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I don't want to belong to any club that will accept me as a member.

(Groucho Marx)

The temptation when beginning a chapter on disgust is to launch into a series of bathroom-style jokes in an attempt to induce sufficient levels of disgust in the reader. As a warning, Miller (2004) observes: "disgust has been shunned as a subject of serious enquiry, no doubt in part because its unsociable stink threatens to transfer to those who study it" (p. 2). We will therefore refrain from such temptation, at least temporarily, although we must note that sensitivity to disgust induction is still a relatively unexplored though potentially fruitful topic for psychopathology research. In fact, we must thank Paul Rozin and his colleagues for having produced one such trail-blazing measure, the Disgust Sensitivity Scale, from which the following items are taken (Rozin, Fallon, & Mandell, 1984): "You discover that a friend of yours changes underwear only once a week"; "You are walking barefoot on concrete, and you step on an earthworm"; and "You are asked to wear Adolf Hitler's sweater", the last item being apparently one of the most disgusting questionnaire items ever invented. It is clear both from these examples and from one's own experience that the range of objects, situations, and actions to which disgust is applied must make it the most generalisable of the basic emotions. When, as we shall argue, disgust comes to be applied to the self or some important aspect of the self, then the foundations for many emotional and other related disorders may be laid. However, when we wrote the first edition of this book we complained that the lack of research on the emotion of disgust meant that the original chapter was one of the most speculative in the book. Since then, however, as McNally (2002) notes, disgust has "arrived" and many of our original speculations about the putative role of disgust in a range of emotion-related disorders have in fact received support, so for good measure we will have to offer further speculations this time.

Darwin (1872/1965, p. 256) noted that the term "disgust" referred, in its simplest sense, to "something offensive to the taste"; thus, we might presume that the evolutionary origins of disgust are concerned with the rejection of noxious substances from within the organism, together with attempts to prevent potentially noxious substances from entering the organism. However, at least one theorist (Tomkins, 1963) has argued that the so-called reactions of "distaste" and "dissmell" should be distinguished from disgust, but we will concur, at least for now (though we offer some additional speculations later), with the more widely held view that these gustatory reactions form the origins of the basic disgust emotion rather than provide alternatives to it. For example, in one of the early classic papers on disgust Angyal (1941) proposed that: "The [disgust] reaction is mainly against ingestion, even in cases where there is no apparent danger of the disgusting materials reaching the mouth" (p. 399).

Angyal noted that occasionally attempts are made to overcome disgust reactions, as in an apparent "epidemic" in 1938 among American university students of swallowing live goldfish. More recently one can detect a trend in Hollywood horror movies and Japanese game shows of inviting the audience to wallow primarily in disgust as much as in any other emotional reaction. Rozin, Lowery, and Ebert (1994) have also pointed to one of the great advantages of studying disgust: "Disgust has a particular advantage for research in that it is easy to elicit in the laboratory in a realistic way without presenting serious ethical problems" (p. 871). Could disgust be the basic emotion for the twenty-first century?

In relation to the question of the definition of disgust, an omnibus definition has been offered by Davey:

A type of rejection response characterized by a specific facial expression, a desire to distance oneself from the object of disgust, a physiological manifestation of mild nausea, a fear of oral incorporation of the object of disgust, and a feeling of "revulsion". (1994a, p. 135)

Davey provides a number of the key components that form part of the definition of basic emotions that we reviewed in Chapter 2, summarised as follows:

1 There is an object or event which may be external, as in the reaction to particular foodstuffs or to faeces, or internal, as in the reaction to particular thoughts or images.

2 The object or event is interpreted to be noxious in either a literal sense or a symbolic sense.

3 The interpretation leads to an appraisal that the object or event should be eliminated or excluded from the organism, because it violates a goal of maintaining a state of non-contamination.

4 The appraisal leads to a propensity for action to distance oneself, either literally or symbolically, from the object or event.

5 Characteristic physiological reactions include a feeling of nausea together with a characteristic facial expression that is universally recognisable (Ekman et al., 1987).

6 There is a characteristic conscious feeling of "revulsion" together with an awareness of other reactions.

7 The reaction of disgust may be accompanied by characteristic behavioural reactions such as removing oneself from the object of disgust.

In relation to the behavioural component of disgust, it is worth noting that the avoidance of disgust-related objects and situations can often be confused with fear-based avoidance; for example, Davey (e.g., 1994a) has argued that a number of specific animal phobias such as those that involve spiders and snakes may be based more on disgust reactions than on fear reactions, a point that we will return to later.

Apart from the evidence on specific peripheral physiology and universal recognition of the accompanying facial expression (see Chapter 3), there have been a number of recent brain-scan studies that support the proposal that there may be some dedicated neural circuitry for the perception, experience, and expression of disgust. Calder, Lawrence, and Young (2001) have summarised several studies of both normal and abnormal functioning that have highlighted the role of the insula and parts of the basal ganglia in disgust (see also Murphy et al., 2003). This work included their own report of a 25-year-old man (Calder, Keane, Manes, Antoun, & Young, 2000) with damage to the insula and putamen who had specific problems for the perception of disgust expressed in different modalities such as faces and sounds, but normal perception of other basic emotions.

Other evidence that disgust is a basic emotion comes from studies of the development of disgust. The reaction of distaste, from which it is proposed that the reaction of disgust derives, can be observed in the newborn infant within 2 hours of birth (Rosenstein & Oster, 1988). Indeed, the facial expression for distaste in the newborn is identical to that for disgust in adults, and this facial expression is shown during development by congenitally blind children, so that the facial expression cannot simply be a learned one (Galati, Miceli, & Sini, 2001). The first item to acquire disgust properties is typically faeces, which occurs at about 2 years of age. The importance of this point was not lost on Freud (1910) who argued that the primary role of disgust was to prevent childhood coprophagia. Of course, from the age of 2 onwards the range of potential items that may become associated with disgust depends on a complex interaction of personal, familial, and cultural factors. For example, at the cultural level there are numerous variations about whether it is permissible to eat the pet dog, McDonald's hamburgers, your grandmother, or the visiting missionary. Indeed, our reactions to other cultures can often be grounded in our disgust reactions to foods acceptable in that culture which are not acceptable in our own, in part because of a quasi-magical belief that "you are what you eat" (e.g., Rozin & Fallon, 1987; Rozin, Haidt, & McCauley, 1999). These cross-cultural studies of disgust can of course provide interesting insights into the range of culturally acceptable activities, although even we have to confess our own surprise at a study reported in Haidt, McCauley, and Rozin (1994) which compared the reactions of North Americans and Brazilians to items such as "eating one's dead pets", but which also included the item "eating a chicken one has just had sex with"! No wonder those Brazilians are so good at football.

Evidence on the perception of emotion in Huntington's disease has shown that such individuals show deficits in the perception of anger, fear, and disgust, with the most marked problem being with disgust (Sprengelmeyer et al., 1996). Gray, Young, Barker, Curtis, and Gibson (1997) have shown that even carriers of the disease have problems with the recognition of disgust. The deficits identified across these studies were apparent with tests of both the facial expression and the vocal expression of disgust. The authors argue on the basis of these and other neuropsychological deficits that a number of basic emotions including disgust may have dedicated neural substrates, as we have argued above.

Much of our discussion so far has focused on the food-related aspects of disgust. However, we believe that this aspect has been overemphasised at the expense of potentially more interesting characteristics which relate to the application of disgust to the self and to other people. In their seminal review of the topic, Rozin and colleagues (Rozin & Fallon, 1987; Rozin et al., 1999) noted that disgust is one of the most powerful ways of transmitting cultural values not only in relation to acceptable and unacceptable foodstuffs, but also in relation to moral values. The Hindu caste system, for example, is in part based on the possibility of interpersonal contamination through contact with particular social groups. As Akhtar et al. (1975) remarked in their study of the form and content of a group of Hindu obsessive-compulsive patients, the largest proportion (46%) were directly connected with dirt and contamination issues. Akhtar et al. suggest that: "The Hindu code of ethics provides a great variety of purification rituals . . . The scriptures regard the human body as basically dirty and an object of disgust" (p. 347).

Rozin, Haidt, and McCauley (1993) state that in their studies of the perception of contamination from a range of human and animal products, one of the most powerful stimuli they have found is, as we noted above, Adolf Hitler's sweater. These examples illustrate that the disgust reaction expands during development to cover non-food-related characteristics of the self and of others. In fact, much of the remainder of this chapter will focus on an analysis of self-disgust and its role in complex emotions such as shame, guilt, and embarrassment, together with a discussion of the role of these disgust-derived emotions in fears and phobias, obsessive-compulsive disorders, and depression. Although the focus of the book is on emotional disorders, we will briefly examine the potential role of disgust in appetitive disorders such as bulimia, anorexia, and certain sexual disorders. First, however, we will review in a little more detail some of the theoretical analyses that have been offered for the role of disgust.

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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