691602.

• After the conducted investigation and observation, the characteristics of the forming incorrect personality were observed in 80% of examined children. According to DSM IV classification, in 50%--from the cluster C, and in 30% cases--the cluster B. According to ICD-10 classification: 26.6% attributes of dependent personality, 16.6%--histrionic personality, 13.3% avoiding personality, 10%--anancastic personality, 6.7% borderline personality and 6.7% antisocial personality.
• There is predominating opinion in literature, connecting restrictive type of psychical anorexia, with disorders of personality of anxiety type--the cluster C, and the figure bulimic--with personality the cluster B. Those results were confirmed with statistical significance in the conducted examinations.
  • Lucka, I; Cebella, A (2004). "Characteristics of the forming personality in children suffering from anorexia nervosa". Psychiatria Polska. 38 (6): 1011–8. PMID 15779665.

• Bulimia and anorexia nervosa are the main diagnostic categories of eating disorders, affecting up to 1.5% of people in the USA at any one time. Both conditions are associated with physical (eg, reduced body mass index, percentage of body fat) and psychosocial (eg, depression, anxiety, quality of life) impairments, as well as high risk of death. Anorexia nervosa is specifically characterised by an excessive exercise engagement with fear of weight gain and aversion of fat, whereas people with bulimia nervosa present with binge eating and purging. These eating disorders are considered one of the most challenging psychiatric conditions to treat, and treatment usually comprises of cognitive–behavioural therapy and pharmacological management. Exercise is usually not recommended for patients with these conditions, mainly due to the belief that it might aggravate the progress of the disorder. However, there is evidence that exercise increases body mass index and reduce depression in people with binge eating. What is uncertain is whether physiotherapy interventions are effective in treating bulimia and anorexia nervosa.
  • Machado GC, Ferreira ML “Physiotherapy improves eating disorders and quality of life in bulimia and anorexia nervosa”, Br J Sports Med, 2014;48:1519-1520.

• The role and utility of antidepressants in AN were published in double-blind, placebo-controlled studies; open-label trials; and a retrospective study. Antidepressants should not be used as sole therapy for AN although their use for confounding symptomatology makes discerning efficacy difficult as they are given together with other therapies. Neurobiological changes due to starvation and AN itself complicate results interpretation. For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated. Use of SSRIs during acute treatment lacks efficacy. Use of SSRIs-primarily fluoxetine and to some extent citalopram, sertraline, or mirtazapine-may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients.
• Health care professionals should use clinical judgment regarding fluoxetine or possibly citalopram, sertraline or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy.

• Marvanova M1, Gramith K2. “Role of antidepressants in the treatment of adults with anorexia nervosa”, Ment Health Clin. 2018 Apr 26;8(3):127-137. doi: 10.9740/mhc.2018.05.127. eCollection 2018 May.

• Although genetic research in eating disorders is frankly in its infancy, patients, families, and clinicians are aware of this research and face challenges in incorporating this knowledge into either their personal conceptions of their (or their family member’s) illness, or in the case of clinicians, helping patients and their families to understand the implications of this knowledge. Simplistic nature versus nurture dichotomies are easy to understand, yet rarely capture the complexity of reality, and definitely fail to do so in the case of eating disorders. Clinicians and researchers must become educated in the nuances of gene x environment interplay and avoid perpetuating purely environmental or purely genetic conceptualizations of eating disorder etiology.
• By definition, eating disorders are complex traits. That means that their inheritance pattern in families does not follow traditional Mendelian patterns, and that they are influenced by multiple genetic and environmental factors of small to moderate effect. There is not one gene for anorexia nervosa or one gene for bulimia nervosa. More likely there are a number of genes that code for proteins that influence traits that index vulnerability to these disorders. Complicating the risk picture even further, these genes exist in concert with other genetic factors that may confer protection against eating disorders, along with main effects of risk and protective environments, as well as gene x environment interplay as we discuss in the following section.
• For decades, parenting styles have been unrightfully blamed for causing eating disorders. Considerable care must be taken when discussing gene x environment interplay not to convey the message that somehow parenting is to blame for these pernicious illnesses. Conversely, a purely genetic explanation should not be taken to mean that parents need not examine their parenting style and the influence that might have on their children.
• In addition to having concerns about their own shape and weight, women with eating disorders may similarly be over-concerned about their children’s weight, even when it is well within normal limits. One study found that 15% of mothers with a history of bulimia nervosa had attempted to “slim down” their normal weight infants. Similarly, Waugh and Bulik found that 20% of the mothers with eating disorder histories in their sample tried to change their children’s appearance. Maternal restriction of children’s eating is a concern, as previous research suggests that maternal control of children’s eating interferes with the development of dietary self-regulation. These effects have been found among children as young as two years of age.
• The influence of maternal perceptions on daughters’ eating disordered behavior appears to continue into adolescence and young adulthood. For example, mothers whose daughters engaged in eating disordered behavior were more likely to view their daughters as overweight than were mothers of non-eating disordered daughters (controlling for weight differences between groups). Further, this appearance pressure is not necessarily limited to weight, as mothers of daughters with eating disorder symptomatology also rated their daughters as less attractive than the daughters rated themselves. These results are concerning, as they suggest that daughters who engage in eating disordered behaviors may not only lack a maternal role model of healthy eating, but also feel maternal pressure to lose weight and enhance their appearance. This of course could reflect several complex intergenerational processes. On one hand, mothers may harbor threshold or subthreshold eating disturbances themselves, and their comments or behaviors could reflect their underlying pathology. Alternatively or complementarily, the daughters’ pathology could render them more sensitive to maternal comments that in other situations may be perceived as culturally normative. These environmental experiences could facilitate the expression of an existing genetic predisposition for eating disorder symptomatology.
• One potential pitfall of genetic research on eating disorders is the misinterpretation that environmental factors such as the media do not matter. Western media’s idealization of an ultra-thin female body type has long been viewed as an important sociocultural risk factor for eating disorders. However, given the ubiquity of this influence in Western cultures, other factors must influence vulnerability to the thin cultural ideal. As Bulik suggests, genetically vulnerable individuals might seek out experiences, such as exposure to thin-ideal media images, which reinforce their negative body image. This hypothesis is supported by a longitudinal study which found that adolescent girls whose eating disorder symptomatology increased over a 16 month period also reported significantly greater fashion magazine reading at Time 2, compared with Time.
• Similarly, individuals genetically predisposed to eating disorder symptomatology such as thin-ideal internalization might also actively choose to affiliate with peers who place a similar high value on weight and appearance. One potential example of this form of active selection could be the decision to join a sorority (particularly for European-American women). European-American sorority members report high levels of eating disorder symptomatology, including weight preoccupation, drive for thinness, and body dissatisfaction. A longitudinal study found that sorority and non-sorority members did not differ on three measures of disordered eating (EDI Drive for Thinness, Body Dissatisfaction, and Bulimia) at Time 1 and Time 2 (first and second year of undergraduate, respectively). However, by Time 3 (third year of undergraduate), non-members’ drive for thinness scores had decreased, while members’ scores on this measure remained roughly the same, and this difference was statistically significant. Thus, the authors concluded that characteristics of the sorority environment could contribute to the persistence of a higher degree of drive for thinness. Although this study did not include a measure of actual or putative genetic vulnerability to eating disorders, it is plausible to speculate that an environment that promotes the maintenance of eating disordered characteristics would be particularly problematic for a genetically vulnerable individual.
• One fascinating and modifiable environmental factor that has emerged as a possible buffer against the development of eating disorders in adolescent girls is family meals. Likewise, breakfast eating may also play a role in preventing the development of eating problems. For example, Fernández-Aranda and colleagues found that women with eating disorders were less likely to have eaten breakfast regularly during childhood compared to non-eating disordered controls. Although retrospective, these findings are consistent with those of a large (n = 2216), longitudinal study which found that breakfast eating frequency was inversely associated with dieting and weight-control behaviors, and positively related to dietary quality and physical activity in adolescents. Overall, these studies offer preliminary insight into potential buffers against eating disorders; however, research in this area has not yet progressed to assess the differential effect of these protective factors in individuals at high-risk for eating disorders versus the general population.
• Another factor that offers promise as a potential buffer against the development of eating disorders is the enhancement of emotion regulation skills. As noted above, individuals with eating disorders experience relatively high levels of perceived stress and difficulties regulating emotion. Thus, interventions aimed at enhancing emotion regulation skills might be of particular benefit to high-risk groups. However, research incorporating mindfulness techniques has not specifically targeted high-risk groups. For example, a recent study investigated the effectiveness of a primary prevention program incorporating elements of mindfulness (e.g., yoga), targeting fifth-grade girls. This program integrated mindfulness into an empirically-based curriculum, which also included other elements, such as media literacy, and the promotion of dissonance regarding idealization of an ultra-slim body type. Compared to a control group, girls in the intervention reported lower body dissatisfaction and uncontrolled eating, and higher social self-concept at post-testing. However, there were no significant changes on other variables assessed including drive for thinness, perceived stress, physical self-concept and perceived competence. Nonetheless, these outcomes do provide some support for the inclusion of mindfulness-based activities in prevention. In contrast, a study with undergraduate women did not find any differences between participants in a yoga program and a control group on eating disorder symptoms at post-testing. Future studies should target high-risk groups, to evaluate the efficacy of mindfulness-based techniques within this specific sample.
• Results from focus groups and clinical case studies suggest that mothers with eating disorders are eager to learn about how best to care for their children, especially with respect to feeding. However, they report that the level of assistance they desire is not routinely offered by their health care providers. In one of the only published interventions conducted with this population, Stein et al. studied 80 mothers with eating disorders and their four to six month old infants to test whether a 13 session intervention of video-feedback treatment in conjunction with cognitive behavioral self-help was more effective than cognitive behavioral self-help alone in reducing mealtime conflict and other aspects of maternal-child interaction. Those mothers in the video-feedback group exhibited significantly less conflict than control mothers as well as significant improvements in infant autonomy and several other interaction measures. In addition, maternal eating psychopathology was reduced across both groups. Such interventions could help break the “cycle of risk” associated with eating disorders, by providing parents with useful buffering strategies.
• Patients read enormous amounts about their illness and are often aware of the genetic research on eating disorders yet they struggle to understand what the data mean for them and the challenges they face every day during recovery. Helping patients to understand the genetic literature is a first step. Although they might not initially see its relevance to their situation, helping them map how disordered eating and temperamental traits track in their families by using techniques such as labeling family trees can provide a useful context for understanding genetic and environmental contributions to their current situation. An understanding of genetic and environmental interplay can provide them with an explanatory model for not only their illness, but also for understanding their sensitivity to the environment. It can help provide them with the motivation to acquire skills that may help buffer them from the environment and combat their biology most effectively.
  • Mazzeo, SE; Bulik, CM (2009). "Environmental and genetic risk factors for eating disorders: What the clinician needs to know". Child and Adolescent Psychiatric Clinics of North America. 18 (1): 67–82. doi:10.1016/j.chc.2008.07.003. PMC 2719561. PMID 19014858.

• One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.
  • McCluskey, S; Evans, C; Lacey, JH; Pearce, JM; Jacobs, H (1991). "Polycystic ovary syndrome and bulimia". Fertility and Sterility. 55 (2): 287–91. PMID 1991526.

• Etiological theories emphasize interpersonal and family dysfunction in the development of anorexia nervosa. Research supports the notion that families of individuals with anorexia nervosa have dysfunctional patterns of communication. The history of treatment for anorexia nervosa emphasizes the need for resolution of interpersonal dysfunction, within the traditions of psychodynamic, family therapy, and multidimensional therapies.
• Interpersonal psychotherapy is a time-limited psychotherapy based on the notion that regardless of etiology, interpersonal relationships are intertwined with symptomatology. The goals of the therapy are to improve interpersonal functioning and thereby decrease symptomatology. Factors identified as important in the development of anorexia nervosa are readily conceptualized within the interpersonal psychotherapy problem areas of grief, interpersonal disputes, interpersonal deficits, and role transitions.

• McIntosh, VV; Bulik, CM; McKenzie, JM; Luty, SE; Jordan, J (2000). "Interpersonal psychotherapy for anorexia nervosa", The International Journal of Eating Disorders. 27 (2): 125–39. doi:10.1002/(SICI)1098-108X(200003)27:2<125::AID-EAT1>3.0.CO;2-4. PMID 10657886.

• Thin body preoccupation and social pressure are important risk factors for the development of eating disorders in adolescents. Some Hispanic groups are at risk of developing eating disorders. Efforts to reduce peer, cultural, and other sources of thin body preoccupation may be necessary to prevent eating disorders.
  • McKnight, Investigators (2003). "Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study". The American Journal of Psychiatry. 160 (2): 248–54. doi:10.1176/ajp.160.2.248. PMID 12562570.

• Childhood impulsivity, as opposed to hyperactivity or inattention, best predicted adolescent BN symptoms, particularly for girls. Among youth with ADHD, treatment received during the follow-up period was not associated with BN pathology.
  Both boys and girls with ADHD may be at risk for BN symptoms in adolescence because of the impulsivity central to both disorders.
  • Mikami, AY; Hinshaw, SP; Arnold, LE; Hoza, B; Hechtman, L (2010). “Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD". The International Journal of Eating Disorders. 43 (3): 248–59. doi:10.1002/eat.20692. PMID 19378318.

• The spectrum of eating disorders varies widely, ranging from mildly abnormal eating habits to life-threatening chronic disease. Given the many different cultural food norms and individual preferences, along with the fact that dieting behavior is extremely common, it can be challenging to differentiate unusual eating behaviors from clinically significant eating disorders.
  • Miller CA1, Golden NH, “An introduction to eating disorders: clinical presentation, epidemiology, and prognosis”, Nutr Clin Pract. 2010 Apr;25(2):110-5. doi: 10.1177/0884533609357566.

• Approximately two-thirds of adolescent girls at any age are dissatisfied with their weight, the proportion increasing with actual weight. Slightly more than half of all girls are dissatisfied with the shape of their bodies, an attitude which also is positively correlated with body weight. Girls are most likely to be distressed about excess size of their thighs, hips, waist and buttocks, and inadequate size of their breasts. Those who are dissatisfied with their bodies are more likely to engage in potentially harmful weight control behaviors, such as dieting, fasting, self-induced vomiting, diuretic use, laxative use and diet pill use. Those who diet are more likely to begin in early adolescence, to be white than black, to be of higher socioeconomic status, to engage in other eating-related practices and to have a poor body image and self esteem. Boys who are underweight are most likely to be dissatisfied with their weight and many with normal weight wish to weigh more. Approximately one-third of boys are dissatisfied with their body shape, desiring larger upper arms, chest and shoulders. Dieting and purging are less likely than exercise to be chosen by boys as methods of weight control. Dieting among boys is more likely to be associated with increased body weight and some sports, such as wrestling. Body consciousness and altered body image are widespread among adolescents, and may be associated with potentially harmful eating practices in both sexes, but more so in girls.
  • Moore DC1., “Body image and eating behavior in adolescents”, J Am Coll Nutr. 1993 Oct;12(5):505-10.

• The UK Department of Health's National Service Framework for Mental Health has stressed the importance of managing such eating disorders as BN in primary care,2 noting that “antidepressants can reduce purging and bingeing whether or not the person is also depressed”. Although this statement is true in the short term, it would seem an optimistic reading of the literature. Prescription of antidepressants may appear to be the easiest route in a primary care setting, but the clinical implication of Bacaltchuk et al's review is that the easiest route may not be the most effective, cost effective, or acceptable for clinicians and their patients.
  However, in the busy world of primary care, the treatment of BN will continue to be driven by available resources. CBT for BN is generally preferred by the family doctor when specialists with such training are available. But the Royal College of Psychiatrists, in collaboration with the Consumers' Association, has recently reported the dearth of specialist eating disorder services beyond southeastern England.3 Thus, in the more likely scenario of limited eating disorder services, use of antidepressant medication may seem more attractive. These 2 reviews agree with that approach and suggest that antidepressant medication will produce positive short term results; however, BN is not a short term illness. Relapse prevention deserves greater scrutiny for patients with BN and anorexia nervosa, and longer term follow up studies should drive the next generation of treatment intervention studies.
  • John F Morgan, ''Cochrane Database Syst Rev. Bacaltchuk J, Hay P. “Review: Antidepressants versus placebo for people with bulimia nervosa”. ;(4):CD003931.

• This study clearly shows a strong association between resolution of bulimia and changes in ovarian morphology, suggesting that changes in the former mirror changes in the latter. It also demonstrates normalization of ovarian morphology in previously polycystic ovaries.
  • Morgan, JF; McCluskey, SE; Brunton, JN; Hubert Lacey, J (2002). "Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study". Fertility and Sterility. 77 (5): 928–31. doi:10.1016/S0015-0282(02)03063-7. PMID 12009345.

• An association between bulimia nervosa and polycystic ovary syndrome (PCOS) has been suggested but also questioned. Since there is still a controversy about this issue, we investigated clinical and biochemical symptoms of PCOS according to the new diagnostic criteria in a large group of bulimic women compared with controls. Seventy-seven women with bulimia and 59 matched healthy women were investigated with respect to menstrual status, polycystic ovaries, hirsutism, acne and sex hormone levels. We found increased occurrence of menstrual disturbances, hirsutism and PCOS in bulimic women, whereas ovarian variables and acne did not differ from controls. Hirsutism score and indices of biologically active testosterone were positively correlated in bulimics but not in controls, while there were no major differences in serum androgens. In conclusion, this study supports an increased frequency of PCOS in bulimic women and may also indicate increased androgen sensitivity in these women. PCOS may promote bulimic behavior since androgens have appetite-stimulating effects and could impair impulse control. Menstrual disturbances and clinical signs of hyperandrogenism should be evaluated in bulimics in order to provide adequate medical care and treatment.
  • Sabine Naessén, Kjell Carlström, Leena Garoff, Rolf Glant & Angelica Lindén Hirschberg; “Polycystic ovary syndrome in bulimic women – an evaluation based on the new diagnostic criteria”, Gynecological Endocrinology Volume 22, 2006 - Issue 7, pages 388-394.

• Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.
  • Naessén, S; Carlström, K; Garoff, L; Glant, R; Hirschberg, AL (2006). "Polycystic ovary syndrome in bulimic women—an evaluation based on the new diagnostic criteria". Gynecological Endocrinology. 22 (7): 388–94.

• Purging can include self-induced vomiting, over-exercising, and the use of diuretics, enemas, and laxatives. Anorexia nervosa is characterized by extreme food restriction and excessive weight loss, accompanied by the fear of being fat.
  • "Anorexia Nervosa". Nationaleatingdisorders.org. Archived from the original on 2013-02-04. Retrieved 2013-02-13.

• In recent years, anorexia and bulimia nervosa, whether combined into a single clinical picture or considered as distinct syndromes, have reached epidemic proportions among adolescents. Professionals in the educational and physical and mental health care fields need to be aware of the influence of social pressures on teenagers' perceptions of body image and appearance. This article reviews the sociocultural, socioeconomic, and sex-related factors which contribute to the development of eating disorders. It is recommended that professionals help adolescents resist societal pressure to conform to unrealistic standards of appearance, and provide guidance on nutrition, realistic body ideals, and achievement of self-esteem, self-efficacy, interpersonal relations and coping skills.
  • Nagel KL1, Jones KH, “Sociological factors in the development of eating disorders”, Adolescence. 1992 Spring;27(105):107-13.

• Bulimia nervosa is a serious eating disorder. People with bulimia nervosa are overly concerned with their body’s shape and weight and engage in detrimental behaviors in an attempt to control their body image. Bulimia nervosa is often characterized by a destructive pattern of binging (eating too much unhealthy food) and inappropriate, reactionary behaviors to control one’s weight following these episodes.
  Binge eating is the rapid consumption of an unusually-large amount of food in a short period of time. Unlike simple overeating, people who binge feel “out of control” during these episodes. This means that one “cannot stop the urge to eat” once it has begun, even after their stomach is full. Binging may “feel good” initially, but it quickly becomes distressing for the person who is absorbed in this behavior. Food is often eaten secretly and quickly. A binge is usually ended only with abdominal discomfort, social interruption or running out of food. When the binge is over, the person with bulimia often feels guilty and will engage in inappropriate behaviors to rid their body of the excess calories that were eaten.
  Inappropriate behaviors to control one’s weight can include purging. Purging behaviors are potentially dangerous and can consist of a wide variety of actions “to get rid of everything I ate.” This can include self-induced vomiting, the abuse of laxatives, enemas or diuretics (e.g., caffeine). Other behaviors such as “fasting” or restrictive dieting following binge-eating episodes are also common, as well as excessive exercising.
• Bulimia nervosa is often under-diagnosed because many people who experience this illness may be of normal weight (or even overweight), as opposed to individuals with anorexia nervosa. The typical age of onset for bulimia nervosa is late adolescence or early adulthood, but onset can and does occur at any time throughout the lifespan. Like other eating disorders, bulimia nervosa mainly affects females, although at least one in 10 individuals with this condition is male. Bulimia nervosa is more common than anorexia nervosa and likely occurs in up to three percent of the population. Like all mental illnesses, Bulimia nervosa is found in all racial, religious, ethnic and socioeconomic groups.
• Constant obsession with food and weight is a primary sign of bulimia nervosa. Other important indicators are signs of binging (e.g., hidden candy wrappers under a bed or multiple empty cereal boxes stuffed in a closet) and purging (e.g., boxes of laxatives or enemas stored in one’s desk without a clear medical indication for these products).
  People with bulimia may also experience irregular menstrual periods or depressed mood. These symptoms may cause a person to go to their doctor. Similarly, doctors may also find they are examining their patients for unexplained stomach pain or sore throat before a diagnosis of bulimia nervosa is made.
  Doctors may see common signs of self-induced vomiting including unexplained damage to the teeth (due to the acidity of vomit) and scarring on the backs of the hands and fingers (due to repeatedly pushing fingers down the throat to induce vomiting). A number of people with bulimia will have swollen cheeks (due to damage of their parotid glands).
• People with bulimia nervosa—even if their weight remains “normal”—can severely damage their bodies by binging and purging. Self-induced vomiting can injure the various parting of the body involved in eating and digesting food: tooth decay, esophageal and stomach injury, and acid reflux are all common in people with bulimia nervosa. Excessive purging behaviors can cause dehydration and changes in the body’s electrolytes (e.g., low potassium). This can lead to multiple problems including cardiac arrhythmias, heart failure and even death.
• Although the precise causes of bulimia nervosa are unknown, scientists agree that it is caused by a combination of genetic and environmental factors. People with a family history of eating disorders or a personal history of mental illness, including depression, anxiety, substance abuse and other illnesses, are more likely to develop bulimia nervosa. Traumatic events (e.g., physical or sexual abuse) as well as life-stressors (including being bullied at school) can also increase the risk of developing bulimia nervosa. While no specific region of the brain has been directly connected with bulimia nervosa, certain chemicals in the brain (e.g., the neurotransmitter serotonin) have been shown to have a relationship with binging and purging behaviors.
• Many medications have been used to treat symptoms of bulimia nervosa, the specifics of which are beyond the scope of this review. The only FDA approved medication for bulimia nervosa is fluoxetine (Prozac). This medication helps by decreasing the symptoms of bulimia nervosa, but it does not cure the illness. As with any other mental illness, it is important to discuss any medication decisions with one’s psychiatrist and other members of the treatment team.
  With thorough treatment and the support of their loved ones, most people with bulimia nervosa can expect to see a significant decrease in their symptoms and to live healthy lives in absence of serious medical complications. Family members and friends can be most helpful in providing nonjudgmental support of their loved one and by encouraging their loved one to seek treatment for this serious mental illness.

• "NAMI National Alliance on Mental Illness", (8 January 2015).

• Prior research on non-clinical samples has lent support to the sexual competition hypothesis for eating disorders (SCH) where the drive for thinness can be seen as an originally adaptive strategy for women to preserve a nubile female shape, which, when driven to an extreme, may cause eating disorders. Restrictive versus impulsive eating behavior may also be relevant for individual differences in allocation of resources to either mating effort or somatic growth, reflected in an evolutionary concept called "Life History Theory" (LHT). In this study, we aimed to test the SCH and predictions from LHT in female patients with clinically manifest eating disorders. Accordingly, 20 women diagnosed with anorexia nervosa (AN), 20 with bulimia nervosa (BN), and 29 age-matched controls completed a package of questionnaires comprising measures for behavioral features and attitudes related to eating behavior, intrasexual competition, life history strategy, executive functioning and mating effort. In line with predictions, we found that relatively faster life history strategies were associated with poorer executive functioning, lower perceived own mate value, greater intrasexual competition for mates but not for status, and, in part, with greater disordered eating behavior. Comparisons between AN and BN revealed that individuals with BN tended to pursue a "fast" life history strategy, whereas people with AN were more similar to controls in pursuing a "slow" life history strategy. Moreover, intrasexual competition for mates was significantly predicted by the severity of disordered eating behavior. Together, our findings lend partial support to the SCH for eating disorders. We discuss the implications and limitations of our study findings.
  • Nettersheim J1, Gerlach G2, Herpertz S2, Abed R3, Figueredo AJ4, Brüne M1, “Evolutionary Psychology of Eating Disorders: An Explorative Study in Patients With Anorexia Nervosa and Bulimia Nervosa.”, Front Psychol. 2018 Oct 31;9:2122. doi: 10.3389/fpsyg.2018.02122. eCollection 2018.

• Interest in all forms of eating disorder in children, adolescents and adults continues to grow steadily across the world. The number of publications grows from day to day but, despite the increasing body of knowledge, the causes and origins of eating disorders are as baffling and obscure as ever.
  Death from anorexia nervosa (AN) was recorded by both Lasegue (1873a,b) and Gull (1874), who first described it. In 1895, both Stephens and Marshall published postmortem finding in the Lancet for a 16-year-old and an 11-year-old patient respectively. In the last five decades there have been several reports of cases of AN with fatal outcomes and subsequent ausopsies (Siebenmann, 1955; Martin, 1955, 1958; Hack, 1959; Mosli, 1967; Chikasue et al., 1988). Gradually work began to be published which covered long observation periods and produced yet more mortality figures. In 1988 in Britain, Patton presented a study of a group of 460 consecutive patients with eating disorders covering the years from 1971-1981. These were divided into two groups for AN and bulimia nervosa (BN) with resulting crude mortality rates of 3.3 percent for the former and 3.1 percent for tha latter. He also carried out a critical evaluation of the methodological problems and the results obtained from earlier studies. Hsu et al. (1979) reported that more than 2 percent had died during an average follow-up period of 5.9 years; Isafer et al. (1985) gave a crude mortality rate of 8.2 percent with an average follow-up period of 12.5 years; and Theander (1985) a crude morality rate of 18 percent over 33 years. Even allowing for the differences in these data, it is clear that AN has the highest mortality rate of all the psychiatric illnesses (Licht et al., 1993).
  However these differences in crude mortality rates are unsatisfactory from a methodological point of view for a number of reasons. These include the way cases were selected and the differing lengths of the observation periods.
  • Neumaker, K.J. (2000). "Morality rates and causes of death". European Eating Disorders Review. 8(2): 181–187. doi:10.1002/(SICI)1099-0968(200003)8:2<181::AID-ERV336>3.0.CO;2-#.

• Previous research demonstrates that the relationship between socio-economic status (SES) and eating disorders is not consistent. The present study compares SES and demographic factors among Swedish women, randomly drawn from the population register and female patients seen for treatment.
• ED's have a higher SES background and live in more privileged socio-demographic areas than CONT. ED's have lower social status, have more separations, and are more often single than CONT.
• These data demonstrate a connection between high socio-economic and demographic data, low social status and eating disorder patients compared to normal controls.

• Nevonen, L; Norring, C (2004). "Socio-economic variables and eating disorders: A comparison between patients and normal controls". Eating and Weight Disorders. 9 (4): 279–84. doi:10.1007/BF03325082. PMID 15844400.

• Annorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this disease.
  • Neumaker, K.J. (2000). "Morality rates and causes of death". European Eating Disorders Review. 8(2): 181–187. doi:10.1002/(SICI)1099-0968(200003)8:2<181::AID-ERV336>3.0.CO;2-#.

• The severity and type of eating disorder symptoms have been shown to affect comorbidity. The DSM-IV should not be used by laypersons to diagnose themselves even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders.
  • Nicholls D1, Bryant-Waugh R, “Eating disorders of infancy and childhood: definition, symptomatology, epidemiology, and comorbidity.”, Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):17-30. doi: 10.1016/j.chc.2008.07.008.

• We document here the first case of bulimia nervosa associated with primary hyperparathyroidism. The binge eating and self-induced vomiting that occurred for more than 10 years disappeared completely after the surgical cure of primary hyperparathyroidism. Depressive and anxiety symptoms also improved dramatically. The possible influence of derangement in calcium metabolism on the neurobiochemical mechanism of bulimia nervosa is discussed.
  • Ozawa, Y; Koyano, H; Akama, T (1999). "Complete recovery from intractable bulimia nervosa by the surgical cure of primary hyperparathyroidism". The International Journal of Eating Disorders. 26 (1): 107–10. doi:10.1002/(SICI)1098-108X(199907)26:1<107::AID-EAT15>3.0.CO;2-U. PMID 10349592.

• The speculation about whether there may be a positive association between sexual abuse in childhood and the later development of clinical eating disorder has been widely considered over the past 15 years. It has sometimes been accepted uncritically as established truth. It is certainly plausible. After all, bulimia and anorexia nervosa differentially affect girls and seem to involve complex feelings about the body which might well have originated in adverse early sexual experience. Furthermore, many patients disclose such experiences in the clinic. The evidence from early research studies, however, does not consistently support all of the clinical speculation. More than one review reached broadly negative conclusions.1,2 The study by Wonderlich et al systematically re-examines publications up to the end of 1994. The authors of this review had to grapple with studies employing a wide variety of methods and samples. They used predetermined criteria of quality but not meta-analysis to sort out which studies could contribute to their conclusions. They were appropriately strict in applying their criteria.
  This review supports the position of clinicians who consider that a history of childhood sexual abuse is worth seeking and may be an important consideration in their patients with eating disorders, but no more important than in many other patients. It may be especially relevant for those who have bulimia nervosa with comorbidity. Patients with such complex problems require careful thought. Finding a background of sexual abuse may prove to be important but should not lead to the conclusion that “all is now explained”. Furthermore, most studies show that only a minority of patients with eating disorders report abuse and inferring past abuse from the fact of present eating disorder is unjustified.
  • Robert L Palmer, Aetiology, "Review: childhood sexual abuse is associated with bulimia nervosa especially when there is psychiatric comorbidity", vol. 1, issue 2; Wonderlich SA, Brewerton TD, Jocic Z , et al. "Relationship of childhood sexual abuse and eating disorders". J Am Acad Child Adolesc Psychiatry, 1997 Aug; 36 : 1107 –15 CrossRefPubMedWeb of Science

• There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.
  • Patel, P; Wheatcroft, R; Park, R; Stein, A (2002). "The Children of Mothers With Eating Disorders". Clinical Child and Family Psychology Review. 5 (1): 1–19. doi:10.1023/A:1014524207660. PMID 11993543.

• This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWEBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual's own level of use.
  • Paxton, SJ; Schutz, HK; Wertheim, EH; Muir, SL (1999).[ https://www.ncbi.nlm.nih.gov/pubmed/10369035 "Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls"]. Journal of Abnormal Psychology. 108 (2): 255–66. doi:10.1037/0021-843X.108.2.255. PMID 10369035.

• While historically, eating disorders were conceptualized as primarily afflicting Caucasian adolescent or young adult women within high-income, industrialized Western Europe and North America, eating disorders are increasingly documented in diverse countries and cultures worldwide. This study highlights recent trends that reflect the changing landscape of culture and eating disorders: stabilization of the incidence of anorexia nervosa and possibly lower incidence rates of bulimia nervosa in Caucasian North American and Northern European groups; increasing rates of eating disorders in Asia; increasing rates of eating disorders in the Arab region; and increasing rates of binge eating and bulimia nervosa in Hispanic and Black American minority groups in North America.
  • Pike, KM; Hoek, HW; Dunne, PE (November 2014). "Cultural trends and eating disorders". Current Opinion in Psychiatry. 27 (6): 436–42.

• The purpose of this study was to assess the relative contribution of personality and emotional experience to self-reported eating attitudes in a group of patients with clinically diagnosed eating disorders, a weight-reduction training group (Weight Watchers), and a control group without body weight problems. Participants in this study (N = 114) completed Estonian versions of the Eating Disorder Inventory-2 (EDI-2; Garner, 1991), NEO Personality Inventory (Costa & McCrae, 1989), and Positive Affect and Negative Affect Schedule, Expanded Form (Watson & Clark, 1994). Data demonstrated validity of the Estonian version of EDI-2 in its ability to identify problems on a continuum of disordered eating behavior. Among the Big Five personality dimensions, Neuroticism made the largest contribution to EDI-2 subscales. Two other dimensions, Openness to Experience and Conscientiousness, also predispose individuals to eating problems. Personality traits made a larger contribution to the self-reported eating pathology than the self-rated effects experienced during the last few weeks. It was argued that personality dispositions have a larger relevancy in the etiology of eating disorders than emotional state.
  • Podar, I; Hannus, A; Allik, J (1999). "Personality and affectivity characteristics associated with eating disorders: a comparison of eating disordered, weight-preoccupied, and normal samples". Journal of Personality Assessment. 73 (1): 133–47. doi:10.1207/S15327752JPA730109. PMID 10497805.

• Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control.
  • Polivy, J; Herman, CP (2002). "Causes of eating disorders". Annual Review of Psychology. 53: 187–213. doi:10.1146/annurev.psych.53.100901.135103. PMID 11752484.

• Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.
  • Pompili, M; Mancinelli, I; Girardi, P; Accorrà, D; Ruberto, A; Tatarelli, R (2003). "Suicide and attempted suicide in anorexia nervosa and bulimia nervosa". Annali dell'Istituto Superiore di Sanità. 39 (2): 275–81. PMID 14587228.

• Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.
  • Quick VM, Byrd-Bredbenner C, Neumark-Sztainer D (May 1, 2013). "Chronic illness and disordered eating: a discussion of the literature". Adv Nutr (Review). 4 (3): 277–86. doi:10.3945/an.112.003608. PMC 3650496. PMID 23674793.

• To date, more than 1365 trials have been generated by searching and over 100 trials have been evaluated in detail. Because of a relatively high number of original exclusions (n=12) the trial inclusion criteria were broadened to include those with non-blinded outcome assessment, providing 34 trials for analyses. Because of incomplete published and available data, at best up to 12 studies had data available for any single analysis. The maximum number of total patients included in a single analysis was 602. The majority of studies evaluated patients with bulimia nervosa of a purging type. The review supported the efficacy of cognitive-behavioural psychotherapy (CBT) and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) like eating disorder syndromes. CBT had been used with efficacy in group settings. Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals, were promising albeit with more modest results generally, and their evaluation in bulimia nervosa approach merits further research. Exposure and response prevention did not appear to enhance the efficacy of CBT. Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.
• There was a small body of evidence for the efficacy of cognitive-behaviour therapy in bulimia nervosa and similar syndromes, but the quality of trials was very variable (e.g. the majority were not blinded) and sample sizes were often small in comparison to pharmacotherapy trials. More trials are needed, particularly for binge eating disorder and other EDNOS syndromes, and trials evaluating other psychotherapies and less intensive psychotherapies.
  • M Resch,G Szendei &P Haász, “Bulimia from a gynecological view: hormonal changes”, Journal of Obstetrics and Gynaecology, volume 24, 2004 - Issue 8 Pages 907-910.

• This article describes the qualitative analysis of a randomized control trial that explores the use of parent-to-parent consultations as an augmentation to the Maudsley model of family-based treatment for anorexia. Twenty families were randomized into two groups, 10 receiving standard treatment and 10 receiving an additional parent-to-parent consultation. Parents of all families were interviewed regarding their experience of treatment and transcripts were analyzed with the assistance of QSR N-Vivo. Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa.
  • Rhodes, P; Brown, J; Madden, S (2009). "The Maudsley model of family-based treatment for anorexia nervosa: a qualitative evaluation of parent-to-parent consultation". Journal of Marital and Family Therapy. 35 (2): 181–92. doi:10.1111/j.1752-0606.2009.00115.x. PMID 19302516.

• The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed.
• It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders.

• Rikani, AA; Choudhry, Z; Choudhry, AM; Ikram, H; Asghar, MW; Kajal, D; Waheed, A; Mobassarah, NJ (October 2013). "A critique of the literature on etiology of eating disorders". Annals of Neurosciences. 20 (4): 157–61. doi:10.5214/ans.0972.7531.200409. PMC 4117136. PMID 25206042.

• The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed.
• Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician.
  • Romanos, GE; Javed, F; Romanos, EB; Williams, RC (October 2012). "Oro-facial manifestations in patients with eating disorders". Appetite. 59 (2): 499–504. doi:10.1016/j.appet.2012.06.016. PMID 22750232.

• Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion = 0.58) related to comparison groups (average proportion = 0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion = 0.44) and a borderline personality disorder (average proportion = 0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion = 0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.
  • Rosenvinge, JH; Martinussen, M; Ostensen, E (2000). "The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998". Eating and Weight Disorders. 5 (2): 52–61. doi:10.1007/bf03327480. PMID 10941603.

• According to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), bulimia nervosa is characterized by recurrent episodes of binge eating followed by 1 or more compensatory behaviors to eliminate the calories (vomiting, laxatives, fasting, etc.) that take place on average a minimum of twice weekly for 3 or more months.5 Patients who do not meet the frequency or length criteria may be diagnosed with DSM-IV eating disorder not otherwise specified.
  Bulimia nervosa is also delineated into 2 distinct subtypes: purging and nonpurging. With the purging subtype, patients engage in some method to remove the binged food from their bodies. This is most often accomplished by self-induced vomiting but can include the misuse of laxatives, enemas, or diuretics. Nonpurging bulimics use fasting or excessive exercise as the primary compensation for binges but do not regularly purge. Regardless of subtype, bulimic patients have negative self-evaluations, placing inappropriate importance on weight and body image.
  • Jona M. Rushing, B.S., Laura E. Jones, M.S., and Caroline P. Carney, M.D., M.Sc. “Bulimia Nervosa: A Primary Care Review”, Prim Care Companion J Clin Psychiatry. 2003; 5(5): 217–224.

• The use of dialectical behavior therapy adapted for treatment of bulimia nervosa was associated with a promising decrease in binge/purge behaviors.
  • Safer, DL; Telch, CF; Agras, WS (2001). "Dialectical behavior therapy for bulimia nervosa". The American Journal of Psychiatry. 158 (4): 632–4. doi:10.1176/appi.ajp.158.4.632. PMID 11282700.

• To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified.
• Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories.
• Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.
  • Schmidt, U; Lee, S; Beecham, J; Perkins, S; Treasure, J (2007). "A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders". The American Journal of Psychiatry. 164 (4): 591–8. doi:10.1176/appi.ajp.164.4.591. PMID 17403972.

• This case describes the beneficial effect on the binge eating component of bulimia nervosa of methylphenidate, which was prescribed to treat comorbid attention-deficit/hyperactivity disorder. Possible mechanisms of action are discussed.
  • Schweickert LA1, Strober M, Moskowitz A., “Efficacy of methylphenidate in bulimia nervosa comorbid with attention-deficit hyperactivity disorder: a case report”, Int J Eat Disord. 1997 Apr;21(3):299-301.

• The cognitive model of eating disorders (EDs) states that the processing of external and internal stimuli might be biased in mental disorders. These biases, or cognitive errors, systematically distort the individual's experiences and, in that way, maintains the eating disorder. This chapter presents an updated literature review of experimental studies investigating these cognitive biases. Results indicate that ED patients show biases in attention, interpretation, and memory when it comes to the processing of food-, weight-, and body shape-related cues. Some recent studies show that they also demonstrate errors in general cognitive abilities such as set shifting, central coherence, and decision making. A future challenge is whether cognitive biases and processes can be manipulated. Few preliminary studies suggest that an attention retraining and training in the cognitive modulation of food reward processing might be effective strategies to change body satisfaction, food cravings, and eating behavior.
• An individual who is a first degree relative of someone who has had or currently has an eating disorder is seven to twelve times more likely to have an eating disorder themselves. Twin studies also show that at least a portion of the vulnerability to develop eating disorders can be inherited, and there is evidence to show that there is a genetic locus that shows susceptibility for developing anorexia nervosa.
  • Siep N1, Jansen A, Havermans R, Roefs A. “Cognitions and emotions in eating disorders.”, Curr Top Behav Neurosci. 2011;6:17-33. doi: 10.1007/7854_2010_82.

• Of the empirical studies undertaken, few investigated a cultural group's eating pathology in both its country of origin and a Western country using the same methodology. To date, the research findings are mixed and it is still unclear if the presentation of an eating disorder differs across cultures. Acculturation has not been consistently taken into consideration and psychological control has not been examined in relation to eating disturbances in non‐Western groups.
  • Soh, NL; Touyz, SW; Surgenor, LJ (2006). "Eating and body image disturbances across cultures: A review". European Eating Disorders Review. 14 (1): 54–65. doi:10.1002/erv.678.

• Patients with eating disorders (ED) frequently exhibit additional psychiatric disorders. This study aimed to examine whether psychiatric comorbidity in ED patients is associated with increased severity of ED symptoms in a sample of 277 women with a current ED (84 anorexia nervosa, 152 bulimia nervosa, 41 eating disorders not otherwise specified). Psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview (SCID) for DSM-IV. Severity of ED-related symptoms was assessed using interviewer-rated scales from the Structured Interview for Anorexia and Bulimia Nervosa (SIAB). Affective and anxiety-related disorders of both axes were linked with increased intensity of weight- and appearance-related fears and concerns. Frequency of binge-eating and frequency of purging both were associated with Axis I anxiety disorders, substance-related disorders, and Cluster B personality disorders. Frequency of dieting was related to anxiety disorders on both axes. Multivariate analyses revealed that Axis I anxiety disorders were more closely linked with severity of ED symptoms than affective or substance-related disorders. The results showed that psychiatric comorbidity of both axes is linked with increased severity of ED symptoms and that there are associations between specific ED symptoms and specific forms of comorbidity.
  • Spindler, A; Milos, G (2007). "Links between eating disorder symptom severity and psychiatric comorbidity". Eating Behaviors. 8 (3): 364–73. doi:10.1016/j.eatbeh.2006.11.012. PMID 17606234.

• Eating disorders, such as anorexia, bulimia, and binge eating disorder, commonly involve a dysregulation of behavior (e.g., a lack or excess of inhibition and impulsive eating patterns) that is suggestive of prefrontal dysfunction. Functional neuro-imaging studies show that prefrontal-subcortical systems play a role in eating behavior and appetite in healthy individuals, and that people with eating disorders have altered activity in these systems. Eating behavior is often disturbed by illnesses and injuries that impinge upon prefrontal-subcortical systems. This study examined relationships between executive functioning and eating behavior in healthy individuals using validated behavioral rating scales (Frontal Systems Behavior Scale and Eating Inventory). Correlations demonstrated that increased dysexecutive traits were associated with disinhibited eating and greater food cravings. There was also a positive association with cognitive restraint of eating, suggesting that increased compensatory behaviors follow disinhibited eating. These psychometric findings reinforce those of other methodologies, supporting a role for prefrontal systems in eating.
  • Spinella, M; Lyke, J (2004). "Executive personality traits and eating behavior". The International Journal of Neuroscience. 114 (1): 83–93. doi:10.1080/00207450490249356. PMID 14660070.

• Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term-the brain and skeletal system-both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food.
  • Starr TB1, Kreipe RE, “Anorexia nervosa and bulimia nervosa: brains, bones and breeding”, Curr Psychiatry Rep. 2014 May;16(5):441. doi: 10.1007/s11920-014-0441-4.

• There were large variations in the outcome parameters across studies. Mortality estimated on the basis of both crude and standardized rates was significantly high. Among the surviving patients, less than one-half recovered on average, whereas one-third improved, and 20% remained chronically ill. The normalization of the core symptoms, involving weight, menstruation, and eating behaviors, was slightly better when each symptom was analyzed in isolation. The presence of other psychiatric disorders at follow-up was very common. Longer duration of follow-up and, less strongly, younger age at onset of illness were associated with better outcome. There was no convincing evidence that the outcome of anorexia nervosa improved over the second half of the last century. Several prognostic features were isolated, but there is conflicting evidence. Most clearly, vomiting, bulimia, and purgative abuse, chronicity of illness, and obsessive-compulsive personality symptoms are unfavorable prognostic features.
• Anorexia nervosa did not lose its relatively poor prognosis in the 20th century. Advances in etiology and treatment may improve the course of patients with anorexia nervosa in the future.

• Steinhausen HC, “The outcome of anorexia nervosa in the 20th century”, Am J Psychiatry. 2002 Aug;159(8):1284-93.

• Anorexia nervosa (AN) has the highest mortality rate between psychiatric disorders, and evidence for managing it is still very limited. So far, pharmacological treatment has focused on a narrow range of drugs and only a few controlled studies have been performed. Furthermore, the studies have been of short duration and included a limited number of subjects, often heterogenic with regard to stage and acute nutritive status. Thus, novel approaches are urgently needed. Body weight homeostasis is tightly regulated throughout life. With the discovery of orexigenic and anorectic signals, an array of new molecular targets to control eating behavior has emerged. This review focuses on recent advances in three important signal systems: leptin, ghrelin, and endocannabinoids toward the identification of potential therapeutical breakthroughs in AN. Our review of the current literature shows that leptin may have therapeutic potentials in promoting restoration of menstrual cycles in weight restored patients, reducing motor restlessness in severely hyperactive patients, and preventing osteoporosis in chronic patients. Ghrelin and endocannabinoids exert orexigenic effects which may facilitate nutritional restoration. Leptin and endocannabinoids may exert antidepressive and anxiolytic effects. Finally, monitoring serum concentration of leptin may be useful in order to prevent refeeding syndrome.
  Circulating concentrations of leptin are exceedingly low during the acute stage of anorexia nervosa. Which symptoms result from these diminished concentrations must be clarified. Furthermore, research is required to evaluate whether or not a too rapid weight gain might induce a physiological counter-regulation which would predispose to renewed loss of weight.
  • Støving RK1, Andries A, Brixen K, Flyvbjerg A, Hørder K, Frystyk J, “Leptin, ghrelin, and endocannabinoids: potential therapeutic targets in anorexia nervosa”, J Psychiatr Res. 2009 Apr;43(7):671-9. doi: 10.1016/j.jpsychires.2008.09.007. Epub 2008 Oct 15.

• Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN.
  • Strumia, R (2005). "Dermatologic signs in patients with eating disorders". American Journal of Clinical Dermatology. 6 (3): 165–73. doi:10.2165/00128071-200506030-00003. PMID 15943493.

• Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area.
  • Swinbourne, JM; Touyz, SW (2007). "The co-morbidity of eating disorders and anxiety disorders: a review". European Eating Disorders Review. 15 (4): 253–74. doi:10.1002/erv.784. PMID 17676696.

• Anorexia nervosa (AN) is a severe mental illness. Drug treatments are not effective and there is no established first choice psychological treatment for adults with AN. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility: these laboratory based findings have been used to develop a clinical intervention based on Cognitive Remediation Therapy (CRT) which aims to use cognitive exercises to strengthen thinking skills.
• This preliminary study suggests that CRT changed performance on flexibility tasks and may be beneficial for acute, treatment resistant patients with AN. Feedback gathered from this small case series has enabled modification of the intervention for a future larger study, for example, by linking exercises with real life behavioural tasks and including exercises that encourage global thinking.
• This exploratory study has produced encouraging data supporting the use of CRT in patients with AN: it has also provided insight into how the module should be tailored to maximise its effectiveness for people with acute AN.

• Tchanturia, K; Davies, H; Campbell, IC (2007). "Cognitive remediation therapy for patients with anorexia nervosa: preliminary findings". Annals of General Psychiatry. 6 (1): 14. doi:10.1186/1744-859X-6-14. PMC 1892017. PMID 17550611.

• This review summarises the results of psychopharmacological treatment studies on anorexia and, bulimia nervosa. Although several drugs have tested in patients with anorexia nervosa, the outcome of controlled studies has been disappointing. Trials of pharmacotherapy for bulimia nervosa have demonstrated that tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors significantly reduce the frequency of binge eating and purging. In some cases, psychotherapists should accept the necessity of psychopharmacological intervention, although this does not imply a known biological cause of the eating disorder. However, the significance of antidepressant medication in the overall treatment of anorexia and bulimia nervosa remains unclear.
  • Thiel A. “Are psychotropic drugs necessary for the treatment of anorexia and bulimia nervosa?”, Psychother Psychosom Med Psychol. 1997 Sep-Oct;47(9-10):332-45.

• The findings suggest that a subgroup of patients with bulimia nervosa may benefit from unguided self-help as a first step in their treatment. Cognitive behavior self-help and nonspecific self-help had equivalent effects.
  • Thiels, C; Schmidt, U; Treasure, J; Garthe, R (2003). "Four-year follow-up of guided self-change for bulimia nervosa". Eating and Weight Disorders : EWD. 8 (3): 212–7. doi:10.1007/bf03325016. PMID 14649785.

• Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes.
  • Thompson-Brenner H1, Eddy KT, Franko DL, Dorer D, Vashchenko M, Herzog DB. "Personality pathology and substance abuse in eating disorders: a longitudinal study.", Int J Eat Disord. 2008 Apr;41(3):203-8.

• The present review focused on the personality profiles of patients with eating disorders. Studies using the Structured Clinical Interview for DSM-III-R Personality Disorder showed high rates of diagnostic co-occurrence between eating disorders and personality disorders. The most commonly observed were histrionic, obsessive-compulsive, avoidant, dependent and borderline personality disorders. Studies using the Cloninger's personality theory suggested that high Harm Avoidance might be relevant to the pathology of anorexia nervosa and high Novelty Seeking and Harm Avoidance to bulimia nervosa. Moreover, high Self-Directedness was suggested to be associated with favorable outcome in bulimia nervosa. The assessment of personality in a cross-sectional study, however, might be influenced by the various states of the illness. Therefore, a sophisticated longitudinal study will be required to advance this area of research.
  • Tomotake M1, Ohmori T, "Personality profiles in patients with eating disorders.", J Med Invest. 2002 Aug;49(3-4):87-96.

• The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a psychometrically sound self-report instrument for assessing women's attitudes towards their own bodies. The BAQ responses of a large sample of patients with eating disorders (ED) diagnosed in accordance with DSM-III-R criteria were compared with those from a normative population and from diverse groups of psychiatrically and physically ill patients. The ED group was distinct, and showed extreme responses in the area of weight and shape concerns. But a better discrimination between the ED and other populations was achieved using subscales that related to 'body disparagement' (an intense loathing of the body) and 'attractiveness', rather than to weight and shape concerns. ED patients may have a more pervasive disturbance in body-related attitudes than is currently widely accepted. Patients with anorexia and bulimia nervosa showed very similar attitudes despite the symptomatic differences between the groups.
  • Ben-Tovim, DI; Walker, MK (1992). "A quantitative study of body-related attitudes in patients with anorexia and bulimia nervosa". Psychological Medicine. 22 (4): 961–9. doi:10.1017/S0033291700038538. PMID 1488491.

• One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase.
• Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society.
  • Toro J1, Gomez-Peresmitré G, Sentis J, Vallés A, Casulà V, Castro J, Pineda G, Leon R, Platas S, Rodriguez R, “Eating disorders and body image in Spanish and Mexican female adolescents”, Soc Psychiatry Psychiatr Epidemiol. 2006 Jul;41(7):556-65. Epub 2006 May 9.

• This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery.
  • Treasure, J; Claudino, AM; Zucker, N (2010). "Eating disorders". The Lancet. 375 (9714): 583–93. doi:10.1016/S0140-6736(09)61748-7. PMID 19931176.

• There are a number of differences in the aetiology of subtypes of eating disorder. The present results suggest that cognitive styles pertaining to the social arena in adolescence, and prior to the onset of any eating disorders, may play a causal role in the development of anorexia nervosa of the binge/purge subtype, but not anorexia nervosa of the restricting subtype.
  • Troop, NA; Bifulco, A (2002). "Childhood social arena and cognitive sets in eating disorders". The British Journal of Clinical Psychology. 41 (Pt 2): 205–11. doi:10.1348/014466502163976. PMID 12034006.

• Aetiology and pathogenesis of eating disorders is a matter of controversy. In some cases they can occur in association with tumours involving the temporal cortex, in temporal lobe epilepsy or in the advanced state of degenerative diseases involving temporal structures. We report about three patients with right frontal intracerebral lesions, one oligo-astrocytoma and two vascular malformations, associated with partial seizures and anorexia nervosa.
• Two patients underwent craniotomy with extirpation of the lesion. In one case histology revealed an oligo-astrocytoma, in the other haemorrhagic infarction due to a venous malformation. The patient with the arteriovenous malformation (AVM) was embolized with microparticles. The patients with the oligoastrocytoma and AVM totally recovered. They gained weight and stayed seizure free. The patient with the infarction remained in a vegetative state.
• Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders. We therefore recommend performing a cranial MRI in all patients with suspected eating disorders, especially if they occur in combination with focal seizures.

• Trummer, M; Eustacchio, S; Unger, F; Tillich, M; Flaschka, G (2002). "Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases". Acta Neurochirurgica. 144 (8): 797–801. doi:10.1007/s00701-002-0934-5. PMID 12181689.

• Eating disorders, including anorexia and bulimia nervosa, are characterised by abnormal eating behaviour and typical psychopathological features, including fear of fatness, drive for thinness, and body image disturbance. In most patients, there is no detectable focal brain abnormality. Nonetheless, associations of anorexia and bulimia nervosa with history of perinatal complications and head injuries suggest a role of cerebral pathology in some cases. A number of case studies describe eating disorders with intracranial tumours, injuries, or epileptogenic foci. However, many clinical descriptions are limited to changes in appetite and lack psychopathological features characteristic of eating disorders. A previous review of 21 anorexia cases associated with brain tumours found that only three of them fulfilled formal diagnostic criteria. In the present paper, we provide a systematic review of published case reports and highlight those relatively rare cases where typical eating disorders appear to be causally associated with localised brain damage.
• This review of published case reports challenges the traditional view that hypothalamic disturbance underlies eating disorders. Although hypothalamic lesions are the most commonly reported neural causes of anorexia-like syndrome, most of them lack the typical psychopathology. Of the eight cases with characteristic psychopathological presentation and suggestive evidence for a causal association, four had frontal and temporal cortical lesions, two brain stem tumours, one hypothalamic tumour, and one hydrocephalus. Implication of frontotemporal circuits is consistent with functional neuroimaging research in eating disorders and with benign changes in eating, such as the gourmand syndrome.49 Therefore, we conclude that evidence favours cortical mechanisms in the genesis of eating disorders over hypothalamic ones. An association of disordered eating with epilepsy was reported in 12 cases. In six of these, remission after a surgical removal of an epileptogenic focus or anticonvulsant treatment suggests that eating disorder may be actively maintained by an epileptogenic focus rather than being a deficit syndrome due to missing normal brain tissue. In five of the reviewed cases, disturbed eating occurred alongside obsessive compulsive psychopathology. This finding parallels the comorbidity and familial cooccurrence of eating disorders and obsessive compulsive disorder50 51 and suggests a common or overlapping neural substrate of the two.
  • Uher R1, Treasure J, "Brain lesions and eating disorders", J Neurol Neurosurg Psychiatry. 2005 Jun; 76(6):852-7.

• Eighteen female inpatients were included in a double-blind placebo-controlled cross-over study aimed at testing the hypothesis that dopamine blockade may enhance the effectiveness of behavior therapy in the short-term weight restoration of anorexia nervosa patients. The patients were given a uniform contingency management program and, after a baseline period, they alternatingly (3-week periods) received pimozide (4 to 6 mg) or a placebo. During the first two periods pimozide almost significantly enhanced the weight gain induced by the behavior therapy program and beneficially influenced the patients' attitude towards treatment.
• Vandereycken, W; Pierloot, R (1982). "Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa. A double-blind placebo-controlled cross-over study". Acta Psychiatrica Scandinavica. 66 (6): 445–50. doi:10.1111/j.1600-0447.1982.tb04501.x. PMID 6758492.

• All dominant models of the eating disorders implicate personality variables in the emergence of weight concerns and the development of specific symptoms such as bingeing and purging. Standardized measures of personality traits and disorders generally confirm clinical descriptions of restricting anorexics as constricted, conforming, and obsessional individuals. A less consistent picture suggesting affective instability and impulsivity has emerged from the assessment of subjects with bulimia nervosa. Considerable heterogeneity exists within eating disorder subtypes, however, and a number of special problems complicate the interpretation of personality data in this population. These include young age at onset, the influence of state variables such as depression and starvation sequelae, denial and distortion in self-report, the instability of subtype diagnoses, and the persistence of residual problems following symptom control.
  • Vitousek, K; Manke, F (1994). "Personality variables and disorders in anorexia nervosa and bulimia nervosa". Journal of Abnormal Psychology. 103(1): 137–47. doi:10.1037/0021-843X.103.1.137. PMID 8040475.

• The Eating Disorder Service at the Children's Hospital at Westmead (CHW) in Sydney, provides comprehensive inpatient and outpatient treatment for children and adolescents with eating disorders. In 2003 the Maudsley Model of family based treatment for anorexia nervosa was introduced to support outpatient care. This has resulted in positive changes in the dynamics of the eating disorder team, a change in the philosophies that underpin the program and the experience of families that consult the service. There has also been a significant decrease in readmission rates. Our experience with the model has resulted in requests to provide training to other clinicians around Australia and a number of ongoing consultative relationships have followed. Implementation of the Maudsley model at CHW is described, followed by an overview of the theory and a summary of the key changes and challenges since moving in this new direction in 2003.
  • Wallis, A; Rhodes, P; Kohn, M; Madden, S (2007). "Five-years of family based treatment for anorexia nervosa: the Maudsley Model at the Children's Hospital at Westmead". International Journal of Adolescent Medicine and Health. 19 (3): 277–83. doi:10.1515/IJAMH.2007.19.3.277. PMID 17937144.

• Clinical observation has long suggested a link between personality and eating disorders. Research has consistently linked anorexia (particularly when the patient does not also have bulimic symptoms) to personality traits such as introversion, conformity, perfectionism, rigidity, and obsessive-compulsive features. The picture for bulimia is more mixed. Traits such as perfectionism, shyness, and compliance have consistently emerged in studies of individuals with bulimia or with anorexia, although research has often found bulimic patients to be extroverted, histrionic, and affectively unstable.
  Research on personality disorders has also examined the relation between eating disorders and personality and has documented considerable, but highly variable, rates of comorbidity, ranging from 21% to 97% for the presence of any personality disorder in patients with various eating disorder diagnoses. Conversely, patients with personality disorders have a higher than normal prevalence rate for eating disorders. The situation is similar for many axis I disorders, such as mood and anxiety disorders, for which comorbidity with axis II disorders hovers around 50%.
• The findings of this study raise questions about the concept of comorbidity as applied to eating disorders and suggest the likely utility for both research and clinical practice of considering eating-disordered symptoms in their characterological context (e.g., references 12, 34). The data from this study suggest that individuals who develop eating disorders who are constricted in most areas of their lives—e.g., who are passive and unassertive, emotionally constricted, and interpersonally avoidant—are likely to express this pattern with anorexic, rather than bulimic behavior. Clinically, these patients tend to be just as constricted in their sexual lives as they are with food, denying themselves pleasure, avoiding sexual relationships, feeling too ashamed or guilty to indicate to their partners what feels good, and so forth.
  Conversely, individuals with eating disorders whose ability to regulate their impulses and affects is tenuous—as expressed in spiraling emotions, tantrums, clinging to others for soothing, self-mutilation, and other impulsive acts—are likely to lose control over their eating in binges and to use self-destructive compensatory measures such as vomiting that momentarily help them regulate their affects. From this point of view, the question of whether bulimic symptoms should be regarded as impulsive behavior may be misplaced. The answer is probably that it depends on the personality configuration within which bulimic symptoms are contextualized. In low-functioning, emotionally dysregulated, type II bulimic patients, binge eating and purging may be functional equivalents of substance abuse, self-mutilation, and promiscuity. For these patients, bulimic symptoms may represent desperate efforts to regulate intense negative affects that call for immediate, and often maladaptive, responses. In contrast, high-functioning, perfectionistic, type I bulimic patients do not struggle with affects of the same intensity, and they have more adaptive coping strategies at their disposal for dealing with their distress. For these patients, binge eating is not equivalent to impulsive behaviors such as drinking or self-mutilation.
  More broadly, the data suggest that eating-disordered symptoms can be one expression, albeit a highly visible and sometimes life-threatening one, of a more general pattern of impulse and affect regulation. Thus, treating eating disorders primarily as disorders of food intake—and hence focusing primarily on altering the behavior, providing nutritional information (to patients who often know more about calories than the nutritionists who work with them), and so forth—may be taking the symptoms too literally. As in the treatment of trauma survivors, safety must be the clinician’s primary concern in treating patients with eating disorders when their symptoms are life-threatening or pose serious consequences for their current or future health. Particularly at those times, pharmacological and cognitive behavioral interventions can be essential components of a treatment plan, as they may be at various other points in the treatment.
• At the same time, however, symptom-focused treatment strategies may fail to address the personality structure that provides a context for understanding disordered eating. Patients whose personality profiles match the overcontrolled, constricted prototype, for example, rarely recognize their stance toward their own impulses and relationships as a problem. What brings them into treatment is typically someone else’s concern about their weight. If their attitudes toward their needs and feelings in general (and not just toward food) do not become the object of therapeutic attention, they are likely to change with treatment from being starving, unhappy, isolated, and emotionally constricted people to being relatively well fed, unhappy, isolated, and emotionally constricted people.
  The data also raise questions about the extent to which axis II is adequate for describing clinically meaningful patterns of personality pathology, at least for women with eating disorders. Patients in the high-functioning/perfectionistic cluster generally lacked diagnosable axis II pathology; indeed, in our study (as in the other studies that have isolated a similar cluster), they were defined by the absence of such pathology. These patients are articulate, conscientious, and empathic, and they tend to elicit liking in others. Yet they clearly have personality pathology—that is, enduring, problematic patterns of thought, feeling, motivation, and behavior. They are self-critical, perfectionistic, competitive, anxious, and guilt-ridden, and these aspects of their personality require clinical attention. The data reported here make sense in light of other findings that roughly 60% of patients treated for clinically significant personality pathology do not have problems severe enough to be diagnosable on axis II and that their personality problems (e.g., perfectionism and chronic feelings of guilt) generally are not reducible to any axis I syndrome (21, 22). Available data suggest that these patients represent the majority of patients treated in clinical practice and are not simply the “worried well.” Either axis II needs to be expanded from a personality disorderaxis to a personalityaxis that includes the range of functioning (from relatively healthy to relatively impaired), or subtypes such as those uncovered here need to be built into axis I.
  From a methodological standpoint, the results of this study suggest that we should routinely test for subtypes in our data sets rather than assuming homogeneity of categories. Group means may not be very meaningful when substantial intracategory heterogeneity exists, particularly if this heterogeneity is ordered, not random. The problem is particularly pronounced if pathology can be expressed in phenotypically opposite directions, leading to means that cancel out patterned within-group variability. Thus, although the etiological data on sexual abuse reported here are correlational and preliminary, they suggest that the same risk factor—sexual abuse—may manifest in opposite personality and behavioral styles—constriction and inhibition on the one hand, and dyscontrol and promiscuity on the other. Whether this is true of other etiologically significant psychosocial variables, such as harsh parental criticism (which, from a clinical point of view, appears sometimes to lead to self-criticism, sometimes to hostility and criticism toward others, and sometimes to both in adulthood), is an important question for future research.
  • Westen, D; Harnden-Fischer, J (2001). "Personality profiles in eating disorders: rethinking the distinction between axis I and axis II". The American Journal of Psychiatry. 158 (4): 547–62. doi:10.1176/appi.ajp.158.4.547. PMID 11282688.

• Circulating concentrations of leptin are exceedingly low during the acute stage of anorexia nervosa. Which symptoms result from these diminished concentrations must be clarified. Furthermore, research is required to evaluate whether or not a too rapid weight gain might induce a physiological counter-regulation which would predispose to renewed loss of weight.
  • Wewetzer C1, Mauer-Mucke K, Ballauff A, Remschmidt H, Hebebrand J., “Possible pathophysiologic, diagnostic and therapeutic implications of new findings on leptin secretion within the scope of anorexia nervosa” Z Kinder Jugendpsychiatr Psychother. 1998 Dec;26(4):244-52.

• Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic.
  • Westmoreland P1, Krantz MJ2, Mehler PS3, “Medical Complications of Anorexia Nervosa and Bulimia”, Am J Med. 2016 Jan;129(1):30-7. doi: 10.1016/j.amjmed.2015.06.031. Epub 2015 Jul 10.

• Published photographs of models that have been modified “in order to narrow or widen the silhouette” should be labelled as “photograph touched up”. Those who failed to comply could face a fine of up to €37,500 , or 30% of the value of the advert featuring the model.
  An earlier version of the bill also made it an offence punishable by up to a year’s imprisonment to encourage excessive thinness, a measure aimed at “pro-ana” websites that extol or promote anorexia or bulimia.
  Catherine Lemorton, president of the government’s social affairs committee, said many of those who ran such sites “suffered themselves with eating problems” and might be damaged further by the threat of prison.
  When the law was first introduced to the house in April this year, Marie-Rose Moro, a psychoanalyst and psychiatrist, said the law would solve nothing. “It would be better to provide more resources to care for anorexic patients,” she said, adding that there should be “more awareness to eating disorders in society”.
  Modelling agencies also attacked the law. “It’s very serious to conflate anorexia with the thinness of models and it ignores the fact that anorexia is a psychogenic illness,” Isabelle Saint-Felix, secretary general of Synam, which represents around 40 modelling agencies in France, told AFP.
  In France, an estimated 30,000 to 40,000 people – almost all of them adolescents – suffer from anorexia nervosa, an eating disorder with a high mortality rate.
  • Kim Willsher, "Models in France must provide doctor's note to work”, The Guardian, 18 December.

• Tumors of the hypothalamic-pineal region may present with a wide variety of symptoms, including disturbed eating. We present a case where such a tumor was misdiagnosed as anorexia nervosa.
• We describe a case of pineal germinoma invading the hypothalamus, which was initially diagnosed as anorexia nervosa.
• Clinical features included weight loss, vomiting, pyrexia, hypernatraemia, and visual disturbance and the typical psychopathology of anorexia nervosa was absent.
• Organic disorder should always be considered before making a diagnosis of anorexia nervosa, particularly if the presentation is atypical.
  • Winston, AP; Barnard, D; D'souza, G; Shad, A; Sherlala, K (2006). "Pineal germinoma presenting as anorexia nervosa: Case report and review of the literature". The International Journal of Eating Disorders. 39 (7): 606–8. doi:10.1002/eat.20322. PMID 17041920.

• Social media have become a significant means for peer-related communication, self-presentation, and identity management. So-called eating disorder websites that propagate a drastic thin ideal and unhealthy eating behaviors have triggered a debate about the harmful facets of social Internet activity. Little research has addressed the language that is used by the authors of these websites. The present study focuses on personal weblogs, a popular form of mostly text-based, diary-like, online journals. We compared 31 pro–eating disorder blogs, 29 recovery blogs, and 27 control blogs by the means of computerized quantitative text analyses. The language of pro–eating disorder blogs featured lower cognitive processing, a more closed-minded writing style, was less emotionally expressive, contained fewer social references, and focused more on eating-related contents than recovery blogs. A subset of 12 language indicators correctly classified the blogs in 84% of the cases. The distinct language patterns appear to reflect the psychological conditions of the blog authors and provide insight into their various stages of coping.
  • Wolf, M; Theis, F; Kordy, H (2013). "Language Use in Eating Disorder Blogs: Psychological Implications of Social Online Activity". Journal of Language and Social Psychology. 32 (2): 212–226.

History

• It was initially assumed that Cheddar Man had pale skin and fair hair, but his DNA paints a different picture, strongly suggesting he had blue eyes, a very dark brown to black complexion and dark curly hair.
  The discovery shows that the genes for lighter skin became widespread in European populations far later than originally thought – and that skin colour was not always a proxy for geographic origin in the way it is often seen to be today.
  • "First modern Britons had 'dark to black' skin, Cheddar Man DNA analysis reveals" Hannah Devlin, The Guardian, 7 Feb 2018

• Lesbianism is not mentioned in the Hebrew Bible, in contrast to male homosexual behavior, which is expressly forbidden as a capital crime. The absence of discussion of lesbianism in this context has raised scholarly interest. Biblical critics have suggested that this difference exists because female homoerotic behavior would not have been considered sexual behavior, which in ancient times was understood to require the emission of semen. A related theory suggests that nothing women did without men would matter because women were not full persons by biblical standards.
  • Rebecca T. Alpert , Jewish Women's Archive, “Lesbianism”

• Women prostitutes who had intercourse with male worshipers were attached to the sanctuaries and temples of ancient Mesompotamia, Phoenicia, Cyprus, Corinth, Carthage, Sicily, Israel, Egypt, Libya, and West Africa, as well as ancient and modern India.
  • The Construction of Homosexuality, David F. Greenberg, p.93

• Male homosexual prostitution having religious significance was an institutionalized feature of the archaic civilizations of the Mediterranean. Most authorities think it was practiced in the Temple of Solomon in Jerusalem, as well as in the worship of neighboring peoples. Yet a few scholars have expressed skepticism.

• Ibid, p.94

• In Akkadian, qadishtum was a holy priestess (who may or may not have been a prostitute). Ugaritic temple personnel included qdshm. At Memphis, a monument to Qudshu, aSyrian goddess associated with love and fertility, refers to her as "the prostitute." A Phoenician inscription on Cryprus dating from the fourth century B.C., referring to a category of temple personnel who played a role in the sacred service of Astarte, identifies the kelev as a religious functionary of some kind. The Sumerogram for assinu a male-homosexual cult prostitute (see below), joins the symbols for "dog" and "woman." Revelation 22:15 excludes dogs along with sorcerers, whoremongers, and idolaters from the holy city; surely it is referencing not to canines, but to men who plaed a sexual-sacramental role in religion. Deuteronomy prohibits cult prostitution because the Hebrews were adopting the practice from their neighbors. It does not follow from the identification of qdeshim as male cult prostitutes that their partners were men: Patai points out that they could have served barren women who hoped to conceive by having intercourse with a holy man. In some Hindu cults, wives have intercourse with priests who represent the god. There is no direct evidence for this custom from the ancient Near East, though it has been reported in the recent past for Morocco, Egypt, and Syria. It does seem incompatible with the restrictions Hebrew men placed on female sexuality, but the story of Elisha and the barren widow could be a garbled version of it.

• Ibid, pp.95-96

• Some of the evidence for homosexual cult practices in surrounding cultures is ambiguous, but clearly rules out male heterosexual prostitution. For example, Hittite texts document the existence of male transvestite eunuch temple priests but do not state clearly that they has sexual relations with worshipers. Babylonian and Assyrian texts refer to asinu and kurgarru, religious functionaries particularly associated with the goddess Ishtar, who danced, played musical instruments, wore masks, and were considered effeminate. They were often depicted carrying a spindle for weaving - a symbol of women's work.
• Prayers and treaty curses attributed the power to turn men into women to the goddess Ishtar, and explained that she had turned the assinu and and kurgarru into women to demonstrate her awesome powers. They were clearly transvestites. References to them as "neither male nor female," "incomplete", "half-men," and as "lacking something" point to castration. Surely their responsibilities did not include fertilizing women.
  • Ibid, p.96

• Roman writers tell; of the Cybele cult practices. Every March, Cybeles followers mourned the death of her androgynous lover Attis (her son in some versions of the myth) by holding ecstatic dances and striking themselves with swords and whips. At the height of frenzy, initiates severed their genitals with a sharp stone or shard of broken pottery (metal instruments were forbidden) and assumed women's clothing.
  When the veneration of Cybele was first introduced to Rome during the Second Punic War, the Roman's disdained her emasculated priests, and forbade citizens from undergoing initiation. But the cult spread as the orientalization of the Empire progressed. Bands of Galli roamed the countryside dressed as women, scourging themselves, dancing and begging. IN the Metamorphoses, also known as The Golden Ass, Apuleius portrays the galli as passive homosexuals who seek out virile young peasant lads to satisfy their cravings; Lucian paints a similar picture in Lucius, or the ass. However, none of the Hellenistic sources mentions ritual homosexuality. In The Life of Constantine, the church historian Eusebius Pamphili, bishop of Caesarea (260?-340), implies, without being too explicit, that the effeminate priests of the goddess worshipped on Mount Lebanon still engaged in homosexual cult practices in his own time, however, as a Christian, Eusebius could have been trying to smear goddess worshipers by imputing to them practices long since abandoned. Without corroboration from contemporaneous pagan sources it is hard to be sure.
  • Ibid, p.98

• Taking all the sources together, - a procedure justified by the prolonged and extensive contacts among the various civilizations of the Mediterranean - it can be safely concluded that anal intercourse formed a part of goddess worship from very early times throughout the Near East, with the possible exception of pharonic Egypt. If Eusebius is to be believed, it was still going on Mount Lebanon until Constantine had the shrine of the moon goddess destroyed in the early fourth century..
  The Hebrews were part of this world. They interacted extensively with Cannanites, Phoenicians, and Mesopotamians, and adopted some of their religious practices. The evidence presented her points to homosexual intercourse with qdeshim, who "did according to all the abominations of the nations, which Yahweh drove out before the children of Israel," as one of the practices they adopted. There is no evidence for analogous lesbian cult prostitution, though female transvestism appears in Canaanite mythology, and the Roman writer Juvenal - not a particularly trustworthy source - contended that women participating in an annual ceremony in honor of the Bona Dea engaged in lesbian acts.
  Scholars have noted the resemblance of Sakti (goddess) worship on the Indian subcontinent to the West Asian cults. Until the practice became illegal in 1948, when India received independence, some of the Hindu temples in many parts of the country had women and boy prostitutes. Communities of hijraspre- and post operative transexual devotees of the Mother Goddess (Parvati, Bahuchara Mata), who dress as women, sing and dance, and beg for alms, can still be found in a number of cities, especially in the north. They perform when the male children are born, and reputedly kidnap and castrate young boys. Many engage in homosexual prostitution, though not in a cultic context.
  • Ibid, pp.99-100

• Goddess cults of South India and Sri Lanka also involve male transvestism (but not prostitution at present), ritualized gashing of the head (symbolic castration) impotence anxiety, and fear of heterosexual intercourse. The consort of the virginal Sri Lankan goddess Pattini is killed and castrated or disemboweled (symbolically castrated). Some of these cults may have been brought to Southern India by Syrian traders in the first few centuries A.D. and adopted by indigenous Buddhist and Jain merchants who married foreigners.
  Receptivity to the new cults can be explained by psychological predisposition (discussed below) and already existing goddess worship in Dravidian folk religion, which involved berdachelike male transvestism. This worship was almost certainly quite archaic. Archeological and linguistic evidence polints to goddess worship and the veneration of the generative organs as prominent features of the Indus Valley civilization that flourished in Western India c. 2700-1700 B.C. The figure of a naked dancing girl, possibly a temple prostitute, has been found in the ruins. Cultural dissemination of these institutions from Sumeria, which traded extensively with the Harrapan civilization, is quite likely. The indigenous tribes of Southern India are thought to be descendants of the pre-Aryan Harrapan civilization.
  Hindu religious and legal texts frown on homosexual cult practices. Male prostitution was probably not a aprt of early Indo-European religion. Hence later cult transvestism and homosexuality are unlikely to have originated with the Aryan invasions; most likely they were indigenous, and survived because the invaders co-opted local cults rather than destroy them.
  • Ibid, p.100

• The male cult prostitution of the ancient Near East bear more than a casual resemblance to the American Indian berdaches described in the previous chapter. Just as the Near East cults linked gender transformation to the service of a goddess, some berdaches took up cross-dressing at the command of a female spirit or goddess. The explorer W.H. Keating reported that the Winnebago considered the moon,
  to be inhabited by an adverse female deity, whose delight it is to cross men in all his pursuits. If during their sleep this deity should present herself to them in their dreams, the Indians consider it enjoined on them by duty to become Cinaedi [receptive homosexuals]; and they ever after assume female garb.
  On the other hand, there are differences. Although the dreams were sometimes taken as omens in the ancient Near East, there is no evidence that they figured in the decisions to undergo castration in the service of the goddess. Intercourse with berdaches does not seem to have had religious significance, adn the healing rituals of those who became shamans did not involve sex. Berdaches were not eunuchs; and they were not attached to temples, or part of a religious hierarchy.
  As I've already argued in the preceding chapter, the geographical distribution of the transvestite shaman role is too great to be due to cultural diffusion in historical times. More plausibly, the assinu and galli evolved from an indigenous berachelike shamanism in the prehistoric Near East. Their special features (affiliation with a temple, castration) developed in the transition from a kinship order to a class differentiated society.
  • Ibid, p.101

• We do not know the family histories of the galli or other transvestite priests, but what we know of the goddess cults favors the second of these two models. The goddess's destructive rage at mortal men who reject her overtures is readily interpreted as a reflection of the child's fear of incest and the threat of his ego boundaries that it represents. The castrated, effeminate, dying son-consort represents the male child who identifies with his mother, loves her, and is punished for it. Flagellation and castration not only administer this punishment to the mother-fixated son, but also induce bleeding, a simulation of menstruation. Whereas Stone Age goddesses are visibly pregnant, those of the archaic civilizations are virginal - a denial of the mother's threatening sexuality. It is consistent with the dynamics proposed that men of ancient Mesopotamia were troubled by impotence, and sought a magical cure for it.
  Spratt considers the family prrocess postulated in the second model to be typical of traditional Indian families, and links this process with the prevalence of male transvestism in village rituals for the goddess. Obeyeskere notes that a number of Indian family practices, some of them dating back at least 1500 years, would tend to produce mother fixation in male children. Fathers indulge their little girls, but then they marry them at a young age to men they may not know. Overnight they become subservient strangers in households dominated by in-laws. Husbands are often emotionally distant, sexually inhibited by Brahmanic traditions holding intercourse to be polluting and dangerous. Failing to find emotional gratification from their husbands, mothers become strongly attached to their infant sons, kiss their penises, and act seductively toward them. IN Sri Lanka, sons sleep next to their mothers until age four or five, sometimes almost until puberty. The father sleeps elsewhere, but comes in to have intercourse, in the child's presence, with his wife.
  • Ibid, p.103

• Slater thought that subordinated mothers were especially characteristic of classical Greece, and found much evidence in Greek mythology for the themes expected on the basis of the family dynamics postulated in our second model. Yet Greeks of the classical age were repelled by the ritual castration. The practice was found primarily in Asia Minor.
  The difference can be laid to the role of the father. If he isa salient figure in the family, he can provide a basis for male identification despite the child's intense attachment to his mother. His presence should instigate oedipal conflict and fear of castration by others - themes one finds in Greek, Indiana nd Sri Lankan mythology - but not self-castration, which will be greeted with horror. Where the father is absent, on the other hand, identification with the mother is potentially stronger and may lead to transvestism without castration anxiety, and self-castration to deny one's masculinity.
  Greek fathers were not ordinarily absent from home for long periods, nor are contemporary Indian fathers; hence the rarity of institutionalized transvestism and self-castration. However, merchants of West Asia engaged in long-distance commerce were probably away from home for months at a time, as were professional soldiers of the standing armies of the monarchies. By contrast, the citizen-soldiers of the Greek city-states were not professionals and lived at home. Terms of service in the Roman army, on the other hand, grew to great length: the general and political leader Marius (d. 86 B.C.) permitted plebes to enlist for as long as twenty years, just about the time that self-castration began to make inroads.
  • Ibid, p.104

• Slater thought that subordinated mothers were especially characteristic of classical Greece, and found much evidence in Greek mythology for the themes expected on the basis of the family dynamics postulated in our second model. Yet Greeks of the classical age were repelled by the ritual castration. The practice was found primarily in Asia Minor.
  The difference can be laid to the role of the father. If he isa salient figure in the family, he can provide a basis for male identification despite the child's intense attachment to his mother. His presence should instigate oedipal conflict and fear of castration by others - themes one finds in Greek, Indiana nd Sri Lankan mythology - but not self-castration, which will be greeted with horror. Where the father is absent, on the other hand, identification with the mother is potentially stronger and may lead to transvestism without castration anxiety, and self-castration to deny one's masculinity.
  Greek fathers were not ordinarily absent from home for long periods, nor are contemporary Indian fathers; hence the rarity of institutionalized transvestism and self-castration. However, merchants of West Asia engaged in long-distance commerce were probably away from home for months at a time, as were professional soldiers of the standing armies of the monarchies. By contrast, the citizen-soldiers of the Greek city-states were not professionals and lived at home. Terms of service in the Roman army, on the other hand, grew to great length: the general and political leader Marius (d. 86 B.C.) permitted plebes to enlist for as long as twenty years, just about the time that self-castration began to make inroads.
• Of course we have no direct proof that eunuch priests were children of absent soldiers or merchants. Moreover, it is probable that most male children raised in such families did not castrate themselves. Men of the matrilineal Mayars of the Malabar coast of South India did not traditionally live with their wives; often they were away from home for long periods serving in the armies of the rajahs. Yet most became neither transvestite nor transexual. In most families, other males would have been present, and mothers were no so seductive and hostile to their son's heterosexuality as to produce an outcome so extreme as self-mutilation. However, if the family configuration described here was common in antiquity, gender ambivalence would have been common enough to create awe and fascination with eunuchs on the part of the populace.
  This awe and fascination made it possible for individual acts of castration to evolve into an institutionalized part of priestly initiation. Perhaps an individual eunuch attracted veneration, founded a local cult and established a sanctuary or temple, or took up residence in a preexisting temple. Such an individual could certainly have been a berdache or a transvestite shaman. Alternately, castration could have evolved from tribal rituals involving mild cutting. 1 Kings 18:26-28 describes the prophets of Baal cutting themselves with swords and lances while dancing in a leaping manner around the altar of Mount Carmel. Lucian of Antioch, a Christian theologian of the third century, reports that gashing with knives was part of the Syrian ceremony of mourning for Adonis. The prophets of the goddess Kali also cut themselves with swords when performing an annual rite in Kerala, India. Paleolithic cave art showing dancers in animal skins leaping testifies to the antiquity of such rites.
  Worshipers of the goddess who castrated themselves would undoubtedly have invented the myths to explain their actions. These myths would inevitably embody residues of the psychological process that gave rise to the castration, while disguising them from the initiates themselves by attributing responsibility to the goddess. Being composed from the raw materials made available by the surrounding culture, these myths would necessarily incorporate prominent themes of that culture, such as the annual vegetation cycle. Provided there were enough young men who responded to their anxieties by amputating their genitals, it would not have taken long for self-castration to become established in the annual rituals. Evidently there were enough. Once established, the prestige of the role might have made it attractive even to young men not especially plagued by maternal separation anxiety.
  • Ibid, pp.105-106

• The attractiveness of intercourse with a euncuh priest remains to be explained. By castrating himself and putting on female garb, the priest was not becoming just any woman. Unconsciously, he may have been identifying with his mother, but in terms of his own culture, he identified himself with a goddess, and presumably acquired some of her powers. Anal intercourse was her method. Although Ishtar was the goddess of love and had many lovers, she was childless. The female hierodules who consecrated themselves to her were called naditu, barren, because their sexual practices could not result in pregnancy. It was in imitation of the goddess and her divine partners that and their male counterparts in the priesthood submitted to anal sex. The male worshipers who had intercourse with the priests and priestess were uniting with the goddess herself. As the cuneiform text quoted earlier indicates, this union was propitious: the goddess must have looked favorably on a gift of precious semen. It brought good fortune to the worshiper and his household, just as the sacred marriage of the king to the high priestess each spring did for the entire kingdom.
  • Ibid, p.106

• One would hardly expect to see instituionalized male transgenerational homosexuality of the Melanesian variety (described in chapter 2) in the archaic civilizations. The conditions that seem to give rise to it in Melanesia do not exist in the early civilizations. WIth the pacification of an extended territory, wives are no longer taken from enemy villages, and amrriage is not aranged through sister exchange between cross-cousings.
  Yet ritualized, transgenerational male homosexuality was a part of early Greek culture. Dominated from the time of the Dorian invasion (c. 1200 B.C.) by powerful, culturally conservative noble families, the eastern part of Crete kept up ancient customs well into historical times. One of these customs was an initation rite for aristocratic youths that bears remarkable resemblance to tribal rituals. Boys were taken from their mothers by kouretes (armed male dancers). Under the auspices of the pre-Olympian Mother Goddess cult of Rhea and Zeus, the boys were cleansed of maternal contamination and reborn as men. A men'shouse figured in the ceremonies, and bull roarers (devices widely used in tribal rituals to simulate the sound of bulls or thunder) were used to terrify the initiates.
  • Ibid, pp.106-107

• As described by Ephoros, a historian of the fourth century B.C., and repeated almost verbatim by Strabo, the initiation had a homosexual component. The boy, chosen for his character and manliness, was abducted in a prearranged mock kidnapping and taken to the country for several months of hunting, feasting, adn homosexual sex. When released he was given a military outfit, an ox for sacrifice to Zeus, and a drinking cup. It was considered shameful not to be chosen. Those who participated were honored throughout their lives.
  Sparta, too, institutionalized relations between mature men and adolescent boys, as well as between adult women and girls, and gave them a pedagogical focus. The few accounts we have, all written by foreigners, do not claim that the relationships were aprt of initiation rites, but the Spartans were secretive about their instiutions, and strangers would not necessarily have learned the details. However, many aspects of Spartan homosexuality and amrriage customs point to tribal origins. Participation was mandatory for all youths of good character. There were ordeals - a common feature of tribal initiation. At their conclusion, all boys in the same-age grade had to marry - as in many tribes. Even after marriage, men lived in men's houses, not with their wives. Wives and male lovers were shared with age-mates. Like Crete, from whom the Greeks believed Spartan instiutions were borrowed, Sparta preserved ancient customs that had disappeared in other city-states.
  • Ibid, p.107

• The notion that Greek homosexuality had its origin in Dorian tribal initiations goes back to Muller, who suggested - without knowing anything of Melanesian life - that its purpose was the mechanical implantation of character via the semen. Bethe and other scholars find support for this thesis in the graffiti with homosexual themes found near a temple of Apollo on the island of Thera, a Spartan colony; they interpret the inscriptions as a record of an initiation. Others, though, consider the graffiti to be nothing mroe than frivilous obscene scribbling.
  The early history of Greek tribal cults remains obscure, but mythology points to the existence of male initiatino rites with a homosexual component. In many myths, including the foundation myths of a number of the city-states, a young man performs heroic feats of hunting under the supervision of an older initiation master with whom he sometimes has a homosexual relationship. On completion of the ordeal he is recognized as an adult and amrries, sometimes to a wife provided by his master. Even though our sources for the myths are late, cultural details of the stories place them in the Dark Ages or earlier, when hunting was still important to the economy - not only as a source of food, but to protect crops and domestic animals from lions and wild boars. The names of some of the ehroes and gods in the stories appear in Mycenean linear B tablets, suggesting that the myths and associated rituals could date back to c. 1500 B.C., if not earlier. They were probably not Minoan, but rather Indo-European.
  • Ibid, p.108

• There are hints in the ethnographic literature suggesting that in the transition from an egalitarian to a stratified social order, pederastic relations come to be restricted to an elite. In Hawaii and the Caroline Island of Micronesia, male homosexual relations (probably transgenerational, definitely not transgenderal) were institutionalized among the aristocrats of the Areoi Society, but not among the population at large. THis restriction often has an economic as well as normative dimension. Mossi chiefs have their young male sorones, while the less affluent commoners do not. Big Namba chiefs of New Gunea have many boy lvoers, commoners only one.
  • Ibid, p.110

• Male homosexual relations in the archaic civilizations also occured in military settings. The early civilizations were often at war, and for muc longer stretches than in the materially impoverished primitive societies. Wars were fought almost exclusively by men, and boys education stressed the martial arts and virtues.
  As in many kinship-structured societies, soldiers were often barred from any contact with women, lest they lose their masculine strengths or be polluted. According to Gilbert Murray, the Archeans who fought at Troy were votaries who had sworn an oath to abstain from intercourse with women until they had captured the city. Extended periods of separation from women would have been conducive to homosexuality, especially under conditions of warfare, whose participants share the intense emotions associated with the risks of combat.
  Many of the early civilizations passed through a stage in which political leadership was monopolized by the military aristocracy. Warfare took the form of armed champions fighting at close quarters as individuals or in small clusters, accompanied by squires. Centralized cordination was virtually nonexistent and warriors were highly competitive. While a cultural emphasis on personal valor and bravery would have made a champion erotically attractive to other men, rivalry would also have stood in the way of an egalitarian relationship. Though some sexual relations could have developed among some aristocratic warriors who fought together as equals, most would have had to involve partners who could not be considered competitors.
  • Ibid, pp.110-111

• Aristocratic warrior societies do seem have had extensive male homosexuality, which was completely accepted. Archeological evidence shows that c. 500 B.C., when they were founding the La Tene culture in France and the northern part of Switzerland, large numbers of Celts were armed for military raids of looting. Their political organization took the form of decentralized chiefdoms, with patron-client relationships linking aristocrats and commoners. According to Artistotle, the Celts esteemed homosexuality. Writing in the first century B.C., Diodorus Siculus found Celtic women charming, and every indicator of their social status suggests that it was quite high. Nevertheless, he adder, Mbr? The men are much keener on their own sex; they lie around on animal skins and enjoy themselves, with a lover one each side. The extraordinary thing is they haven’t the smallest regard for their personal dignity or self-respect; they offer themselves to other men without the least compunction. Furthermore, this isn’t looked down on, or regarded as in any way disgraceful: on the contrary, if one of them is rejected by another to whom he has offered himself, he takes offence.
  Evidence that the Celtic love of warriors may have extended to the British Isles (which the Celts invaded c. 200 B.C.) can be found in the Irish saga Tain Bo Caulinge. The hero Cuchulain explains that he does not want to fight his foster0brother and former comrade in arms Ferdia:
  • Ibid, p.111

• The Babylonian ‘’Epic of Gilgamesh’’ describes an intimate relationship between Gigamesh, king of the city-state of Uruk and Enkidu, a totally uncivilized, virile wild man sent by the gods in response to complaints from the nobles that Gilgamesh was sexually exploiting their sons and daughters. After a belligerent confrontation in which Gilgamesh emerges victorious, the two become close friends and embarked ona series od dangerous adventures together.
  Explicit homosexual reference are lacking, but there are hints that the relationship between Gilgamesh and Enkidu was sexual.
  • Ibid, p.112

• The conditions of warfare, we may conclude, seem to have encouraged homosexual bonding between male warriors in some of the early civilizations. This was especially true when weak military organization left military leadership to individual heroes and their followers. The relationships that ensued typically involved males of discrepant ages or social statues. Where armies were organized more bureaucratically, relationships of this kind would have been less common.
• Lesbian relationships were rare among adult women in most kinship structures societies. The extent to which that was also true in the archaic civilizations probably varies somewhat. Early Greek civilization may have had ritualized lesbian initiations for young women – in the case of Sparta, continuing into the classical age – but if comparable rites were performed in early civilizations, evidence of them has been lost. The restriction of women’s religious and political roles that accompanies the rise of early civilizations may have entailed the suppression of female initiations and inattention to myths with lesbians themes.
  These restrictions encourages lesbian relations by depriving women of amle compansionship, and by fostering close relationships with other women. Prince and wealthy men of the Azande in southern Sudan have large numbers of wives, all of whom must necessarily do without their husband most of the time. The risk of death for adultery discourages extramarital heterosexual affairs. Instead, women turn to other women. The ease of disguising a lesbian affair as a simple friendship makes it difficult for husbands to interfere, even though most of them dislike lesbianism and fear that it could magically injure them.
  Most Athenian women of the classical age were confined to the home much of the time, and had little opportunity to meet women of their own social status. However, if they were at all affluent, they spent that time in the women’s section of the house, where men did not enter, alone with female slaves. What they did with one another is anyone’s guess; Greek men did not write about that sort of thing. In the case of Egypt, paintings show women being dressed or coiffed by female servants. The scenes are sensuous, but not sexual. Whether lesbian relationships commonly developed between mistresses and their servants us unknown.
  • Ibid, pp.116-117

• Wherever harems existed, as in India and the Near East, they became known for lesbianism. Harem women were deprived of men (except for eunuch guards) and spent most of their time with one another. Inevitably, their emotional and sexual involvements centered on co-wives. Jealous husbands might threaten severe punishments, but the seculusion of women must have made detection very difficult.
• Class-structured homosexuality appears with the dawn of economic stratification. Here the two partners are drawn from different economic strata or classes, the wealthier partner purchasing or commanding the sexual services of the poorer. The partners may differ in age, gender, or preference for particular types of contact, but these differences do not define the relationship. What does is the preference of the wealthier partner. Thus Captain Blight, visiting Tahiti in the late eighteenth century, observed a chief sucking the penis of his attendant. By the usual conventions linking rank and sex role, this transaction should not have occurred. The attendant should have been sucking the chief. However, the chief occupied a social position that enabled him to gratify his personal preference irrespective of conventions about homosexual roles. In societies were social relations are commercialized wealth bestows sexual power.
  ‘’’Two forms of homosexuality are particularly common in antiquity: prostitution and intercourse with slaves.’’’ After examining each we will turn to the related topic of castration in nonreligious contexts.
  • Ibid, p.117

• The demand for prostitutes in antiquity came from merchants and sailors far from home, and from men who had difficulty gaining sexual access to partners who did not have to be paid (because patriarchal restrictions made it difficult to obtain respectable women and boys). The supply developed in response to the growth of economic inequality. With the disintegration of the redistributive channels of clan society and the privatization of the means of production, the dispossessed sometimes turned to prostitution to support themselves. But not all prostitutes were poor. Tahitian and Rwandan chiefs used their wealth to attract men who were not impoverished to their court, and made them available to guests. In the absence of taboos or legal restrictions against homosexuality (see chapter 4), male homosexual prostitution developed alongside female heterosexual prostitution.
  Even when the kinship order is intact, economic inequality can lead to homosexual prostitution. Transgenerational male homosexuality was universal in the Big Namba chiefdoms of Malekula Island in the New Hebrides, the boy’s lover being his sister’s true or possibly classificatory sisters’ husband. Though he had exclusive sexual rights, he could sell these rights to other men. Since the boy worked in his partner’s garden, an element of economic exploitation entered the relationship. Similarly, in the Libyan oases of Siwah and El Garah fifty years ago, parents prostituted their sons to the wealthier men. No comparable pecuniary elements are mentioned in the ethnographies of the more egalitarian New Guinea cultures.
  With the emergence of well defined classes, prostitution became ubiquitous, and freed from it cultic trappings. It was a feature of everyday life in ancient Mesopotamia; there was even a guild for practitioners. A hint of exploitations appears in an Assyrian tablet dated at 716 B.C. that refers to them:
  When a male prostitute (sinnisanu = effeminate man) entered the brothel, as he raised his hands in prayer, he said, “My hire goes to the promoter. You [Ishtar] are wealth, I am half.
  • Ibid, pp.117-118

• Athens and other Greek harbor towns had male brothels from an early date, but it was considered shameful for a free citizen to prostitute himself for money. A law attributed to Solon, himself a pederast, provided that an Athenian citizen who did so was barred from certain religious functions and public affairs, and could not speak before of the Assembly or Council on pain of death. If a father or guardian prostituted his minor ward for money, the ward was absolved of traditional responsibilities toward elderly parents or guardians. It was contrary to the egalitarian ethos of citizenship for a free man to place himself at the service of someone else for money. ‘’’Someone who would sell his body, it was said, might as readily sell the interests of the state. The use of legislation to enforce this ethos reflects the recognition that economic pressures associated with the commercialization of the Greek economy were eroding the social basis of citizenship to a potentially dangerous degree. It was Salon who prohibited indebted Athenian citizen from being sold abroad into slavery.
  Foreigners were not covered by Solon’s legislation, and for this reason it is thought that many of Athen’s male prostitutes were aliens. While some may have become prostitutes from economic necessity, others were prisoners of war who had been sold into brothel slavery. Plato’s Phaedrus is named for a citizen of Elis who had been captured by the Spartans and sold to an Athenian house of prostitution.
  Although the Athenians stigmatized prostitutes, they did not deprive them of all legal rights; according to Aiskhines, prostitutes could go to court to collect from nonpaying customers. Patronizing prostitutes was considered perfectly acceptable, not shameful or illegal. Each year, the Athenian Council confirmed special tax on male prostitutes, suggesting that they were numerous enough to warrant attention as a source of revenue.
  By all accounts, prostitution flourished in Rome after the Second Punic War (218-201 B.C.), when wealth poured into the city, and the large-scale displacement of free farm laborers by slaves created massive unemployment. Brothels opened not only in Rome, but also in large and medium-sized towns throughout Italy. A reference in a public speech of the elder Cato to the high price of male prostitutes makes clear that only the affluent could indulge.
  Most male prostitutes were slaves owned by a procurer, however, some prostitutes were freedmen or even free. Under Augustus the government began taxing male prostitutes, and also granted them a legal holiday.
  • Ibid, pp.118-119

• The Douleq papyrus (c.1400 B.C.) suggests that female temple prostitutes may have served the cat goddess (Carlton, 1977:109), and Breasted (1906:4.74-75, 5.132) concludes from para. 128 of the Papyrus Harris (twelfth century B.C.) that women captured in war were made to serve as temple prostitutes, but the papyrus does not actually state the nature of their services. That is true of many of the references to female temple slaves or personnel mentioned by Hogarth (1914). The Egyptians seem to have regarded sexual intercourse as ritually defiling and prohibited it inside their temples (Quibell, 1907: 12-14; Manniche, 1977). By the Ptolemaic period the situation may have changed. The Greek geographer Strabo, who visited Egypt just after it had been conquered by Rome, reports that one of the most beautiful girls of an illustrious family was dedicated to Amun, became a prostitute, and had intercourse with men until she menstruated; then she was married (17.1 46). This practice may have been borrowed from Babylonia, where a similar custom was noticed by Herodotus some hundreds of years earlier (1.199).
  • Ibid, p.128

• Cult prostitution may have failed to take root in Egypt because of the way the kingdom was unified. Some scholars think unification was achieved when nomadic, sun-worshiping desert tribes from Upper Egypt (in the south) conquered the sedentary cultivators of the delta (lower Egypt). The defeated farmers may have engaged in ritual sex to promote fertility, but the victorious nomads almost certainly did not. Though the goddesses of the indigenous farming culture survived, their cults were presumably abolished or transformed by conquerors. ‘’’One suspects that once irrigation was established, ceremonial interest would have shifted from the promotion of crop growth to the control of the flooding of the Nile, for which sexual rites would not have provided a magical analogue.’’’ The absence of maternal destructiveness toward men in myth suggests that Egyptian family arrangements did not give rise to the psychodynamics associated with religious self-castration, as they seem to have done in Asia Minor.
  The coronation ceremony for a new king looks very much like it evolved from an earlier tribal ritual that transferred charismatic powers homosexually, but in the historical period the transmission was symbolic, not sexual. Unlike kinship-structured societies that ritually sodomize all male youths, or the aristocratic societies that do it only to young nobles, the Egyptian ceremony was performed for the king alone. His was a charisma not shared by ordinary mortals, even aristocrats.
  • Ibid, pp.128-129

• Even in the absence of ritual performance, Egyptian culture retained the belief that homosexual intercourse with a god was auspicious. In one coffin text, the deceased vows, “I will swallow for myself the phallus of Re…;” another, referring to the earth god Geb says, “his phallus is between the buttocks of his son and heir.”
  Two fragmentary manuscripts attest to the existence of homosexuality outside a cult context toward the end of the Sixth Dynasty (c. 2272-2178 B.C.). The texts begin by describing a conspiracy to obstruct a judicial hearing, but the outcome is unknown because part of the manuscript is missing. The narration resumes by telling of a commoner who discovers King Neferkare (pepe II) was making regular secret nocturnal visits to the home of General Sisene, a top royal administrator, who was unmarried or living without a wife. A homosexual relationship between Neferkare and his general is clearly implied. Because of a gap in the manuscript, the connection (if any) between the conspiracy and the affair is unclear.
  The published translation of the manuscript is neutral in tone and non judgemental in its treatment of the affair, but in a letter to me, the Egyptologist. Gwyn Griffiths insists that “the whole piece conveys an atmosphere of royal corruption.” Posener, the translator, points out that Neferkare’s ninety-year reign was a period of political decline in which the monarchy came under the sway of the nobility. Both episodes, he suggests, can be seen as manifestations of decay. ‘’’Yet this interpretation is speculative.’’’ Even if it is valid, it does not necessarily follow that Egyptians of the time viewed homosexuality negatively. Someone who had no prejudice against heterosexuality might nevertheless raise an eyebrow upon learning that the president of the United States was paying secret nocturnal visits to the home of a female cabinet officer. The Egyptians might have considered it undignified for the king, who was considered the incarnation of divinity, to have an affair with a mere mortal. Pharaoh was considered so sacred that most people were not even permitted to touch him.
  • Ibid, pp.129-130

• The existence of a tomb for two manicurists and hairdressers of King Niuserre of the Fifth Dynasty (c. 2600 B.C.) suggests that in this early period homosexuality may not have been stigmatized. Bas-reliefs on the walls of the tomb depict the two men in intimate poses, holding hands, embracing, noses touching. Egyptian art rarely depicts men and women embracing; scenes of two men doing so are virtually unknown. None of the drawings is sexually explicit, but Egyptian art rarely was. If the men were lovers, it would be reasonable to conclude that male homosexuality was fully accepted. Both men were wealthy, and their position at court prestigious. Their tomb was a gift from the king (as indeed all tombs theoretically were).
  An unusual degree of intimacy is also shown in depictions of King Ikhnaton (1379-1362 B.C.) and his son-in-law and probable co-regent Smenkhare. They are shown together nude – a convention quite rare in Egyptian representations of royalty. On a stele, Ikhnaton strokes Smenkhare under the chin. Smenkhare is given titles of endearment that had been used previously for Ikhnaton’s concubines and queen. Ikhnaton is depicted with a swollen belly, a generally feminine physique, and without genitals. <br? Several texts indicate that the Egyptians stigmatized the receptive role in anal intercourse between men just as the Mesopotamians did. Ina coffin text in the Heracleopolitan Period (Ninth and Tenth Dynasties), consisting of magical passages to be recited after death to gain immortality, the deceased boasts, “Atum [a god] has no power over me, for I copulate between his buttocks.” The formula equates interpersonal power with sexual role performances: he who can force a god to submit to him sexually has nothing to fear from him.
  • Ibid, p.130

• A connection between homosexual role differentiation and gender stereotyping is evident in the mythological conflict between two gods, Horus and Seth. The story of their enmity is very old, probably dating back to the predynastic conflict between Upper and Lower Egypt, which is represents metaphorically. Ina version of the myth dating from the reign of Rameses V in the Twentieth Dynasty, c. 1160 B.C., the gods held a trial to adjudicate the conflicting claims of Horus and his older brother to succeed Osiris as ruler of Egypt. When the trial recessed for the night,
  Seth made his penis erect, and put it between Horus’ buttocks, and Horus put his hands between his buttocks, and received Seth’s semen. Then Horus went to tell his mother Isis: “Help me, Isis my mother! Come, see what Seth has done to me.” And he opened his hand and let her see Seth’s semen. With a scream she took her weapon and cut off his hand and threw it in the water, and conjured for him a hand to make up for it.
  When the trial resumed, Seth pleaded:
  Give me the office of Ruler, L.P.H., because as for Horus here, I have played the male role with him.” Then the Ennead [the nine gods judging the trial] screamed aloud and belched and spay in Horus’ face.
  Isis’s reaction to the episode – cutting off Horus’s hand – suggests that Seth’s semen was so contaminating that it could not be washed or wiped off: it had to be cut off, along with the hand it had polluted. Westendorf points out that the Egyptians believed semen had the effect of poison when introduced into the body – presumably in the “wrong” spot. Given this ideological manifestation of antipathy to most forms of nonprocreative sex, Seth’s aggression was a particularly grave transgression. Since gender roles are defined only by contrast, Seth’s announcement that he played the “male role” implies Horus’s role was “female.” Although both Seth and Horus are morphologically male, the myth defines their gender not by their anatomy but by the roles they played. To penetrate is to be male, to be penetrated, female.
  • Ibid, pp.130-131

• It is often suggested that religious borrowing continued under the first monarchs, possibly to win the loyalty of the indigenous population; but the evidence for syncretism under Saul and David is not great. However, Solomon employed Phoenician architects in the construction of his temple, and they borrowed their design from that of the Syrian, Shechemite, and Hazorite temples. TO accommodate his many foreign wives, Solomon built temples to their gods and offered them sacrifices.
  Even in the premonarchical times, devout Yahwists may have been offended by the fertility cults’ use of “magical” techniques to control the gods. The Jewish view that humans cannot force God to do anything may have been present even at this early date. Later, sharpening gender stereotypes and restrictions on women would have intensified hostility to cult prostitution; under the monarchy, the prophets rallied against female promiscuity and prostitution. However, there is no evidence of conflict between the worshippers of Yahweh and the followers of other gods during the early monarchy.
  Open resistance to the fertility cults first appeared under Ahab, ruler of the northern kingdom of Israel (874-853 B.C.). Under the influence of Jezebel, a Phoenician princess, he sponsored the public worship of Baal, built him an altar and also built and Asherah. This marriage, like many of Solomon’s, was a device for cementing an alliance with a foreign power. Zeitlin argues that the cult had little popular support and aroused determined opposition from faithful Yahwists. However, Elijah complained to Yahweh that “the children of Israel have forsaken thy covenant, thrown down thine altars, and slain thy prophets with the sword…” Wheb he asked the assembled Israelites to choose between Baal and Yahweh, they remained silent. To the extent that popular opposition did exist, it probably centered on the execution of Yahwist priests and the destruction of Yahweh’s altars.
  • Ibid, pp.138-139

• The later kings of Judaea continued to follow the political winds in their patronage of foreign cults. When Ahaz (died c. 720 B.C.) was besieged by the Aramean and Israelite armies, he asked the Assyrians for aid. When they responded favorably, he paid them tribute and also set up a copy of the Assyrian altar in the Temple of Yahweh. Later, when the Edomites and Philistines attacked, Ahaz shut the Temple and sacrificed to the Aramean gods, who HAd shown their greater power by defeating him some time before. A century later, Manasseh erected altars for Baal and Ashoreth in the Temple courtyards and introduced an image of Asherah into the Temple itself. Assyrian annals portray Manaasseh as a vassal-king, of Assyria. Undoubtedly, he was trying to accommodate the religious practices of his sponsors.
  A policy of accommodating foreign cults or synthesizing them with the worship of Yahweh was presumably favored by the priests of the various cults, as well as by foreign residents, court circles favorable to the neighboring powers, and farmers, for whom the fertility cults would have had great significance. ‘’’Women were especially devoted to the polytheistic cults, possibly because of their greater concern with fertility, possibly because they could identify more readily with a religion that featured goddesses and priestesses than with one that had neither. Yahweh was depicted largely in male terms and was served exclusively by male priests. Opposition would have come from the priests of Yahweh, whose jealousy they projected onto their god, and his adherents among the laity. This might have included herders, who had little reason to be interested in rites connected with agricultural fertility, and most certainly the prophets, who associated foreign worship with class inequalities and royal grandiosity that violated the ideals of egalitarianism associated with the tribal period.’’’
  Those Judean kings who sponsored campaigns against the foreign cults did so in a spirit of nationalistic self-assertion. As a destroyed the idols after winning a decisive military victory against an Ethiopian army. His successor Jehosephat, who continued Asa’s religious reforms, allied with Israel and won major victories, preserving Judeas political independence.
  • Ibid, pp.139-140

• Hezekiah, who destroyed the Asherim, purified the Temple, and restored the worship of Yahweh in its earlier form, did so in the context of his successful defiance of Assyrian rule. His attempt to centralize the observance of Passover in Jerusalem can be seen as a tactic to strengthen royal power and prepare for the political recovery of Israel. Josiah’s reforms, which involved burning the Asherah that had been placed in the Temple, destroying places of worship, and killing priests throughout the land, were undertaken at a time when Assyrian power had been seriously weakened by an Egyptian revolt. Indeed, the Assyrian Empire was overthrown by the Medes and Persians during Josiah’s reign.
  In each case, the repression of foreign cults entailed the suppression fo the homosexual prostitution that went with them. Asa “put away the qdeshim out of the land.” Jehosephat “put away out of the land…the remnantof the qdeshim that remained int eh days of his father Asa.” Josiah “broke down the houses of the qdeshim, that were in the house of Yahweh, where the women were weaving coverings for the Asherah.” ‘’’It was during his reign that a book of the Law, thought by most scholars to have been Deuteronomy, was conveniently discovered in th Temple.’’’ Although some of the manuscript may have been written earlier, many scholars think it was forged during Josiah’s reign in order to legitimate his reforms. It is in Deuteronomy that the prohibition of cult prostitution appears.
  The extend of popular support for these efforts is hard to gauge, but may not have been great. The worshipers whose religious sanctuaries and paraphernalia were destroyed could only have been antagonized. When Jeremiah prophesied to the Judaens in exile in Egypt, a “great assembly” of men and women gathered to complain:
  “But since we let off to offer to the Queen of Heaven, and to pour out drink-offerings unto her, we have wanted all things, and have been consumed by the sword and by the famine.”
  • Ibid, p.140

• Others may have reasoned that political and military contests showed how strong a nation’s gods were. If Judaea defied Assyria with impunity, if Yahweh worshipers were able to destroy their opponent’s temples and altars, it could only mean that Yahweh was stronger than Baal or Ashtoreth, and that his rituals, rather than theirs, should be performed.
  ‘’’It cannot be stressed too strongly that none of the campaigns against cult prostitution was directed at homosexuality in the population at large.’’’ The targets were religious cults associated with foreign powers. Nationalistic rulers suppressed these cults when they strove for independence from rival powers. In so doing, they tried to abolish the ritual practices associated with these cults, including homosexual prostitution.
  ‘’’None of the biblical passages we have examined thus far suggests that the Hebrews viewed homosexuality any different than the way other peoples of the ancient Near East viewed it. There are passages in Leviticus that might suggest a very different conclusion, but we defer a discussion of them to the next chapter, where it will be argued that they represent a fairly late development. Provisionally, we conclude that at least until the Babylonian exile in 586 B.C., the Hebrews had no prohibition against homosexuality.’’’ Some of them engaged in it as part of their polytheistic religious practices on and off from the time of the conquest of Canaan to the exile.
  • Ibid, p.141

• Contacts with the East beginning in the late Neolithic (end of the fourth millennium B.C. to 2800 B.C.) gave Crete its goddess worship. Minoan depictions of men wearing women’s clothing in cult scenes suggest that that worship included homosexual cult prostitution, as it did in West Asian goddess worship. Later Greek myths of gods changing men into women (e.g., Tiresias, Kaineus) may derive from garbled recollections of transvestism ion the pre-Olympian cults. By the time the Greeks emerged from the Dark Age and produced the writings that tell us of life in the classical age, they considered these cult practices to be alien.
  By that time, the homosexual component of tribal initiation rites had also disappeared in most of Greece.
  • Ibid, p.141

• Still later, Lucian, a satirist of the second century A.D., expressed this catholicity of taste in the short story “The Ship or the Wishes.” One of the characters Timolaus, wishes he owned a set of magic rings that would fulfill his desires. The ring he wants most will
  make the pretty boys and women and whole peoples fall in love with me – no one will fail to love me and think me desirable: I shall be on every tongue. Many women will hang themselves in despair, boys will be made for me and think themselves blessed if I but glance at one of them, and pine away for grief if I ignore them.
  This interchangeability of boys and women was taken for granted. Thus Xenophon remarks that when prisoners of war were ordered released, “the soldiers yielded in obedience, except where some smuggler, prompted by desire ofa good-looking boy or woman, managed to make off with his prinze.” Similarly, when Plato argues in the ‘’Laws’’ that it was possible for people top exercise sexual restraint, he recalls that the renowned athlete Ikkos of Taras “never had any connection with a woman or a youth during the whole time of his training.”
  To be sure, it was recognized that some men preferred women, and others, male partners. Atheneus, for example, remarked that Alexander the Great was indifferent to women but passionate for males. In Euripide’s play ‘’The Cyclops’’, Cyclops proclaims, “I prefer boys to girls.” Plato was never married. The philosopher Bion (third century B.C.) advised against marriage and restricted his attention to his (male) pupils. The Stoic philosopher Zeno (late fourth and early third centuries B.C.) was also known for his exclusive interest in boys.
  Aristophanes’ speech in Plato’s ‘’Symposium’’ explains these preferences by fantasizing that the ancestors of the human race had two pairs of arms and legs, two heads, and two sets of sexual organs. Some were double males, some were double females and some half maale and half female. After the gods split the twins, their descendants sought, and continue to seek, reunion with the “missing half,” whether of the same or opposite sex. Since humans who preferred same-sex partners would still have had to reproduce heterosexually for the myth to explain same-sex preferences in the next generation, it is not so clear that Aristophanes’ explanation implies exclusive sexual choices. Still it does presume specialized preferences.
  • Ibid, pp.145-146

• Hellenistic writers even imagined debates about the relative merits of male and female partners. Some argues that is made little difference. One of the characters in Plutarch’s ‘’Erotikos’’, or ‘’Dialogue on Love’’, argues that “the noble lover of beauty engages in love whether he sees excellence and splendid natural endowment without regard for any difference in physiological detail.” He will be “fairly and equably disposed toward both sexes, instead of supposing that males and females are as different in the matter of love as they are in their clothes.” His interlocuters, however, have more definite tastes. So do the protagonists in ‘’Love’’, a sophistical treatise attributed to Lucian. Even here, though, the arguments in favor of boys or women largely concern the practical advantages of each. Moral considerations are never raised, and boy lovers win the debates as often as those who prefer women.
  In this sense, homosexuality and heterosexuality are treated as having equal status. Thus Athanaeus remarked that “Sophocles liked his young lads in the same way that Euripides liked his women.” As long as they were exercised in moderation, sexual preferences for boys or women did not become the basis for imputations of moral character or competence in other spheres of life.
  ‘’’Note that in most of these passages it is boys, not men, who are placed on an equal footing with women. This preference for youths stemmed from the intensely competitive individualism of Greek male culture.’’’ Male competitiveness developed as clan structures broke down and property became privatized. It dominated aristocratic life everywhere except Sparta, where kingship was hereditary, the senate of elders elected for life (minimizing rivalry for political office), and wealth distributed equally. Greek men were sensitive to status distinctions, and since status among the greeborn was not fixed, men view for position.
  • Ibid, p.146

• Preoccupation with status pervaded sexual culture to the point where the Greeks could not easily conceive of a relationship based on equality. Sex always involved superiority. Though ‘’The Interpretation of Dreams’’ by Artemidorus Daldianus dates from the second century A.D., it reflects earlier attitudes on this score quite accurately. The section on sexual dreams indicates that
  Having sexual intercourse with one’s servant, whether male or female, is good; for slaves are possessions of the dreamer, so that they signify, quite naturally, that the dreamer will derive pleasure from his possessions….If a man is possessed by a richer, older man, it is good. For it is usual to receive things from such people. But to be possessed by someone who is either younger than oneself or destitute is unlucky. For it is usual to give things to such people. The same also holds true if the possessor is older but a beggar…. Possessing a brother, whether he is older or younger is auspicious for the dreamer. For he will be on top of his brother and disdainful of him. And whoever possesses his friend will become his enemy, since he will have injured his friend without provocation.
  Submission was evidentially not dishonorable when it was to someone whose social status was clearly superior, e.g.,a rich older man. But when the aprtners were of similar social status (brother, friends), possession implied status derogation, and this was an insult. The Persian soldier who, on a red-figure vase painting, presents his behind to a sexually aroused Greek man as being humiliated by his captor.
  Most men accommodated these status considerations by choosingan status inferior (a slave or prostitute), or a free younger partner, whose youth made him ineligible for military service or political office-hence someone who was not a rival. The idealized homosexual relationship thus involved an adult lover, usually between the ages of twenty and thirty (‘’the erastes’’), and an ‘’eromenos’’ or ‘’paidika’’, a prepubescent adolescent who beard had not begun to grow. The relationship was ordinarily temporary, ending or becoming a nonsexual friendship when the youth reached maturity.
  Affairs between two adult men were less common, and were somewhat stigmatized, though not severely. Plato thought highly of those who
  love boys only when they begin to acquire some mind – a growth associated with that of down on their chins. For…those who begin to love them at this age are prepared to be always with them and share all with them as long as life shall last.
  • Ibid, p.147

• The relationships between Agathon and Euripides, Parmenides and Zeno, and Crates and Polemo all continued into adulthood, apparently without creating any serious problems for them.
  Ideally, the older partner in a pederastic relationship strove to win the admiration and love of the younger through exemplary conduct, while the younger sought to emulate the older. Sex thus served to prepare young men for adulthood. In Sparta this pedagogic function was heavily militarized, while in Athens it involved preparation for the more varied life of an Athenian adult. Its importance in the Hellenistic era may be inferred from Plutarchs remarks about boys’ upbringing:
  the nurse rules the infant, the teacher the schoolboy, the gymnasiarch, the athlete, his lover (‘’erastes’’) the youth, who, in the course of age is then ruled by law and his commanding general.
  He does not even mention the boys’ parents!
  Plato makes clear in the ‘’Symposium’’ that it was perfectly acceptable to court a lad, and admirable to win him. The youth, on the other hand, was not to appear too eager to be seduced, nor was he to initiate a courtship. On the contrary, he was supposed to be coy, to resist, to rest the sincerity and worthiness of his lover, Their reputations ahnfing in the balance, youths had to be careful not to cross the line between honorable and discriminatory acquiescence and shameful over eagerness or manipulability. Aristophanes’ defense of homosexually active youths in the ‘’Symposium’’:
  Some say they are shameless creatures, but falsely: for their behavior is due not to shamelessness but to daring, manliness, and virility, since they are quick to welcome their like. Sure evidence of this is the fact that on reaching maturity these alone prove in a public career to be men.
  Shows how thin and ambiguously placed that line was. It had significance for a young man’s later career, for to be able to say no to an enticing but inappropriate liaison was to demonstrate self-mastery and invulnerability to manipulation. These were important character traits in a political leader. With so much at stake, fathers tried to shield their sons from importunate suitors much the way Victorian fathers who themselves sought out young girls tried to safeguard their daugher’s virility.

• Ibid, p.148

• Because the subordination of the young is a seemingly natural, and for any individual temporary feature of a patriarchal social order (to some extent, of any social order), it was possible for an adolescent to allow himself to be seduced by an older man without opprobrium. His behavior reflected only temporary, not permanent submission and was therefore not stigmatizing, Despite this dispensation for youth, and even though most men preferred handsome, muscular youths as partners, youths could not entirely escape suspicion of effeminacy. Plato wonders in the ‘’Laws’’, “who will not blame the effeminacy of him who yields to pleasures and is unable to hold out against them? Will not all men censure as womanly him who imitates the woman?” Treating a lad like a woman could hardly be expected to masculinize him.
  To avoid the threatening gender implications of anal penetration, intercourse was often face-to face and intercrural – though inevitably there were exceptions. Ideally, the ‘’eromenos’’ was not supposed to consent to sex out of gratitude or admiration, not lust. Again we know that there were exceptions, possibly many. Nevertheless, suspicions that a boy enjoyed his experience or had playeda female role were often raised and not easily allayed, particularly if the relationship continued after the boy reached maturity.

• Ibid, p.150-151

• Attitudes toward prostitution also figured in the ambivalent response to the eromenos. Though it was not illegal, it was considered shameful for a citizen to become a prostitute. Ina relationship between an ‘’erastes’’ and an ‘’eromenos’’, both parties were ideally supposed to act from the loftiest of motives. But if an eromenos asked his lover for an expensive gift, was he prostituting himself? As with gender boundaries, distinctions between prostitution and romantic love proved to be difficult to draw in practice. As a result, boys’ motives were often suspect.
  It would be a gross error to suppose that the Athenians thought less of homosexuality because they belittled male effeminacy or sometimes suspected teenage lovers of unbecoming motives. Pederasty did not lurk in the shadows of Greek life; it was out in the open. The gods practices it, and it had its own patron god – Eros. In legend, it exemplified the noblest qualities of devotion and sacrifice. Lyric poets celebrated their youthful flames. In Plato’s ‘’Phaedrus’’, homosexual love inspired by male beauty had the potential to develop into the most exalted love for ideal beauty and truth. By comparison, the object of heterosexual love lacked the special qualities that could inspire a spiritual or philosophical quest. Even those who deplored some of its ramifications never questioned that all men were capable of powerful homosexual attraction.
  Nonetheless, as Focault rightly suggests, homosexuality was problematic to the Athenians. Their extreme democratic individualism and competitive status-seeking, channeled largely into political affairs, placed an enormous burden on personal character. Sexual comportmen was a field on which character was revealed. It was not only one – behavior in battle counted for much – but it was an important one; important because male supremacy was such an integral element of Athenian life. So integral that the culture of male supremacy colored all social relations.
  • Ibid, p.151

• The Etruscans were a people who lived in what is now Italy during the first millennium B.C. The precise extent to which Etruscan culture was influenced by contributions from Lydia in Asia Minor (where Herodotus said the Etruscans originated), Greek and Phoenician settlers (whose presence in Sicily and Sardinia is attested as early as the eighth century B.C.), and the indigenous Villanovans remains controversial; there is evidence for all three. From the Phoenicians they took their Astarte-worship; whether cult prostitution came with it is unknown but not unlikely.
  Leaving aside the question of sacral homosexuality, the Etruscans’ sybaritic way of life, and the liberties their women enjoyed shocked their less affluent neighbors and earned them a reputation for loose morals. According to Theopompus, a Greek historian of the mid-fourth century B.C., after a gathering of family or friends,
  the servants bring in sometimes courtesans sometimes handsome boys, sometimes their own wives. When they have taken their pleasure of the women or the men, they make strapping young fellows lie with the later….They certainly have commerce with women, but they always enjoy themselves much better with the boys and young men. The latter are in his country quite beautiful to behold, for they live lives of ease and their bodies are hairless.
  Parallel observations, all derived from Theopompus, can be found in the writings of Aristotle and other Greeks. Unfortunately, Theopompus is not considered a wholly reliable source. Still, there is no reason for thinking him wrong about the prevalence of pederasty among the Etruscans.
  The extent to which the less affluent Roman peasants shared Etruscan sexual mores is not known. Late Romans often idealized their past and consciously rewrote history to serve patriotic ends. While one would not expect Etryscan-style orgies from a community of poor farmers, male homosexuality is far from unknown in peasant societies. Romans took much from the Etruscans, including religion, art, and architecture.
  • Ibid, pp.152-153

• There are the barest of hints the Romans who shared with the Greeks a common Indo-European heritage, also shared their tribal homosexual initiation rites. Mars, the principal Roman god in ancient times was associated with Indo-European expansion. His sons, Romulus and Remus, nursed by a she-wolf, founded Rome. Wolves were sacred to Mars. Seemingly there sis nothing here to suggest homosexuality. However, drawings on a box discovered the ancient Latin city of Palestrina-Praeneste depict a naked Mars with several youths. This could have been an initation scene. According to Livy, Romulus led abachelors or ‘’iuvenes’’ in hunting, brigandage, warfare, and abduction of women. Some of these activities were associated with male initiation classes among other Indo-European peoples, including the Spartans. The she-wolf of the legend may actually have been a male initiator wearing a wolf skin. Norse and Teutonic warriors wore wolf and bear skins to absorb the ferocity of the carnivore, and the wolf and bear had special significance for initiates in Greece. When we recall that the Sambia of New Guinea, who prepare male youth for adulthood by sodomizing them, equate the penis with abreast, and semen with mother’s milk, it does not seem farfetched to suppose that the legend of Romulus and Remus derives from an almost-forgotten homosexual initiation ceremony.
  Those ceremonies could have been part of the Bacchic mysteries. We do not know just when the mysteries first entered Italy, but they may have done so at an early time. The worship of Dionysos-Bacchus was probably imported to Greece from West Asia, perhaps in Minoan or Mycenean times; it could have come to Italy directly from Asia Minor, or directly, via the Greeks. By the sixth century B.C., Bacchus was associated with the cthonian goddesses at Tarentum. The Greeks in Campania had a Bacchus cult of their own in the first half of the fifth century B.C., Bacchus cult of their own in the first half of these fifth century B.C. The wide extend of Bacchic worship in the second century B.C., when a scandal broke out in connection with its orgiastic worship, suggests that that the cult had never died outm despite its exclusion from the state religion. Perhaps it had survived in the Italian countryside all along unknown to city-dwellers. In Greek myth, Dionysus was the eromenes of Polumnos (and the ‘’erastes’’ of Adonis), and the Dionysian mysteries were connected with male-homosexual initiation rites at Megara and Argos.

• Ibid, pp.153-154

• Though he is considered an unreliable source, Valerius Maximus, a Roman historian of the first century A.D., reported an incident involving male homosexuality as early as the fourth century B.C., suggesting that it was known in very early times, but there is little to indicate that it was common. Romans of the early Repunblic seem to have been more prudish than the Greeks. They never felt comfortable with public nudity (statues of men, for example, are clothed, unlike those of the Greeks) and did not value sensuality or male beauty as highly. Roman institutions such as the family and educational system were not as favorable to an institutionalized male erotic interest in other males, and this seems to have been the Roman view of the matter as well. Cicero and Plutarch both traced the origin of Greek pederasty to the gymnasium. In fact, much of the Roman vocabulary of homosexuality consisted of Greek loan words.
  Though it may have been less institutionalized a feature of Roman life than of Greek, homosexuality was by no means uncommon. Polybius, a Greek historian who visited Rome in the second century B.C., reported that ‘’most’’ young men male lovers. Many of the leading figures in Roman literary life in the late Republic – Catullus, Tibullus, Vergil and Horace – wrote homophile poetry. From at least 160 B.C., eromenoi were a conspicuous feature of Roman life – as were ‘’hetaerai’’. Sextus Propertius, a poet of the first century B.C., prayed that his enemies would fall in love with women, and his friends with boys. Juvenal, a satirist of the first and second centuries A.D., wrote of young Armenian lads being corrupted when they came to Rome. Roman homosexual tasted were so taken for granted that when Anthony asked Herod to send his young brother-in-law Aristobulus to the Roman court, Herod refused, because
  he did not think it safe for him to send one so handsome as was Aristobulus, in the prime of life, for he was sixteen years of age, and of no noble a family; and particularly not to Anthony, the principal man of the Romans, and that would abuse him in his armours, and besides, one that freely indulged himself in such pleasures as his power allowed him without control.

• Ibid, pp.154-155

• Even after making allowances for malicious gossip, we can conclude that many of the Roman emperors had homosexual tastes, often not exclusive. Male prostitution flourished throughout northern Italy.
  As in Greece, sexual preferences were frequently not exclusive. The poet Martial, writing in the first century A.D., took ambisexuality for granted in one of his ‘’Satires’’:
  And when your lust is hot, surely
  if a maid or pageboy’s handy, to attack
  instanter, you won’t choose to grin and bear it?
  I won’t! I like a cheap and easy love!
  Indifference to the sex of a sexual partner is equally manifest in other literary sources, including Catullus, Philostratus, Horace, Platus, and Tibullus. The poet Meleager wrote love verses to women and men alike. The “rake’s progress” traced by Dio Chrysostom took him from women to male partners:
  Bored with harlots, he seduces well-bred girls and married women and when this becomes too tedious, because it is easy, he turn in his last state of degeneracy to seducing boys.

• Ibid, p.155

• According to Cato, Julius Caesar was “every woman’s husband and every man’s wife.”In speeches denouncing his opponents Verres and Gabinius, Cicero characterized both of them as bisexual. Pathic males were often accused of adulterous affairs with women.
  Lesbianism was also known to the Roman’s but it is difficult from the few references to it in literature to get a sense of its prevalence, the customs surrounding it, or the meanings it had and the responses it evoked.
  Historians have often asserted that the Romans must have had a negative view of male homosexuality because it was illegal under the Lex Scantina, in later centuries, often for political reasons, but it is uncertain that the charges had anything to do with homosexuality, and the penalties do not appear to have been serious. Even when Cicero mentions homosexuality in denouncing his opponents, he never suggests that is was illegal. Moreover, a trial is reported in which a man found in the bedroom of a married woman gained acquittal on adultery charges after testifying that he was there for an assignment with a male slave. This casts grave doubt on the illegality of homosexuality.
  To many Romans of the late Republic, oral sex and anal intercourse were highly aggressive acts. One of Catullus’s poems threatens his critics:
  I will bugger you and I will fuck your mouths
  Aurilus, you pathic, and you queer, Furius,
  who have thought me, from my little versus,
  because they are a little delicate, to be not quite straight.

• Ibid, pp.156-157

• Statues of the god Priapus stood erect in Roman gardens to threaten intruders with sexual assault, and according to Valerius Maximus, convicted adulterers were sometimes handed over to the servants or slaves of cuckolded husbands to be raped (or killed, fined, flogged, or mutilated.)
  The perception of homosexual acts as aggressive led to strenyous efforts to protect freeborn youths from seduction. Quintilian’s ‘’Institutes of Oratory’’ advised parents to have their children educated at home rather than at school, and then to make sure a trustworthy chaperone is present. To rape, seduce, or proposition a freeborn youth (or maiden), or for an official to pressure his subordinate to submit to him, was beyond the pale. The shame such acts incurred can be inferred from the suicide of Laetorius Mergus, a tribune of the early third century B.C., when summoned by the comitia on charges of trying to seduce an underling during the Third Samnite War. In later centuries, a charge of seducing a free youth could discredit the testimony of a witness in a court case.
  To some Roman, even sex with slaves or prostitutes was dishonorable, but that was not the prevalent view. For most Romans, it was the social status of the partner that made a homosexual act unacceptable. Male prostitution was lawful; it was taxed, and the prostitutes had a legal holiday of their own. Many a young man had a ‘’’concubinus’’’ – a male slave to use sexually before marriage. As possessions, slaves were expected to be passive and subordinate; they had no honor that could be compromised by their compliance. To Plautus, they were perfectly acceptable as sexual partners: “as long as you hold off from a bride, a single woman, a virgin, young men and free boys, love anybody you please.” In the ‘’Satyricon’’ of Pertonius, the slave Trimalchio confesses, “For fourteen years I pleasured him; it is no disgrave to do what a master commands. I also gave my mistress satisfaction.” Much of the homophile verse written in Latin may have been dedicated to slaves.

• Ibid, pp.157-158

• In a political system that relied heavily on patronage, the hierarchy of subordination included freedmen who remained dependent on their former masters. According to a lawyer quoted in Seneca the Elder, “sexual service is an offense for the free born, a necessity for the slave, and a duty for the freedman.” Even when it was considered socially inappropriate, homosexual desire was not considered abnormal as long as it took the active form. Lucretius thought erotic interest in “a lad with womanish limbs” to be entirely normal. Quintilian, who advices parents to guard their sons, added that much of the problem in raising children to a high moral standard is that they see our mistresses, our male objects of affection.” The Pompeiian graffiti referring to homosexuality, mostly written after the city was destroyed by a volcano in A.D. 62, treat it with good humor. As in Greece, the Romans tended to consider the passive or receptive role incompatible with the honor and dignity of a free citizen, especially when it continued into adulthood. Sexual submission to a powerful patron was, seemingly, a familiar way of building a career, but it left the client vulnerable potentially ruinous denunciations. A man’s failure to live up to the standard of masculinity expected of someone in his rank was especially disturbing in a society that was attempting the systematic subjugation of the entire known world.
  The growth of empire and long periods of peace intensified Roman concerns about effeminacy. As wealth from the conquered territories flowed into Rome, a life of conspicuous luxury became possible for a minority. Under Greek influence, the rich filled their days and nights with banquets, drinking, gambling, and theatergoing, wore perfumes and jewelry, and carried on extramarital affairs, both heterosexual and homosexual. Effeminacy was not as stigmatized in this circle as it had been among the yeoman farmers or soldiers. The homoerotic poetry of the late Republic reflects this devotion to the pursuit of carefree, self-indulgent pleasure.

• Ibid, pp.158-159

• Some considered this new life-style dissolute and debauched and feared that it would weaken the empire militarily. Flagrant effeminate homosexuality within this leisure class was seen as part of this life-style and was sometimes condemns in the name of rustic simplicity. Cassius Dio’s history of Rome imagines Queen Boudicca of Britain deprecating the Romans for bathing in warm water, eating dainties, and sleeping of soft couches with boys.
  The extra marital heterosexual r of this circle were no less a subject for complaint. Sallust, lamenting the moral decline that began with the plunderer of foreign wealth and culminated in the Catiline conspiracy, deplored
  the passion which arose for lewdness, gluttony, and other attendants of luxury…men played with the women, women offered their chastity for sale; and to gratify their palates they scoured land and sea; they slept before they needed sleep; they did not await the coming of hunger and thirst, or cold or of weariness, but all these things their self-indulgence anticipated. Such were the vices that incited the young men to crime, as soon as they had run through their property.
  Horace, too, linked the civil war with vice and immorality.
  It was in this atmosphere that the Emperor Augustus issued the Lex Julia, de adulteriis coercendis sometime between 18 and 16 B.C. Like so many later revolutionaries, Augustus worried that the new generation, which had not known the devastation of the war that brought him to the throne, took peace and prosperity for granted and lacked firm moral character. He wanted to ensure that enough boys were born to meet future military needs, but men were declining to marry to have children, so as not to tie themselves down with responsibilities that would interfere with having a good time.

• Ibid, pp.159-160

• The Lex Julia was Augustus’s response to these concerns. The punishment of adultery, formerly a totally private matter, became a state function. Incentives were provided for marriage and childbearing. Because very little of the text has survived, its details are not known. Jurists of the early third century held that it prohibited the statutory rape of a male minor, but it is not clear, whether this was part of the original statute or whether they were extending its scope by interpretation. In any event, since resources were not allocated to enforcement, the legislation, which was bitterly resented, had little impact, and homosexual relations continued during the first two centuries of the Empire, often by the emperors themselves. When accused of plotting against the Emperor Domitian toward the end of the first century A.D., Julius Calvaster claimed that he and his co-conspirator had met for homosexual purposes, suggesting that it was then neither illegal nor seriously stigmatized. Writing in the second half of the second century, Aulus Gellius, a judge, observed that the Augustinian laws on having children were an “ancient history” and hermaphrodites, “instruments of pleasure.”

• Ibid, p.160

• The earliest Chinese references to male homosexuality appear during the Han dynasty. Van Gulik concludes that male homosexuality was quite fashionable in this period, and it may have been - the first three emperors of the dynasty all kept "powdered and rogued boys" as well as wives. So did the later Han emperors. Han sources also mention that some princes kept young boys as catamites. These relationships appear to have been entirely secular; if there had been cult prostitution or ritualized homosexual initiation rites, no evidence of them has survived.
  Homosexuality is attested outside court circles only at later dates. The poet Li-Po (d. A.D. 762) wrote love poetry to his young male lover, and in the Five Dynasties Period (A.D. 907-960), transgenerational male-homosexual relationships were generally accepted. When the older ch'i hsung called at the home of the younger ch'i ti, he was welcomed by the entire family as i he had been a prospective bridegroom. If the ch'i later married, it was customary for the ch'i hsung to pay the expenses.
  Patriarchal power was too strong for a lesbian equivalent to emerge in ancient China; only when foreign trade and investment made it possible for women to subsist independently of fathers or husbands did lesbian marriages - not necessarily transgenerational - formalized by contracts and gifts emerge.

• Ibid, p.161

• Although a law against male prostitution called for heavy penalties during the brief Cheng-hoperiod (A.D. 111-17), it thrived during the Northern Sung and Southern Sung dynasties (1127 - 1279). The prostitutes had a guild of their own and appeared in public rouged and adorned as women. At some point, they acquired their own god, Tcheou-Wang. This was a period of economic expansion, the spread of a cash economy, and growing inequality. The larger cities brought together poor males who had to rent their bodies to support themselves and middle - and upper - income men with the money to pay for them. This conjunction persisted, and so did prostitution. When the Jesuit Matteo Ricci visited Peking in 1583 and again in 1609-10, he found male prostitution to be altogether lawful, and practiced openly: there are public streets full of boys got up like prostitutes. And there are people who buy these boys and teach them to play music, sing and dance. And then, gallantly dressed and made up with rogue like women these miserable men are initiated into this terrible vice. *Government officers appeared in public with their fourteen-to-eighteen-year-old pipe-bearers, and male brothels operated in Canton and other cities. * References to eunuchs appear in oracle bones of the Shang dynasty, c. 1300 B.C. Evidently the Shang castrated captured soldiers of the Chiang, a Tibetan people they conquered, presumably to prevent them from procreating, but it is not known what they did with them. Probably they were enslaved. The castration of Chinese men began early in the Chou dynasty as a punishment for crime. Some men were sentenced to execution, others had the option of choosing it to avoid execution. As in other ancient civilizations that castrated criminals, the Chou period was one of great social differences between lords and serfs.

• Ibid, p.162

• During the Chou dynasty, the imperial palace began to use eunuchs to guard the royal wives and concubines, and as domestic servants. The number allocated each member of the royal family came to be fixed by law; for the emperor it was 3,000.
  During the second half of the Chou dynasty they served as political advisers and heads of armies and figured prominently in government in the Han and alter dynasties. When the demand for palace eunuchs exceeded the supply of men castrated involuntarily, volunteers were sought. As officials were often in a position to extort bribes, some eunuchs became quite wealthy. To obtain these positions, men castrated themselves or were castrated by parents who hoped to achieve upward social mobility for the entire family.
  Although it is unlikely that all eunuchs were implicated in homosexual relationships, a number of them did become sexual partners and/or lovers of the emperors they served.

• Ibid, p.163

• At the time of the Spanish Conquest in the early sixteenth century, berdaches were present in many of the kinship-based Indian groups of Central and South America. There were also hereditary chieftainships, characterized by marked inequalities of wealth, in which chiefs kept transvestite men for their own sexual purposes.
  The more complex civilizations of the Yucatan, the Pacific Coast and the valley of Mexico were all based on agriculture, arts and crafts and state sponsored polytheistic religions administered by full-time priests.
  • Ibid, p.163

• One of the Spanish sources, Bartolome de las Casas, writing in 1542, reported that Mayan parents supplied their adolescent sons with boys to use as sexual outlets before marriage, but that if someone else sodomized them, the penalty was equal to that for rape. Since de las Casas denied the existence of homosexuality in some other Indian groups, his attribution of homosexuality to the Mayans cannot be attributed to a blanket prejudiceagainst Indians. Other missionaries also reported widespread male homosexuality among the Mayans. Young Mayan men lived in men's houses until they married at about age twenty.
• Father Pierre de Gand, also known as de Mura, found sodomy to be virtually universal among the Aztecs, involving even children as young as six. Cortez also found sodomy to be widespread among the Aztec's, and admonished them to give it up-along with human sacrifices and cannibalism.

• Ibid, p.164

• Some of the people who made up the Inca empire also had institutionalized homosexuality. This includes the Yauyos, who had "public houses filled with men who dressed as women and painted their faces," the Liysacas of Lake Chucuito, and Indians in the vicinity of Puerto Viejo in the north (now Ecuador) and on the island of Puna. In some parts of the empire, boys were dedicated to the temple, where they were raised as girls; chiefs and headmen had ritual intercourse with them on special holidays. The Inca princes themselves, however, did not engage in these practices.
  • Ibid, p.165

• That the harshness of Inca and Aztec legislation toward homosexuality involved more than a reaction to indigenous berdaches is suggested by the equally severe penalties imposed on other violations of morals legislation. The Incas punished pimps and prostitutes severely, by death if the offense was repeated. Incest and adultery were capital offenses in both empires. Drunkeness was illegal under the Incas and a capital offense under the Aztecs. Abortion was also a capital offense under the Aztecs. Aztec youths lost their rights to land if they did not marry by a certain age. Inca men were also forced to marry.
  • Ibid, p.167

• When Balboa came to Panama, he killed forty transvestites by feeding them to his dogs.
  • Ibid, p.168

• The Aryans entered India as pastoral warrior-nomads contemptuous of the sedentary cultivators they conquered. Female deities played a relatively modest role in their religion. Religious leaders were conventionally gendered priests (Brahmins), not transvestites or transexuals. They married women. Their authority, which rested on knowledge of written sculpture, formulaic prayer, and performance of the sacrifices, was incompatible with orgiastic worship. Like the Aztec, Hebrew, and Egyptian priests, they recoiled from indigenous fertility-cult practices associated with planting and prohibited them in the law books they prepared.
  Sustained by a very ancient tradition that sexual abstinence magically bestows power and immortality, the Brahmins defined a wide range of sexual practices as polluting. Homosexual acts were forbidden along with some heterosexual practices and solo performances.
  This rejection of homosexuality did not result in much repression. The Laws of Manu imposes only a mildpenance forhomosexual contact-ritual immersion with clothes on.
  • Ibid, p.169

• Custom was often far from ascetic or antihomosexual. Pre-Aryan sex worship was accommodated rather than suppressed. Though Siva was not a full-fledged god in the Vedic literature, he later became the focus of a phallus cult. Some eroticism appears in the Brahmanas written down c. 300 B.C. or later. In an atmosphere of extreme tolerance, Sakti worship and heterodox tantric cults based on sacramental intercourse persisted - unmolested by practitioners of extreme asceticism and self-denial. Notwithstanding the statement in the Mahabarata that oral sex is a crime, it is depicted in the erotic temple sculptures, as are lesbian scenes and bestiality.
  Nor does eroticism appear to have been confined to religious settings. The Silippadhikaram, a Tamil epic of the second century A.D., states that the city of Puhar reserved a seperate quarter for prostitutes. Eunuchs, some of them dressed as women, were part of court life and enriched its sexual opportunities as early as 400 B.C.; they remained a part of the royal households until Independence.

• Ibid, p.170

• It can be safely assumed that the deterioration in the status of Indian women which occurred in historical times led to a devaluation of male effeminacy, but not to the point where temple prostitution or eunichism was prohibited. They became illegal only after India gained Independence.

• Ibid, pp.170-171

• In Jainism, liberation from material existence is achieved through extreme bodily mortifications. Monks forswear all sexual contact; the laity may marry, but must remain fauthful to their spouses. This doctrine could hardly have favored homosexuality, but it was so unsympathetic toall kinds of sexual expression that it did not especially single out homosexuality for special repression. The severity of its demands has limited its appeal; there are only a couple millions Jains int eh entire world.
  Buddhism, founded a generation later, eschewed extremesof asceticism in favor of a "Middle Way" in which liberation is achieved by suppressing all desire. As in Jainism, this entailed chastity for monks and nuns. Buddhism, too, could hardly favor homosexuality. As it evolved, though, it developed heterodox tantric rituals that permitted intercourse, primarily heterosexual. In practice, homosexuality didn't do too badly in Buddhist lands.

• Ibid, p.171

• This condemnation must be placed in the broader context of a generally restrictive, though not ascetic, sexual morality in the Koran. The wine-driunking and pursuit of women of which the bedouins were enamored were frowned on by the town merchants of Mecca, who included Mohammed's own tribe, the Quraysh. Still, his placing eternally youthful male and female virgins in Paradise to serve believers suggests that this repudiation of hedonism was not unambivalent.
  Over time, Moslem religious writings becamemore punitive toward homosexuality. A number of hadith (sayings attributed to Homammed and collected or forged after his death) call for the death penalty. Converts from Judaism and Christianity ma have been responsible for this punitiveness. Most converts were members of the upper classes who had a classical Hellenistic education that exposed them to Roman, Jewish, and Sassanian law, as well as to the ecclesiastical law of the Eastern churches.
  These influences are quite apparent. Most of the hadith favor stoning sodomites to death. In one exception, Ali, Mohammed's son-in-law and the fourth caliph, wanted to burn them in imitation of the destruction of Sodom. Abu-Bakr, Mohammed's father-in-law and the first caliph, is reported to have had a man burned for passive anal homosexuality. Stoning was the traditional Jewish penalty; and though the matter is not certain, Byzantine law may have provided for burning since the end of the fourth century A.D., as we discuss in chapter 5.

• Ibid, p.173

• Within decades of Mohammed's death, Arab armies conquered Palestine and Syria, then Mesopotamia, Iran, Egypt, and North Africa. Soon after, Moslem armies captured Sicily and India. Male homosexuality was already common and accepted in some of these regions. Christianity and Zoroastrianism had probably not altogether eradicated this acceptance by the time of the Arab conquest. Nevertheless, literary conservatism stood in the way of any poetic treatment of homosexuality for a century. Only with the advent of the Abbasid caliphate in the middle of the eighth century do we find poets writing homoerotic verse to beautiful youths.

• Ibid, p.174

• Ever since the sixteenth century, Western visitors have commented on the pervasiveness of Turkish pederasty. Large numbers of boys were captured or purchased for personal use, placed in brothels, or resold; the demand for them struck all observers as remarkable.

• Ibid, p.179

• Burton found the cities of Afghan to be "saturated with the Persian vice" at the end of the ninteenth century. Afghan merchants were invariably, "accompanied by a number of boys and lads almost in woman's attire with kohl'd eyes and rouged cheeks, log tresses and henna's fingers and toes, riding luxuriously in Kajawas or camelpanniers. They are called Kuch-i safari or traveling wives, and the husbands tridge patiently by their sides.
  Male homosexuality remains common in Afghanistan, as does harem lesbianism.

• Ibid, p.180

• The Moslem rulers of India often maintained youthful male lovers, and male brothels flourished. Burton visited a number of them in 1845.
  At first glance, the early Mongols appear to have been an exception to the broad pattern. The Great Yassa, a law code issued by Ghenghiz Khan or at his death for the still-pagan Mongol tribes around 1219, to supplement Mongolian customary law, mandated the death penalty for both sodomites and adulterers. This is not what one would expect in a tribe of nomadic pastoralists with a shamanistic religion. It seems likely that this severe penalty reflects the influence of Christians, Jews, or Moslems, to whom Ghengiz extended hospitality. Ghenghiz was himself illiterate, and might well have called on a literate foreigner to prepare a code of laws.
  • Ibid, p.181

• Zoroastrianism, founded in Iran at an unknown date by the prophet Zoroaster (Zarathura) who reformed the old Aryan religion on, took a far harsher view of homosexuality. The subject is not mentioned in the Gathas (the earliest known Zoroastrian scriptures), which are attributed directly to Zoroaster. However, the later Vendidad, or Code Against the Devas, which contains much of the Zoroastrian moral teaching, places sodomites among the ranks of those who may be killed on the spot, along with brigands, burners of carrion in a fire, and criminals taken in the act. Later texts, from the ninth century A.D., continue to regard homosexuality as heinous.
  • Ibid, p.186

• Indeed, in the sixth and seventh centuries, when the penitentials were first issued, the church had great difficulty in persuading sinners to confess and submit to penance. Many waited until they were about to die to confess. Only in 1215 did the Fourth Lateran Council require confession at least once a year.
  • Ibid, p.264

• Perhaps more to the point, the severe penances for homosexual offenses are matched in a number of the penitentials by equally severe penances for heterosexual sins. Thus the Irish Penitential of Cummean calls for seven years' penance for men guilty of habitual homosexual practices (less for a first offense) and seven years' penance for heterosexual adultery. The book of ecclesiastical discipline issued by Region of Prum specifies a penalty of three years for anal intercourse whether the anus is that of a male or a female and also three years for heterosexual fornication. Similarly, the Book of David (c. 500-525) states that those who have committed fornication with a woman who hass been vowed to Christ or a husband, or with a beast or a male "for the remainder of their lived dead to the world shall live unto God" - presumably in perpetual encloisterment. The Penitential of Theodore requires three years' penance if a woman practices vice with another woman - or with herself and also demands equal maximum penalties of fifteen years in cases of heterosexual or homosexual fornication.
  • Ibid, p.264-265

• There are other penitentials in which harsher penances are imposed on those guilty of sodomitical fornication than on those who commit the conventional kind, but these references to sodomy do not necessarily concern homosexuality alone. In the eighth century, the Venerable Bede referred to anal intercourse with a wife as a sodomitical crime, and later church authorities also adopted thisusage. Many of the references to sodomy or to oral sex in the penitentials suggest that the authors had heterosexual contacts in mind. The penalties for these heterosexual offenses are no less severe than those for homosexual ones. For example, the Penitential of Theodore demands fifteen years of penance in the worse cases of unnatural intercourse with a wife ("si in ntergo nupersit"). As in the early church, homosexuality was not the primary category for distinguishing acceptable sex from unacceptable; the principal distinction had to do with the potential for conception.
• The attitudes of individual churchmen varied quite widely. Some were quite puntitive. We have already mentioned Benedict Levita, who in the mid-ninth century forged a Carolingian capitularly calling for "sodomites" to be incinerated. However, this was exceptional for its time.

• Ibid, p.265

• On the whole, though, less repressive views prevailed. Alcuin, an Anglo Saxon scholar at the court of Charlemagne (and later abbot of Tours) deplored adultery and incest in his writings, but said nothing about homosexuality. Although his silence may have reflected only his own romantic feelings towards his male students, Peter Lombard, the twelfth century Italian theologian and bishop of Paris, who is not similarly suspected, also said virtually nothing about homosexuality though he discusses other sexual sins in his writings. Saint Anslem, the twelfth century archbishop of Canterbury, urged that the ecclesiastical penances for homosexuality adopted at te Council of London in 1102 be moderated because "this sin has been so public that hardly anyone has blushed for it, and many, therefore, have plunged into it without realizing its gravity."
  The homophilic poetry of the tenth and eleventh centuries strongly suggests that the moderate position articulated by Anslem was the dominant one. Latin poets, many of them monks, wrote unselfconsciously of their romantic feelings toward men or boys. Two examples are particularly noteworthy because they were written by men who either were or were about to become bishops.

• Ibid, p.266

• Evidently, Baudri was being reproached for his youthful indiscretions; probably they were considered imappropriate for someone who had become an abbot. He does not even hint that his homosexual interests were considered more objectionable than his heterosexual ones. Neither potet shows fear of being punished for confessing to past homosexual interests or intimates that it was wrong to have had them. Some of the homophile poetry of their day circulated widely, and there is no evidence that its authors suffered from the publicity.

• Ibid, p. 267

• Beginning in the mid-thirteenth century,