‘Roid Rage

Stop Press:
Discussion (and speculation) about Olympic doping including 100m/200m results
Science of Sport
Steroid Nation

I was listening on the radio just now about UK medal hopes at the Beijing Olympics. It seems we’re doing quite well. Unfortunately I have an anti-talent at sports; at primary school I would only be picked second last if my brother beat me to the wooden spoon. Many years later I lived with a girl and she would watch football on our ancient TV, whilst I sat in my room with the door shut reading ‘The Road to Wigan Pier’.

What’s more my bag is the speculation about the scale of abuse of performance enhancing drugs and their psychiatric sequelae. There are a number of substances used by athletes in order to improve performance. and of these the most common are anabolic steroids.

In the UK anabolic steroids are class C drugs and can be sold only by pharmacists with a doctor’s prescription (most often for hypogonadism). It’s legal to possess or import steroids as long as they’re for personal use, but possession or importing with intent to supply is illegal and could lead to 14 years in prison and an unlimited fine. A UK government source states that in 2003 300,000 steroid tablets were seized.

Use of anabolic steroids in the UK is suspected to be widespread and is not just the preserve of elite athletes; in a survey of 687 students at a British college the overall rate of current or previous use was 2.8% (4.4% in males, 1.0% in females) and, of these, 56% had first used anabolic steroids at the age of 15 or younger. A BMA report in 2002 found that as many as half of the members of dedicated bodybuilding gyms admitted to taking anabolic agents, and that steroid use ran as high as 13% even in some high street fitness centres.

Anabolic steroids are synthetic derivates of the hormone testosterone and allow the user to increase both the frequency and intensity of workouts, in addition to increasing muscle capacity, reducing body fat, increasing strength and endurance, and hastening recovery from injury. Users have varied aims. The majority may wish to enhance their physical appearance in order to achieve a ‘perfect body’, whilst a smaller proportion have experienced physical or sexual abuse, and are trying to increase their muscle size to protect themselves. A further group (possibly between 5 and 10%) includes people who have a form of body dysmorphic disorder (sometimes called ‘reverse anorexia nervosa’), in which they believe that they look small and weak, even if they are large and muscular (Brower et al, 1991).

The steroids are taken orally, or by intramuscular injection and according to a number of regimes – ‘stacking’, ‘cycling’ and ‘pyramiding’.

Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of nonuse. Other work has suggested that adolescents who abuse anabolic steroids have nearly triple the incidence of violent behaviour. Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. Symptoms usually resolve in a few weeks if steroid use is discontinued, although may persist for as long as a month even if adequately treated with antipsychotics.

Steroid users have been shown to have a higher prevalence of cluster B (histrionic, narcissistic, antisocial and borderline) personality traits than community controls . Self report questionnaires and informant histories have been used to retrospectively assess the personality type of anabolic steroid misusers before their first use. Such work suggests that they start out with personalities similar to those of non-using bodybuilders, but develop abnormal personality traits that could be attributed to steroid misuse.

A study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSM–III–R criteria. They identified 5 participants (12.2%) who met the criteria for a manic episode during steroid exposure; a further 8 (19.5%) only narrowly missed the diagnosis. Significantly more participants developed a full affective syndrome during periods of steroid exposure (22%) than non-exposure (5%), and 10 were ‘stacking’ when they experienced manic symptoms.
Symptoms of steroid withdrawal include mood disorders (with suicidal depression as the most life threatening complication), apathy, feelings of anxiety, difficulty in concentrating, insomnia, anorexia, decreased libido, fatigue, headache, and muscle and joint pain. It is difficult to distinguish symptoms that may be physical in origin from those more psychological. Observing oneself to lose muscle mass, strength, performance and confidence after cessation of steroid use has a powerful negative effect on mood, and this may lead to a strong desire to take steroids again.

So, you’re all asking yourself, what’s FP’s advice? Listen to Noam Chomsky:

‘Take, say, sports — that’s another crucial example of the indoctrination system, in my view. For one thing because it … offers people something to pay attention to that’s of no importance; that keeps them from worrying about things that matter to their lives that they might have some idea of doing something about. And in fact it’s striking to see the intelligence that’s used by ordinary people in [discussions of] sports [as opposed to political and social issues


Sources for this posting:


I have leant very heavily on Anabolic androgenic steroids: what the psychiatrist needs to know

This BBC Ethics page has a concise summary of the arguments for and against use of performance enhancing drugs in sport

The talk to Frank site anabolic steroids page

News reports:

Steroids a dangerous new trend BBC February 2 2004

BBC 8 June 2006 Body builder misuse alarm

BBC 11 April 2002 Steroid misuse widespread

Radio programmes (I can’t get these to work, but perhaps you can…)

BBC Radio 4 Diet and Drugs 24 April 2002

BBC Radio 4 The Long View 14 October 2003

Woman’s hour East German doping 7 November 2005

Cognitive dissonance or a psychiatrist at Hay

Cognitive dissonance is a psychological theory which was first described by Leon Festinger and, simply put, is the state of having two cognitions (ideas) that are mutually inconsistent.  It is held that the state of cognitive dissonance is a very unpleasant one, characterised by psychological tension and discomfort.  The theory holds that we are as motivated to change our behaviour due to cognitive dissonance as we might be to act to reduce hunger. 

An example of this might be a person who has always been very opposed to extra-marital affairs.  If he or she found themselves having such an affair, this would be inconsistent with this attitude causing cognitive dissonance. At this point he or she would have two choices: stop the affair, or justify the affair.  We are more likely to change our attitudes and justify our behaviour, than alter our behaviour.  

This makes sense from an evolutionary point of view as we are programmed to develop a set of beliefs to guide our lives.  It is not beneficial to be so open minded that we would be constantly changing our minds as this would make swift action difficult.  To avoid cognitive dissonance in the first place we are programmed to have an in built confirmation bias; this is where we notice, seek and remember information that confirms what we already believe and disregard or minimize information that conflicts with our world view. 

For a gentle introduction on this subject listen to this clip on cognitive dissonance on the Today Programme 


Frontier Psychiatrist has just returned from the Hay Festival and in retrospect I can see confirmation bias at work in my choices of speaker meetings.  I almost entirely went to see people with whom I knew I already agreed, and justified this to myself on the basis that their ideas would useful as a source of further ammunition when arguing on the rare occasions when I get invited to parties. 

The only real exception to this was Cherie Blair,  wife of the former British Prime Minister, for whom I had a free ticket.  She makes me feel conflicted, which is hardly surprising as she’s rather conflicted herself.  She hates the press, but she wishes to use it to have her side of the story told.  She protects her privacy vigorously, but divulges cringing personal details in her autobiography.   She calls this autobiography ‘Speaking for Myself’ as if, as a highly successful barrister, she’s such a victim that she’s never had the chance before.  She’s a socialist, but she owns three houses.  And she makes her problems with being the wife of a head of state so painfully obvious; she publishes a book called ‘The Goldfish Bowl’ about previous spouses in Number 10.   Psychoanalysing this woman is too easy.  She also gave a really boring speech.


I was looking forward to seeing Gore Vidal, but he left me not just cold, but feeling soiled, such was his constant negativity.  He criticized John McCain for not attempting to escape from a Vietcong POW camp.  I don’t think that Vidal has any experience of such scrapes, so should hold counsel until he’s tried himself.  My brother asked him whether he had any ‘words of advice for young people‘.  ‘Grow up’ said Vidal.  Perhaps it’s too late to take his own advice.

Much smaller fry was Mark E. Smith of The Fall.  The interviewer was Jon Gower. I’ve never heard of him either.  Early on during the interview Smith accused Gower of not having read this autobiography.  Gower had to admit that he hadn’t finished it, but to show he’d read what he had carefully, asked the most in depth and convoluted questions, most of which were answered by Smith with a simple ‘yeah’ followed by tittering from the audience.  I spent most of the interview wanting to jump on the stage and wrestle the microphone away from him.  Every psychiatrist knows – the best way to get someone’s story is to ask open questions.  A breath test for Smith and full refund to the audience wouldn’t have been out of place either. That was my question about the security guards.

Christopher Hitchens did nothing to quash allegations of a drink problem by coming to the stage with a glass of wine.  Apart from his rudeness towards a audience questioner, which boarded on bullying, we were in complete agreement.  Further agreement but slight boredom accompanied talks by Naomi Klein and Joseph Stiglitz.  It’s not always a good idea to read the corresponding books before seeing a talk, as the speakers just regurgitate the same facts you’ve already read.  Will Self as ever didn’t disappoint.  My brother got further coverage in the press by asking him about his love of long and seldom used words.

For us the festival ended with Rob BrydonOliver James says that he’s rarely met a comedian who’s not personality disordered or depressed.  I hope he’s wrong in Mr Brydon’s case, as he seems so very nice and so very amusing.  

Guess the diagnosis – Gordon Brown


People in the press have been playing one of my nasty habits – guess the diagnosis of someone you’ve never met.  In this case the beleaguered UK Prime Minister Gordon Brown.

For anyone who lives in a cave, Mr Brown came to be PM about a year ago having been the Chancellor of the Exchequer for ten years.  During this time he presided over unbroken economic growth and was well know for his prudent policies and dour demeanour.  Whilst his lack of easy charm and attention to detail made him apparently trustworthy as the head of the economy, they haven’t played out well as PM, especially as he is following the TV friendly and charismatic – but warmongering  – Tony Blair.  Incidentally, I met Brown’s private secretary, a rather attractive girl, at a party once and was thinking of trying to get off with her but regrettably she left before I could work any magic. 

Writing in The Times, GP Dr Thomas Stuttaford has speculated that Mr Brown has personality traits which might lead him to be diagnosed with a DSM-IV cluster A personality disorder.  He also says that Tony Blair would meet all the criteria for histrionic personality disorder

(If you need to brush up on personality disorders here’s a link to my previous post on the subject) 

BPS research digest disapproves

There are two issues here.  Is Dr Stuttaford proper to speculate in such a way?  Yes, in that we are in a free country, and it would be cheeky for me to say no when I have done similar myself*.  But he is very careless.  You can’t make these kind of diagnoses without meeting the patient, and it is sloppy to take a cursory glance at the DSM criteria and then imply that if someone possibly meets particular criteria and the diagnosis is likely.  He should at least have stated that what he is presenting is purely idle speculation.

Is he actually right?  Unlikely. With regards to Tony Blair, Dr Stuttaford can’t have looked very carefully at the DSM-IV histrionic personality disorder criteria.  Is he saying, for instance, that Tony Blair’s interactions with others are ‘often characterized by inappropriate sexually seductive or provocative behaviour’ or that he ‘consistently uses physical appearance to draw attention to (him)self’? (DSM IV criteria)

He says of Mr Brown:

‘He is likely to be demanding, self- absorbed, have difficulties in relationships with others, suffer discomfort in social situations with unfamiliar people, have vaguely unsettling inappropriate gestures or facial expressions and may be so focused that he finds it difficult to concentrate on subjects other than that which has caught his immediate attention’

I find it difficult to believe that anyone with these sort of characteristics could not only elevate himself to the job of PM(think of the political deals and alliances necessary), but also run the country for more than five minutes with this sort of personality.  ICD-10 states that a personality disorder is ‘usually accompanied with considerable personal and social disruption’ which sounds incompatible with any of Mr Brown’s achievements.   Dr Stuttaford is talking bollocks I fear. 

David Owen, former Labour minister and SDP leader, has written a book about illness suffered by heads of state, and has also coined a term ‘hubris syndrome’ which I think he is un-secretly hoping will pass into common parlance, if not into diagnostic manuals.  Rather less prestigiously, I wrote a post on a leaders and their drug problems, prompted by speculation that Moses was under the influence of psychedelic drugs. 

Other articles on this subject:


*It would be hard to imagine that  Josef Fritzl is not  even a little bit anti-social though…

Josef Fritzl – psychopath?


There’s news that Josef Fritzl, the man who imprisoned his daughter for 24 years in a dungeon of his own making, will plead insanity when his case goes to trial.  I also saw Glenn Wilson, who works at the IoP on TV speculating that Mr Fritzl is a psychopath.  

I’ve talked about personality disorders elsewhere; but in brief: your personality can be defined as ‘the characteristic, and to some extent predictable, behaviour-response patterns that each person evolves, but consciously and unconsciously as his or her style of life’ (Campbell’s Psychiatric Dictionary).  Personality disorders on the other hand relate to when the way in which an individual interacts is so rigid and fixed as to severely limit the likelihood of effective functioning and/or satisfying interpersonal relationships.  The point when a personality is sufficiently beyond the normal to warrant a personality disorder diagnosis is difficult and define and personality disorder is less a diagnosis and more a label of social non-conformity.  

Psychopathic personality disorder is synomymous with anti-social personality disorder (DSM-IV) and dissocial personality disorder (ICD-10) 

Back to Mr Fritzl.  Here’s the ICD-10 classification for dissocial personality disorder (DSPD)

F60.2 Dissocial personality disorder

Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms and characterised by:

(a) callous unconcern for the feelings of other

(b) gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations

(c) incapacity to maintain enduring relationships; though having no difficulty in establishing them

(d) very low tolerance to frustration and a low threshold for discharge of aggression, including violence

(e) incapacity to experience guilt or to profit from experience, especially punishment

(f) marked proneness to blame others or to offer plausible rationalizations for the behaviour that has brought the patient into conflict with society

Mr Fritzl clearly has most of these in spades, so much so that it would not be entirely unreasonable if a whole new subtype of this personality disorder should be invented just for him.  People with DSPD are known to have a reduced ability to empathize with another person’s emotional state, or to recognise it from their face.  I remember a forensic psychiatrist explaining to me the response one of his patient gave when asked to name the emotion of the face of a person shown to him on a card (the emotion was fear)

‘I’m not sure what it’s called but that’s the way people look when I stick a knife in them’ 

Which still gives me the creeps. 

It’s also possible that Mr Fritzl is psychotic in some way, but this seems unlikely given how well he has been seen to function in society and how calculating and precise the planning for his deeds appear to have been. 

It will be brave psychiatrist who attempts to defend his insanity plea as an expert witness. 


I’ve also been very interested to learn of how Austrian society could let this sort of thing happen.  I’ve read in the press that people in general and institutions in particular are extremely reluctant to believe that anyone of social standing could do anything untoward.  Data protection laws are also weighed towards the criminal – any conviction is wiped after fifteen years, which means that the information relating to Mr Fritzl’s rape conviction was not available when he applied to adopt the children he had conceived with his daughter.  Austrian police also said almost immediately that Mrs Fritzl knew nothing of her husbands activities – more wishful thinking perhaps?

It would be easy to get snotty.  Here in the UK we’ve had our share of psychopaths whose crimes evaded the authorities for years.  Peter Sutcliff, who killed thirteen, was eventually caught because his car had false number plates.  Dennis Neilsen killed at least fifteen and was caught because his drain was blocked with flesh. 


And another thing, which no one else seems to be saying.  Mr Fritzl really looks like a pervert to me.  The supercilious smirk, the arched eyebrows with the right slightly higher as if in challenge.  Dogs and their owners eventually look the same people say.  Is it possible that psychopaths eventually look like their acts?

Anorexia and bulimia nervosa (and John Prescott)


John Prescott has come out in the papers today as saying that he was suffering from bulimia nervosa whilst he was Deputy Prime Minister.

With two jags, an affair, some punches and a poorly timed croquet game and now a psychiatric illness, I’m impressed with how much mileage John Prescott has provided the red tops with other the past few years.  Bulimia is quite something for someone who was right at the top of the political pile to admit to.  Food’s a difficult thing – if you have a problem with it, eating too much or too little, you can’t just stay away from it.  And everywhere there are pictures of perfect bodies reproving you for not being just like them.   

Here’s a bit about eating disorders for the curious: 

The International Classification of diseases recognises a number of eating disorders, of which are two major flavours identified – anorexia nervosa (F50.0) and bulimina nervosa (F50.2).  If someone presents with a difficulty with their eating which doesn’t fit into either of these patterns then they are classified as having an eating disorder, unspecified (F50.9) 

Anorexia Nervosa is characterised by deliberate weight loss resulting from under-nutrition with associated with endocrine and metabolic disturbance. It occurs most commonly in adolescent girls and young women with males of the same age affected rarely.  For a definitive diagnosis:

  • Body weight must be maintained at 15% below that expected
  • weight loss is maintained by the avoidance of ‘fattening’ foods
  • There need be body-image distortion, where dread of fatness persists as an intrusive overvalued idea. 
  • Amenorrhoea (lack of periods) in women and loss of libido in men. 
  • Delay or arrest of puberty.

In contrast bulimia nervosa is characterised by repeated bouts of overeating and an excessive preoccupation with the control of body weight.  The age and sex distribution is similar to AN, with the age of onset being slightly later.  Bulimic patients often have a history of anorexia nervosa.  For a definitive diagnosis:

  • There is a persistent preoccupation with eating and a craving for food; the patient binges
  • The patient attempts to counteract the ‘fattening’ effects of the food by vomiting, but could also attempt control by purgative abuse or use of appetite suppressants. 
  • There is a morbid dread of fatness

There are two subtypes of BN – purging (with regular use of vomiting/laxatives etc.) and non purging (where compensating behaviours are exercise or fasting). 

Both these diseases are serious.  The death rate for suffers of AN is twelve times that of the general population, the worst of any psychiatric disorder.  Suicide rates for those with AN are two hundred times that of the general population.  The two conditions are also often associated with other psychiatric difficulties such as depression, personality disturbance and alcohol abuse. 

Given his age and presentation Mr Prescott’s case is atypical and and it will be interesting to read about it in his forthcoming biography (this can’t have done his sales any harm) 


Here‘s a Guardian article by Decca Aitkenhead about Prescott

NHSblogdoc is rather less charitable than I am

Scientology and Psychiatry


It’s a few months since a video of Tom Cruise expounding on Scientology was released on the internet.  Described as ‘a complete fanatic‘ by the Gawker blog and worse elsewhere, he did come across as single-minded on the subject.  A recent book by Diana Spencer biographer Andrew Morton suggests that Cruise may be second in command in the Scientology Church behind David Miscavige.  

As much as it is possible with someone who has the adoration of thousands and earns more than I do in a year in about ten minutes, I do have some sympathy with Cruise for the ridicule he has received.  The beliefs of any religion or cult sound ridiculous when one takes a step back from them.  And impenetrable jargon could be expected from someone who believes himself to be talking to the converted.  It is only because the belief structure of, say, Christianity is so accepted in our culture that it does not seem fantastical.  If you subscribe to this viewpoint, then in saying what he says Cruise is no more deluded than any evangelical Christian, albeit one that is a member of a large, secretive and powerful group.

But this is not what I wish to examine here. 

For all the qualified sympathy I have for Cruise, he would be unlikely to extend the same to me.  Scientologists don’t like psychiatrists or psychologists.  Here Cruise talks about his dislike of psychiatry in the context of his previous comments on Brooke Shields using anti-depressants.  Taking an uncompromising stance, he insists that he had studied the history of psychiatry and had formed a negative opinion he wishes to share with others on this basis. 

In 1969 the Church of Scientology set up an organisation called the Citizens Commission on Human Rights which runs an  ‘Industry of Death’ museum located at 6616 Sunset Boulevard.  They have also made a documentary called ‘Psychiatry: An Industry of Death’ clips of which can be watched on YouTube

Here are some of the allegations levelled at psychiatrists by the CCHR website:

Psychiatrists are using electroshock, drugs and other barbaric means to torture political dissidents.

20 million children worldwide are taking psychiatric drugs, which can cause suicide, hostility, violence, mania and drug dependence.

More than 100,000 patients die each year in psychiatric institutions.

Annually, psychiatrists kill up to 10,000 people with their use of electroshock—460 volts of electricity sent searing through the brain. Three-quarters of all electroshock victims are women.

Psychiatrists and psychologists have raped 250,000 women. Studies show that 10 to 25 percent of psychiatrists sexually assault their patients; of every 20 of these victims one is likely to be a minor. 

Here’s a tour video of the Industry of Death Museum. Bedlam (now the Bethlem Hospital, South London) where ‘patients were chained like animals’ gets an early mention.  It appears that, according to the museum, psychiatrists are responsible for pretty much every ill of the modern world, including eugenics, ethnic cleansing and terrorism.  This seems somewhat unfair.  Details of these accusations can be seen as chronicled by two jokers at this blog who describe their visit to museum as the highlight of their trip to LA.

A lot of what the Scientologists metaphorically beat psychiatrists with has some basis in truth.  It’s no secret that psychiatry has been used to control political dissidents and that our knowledge of what causes psychiatric disease is patchy.  It is also a common criticism that psychiatrists seek to pathologise all of human behaviour and emotion.  But I do not think that you can legitimately criticise modern psychiatry because some people have sought to use what we know of psychology for nefarious ends, nor can they discount accumulated knowledge on mental health problems on the basis that their aetiology is incompletely understood; there are in fact plenty of diseases about which little is understood and that are treated empirically – think autoimmune disease.  

What do the Scientologists suggest instead of current approach for the mentally ill of society?  They make some suggestions for alternatives on the CCHR website.  Here there seems to be a strong emphasis placed on rooting out physical causes for psychiatric problems, something that psychiatrists should do as a matter of course.  For acute settings, In 1974, Scientology founder Hubbard penned the Introspective Rundown intended for Scientologists suffering from a psychotic breakdown.  Lisa McPherson was undergoing this protocol when she died in 1995.

Tom Cruise himself suggests an approach involving exercise and vitamins.  I have no doubt that increased exercise and diet  (but not vitamins, all they are good for it producing expensive urine) would would improve my patient’s mental health markedly, but I’d like to see him persuading them to do it without brainwashing them first.  

Update: Here’s an interesting article about scientology and psychiatry from Salon.com

Reported in the article from International Scientology News #38, 1995

"There are a lot of opinions out there as to what is wrong with Earth, 1995. But if you really want to eliminate those problems all you have to do is work for the objectives that we, as members of the IAS, have set for the year 2000: Objective One – place Scientology at the absolute forefront of Society. Objective Two – eliminate psychiatry in all its forms. Let’s get rid of psychiatry, and let’s bring Scientology to every man, woman and child
on this planet."

This quote is also reported in wikipedia

Psychosis at 30,000ft

Several newspapers including The Guardian and The Irish Independent have reported have reported over the past few days that an Air Canada 767 bound for London Heathrow had to divert to Dublin Shannon following one of the co-pilots suffering from ‘nervous breakdown’. 

The Irish Independent reports that the co-pilot had been ‘acting in a peculiar manner and was talking loudly to himself’ during the transatlantic crossing and the crew had become concerned.  From The Guardian we learn that he was restrained after yelling and "invoking God" while at the controls of the plane.  The Guardian continues by quoting one of the passengers on board, who said that the co-pilot was carried into the cabin with his hands and ankles cuffed after being restrained by, amongst others, an off-duty Canadian soldier.  He was subsequently handcuffed to a seat as his captain requested permission to land from Irish air traffic authorities.

I read of what sound like quite severe psychotic symptoms: ‘His voice was clear, he didn’t sound like he was drunk or anything, but he was swearing and asking for God. He specifically said he wants to talk to God’. When the plane landed in Dublin, he was met by a medical team who assessed him at the scene before transferring him to a psychiatric unit in Ennis.  

It’s hard to imagine a more difficult situation for any of the people involved in this incident.  It must have been terrifying for the passengers on board the aircraft as well as extremely distressing for the crew to have to restrain one of their colleagues. We should reserve some of our sympathy for the co-pilot too.  A previously high functioning individual, when he recovers he will have to come to terms with what has happened as well as facing the end of his flying career.  

A search of the Canadian Civil Aviation authority website suggests that anyone with a history of psychotic illness is not permitted to fly aircraft. It is therefore likely that this is a first presentation of psychiatric illness for this pilot, or possibly he has in some way concealed any problems he has had in order to maintain his chosen career ultimately putting passengers at risk. 

A recent article in the New Scientist is about antidepressant use amongst pilots.  It tells us that most aviation authorities do not allow pilots on antidepressants to fly.  The Australian Civil Aviation Authority is one of the few that do and a study there suggested that pilots on antidepressants were not at greater risk of accidents.  It also suggests that banning pilots from flying who are taking antidepressants may actually increase accidents by discouraging depressed pilots from seeking treatment.  Perhaps this pilot did not seek help until it was too late with very nearly devastating consequences.