The Revolting Self: Perspectives on the Psychological, Social, and Clinical Implications of Self-Directed Disgust

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Self-disgust (viewing the self as an object of abhorrence) is somewhat of a novel subject for psychological research and theory, yet its significance is increasingly being recognised in the clinical domain. This edited collection of articles represents the first scholarly attempt to engage comprehensively with the concept of self-directed disgust as a potentially discrete and important psychological phenomenon. The present work is unique in addressing the idea of self-disgust in depth, using novel empirical research, academic review, social commentary, and informed theorising. It includes chapters from pioneers in the field of psychology, and other selected authorities who can see the potential of using self-disgust to inform their own areas of expertise. The volume features contributions from a distinguished array of scholars and practising clinicians, including international leaders in areas such as cognition and emotion, psychological therapy, mental health research, and health and clinical psychology. This collection of papers offers a stimulating and timely investigation of that which the authors refer to as "the revolting self"; it is an invaluable handbook for all those academics and clinicians who want to understand and explore the concept of self-disgust further.

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Chapter One - An Introduction to the Revolting Self: Self-disgust as an Emotion Schema

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Philip A. Powell, Jane Simpson, and Paul G. Overton*

Heaven only knows how hard I have tried to make a decent creature out of myself, but my vileness is uncontrollable…I am without medicine, a big, fat, stupid creature, without health or strength, and I am disgusted with myself.

Talbot & Ellis, 1896, p. 343

Boasting somewhat humbler origins as a mechanism of disease avoidance (Curtis, Aunger, & Rabie, 2004; Oaten, Stevenson, & Case, 2009), the human disgust response has matured considerably throughout biological and sociocultural evolution, into its current multifaceted and broader form. Modern theories of disgust depict a heterogeneous emotional construct, with multiple elicitors spanning the sociocultural environment and producing qualitatively diverse response patterns (Simpson, Carter, Anthony, & Overton, 2006). Anchored around a shared function of avoidance and/or rejection, contemporary disgust elicitors include a range of undesirable physical attributes, certain animals and their secretions, decaying or spoiled organic material, unsanitary environments, atypical sexual practices, particular sociomoral violations, and immoral character traits (Rozin, Haidt, & McCauley, 1999). Although substantial cross-cultural consensus exists regarding what constitutes a repugnant entity, there is also notable sociocultural variation, particularly concerning deviations from sociomoral norms (Elwood & Olatunji, 2009). Thus, while we appear predisposed to acquire adaptive disgust reactions to a core set of stimuli (i.e., those signalling potential pathogen presence; Curtis & Biran, 2001), the acquisition of a full disgust-eliciting repertoire is advantageously flexible, readily shaped by sociocultural learning (Rozin, Haidt, & McCauley, 1999; Sawchuk, 2009). The evolutionarily adaptive implications of a malleable disgust system are clear, as the sociocultural input equips a developing organism for biological survival and social success under the conditions of the particular environment into which they emerge. Accordingly, the functional disgust response can be construed broadly as an acquired emotional gauge of that which is not acceptable within an individual's sociocultural surroundings (Power & Dalgleish, 2008).

 

Chapter Two - Digging Disgust Out of the Dumpster: A Neuropsychological Defence of Self- and Other-directed Disgust as a Moral Virtue

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Jason A. Clark

Introduction

Calls to label nearly every emotion as “toxic” have a long history, and calls to abandon emotion altogether as a guiding moral force are common. Two of the emotions that have recently been targeted as toxic are shame and disgust. While considerable evidence suggests that the biological or cultural co-optation of disgust for norm enforcement occurred because it was adaptive (Chapman, Kim, Susskind, & Anderson, 2009; Kelly, 2011; Navarrete & Fessler, 2006; Tybur, Lieberman, & Griskevicius, 2009), research has also shown potentially troubling influences of disgust on moral behaviour (Pizarro, Inbar, & Helion, 2011; Schnall, Haidt, Clore, & Jordan, 2008; Wheatley & Haidt, 2005). If disgust is not currently adaptive, there is prima facie reason to ask whether it was ever so and, if so, what sociomoral changes humans have undergone since then that were sufficiently radical to alter disgust's status.

 

Chapter Three - Disgust and Self-disgust: A Disability Studies Perspective

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Donna Reeve

Introduction

There has been very little written within disability studies about the role of self-disgust in the lives of disabled people, which is probably not surprising given that there is little mention of disgust per se in relation to disability. In order to consider how self-disgust may occur in the lives of disabled people, it is therefore necessary to look at the role of disgust in contemporary disablism and their interconnections. In doing so, I will be adopting a sociological, rather than psychological, approach to disgust and self-disgust, arguing that both dimensions need to be considered if the impact of these cognitive schemas on disabled people are to be fully understood.

This chapter will start by briefly discussing several approaches to disgust—principally the ideas of Paul Rozin (psychology), Martha Nussbaum (philosophy), and Sarah Ahmed (sociology of emotions). After presenting an historical analysis of how disgust contributed to the exclusion of disabled people from society (Hughes, 2012), this chapter will then look at how disgust can be seen within contemporary psycho-emotional disablism, experienced by disabled people at the start of the twenty-first century. Disgust can be revealed when a stranger avoids interacting with a disabled person on the street, within newspaper reports of disabled people as workshy benefit scroungers, and as part of disablist hate crime. These acts of psycho-emotional disablism contribute to the social marginalisation of disabled people and their cultural representation as less than human.

 

Chapter Four - Self-disgust and Adaptation to Chronic Physical Health Conditions: Implications for Avoidance and Withdrawal

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Lisa M. Reynolds, Sarah A. McCambridge, and Nathan S. Consedine

Introduction

An increasingly diverse body of work is investigating how emotions such as fear, embarrassment, and disgust may impact on health behaviours in ways that are at times beneficial and, at others, detrimental (Consedine & Moscowitz, 2007). Of all emotions, disgust is the most directly relevant to health, with origins in adaptive responding to health risks and contamination threat (Curtis, Aunger, & Rabie, 2004; Davey, 2011). Until recently, however, disgust has received little attention in health research. This emerging interest in disgust, and the associated withdrawal and avoidance response in health contexts, are our foci over the following pages. We begin by outlining the function, manifestations, and established elicitors of disgust, before moving to consider the specific nature of self-disgust, evaluating the implications self-disgust may have for physical health, and examining its possible relevance as individuals adapt to chronic physical health conditions.

 

Chapter Five - Self-directed Disgust: Reciprocal Relationships with Sex and Sexual Dysfunction

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Peter J. de Jong and Charmaine Borg

Contemporary models of sexual behaviour propose that sexual responses involve an interaction between sexual excitatory and sexual inhibitory processes (e.g., Bancroft & Janssen, 2000). From such a perspective, the generation of sexual responses may be compromised when sexual inhibition outbalances sexual excitation. Accordingly, relatively strong inhibitory tendencies may interfere with having pleasurable sex and may give rise to sexual problems, which in turn may set the stage for the generation of a wide range of subsequent difficulties (e.g., depression, anxiety) and negative self-evaluative processes.

Recently, we have argued that disgust and disgust-related preoccupations might be important players that fuel inhibitory tendencies in sexual contexts (de Jong & Peters, 2009). It should be acknowledged, however, that thus far disgust has received only scant attention in the “sex” literature, and it is only in the last couple of years that disgust has become a topic of more systematic empirical investigation in the context of sex research (for a recent review, see de Jong, van Overveld, & Borg, 2013). When it comes to self-disgust—the central topic of this book—the empirical work is even more limited, although it needs mention that there is some work in the context of post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) that focuses on self-disgust as a factor that may help explain the phenomenology of individuals who are victims of sexual assault (e.g., Badour, Feldner, Babson, Blumenthal, & Dutton, 2013; Olatunji, Elwood, Williams, & Lohr, 2008).

 

Chapter Six - Disgust and Interpersonal Experiences: The Complex Emotional Experience of Rejection

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Dean McKay and Rebecca Lo Presti

Recent research has supported a role for disgust in a wide range of psychological conditions (Phillips, Senior, Fahy, & David, 1998). This is a fairly recent development, with most studies conducted over the past twenty years and beginning with the disease-avoidance conceptualisation of phobias (Matchett & Davey, 1991). One potential explanation for the lack of consideration given to disgust is the general under-reporting of disgust experiences by clients. Further, attributing psychological distress to disgust, as opposed to fear or dysphoria, is a less common attribution, and our existing taxonomies emphasise these emotional experiences over disgust (Olatunji & McKay, 2009). In addition to this, most assessment instruments overlook disgust as a contributory emotional state for psychopathology (Olatunji, Williams, Tolin et al., 2007). This suggests that models of psychopathology do not take into consideration the role of disgust, and that until recently most clinical researchers did not even assess for the presence of this emotional state.

 

Chapter Seven - Contaminated by Trauma: Understanding Links between Self-disgust, Mental Contamination, and Post-traumatic Stress Disorder

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Christal L. Badour and Thomas G. Adams

A traumatic event is defined as an experience in which an individual directly encounters, witnesses, or is presented with details regarding a situation involving actual or threatened death, serious injury/harm, or sexual violation (American Psychiatric Association, 2013). Frequently studied traumatic events include exposure to interpersonal victimisation (e.g., rape, childhood sexual abuse, physical assault); combat; natural or manmade disasters; accidents or serious illnesses/injuries. Evidence suggests traumatic event exposure is relatively ubiquitous, with the majority of adults encountering at least one traumatic event during their lifetime (Kessler Sonnega, Bromet, Hughes, & Nelson, 1995; Norris, 1992; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Immediately following a trauma, nearly all individuals exhibit a characteristic pattern of symptoms that includes intrusive recollections of the event, heightened emotional or physiological arousal, and attempts to avoid reminders of the event (Blanchard & Hickling, 2004; Riggs, Rothbaum, & Foa 1995; Rothbaum, Foa, Riggs, & Murdock, 1992). While these symptoms generally remit within approximately three months for the majority of traumatised individuals (APA, 2013), a substantial minority continues to experience these reactions well beyond the occurrence of the traumatic event and report distress and impairment as a result (e.g., Kessler et al., 2005; Pietrzak, Goldstein, Southwick, & Grant, 2011). This pattern of symptom non-remittance is characteristic of post-traumatic stress disorder (PTSD), a condition conceptualised as failing to recover from the effects of a traumatic event (Foa & Rothbaum, 1998; Gilboa-Schechtman & Foa, 2001; Yehuda & Ledoux, 2007).

 

Chapter Eight - Depression as a Disorder of Disgust

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Fahad S. M. Alanazi, Philip A. Powell, and Michael J. Power

This chapter will consider the importance of disgust as a critical emotion in depression. The available literature on disgust and depression will be reviewed, and it will be argued that the most important form of disgust in depression is when it comes to be focused on the self, particularly in the form of more complex emotional states (e.g., shame and guilt), in terms of their derivation within a basic emotions approach (Power & Dalgleish, 2008). An aetiological model of depression (SPAARS) will be presented which incorporates multilevel representation systems of emotion. Within this model, it will be proposed that the depressive state is a direct result of the emotional coupling of sadness and self-disgust.

Introduction

Disgust is argued to be one of several basic human emotions (Darwin, 1872/1989; Ekman, 1992; Phillips, Senior, Fahy, & David, 1998), and it plays a significant role in our daily emotional life (Rozin, Haidt, & McCauley, 1999). Although for some time disgust was a neglected and “forgotten” emotion in psychiatry (Phillips et al., 1998), it is now enjoying increased prominence as a research topic in its own right (McNally, 2002). Multiple operational definitions of “disgust” exist. The emotion was originally researched and operationalised psychologically in the context of its oral origins, defined as “revulsion at the prospect of (oral) incorporation of offensive objects” (Rozin & Fallon, 1987, p. 23). Since then, psychological definitions have broadened to acknowledge wider elicitors of disgust, including those from core, animal-reminder, interpersonal, and sociomoral domains (Rozin, Haidt, & McCauley, 1999). Whilst the physiological expression of disgust (or “distaste” as it may be more accurately described) is observable from birth (Rosenstein & Oster, 1988), the actual range of stimuli that comes to elicit disgust in an individual is determined socioculturally and, as is argued in the current volume, may extend to incorporate the self (Power & Dalgleish, 1997).

 

Chapter Nine - Self-disgust in Eating Disorders: A Review of the Literature and Clinical Implications

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John R. E. Fox, Neesha Grange, and Michael J. Power

Introduction

Eating disorders (EDs) are rare, but life-threatening, mental health problems that often have their onset during childhood or adolescence and most commonly affect females (Hoek, 2006; Hoek & van Hoeken, 2003). They are characterised by an over-evaluation of shape, weight, and the control of eating (Fairburn, Cooper, & Shafran, 2003). More specifically, anorexia nervosa (AN) is characterised by a preoccupation with maintaining a low body weight (body mass index (BMI) ≤ 17.5 kg/m2), a disturbance in the way one's body weight and shape are perceived, and an extreme restriction of food due to an intense fear of gaining weight (American Psychiatric Association (APA), 2013). Individuals with AN may attempt to maintain a low body weight by restricting their diet (restricting type), or by regularly engaging in self-induced vomiting or the misuse of diuretics, laxatives, and enemas (binge-eating/purging type; APA, 2013). Bulimia nervosa (BN) involves recurrent episodes of binge-eating and compensatory behaviours that occur at least twice weekly for a period of three months and a marked dissatisfaction with body shape/weight (APA, 2013).

 

Chapter Ten - Varieties of Disgust in Self-harm

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Outi Benson, Zoë V. R. Boden, and Diego Vitali

Introduction 1

Self-harm can be defined as self-administered, non-accidental injury to one's own body without suicidal intent. Whilst self-harm by overdosing on medicines, such as paracetamol, is also very common, what we go on to say in this chapter should be read as applying only to cutting, burning, scratching, punching, or otherwise damaging the skin. Overdosing, though it often co-exists with these other forms of self-harm in an individual, has a different function and phenomenology.

Self-harming is reported within both clinical and non-clinical populations (Gratz, Conrad, & Roemer, 2002), and is increasing among adolescents and young adults (Fortune & Hawton, 2005). The extant literature explores a number of reasons why individuals engage in self-harm, suggesting that it acts as a method of releasing, expressing, or regulating distress, it blocks memories/flashbacks, and/or it helps the individual manage distressing dissociative experiences (e.g., Briere & Gil, 1998; Gratz, 2003; Linehan, 1993). Self-harm appears to both down-regulate and control overwhelming feelings, and to up-regulate them, allowing the individual to “feel something” after a period of “feeling numb” (Horne & Csipke, 2009). Symbolic meanings of self-harm have also been posited, such as communicating or recording inner pain (Crowe & Bunclark, 2000; McLane, 1996; Milia, 2000; Miller, 1997).

 

Chapter Eleven - Psychodynamics of Self-disgust: Expulsion and Attack as Attempts to Retain Integrity of the Personality

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David Jones

Introduction

While shame has received much attention in the psychotherapeutic literature, far less regard has been paid to disgust. Yet self-focused disgust, an unstable phenomenon, may stimulate highly violent responses, both physical and emotional, as it threatens the integrity of the personality. In this chapter, which is primarily based on clinical practice, it is argued that prejudice and violence are often linked with self-disgust reactions, which operate both on an individual level and also on a broader social level (Hodson & Costello, 2007; Inbar, Pizarro, Iyer, & Haidt, 2012; Inbar, Pizarro, Knobe, & Bloom, 2009). This is examined using the psychoanalytic concepts of splitting, projection, and introjection, which are defences concerned with the interplay between the deepest, most primitive parts of the mind (the instinctual location of disgust) and experience of, and enactment within, the internal world. Clinical examples, including some from forensic practice, are given to illustrate these psychological processes at work. Most of these examples relate to feelings around same-sex relations (homosexuality), which has featured prominently in my own clinical work.

 

Chapter Twelve - Self-disgust, Self-hatred, and Compassion-focused Therapy

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Paul Gilbert

Until recently, there was general agreement that the affect of disgust had been relatively neglected in the study of social relationships and psychopathology (Davey, 2011; McNally, 2002; Phillips, Senior, Fahy, & David, 1998). This may have been partly due to the fact that it was seen as an evolved emotion designed to deal with body contamination and the prevention of disease, rather than the regulation of psychological processes (Oaten, Stevenson, & Case, 2009). Now, however, as de Jong & Borg note in their chapter (this volume), disgust can be recruited into various domains such as pathogen avoidance, sexual avoidance, and certain types of purity-linked moral violations (see also Rozin, Lowery, Imada, & Haidt, 1999). So, as this book attests, we now know that disgust can be associated with interpersonal relationships (finding other people's behaviours or presentations disgusting) and self-judgements, feeling disgusted with our bodies, fantasies, emotions, and general sense of being. Power and Dalgleish (1997; and see Alanazi, Powell, & Power, this volume) suggested, for example, that disgust is central to the emotion of shame—which is a self-conscious experience that this chapter will explore.

 

Chapter Thirteen - Reflections on the Revolting Self: A Commentary and Further Directions

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Philip A. Powell, Paul G. Overton, and Jane Simpson

The present volume represents the first collection of scholarly works on a topic that, until recently, received scarce attention as a potentially discrete and important psychological phenomenon in its own right. The chapters contained herein have shed some initial light on the concept of disgust for the self, in contexts as diverse as morality, disability, interpersonal violence, physical health, and mental wellbeing. Whilst it is our expectation that self-disgust is likely to be a construct of future interest primarily in the field of mental health, including in the psychology of eating disorders (see Fox, Grange, & Power, this volume), sexual dysfunctions (see de Jong & Borg, this volume), and traumatic stress (see Badour & Adams, this volume), we have seen glimpses of how it may be extended to wider, interdisciplinary problems (see Clark; Reynolds, McCambridge, & Consedine; and Jones, this volume). Selected chapters have challenged our a priori assumptions that self-disgust (as a maladaptive disgust-based construct) plays a pivotal role in certain experiences, including self-harm (see Benson, Boden, & Vitali, this volume) and cases of disability (see Reeve, this volume); others have served to reinforce and extend our own initial expectations (see Alanazi, Powell, & Power; and McKay & Lo Presti, this volume).

 

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