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PROFESSOR: I have what I think
of as a couple of fascinating

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questions that I will use to
occupy us for the next -- for

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the last couple of lectures
of the course.

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In the context of talking about
sleeping and dreams, I

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mentioned that the hunger drive
is strong, but it's not

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so strong that if you wanted
to, you couldn't starve

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yourself to death.

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But an interesting question
would be why an otherwise

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healthy adolescent girl
would do that.

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And why in doing that she would
argue vociferously that

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there was nothing wrong with her
and that she wasn't hungry

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even while starving herself
potentially to death.

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That's one question.

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That will occupy
probably today.

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You'll see that I did handouts
for both this lecture and the

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next lecture rolled together
in case I get to

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the next one today.

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The second question is -- well,
you might have found the

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evolutionary psych argument
about asymmetries between the

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sexes in terms of what they want
in relationships to be

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reasonably compelling.

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That argument about
guys wanting to --

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everybody wanting to propagate
their genes, but because women

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get pregnant and are thus tied
up with the baby for an

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extended period of time, that
you end up with an asymmetry

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that would cause males to want
more sex, more often, with

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more partners, than women.

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You might have found that
appealing, at least as an

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intellectual construct.

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But how would we explain, would
that explain, how might

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it explain why at least some
males end up engaging in

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coercive sexual behavior, sexual
behavior that does not

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appear to be consensual
between the partners?

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And that's what's going to
occupy us for the last lecture

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of the course.

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Now these are very different
problems, the problem of

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eating disorders on the one
hand and coercive sexual

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behavior, or more colloquially,
date rape on the

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other side.

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But they do have some
interesting parallels, one

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with the other.

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These are outlined a bit, I
guess, in the abstract part of

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the handout.

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They're both problems that
are gender specific.

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The overwhelming number of
eating disorder patients are

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female, and the overwhelming
number of people who get into

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trouble for, you know, brought
up on charges in coercive

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sexual behavior cases, for
instance, are male.

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So they're gender specific.

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That's of some interest.

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They both serve a useful
function at the end of the

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course, because they're both
useful for bringing back theme

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after theme that we've seen
throughout the course, themes

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like revisiting is it nature,
is it nurture?

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Is it biology or is
it sociology?

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And the answer always turns out
to be, or often turns out

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to be, that these are
complicated interactions.

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And the problems of eating
disorders and coercive sex

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turn out to be particularly rich
interactions between a

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number of factors.

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And by the same token, neither
of them is well dealt with in

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any simpleminded, oh, give them
a pill, for instance,

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kind of way.

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And they're both what could
be described as

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being successful disasters.

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I'll elaborate on that later.

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But both of them are in a
perverse sense successful

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behaviors and in a more obvious
sense disasters,

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unsuccessful.

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Let me start by sketching a
portrait of what would be a

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typical patient with the
diagnosis of anorexia nervosa.

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The term simply means
-- anorexia

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means a lack of appetite.

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Nervosa is just what
you stick on when

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it's of nervous origins.

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You know, you could have called
it psychogenic or

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something like that.

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It just means a loss of appetite
that you're not going

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to explain by some
organic cause.

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A typical patient would be an
adolescent girl, say fourteen,

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fifteen, sixteen, who gets
brought typically by her

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family to the doctor.

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Very skinny.

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Part of the characteristics you
can see on the clinical

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criteria for the diagnosis --

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part of the characteristic is
a refusal to maintain what's

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considered a normal
body weight.

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So maybe, you know, at her
height and age, she should

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weigh about a hundred pounds.

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She might come in weighing
seventy-five pounds looking to

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all the world like she
is emaciated --

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looking to all the world but
one like she's emaciated.

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One of the characteristics
is a --

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well, I think it's
on the handout --

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distortion of body image,
a denial that

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you're actually skinny.

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And it's not just, you know,
some sort of a cranky, you

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know, what did you get
in biology this term?

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Did you flunk biology
this term?

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No, I didn't flunk biology this
term When you can see on

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the report card that it says
F or something like that.

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It's not that kind of denial.

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It's almost like a perceptual
disorder, where a young girl

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who looks to everybody else like
she is a famine victim

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looks at herself in the mirror
and says, I look fat.

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As though she was seeing
something that literally

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wasn't there.

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This is combined with an intense
fear of being fat, of

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being overweight.

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And one of the official
diagnostic criterion is a

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cessation of menstrual cycles
for more than three months.

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There was an interesting
article --

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Bo, you sent it around, right?

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Did you send around the New York
Times thing about EDNOS?

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An interesting article in the
New York Times science section

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last week pointing out
one of the problems

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in psychiatric diagnosis.

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Suppose you got a patient.

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She's fifteen years old, skinny
as a rail, intense fear

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of being fat.

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Says she looks fat.

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And her monthly cycles are
irregular, but they've never

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disappeared for a full
three months.

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Under the official rules of the
game, you can't give her a

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diagnosis of anorexia because
she doesn't meet all the

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diagnostic criteria.

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Clearly has an eating
disorder.

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What you end up labeling her
as is eating disorder not

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otherwise specified.

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EDNOS is the official
category for this.

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It becomes an issue in the
economics of health care

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because what you can get
reimbursed for, what you can

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treat for, are real diseases.

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I mean, reasonably enough, you
can't go to your doctor and

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say, you know, I want a pile
of drugs and therapy that I

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want somebody else to pay for
because I hate my calculus TA

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pathologically.

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Yeah, OK.

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You can't just decide that --

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well, you can just decide that
you're ill in something.

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Or you can't just walk in and
say, you know, I want

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you to treat me.

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I desperately need you to change
the shape of my nose,

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and I'm not thrilled with my
rear end and, you know, I kind

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of want you to reshape my whole
body because, you know,

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my body, it's just not right.

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You have to get a diagnosis of,
you know, body dysmorphic

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disorder or something like that
before you can persuade

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the third party payers
to do it.

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Anyway, in psychiatric land this
is a big problem because

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it's very difficult
to come up with --

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you know, there's no
blood test, right?

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If you've got polio, there's
a polio virus

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somewhere to look for.

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If you've got an eating
disorder there's not.

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And so exactly how to
label people is

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a substantial problem.

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But I'm not going to
say more about it.

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In any case, so here's
a patient.

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This disorder is interesting
as an interplay of mind and

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body in many, many ways.

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Part of the reason that it's
interesting is because there

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are all sorts of psychiatric
consequences that just arise

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from the fact that
this girl --

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I'll stick with it being a
female patient because

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anorexia is about eight to one,
nine to one female --

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because she's starving
herself.

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For instance, starving yourself
is depressing.

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If you are really hungry, you
also tend to have more

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symptoms of clinical
depression.

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Is depression part of the
eating disorder pattern?

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Is it part of the pathology
or is it a side

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effect of the pathology?

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In any case, it is not
an uncommon disorder.

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Point prevalence is jargon for
saying if I go and look at a

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population at this point in
time, how many people have the

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disorder I'm looking for?

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And if you look at a population
of young women, the

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point prevalence of anorexia
is about half of a percent.

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If you broaden it to this EDNOS,
eating disorder not

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otherwise specified category,
that can go up to anywhere

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between 2% and 5% depending
on what you read.

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If you look at prevalence rates,
as I say, they're about

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eight to one female to male.

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So it's a very heavily
female disorder.

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And it's a dangerous disorder.

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For patients with full-blown
anorexia diagnosis, the

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mortality rate can be
as high as about 5%.

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That's very high for a disorder
of a population

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that's otherwise, you know,
young healthy women.

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What kills you, by the way, is
not starving to death, but

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things like heart attack.

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Your electrolytes get to be so
out of balance that your heart

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fails to work and things
of that sort.

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It is also a disorder, in
a sense like multiple

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personality disorder, that has
changed greatly in its

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frequency in the population in
historical time, like the last

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forty years.

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00:12:32,340 --> 00:12:35,820
It's different from multiple
personality disorder in that

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this change may be a real
change in incidence.

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Remember the argument was that
in multiple personality

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disorder, dissociative disorder
had been there all

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along, and that multiple
personality was merely the way

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that it manifest itself, that
the dissociative disorder

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manifested itself in modern
Western culture.

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In the case of eating disorders,
it really may be

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00:13:04,760 --> 00:13:10,740
that the disorder is itself more
frequent than it's been

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in the past.

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00:13:12,780 --> 00:13:14,680
It is certainly a --

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depends on what society
you are in.

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00:13:20,470 --> 00:13:25,110
It was characteristically, even
as recently as probably

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00:13:25,110 --> 00:13:27,930
twenty years ago, it was
absolutely characteristically

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a disease of middle-class
white girls.

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00:13:32,050 --> 00:13:39,100
It has since managed to embrace
diversity and reach

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00:13:39,100 --> 00:13:42,270
out to other groups in
Western culture.

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For instance, virtually unknown
in Japan until fairly

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recently, but now is a disorder
showing up in Japan.

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I think I just read something
that even more recently, it's

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now starting to show up
in mainland China,

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where it was unknown.

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One of the requirements for
a good eating disorder

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00:14:01,030 --> 00:14:03,350
population, by the way,
is a culture where

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00:14:03,350 --> 00:14:04,650
there's lots of food.

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00:14:04,650 --> 00:14:07,890
You don't have people with
eating disorders of

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00:14:07,890 --> 00:14:12,580
this sort in famine.

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00:14:12,580 --> 00:14:16,390
You can be seventy-five pounds
when you're supposed to be a

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00:14:16,390 --> 00:14:18,670
hundred pounds because there
isn't enough food, but it's

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00:14:18,670 --> 00:14:23,410
not because you're refusing to
maintain your body weight.

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00:14:23,410 --> 00:14:29,450
So it is a disorder of a
society that is feeding

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00:14:29,450 --> 00:14:33,640
everybody, that would be
able to feed everybody

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00:14:33,640 --> 00:14:35,550
successfully.

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00:14:35,550 --> 00:14:38,000
So where does this come from?

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00:14:38,000 --> 00:14:39,090
What's it's etiology?

238
00:14:39,090 --> 00:14:42,650
What are the risk factors
that contribute here?

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00:14:45,970 --> 00:14:48,490
I can tell it must be time
to flip pages on

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00:14:48,490 --> 00:14:50,090
the handout, right?

241
00:14:50,090 --> 00:14:50,990
Look at that.

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00:14:50,990 --> 00:14:52,630
What's the causes?

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00:14:52,630 --> 00:14:59,240
And it reminds me to caution,
to step back

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00:14:59,240 --> 00:15:00,160
for a couple of cautions.

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00:15:00,160 --> 00:15:06,620
The primary caution here is that
this is not intended to

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00:15:06,620 --> 00:15:11,250
be talking about you
specifically.

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00:15:11,250 --> 00:15:13,980
Because, well, all right,
here, let's jump ahead.

248
00:15:13,980 --> 00:15:19,410
We can say stuff about,
again typically, the

249
00:15:19,410 --> 00:15:21,670
girl who is a patient.

250
00:15:21,670 --> 00:15:23,490
There are characteristics
that --

251
00:15:23,490 --> 00:15:25,480
not every -- you know,
it's a big, wide

252
00:15:25,480 --> 00:15:27,020
distribution as usual.

253
00:15:27,020 --> 00:15:31,190
But we can say something about
where the sort of typical

254
00:15:31,190 --> 00:15:32,650
patient might lie.

255
00:15:32,650 --> 00:15:38,130
Typically she is adolescent --

256
00:15:38,130 --> 00:15:42,110
sometime after the onset of
puberty is the, sort of, risk

257
00:15:42,110 --> 00:15:46,030
period for the onset of
anorexia typically --

258
00:15:46,030 --> 00:15:50,130
described as a good girl,
something of a perfectionist,

259
00:15:50,130 --> 00:15:52,380
the one who never gave
any trouble.

260
00:15:52,380 --> 00:15:54,660
And now you should be
immediately able to see why I

261
00:15:54,660 --> 00:15:57,020
put this caution in that I'm
not talking about you.

262
00:15:57,020 --> 00:16:02,160
Who in the world gets to MIT
by being a bad, evil,

263
00:16:02,160 --> 00:16:03,170
non-perfectionist?

264
00:16:03,170 --> 00:16:05,250
Well, you know, there's a couple
of you here maybe who,

265
00:16:05,250 --> 00:16:07,470
you know, just got through
because you're brilliant, bad,

266
00:16:07,470 --> 00:16:09,810
evil, non-perfectionists
or something like that.

267
00:16:09,810 --> 00:16:13,880
But the rest of you spent those

268
00:16:13,880 --> 00:16:16,920
adolescent years being --

269
00:16:16,920 --> 00:16:18,890
those of you who were women --
the rest of you didn't spend

270
00:16:18,890 --> 00:16:19,940
your time being women.

271
00:16:19,940 --> 00:16:24,090
But, you know, you spent your
time being good and doing your

272
00:16:24,090 --> 00:16:25,960
homework and not raising
a lot of trouble

273
00:16:25,960 --> 00:16:27,160
and stuff like that.

274
00:16:27,160 --> 00:16:27,790
Oh, great.

275
00:16:27,790 --> 00:16:30,890
Now let's talk about
the family a bit.

276
00:16:30,890 --> 00:16:34,000
It's an interesting disorder
because it turns out to be

277
00:16:34,000 --> 00:16:35,930
important to talk about
the family.

278
00:16:35,930 --> 00:16:42,670
If you are dealing with a lot
of other health issues, your

279
00:16:42,670 --> 00:16:45,110
family background is of some
interest, particularly for

280
00:16:45,110 --> 00:16:49,540
sort of genetic reasons, but the
structure of your family

281
00:16:49,540 --> 00:16:52,210
is typically not desperately
important.

282
00:16:52,210 --> 00:16:54,120
Here it may really
be important.

283
00:16:54,120 --> 00:16:57,280
The family -- again, wide range
possible -- but the

284
00:16:57,280 --> 00:17:01,740
typical family would be one
that's described as -- what

285
00:17:01,740 --> 00:17:02,590
have I got here? --

286
00:17:02,590 --> 00:17:05,300
overprotective and also

287
00:17:05,300 --> 00:17:07,580
perfectionist, achievement oriented.

288
00:17:07,580 --> 00:17:09,550
And you're sitting there saying,
oh my god, not only

289
00:17:09,550 --> 00:17:13,630
was I good, but my family,
they're overprotective, and

290
00:17:13,630 --> 00:17:15,190
they're achievement oriented.

291
00:17:15,190 --> 00:17:18,440
And when I said that what I
really wanted to do was go to

292
00:17:18,440 --> 00:17:21,430
the community college, they
locked me in my room for three

293
00:17:21,430 --> 00:17:24,900
days until I finished the MIT
application and stuff.

294
00:17:24,900 --> 00:17:28,440
You know, this is our history.

295
00:17:28,440 --> 00:17:29,560
These are our people.

296
00:17:29,560 --> 00:17:31,850
We know them.

297
00:17:31,850 --> 00:17:34,300
The other characteristic, to
introduce a little piece of

298
00:17:34,300 --> 00:17:40,910
jargon here, the families are
described as enmeshed.

299
00:17:40,910 --> 00:17:45,040
This is a piece of jargon that
I understand well, because I

300
00:17:45,040 --> 00:17:50,240
come from a family that is
beautifully described, you

301
00:17:50,240 --> 00:17:52,770
know, beautifully fits
the enmeshed idea.

302
00:17:52,770 --> 00:17:56,600
I don't understand how my
sisters got through their, you

303
00:17:56,600 --> 00:17:59,120
know, youth without an
eating disorder.

304
00:17:59,120 --> 00:18:02,250
Because every year when I talk
about this, if I talk about

305
00:18:02,250 --> 00:18:06,480
the risk factors, you know, it
just sounds like my family,

306
00:18:06,480 --> 00:18:09,190
our nice achievement-oriented
enmeshed family.

307
00:18:09,190 --> 00:18:13,070
Enmeshed means a family
where people --

308
00:18:13,070 --> 00:18:16,580
imagine a family, like yours
maybe, where people finish

309
00:18:16,580 --> 00:18:19,050
each other's sentences
and stuff like that.

310
00:18:19,050 --> 00:18:25,230
They're sort of all over each
other psychologically.

311
00:18:25,230 --> 00:18:27,690
You know what they want.

312
00:18:27,690 --> 00:18:30,690
They know what you want.

313
00:18:30,690 --> 00:18:37,610
The place to see it in the Wolfe
family, as my wife who

314
00:18:37,610 --> 00:18:41,490
of course married into this
found out, is go out

315
00:18:41,490 --> 00:18:43,490
to dinner with them.

316
00:18:43,490 --> 00:18:46,140
You don't want to do this,
because it's pathological.

317
00:18:46,140 --> 00:18:48,880
First you've got to decide where
to go for dinner, right?

318
00:18:48,880 --> 00:18:50,890
So everybody gets together.

319
00:18:50,890 --> 00:18:52,190
You decide where to
go to dinner.

320
00:18:52,190 --> 00:18:53,900
You've almost got a consensus.

321
00:18:53,900 --> 00:18:57,500
You're going to go to Legal
Sea Foods or something.

322
00:18:57,500 --> 00:19:01,960
At which point one of us, it
might well be me, points out

323
00:19:01,960 --> 00:19:03,640
my mother doesn't really
like fish.

324
00:19:03,640 --> 00:19:05,520
Is my mother fussing
about this?

325
00:19:05,520 --> 00:19:07,810
No, my mother's perfectly happy
to go along with what

326
00:19:07,810 --> 00:19:09,080
everybody else wants.

327
00:19:09,080 --> 00:19:13,960
But, you know, I'll say,
you know, but Mom

328
00:19:13,960 --> 00:19:14,790
doesn't like fish.

329
00:19:14,790 --> 00:19:16,970
Well, actually, these days
I would say, but Gaga

330
00:19:16,970 --> 00:19:18,310
doesn't like fish.

331
00:19:18,310 --> 00:19:23,270
My eldest child when he was a
toddler named my mother Gaga.

332
00:19:23,270 --> 00:19:27,750
And that's been her name ever
since, which is, you know, she

333
00:19:27,750 --> 00:19:29,340
deals with it.

334
00:19:29,340 --> 00:19:34,710
Anyway, so all right, we've
got to cancel that one.

335
00:19:34,710 --> 00:19:37,410
So now the whole conversation
starts again.

336
00:19:37,410 --> 00:19:39,660
And you can do this for hours.

337
00:19:42,250 --> 00:19:45,060
Julie, my spouse, learned the
best thing to do, particularly

338
00:19:45,060 --> 00:19:48,390
if we're out somewhere, you're
wandering around trying to

339
00:19:48,390 --> 00:19:51,440
decide where to go to a
restaurant, is just drop about

340
00:19:51,440 --> 00:19:52,920
five, six paces back.

341
00:19:52,920 --> 00:19:55,200
You just don't want to be
in this conversation.

342
00:19:55,200 --> 00:19:59,740
But eventually we'll end up at
a restaurant, at which point

343
00:19:59,740 --> 00:20:04,190
everybody's ordering for
everybody else and is ordering

344
00:20:04,190 --> 00:20:08,430
stuff that they don't
necessarily want to eat, but

345
00:20:08,430 --> 00:20:09,980
they think somebody else
might want to eat.

346
00:20:09,980 --> 00:20:11,230
My mother is the
queen of this.

347
00:20:11,230 --> 00:20:14,500
My mother will order things she
doesn't even like because

348
00:20:14,500 --> 00:20:17,000
she thinks one of her children
wants to try it or

349
00:20:17,000 --> 00:20:18,160
something like that.

350
00:20:18,160 --> 00:20:21,300
And this is still true now that
her children are in their

351
00:20:21,300 --> 00:20:23,980
late forties.

352
00:20:23,980 --> 00:20:26,250
It's OK, Ma.

353
00:20:26,250 --> 00:20:28,720
I'm not starving anymore.

354
00:20:28,720 --> 00:20:30,790
Anyway, that's enmeshed.

355
00:20:33,810 --> 00:20:39,840
These families are also
characteristically intolerant

356
00:20:39,840 --> 00:20:44,380
of expressions of conflict
and anger.

357
00:20:44,380 --> 00:20:48,750
It's not that there aren't
conflicts in these settings,

358
00:20:48,750 --> 00:20:52,800
but the family will act as a
unit to smooth them out.

359
00:20:52,800 --> 00:20:59,250
This is not a, you know,
dramatic family where people

360
00:20:59,250 --> 00:21:04,250
throw crockery at each other
and then, you know, in act

361
00:21:04,250 --> 00:21:06,340
five they all hug or something
like that.

362
00:21:06,340 --> 00:21:12,310
This is a family where if
there's an issue, it's dealt

363
00:21:12,310 --> 00:21:15,200
with in some quiet,
perhaps even

364
00:21:15,200 --> 00:21:18,330
subterranean, kind of a way.

365
00:21:21,420 --> 00:21:28,060
So that's sort of the patient
and the family.

366
00:21:28,060 --> 00:21:34,490
And then you've got to ask,
given a disorder that has been

367
00:21:34,490 --> 00:21:39,850
a disorder of Western
middle-class culture, you've

368
00:21:39,850 --> 00:21:43,920
got to ask what it is about
the culture that might be

369
00:21:43,920 --> 00:21:45,980
contributory here.

370
00:21:45,980 --> 00:21:54,840
Again, there are other
situations in which the

371
00:21:54,840 --> 00:21:58,230
broader environment is
important, like is it putting

372
00:21:58,230 --> 00:22:01,670
stress on you in some sort
of global kind of a way.

373
00:22:01,670 --> 00:22:04,660
But here the specific demands of
the culture turn out to be

374
00:22:04,660 --> 00:22:06,300
of particular interest.

375
00:22:06,300 --> 00:22:15,920
And the particular demand that
people focus on is the degree

376
00:22:15,920 --> 00:22:20,670
to which American culture, more
broadly Western culture,

377
00:22:20,670 --> 00:22:26,240
is simultaneously obsessed with
both food and thinness.

378
00:22:26,240 --> 00:22:29,510
This is a difficult combination,
right?

379
00:22:29,510 --> 00:22:33,610
So how do we know that
this is a culture

380
00:22:33,610 --> 00:22:35,430
obsessed with thinness?

381
00:22:35,430 --> 00:22:41,000
One of the most telling ways
is to take a look at the

382
00:22:41,000 --> 00:22:43,570
ideals of female beauty.

383
00:22:43,570 --> 00:22:49,810
What is it that society as
a whole declares to be

384
00:22:49,810 --> 00:22:54,330
beautiful in women?

385
00:22:54,330 --> 00:23:00,450
And if you do something --

386
00:23:00,450 --> 00:23:03,530
I should check if there's
a cool website for this.

387
00:23:03,530 --> 00:23:06,380
If you just line up the pictures
of Miss America, for

388
00:23:06,380 --> 00:23:12,970
instance, over the last fifty,
sixty years -- if you take a

389
00:23:12,970 --> 00:23:17,230
look at Miss America from the
1940s, you would agree that

390
00:23:17,230 --> 00:23:20,290
she's a perfectly
attractive-looking woman, but

391
00:23:20,290 --> 00:23:24,290
you'd think she looks
a little chunky.

392
00:23:24,290 --> 00:23:31,180
There's a lot more on her than
would be the case for a modern

393
00:23:31,180 --> 00:23:34,130
Miss America or a modern --

394
00:23:34,130 --> 00:23:40,350
open up a fashion magazine at
random and look at the models.

395
00:23:40,350 --> 00:23:45,470
Much skinner than the ideal
would have been a couple of

396
00:23:45,470 --> 00:23:46,510
generations ago.

397
00:23:46,510 --> 00:23:54,350
Or take a look at one that I
learned about when my children

398
00:23:54,350 --> 00:23:57,350
became big fans of the
James Bond movies.

399
00:23:57,350 --> 00:24:02,220
So in every James Bond movie,
there's the girl, right.

400
00:24:02,220 --> 00:24:05,470
She's been getting a lot
skinnier over the years.

401
00:24:05,470 --> 00:24:07,550
If you go back to the
early ones --

402
00:24:07,550 --> 00:24:09,620
I don't know how many of you
are great James Bond

403
00:24:09,620 --> 00:24:10,350
aficionados.

404
00:24:10,350 --> 00:24:15,270
But if you go back and look at
a movie like Goldfinger --

405
00:24:15,270 --> 00:24:18,130
I will not recite all the
names of the characters

406
00:24:18,130 --> 00:24:22,760
because they're all bad lewd
puns I'm realizing as I'm

407
00:24:22,760 --> 00:24:24,200
thinking about this --

408
00:24:24,200 --> 00:24:31,540
but if you go back and look at
the girl in Goldfinger or in

409
00:24:31,540 --> 00:24:34,780
Dr. No or something like that,
you will find again --

410
00:24:34,780 --> 00:24:38,000
that's from the early '60s, mid
'60s -- you'll find that

411
00:24:38,000 --> 00:24:40,930
she looks, you know, perfectly
attractive woman.

412
00:24:40,930 --> 00:24:45,430
But again, there's more of her
than there would be in --

413
00:24:45,430 --> 00:24:48,430
who's the tart in the
most recent --

414
00:24:48,430 --> 00:24:49,430
AUDIENCE: Halle Berry.

415
00:24:49,430 --> 00:24:50,090
PROFESSOR: Halle Berry.

416
00:24:50,090 --> 00:24:50,300
Yes.

417
00:24:50,300 --> 00:24:51,460
Nothing there, right.

418
00:24:51,460 --> 00:24:52,840
She's pretty skinny.

419
00:24:57,030 --> 00:24:59,960
And another move in the James
Bond thing, which is an

420
00:24:59,960 --> 00:25:05,030
interesting thing in its own
right, which is that they

421
00:25:05,030 --> 00:25:08,870
still have to end up together
by the end of the movie, but

422
00:25:08,870 --> 00:25:11,660
they're getting a lot
crankier about the

423
00:25:11,660 --> 00:25:14,100
whole business, right.

424
00:25:14,100 --> 00:25:15,480
It's like they get
into this movie.

425
00:25:15,480 --> 00:25:18,490
They realize that by the end of
the movie, I've got to, you

426
00:25:18,490 --> 00:25:21,980
know be in one of those silly
scenes with whoever's playing

427
00:25:21,980 --> 00:25:25,830
Bond this week, but he's
a jerk really.

428
00:25:25,830 --> 00:25:27,160
But anyway, that's
a separate issue.

429
00:25:27,160 --> 00:25:31,050
Anyway they've been getting
skinnier and skinnier.

430
00:25:31,050 --> 00:25:34,570
Barbie has been skinny forever,
but gets blamed --

431
00:25:34,570 --> 00:25:37,840
is held up literally
as an icon for this

432
00:25:37,840 --> 00:25:39,710
problem, you know.

433
00:25:39,710 --> 00:25:41,550
Women do not look like Barbie.

434
00:25:41,550 --> 00:25:47,500
If you scale Barbie up to human
size, there are serious

435
00:25:47,500 --> 00:25:52,370
biomechanical problems that
ensue, apparently.

436
00:25:52,370 --> 00:25:55,180
Somebody wrote a marvelous --
there's a great engineering

437
00:25:55,180 --> 00:25:59,730
piece on that somewhere that
I saw once upon a time.

438
00:25:59,730 --> 00:26:02,970
There are cantilevering problems
and all sorts of very

439
00:26:02,970 --> 00:26:06,210
bad problems with Barbie
if you scale her up.

440
00:26:06,210 --> 00:26:10,730
But the notion is that the ideal
of what is beautiful has

441
00:26:10,730 --> 00:26:12,440
been getting skinnier
and skinnier.

442
00:26:12,440 --> 00:26:19,690
At the same time, there has been
this surge in both the

443
00:26:19,690 --> 00:26:24,020
availability and the diversity
of food available.

444
00:26:24,020 --> 00:26:31,440
So you're expected to be skinny
while plunked down at

445
00:26:31,440 --> 00:26:35,210
this spectacular all
you can eat buffet.

446
00:26:35,210 --> 00:26:37,920
And that's, you know, you can
imagine that there are a

447
00:26:37,920 --> 00:26:39,590
certain amount of
problems there.

448
00:26:39,590 --> 00:26:43,950
There are specific populations,
and these are

449
00:26:43,950 --> 00:26:46,340
unsurprising specific
populations, where you see

450
00:26:46,340 --> 00:26:52,120
higher than average rates
of eating disorders.

451
00:26:52,120 --> 00:26:58,010
So for instance, gymnasts,
eating disorders are

452
00:26:58,010 --> 00:27:00,790
overrepresented in
that population.

453
00:27:00,790 --> 00:27:06,390
If you're looking for male
eating disorder patients, a

454
00:27:06,390 --> 00:27:13,620
great place to look is in the
wrestling population.

455
00:27:13,620 --> 00:27:14,410
Why is that?

456
00:27:14,410 --> 00:27:17,760
Well, if you're wrestling in a
weight class and you have to

457
00:27:17,760 --> 00:27:20,780
be exactly this weight,
particularly since there's a

458
00:27:20,780 --> 00:27:25,020
pressure to wrestle in the
lightest weight class you can

459
00:27:25,020 --> 00:27:28,460
sort of get away with, there's
going to be a lot of pressure

460
00:27:28,460 --> 00:27:33,170
of the sort that's similar to
this pressure that you might

461
00:27:33,170 --> 00:27:39,140
imagine being applied by an
ideal of female beauty that's

462
00:27:39,140 --> 00:27:41,540
very skinny.

463
00:27:41,540 --> 00:27:43,990
So there are these pressures
-- yes, yes, yes?

464
00:27:43,990 --> 00:27:46,830
AUDIENCE: In wrestling they
also have [UNINTELLIGIBLE]

465
00:27:46,830 --> 00:27:50,345
they measure you a set
number of hours

466
00:27:50,345 --> 00:27:51,653
before the actual match.

467
00:27:51,653 --> 00:27:53,210
PROFESSOR: Yes.

468
00:27:53,210 --> 00:27:56,010
There are all sorts of reasons
why this is not inclined to

469
00:27:56,010 --> 00:28:02,090
produce wholesome eating
behavior as I understand it.

470
00:28:02,090 --> 00:28:04,040
My own personal wrestling
career --

471
00:28:04,040 --> 00:28:07,640
[LAUGHTER]

472
00:28:07,640 --> 00:28:11,650
Why are they all laughing?

473
00:28:11,650 --> 00:28:14,660
You know, it's only mildly --
well, I suppose maybe it's

474
00:28:14,660 --> 00:28:17,070
completely hilarious.

475
00:28:17,070 --> 00:28:18,470
It was clear that I wasn't
going to wrestle

476
00:28:18,470 --> 00:28:19,330
heavyweight, right.

477
00:28:19,330 --> 00:28:23,480
But, you know, the world is
full of these little tough

478
00:28:23,480 --> 00:28:26,910
guys as opposed to just
merely little guys.

479
00:28:26,910 --> 00:28:29,464
[LAUGHTER]

480
00:28:29,464 --> 00:28:38,200
Kristin, that letter I was
writing for you -- it's really

481
00:28:38,200 --> 00:28:40,800
bad when the people in your
lab are the ones who are

482
00:28:40,800 --> 00:28:43,240
becoming hysterical.

483
00:28:43,240 --> 00:28:45,700
Anyway, I might as well
complete this

484
00:28:45,700 --> 00:28:46,950
embarrassing story.

485
00:28:50,800 --> 00:28:54,060
High school wrestling,
the gym teachers were

486
00:28:54,060 --> 00:28:56,690
always weird people.

487
00:28:56,690 --> 00:29:00,700
And so high school wrestling you
had to wrestle by weight

488
00:29:00,700 --> 00:29:01,600
class, right.

489
00:29:01,600 --> 00:29:02,630
That made sense.

490
00:29:02,630 --> 00:29:06,870
But our guy thought it
was like a circle.

491
00:29:06,870 --> 00:29:09,640
So you wrestled the guy
next to you in weight.

492
00:29:09,640 --> 00:29:13,500
Well, if you were the lightest
guy, it's going to be a hoot.

493
00:29:13,500 --> 00:29:17,900
Let's get him to wrestle
the heaviest guy.

494
00:29:17,900 --> 00:29:20,880
Which was actually OK because
the heaviest guy was just

495
00:29:20,880 --> 00:29:25,420
about as athletically
talented as I was.

496
00:29:25,420 --> 00:29:27,770
The major danger was that he
would fall on me, right,

497
00:29:27,770 --> 00:29:30,250
because then it was just
going to be all over.

498
00:29:30,250 --> 00:29:33,350
So I'm --

499
00:29:33,350 --> 00:29:35,050
athletics was not
my strong suit.

500
00:29:35,050 --> 00:29:37,090
So there was no danger that
I was going to do him any

501
00:29:37,090 --> 00:29:39,690
serious damage.

502
00:29:39,690 --> 00:29:41,890
And there was no serious danger
that, as long as he

503
00:29:41,890 --> 00:29:44,760
didn't fall on me, I was
going to get hurt.

504
00:29:44,760 --> 00:29:48,300
So I figured out a way to get
on his back and sort of rode

505
00:29:48,300 --> 00:29:54,190
him around for a while, and did
sort of manly things that

506
00:29:54,190 --> 00:29:56,860
looked like I might be trying
to flip him, but that wasn't

507
00:29:56,860 --> 00:29:59,320
ever going to happen.

508
00:29:59,320 --> 00:30:04,370
It was a great moment, made
greater of course by

509
00:30:04,370 --> 00:30:07,640
the fact that --

510
00:30:07,640 --> 00:30:10,400
never mind.

511
00:30:10,400 --> 00:30:11,660
No, I should continue.

512
00:30:11,660 --> 00:30:15,780
This was also -- he was --

513
00:30:15,780 --> 00:30:17,460
this was full of --

514
00:30:17,460 --> 00:30:23,750
this guy, deeply homophobic gym
teacher who also was fond

515
00:30:23,750 --> 00:30:28,700
of explaining that how hard you
wrestled showed whether

516
00:30:28,700 --> 00:30:31,510
you were a real guy.

517
00:30:31,510 --> 00:30:36,720
And anyway, it goes downhill
from there.

518
00:30:36,720 --> 00:30:39,280
So in any case, the --

519
00:30:39,280 --> 00:30:40,270
where were we?

520
00:30:40,270 --> 00:30:41,960
Oh yes.

521
00:30:41,960 --> 00:30:45,030
This explains why my wrestling
career did not produce any

522
00:30:45,030 --> 00:30:46,450
eating disorders in my case.

523
00:30:46,450 --> 00:30:52,850
So there are these societal or
specific cultural factors that

524
00:30:52,850 --> 00:30:56,680
might be pushing one towards
these sort of disorders.

525
00:30:56,680 --> 00:31:00,590
And then there's the question
of whether or not there's a

526
00:31:00,590 --> 00:31:02,720
biological factor there.

527
00:31:02,720 --> 00:31:04,380
Is there some sort of a genetic

528
00:31:04,380 --> 00:31:08,530
predisposition towards this?

529
00:31:08,530 --> 00:31:13,810
The sorts of things that people
point to are data, for

530
00:31:13,810 --> 00:31:17,760
instance, that there are
family histories of

531
00:31:17,760 --> 00:31:24,580
depression, more depression
showing up in the families of

532
00:31:24,580 --> 00:31:27,280
eating disorder patients than
in the general population.

533
00:31:27,280 --> 00:31:30,270
There's also more depression
in eating disorder patients

534
00:31:30,270 --> 00:31:31,150
themselves.

535
00:31:31,150 --> 00:31:37,240
But as I've said, that's hard
to disentangle from the

536
00:31:37,240 --> 00:31:45,840
effects of starvation, that that
itself produces problems.

537
00:31:45,840 --> 00:31:53,780
In any case, well actually there
is one thing that is

538
00:31:53,780 --> 00:31:58,880
potentially a biological
underpinning.

539
00:31:58,880 --> 00:32:05,230
Has nothing to do with the brain
at all, but is simply --

540
00:32:05,230 --> 00:32:11,490
in diet land, these are known
as set point issues.

541
00:32:11,490 --> 00:32:18,450
There's a notion that people
come with some sort of weight

542
00:32:18,450 --> 00:32:21,640
that is sort of the weight
that they are set for.

543
00:32:21,640 --> 00:32:25,010
The little thermostat in the
hypothalamus is to say, you

544
00:32:25,010 --> 00:32:27,560
know, you're going to be
180 pounds or whatever.

545
00:32:27,560 --> 00:32:31,080
You can push this around, but
this is where we want to be.

546
00:32:31,080 --> 00:32:34,490
It's related to the fact that
there are certainly genetic

547
00:32:34,490 --> 00:32:38,560
factors that are making you one
body shape versus another

548
00:32:38,560 --> 00:32:39,220
body shape.

549
00:32:39,220 --> 00:32:44,180
And if you are one shape and
you're feeling strongly

550
00:32:44,180 --> 00:32:47,370
pressured to be another shape
that is not the shape that you

551
00:32:47,370 --> 00:32:50,250
were sort of built to be, that's
considered to possibly

552
00:32:50,250 --> 00:32:54,420
be a biological factor
pushing people

553
00:32:54,420 --> 00:32:56,840
towards eating disorder.

554
00:32:56,840 --> 00:32:59,360
That's not like the sort of
factors we're thinking about

555
00:32:59,360 --> 00:33:04,160
as a genetic predisposition to
something like schizophrenia.

556
00:33:04,160 --> 00:33:07,600
That's really an interaction of
body type with these sort

557
00:33:07,600 --> 00:33:10,900
of cultural pressures.

558
00:33:10,900 --> 00:33:16,020
All right, so you've got
characteristics of family,

559
00:33:16,020 --> 00:33:19,620
patient, the culture as a whole,
possibly biological

560
00:33:19,620 --> 00:33:20,470
underpinnings.

561
00:33:20,470 --> 00:33:27,170
How might all of this contribute
to producing an

562
00:33:27,170 --> 00:33:28,390
actual disorder?

563
00:33:28,390 --> 00:33:33,250
One way to think about this is
to think about it as a trap

564
00:33:33,250 --> 00:33:37,120
that some subset of
girls fall into.

565
00:33:37,120 --> 00:33:38,390
Not consciously.

566
00:33:38,390 --> 00:33:41,620
Nobody wakes up in the morning
and says, "Gee, I think I'll

567
00:33:41,620 --> 00:33:43,710
have an eating disorder."

568
00:33:43,710 --> 00:33:47,710
But the unconscious
process might run

569
00:33:47,710 --> 00:33:50,980
something like the following.

570
00:33:50,980 --> 00:33:52,600
You hit puberty.

571
00:33:52,600 --> 00:33:54,530
So, all right, so you've been
this sort of perfectionist

572
00:33:54,530 --> 00:33:59,060
good girl all along.

573
00:33:59,060 --> 00:34:06,130
You hit puberty and sort of a
time that stretches or strains

574
00:34:06,130 --> 00:34:07,870
perfection altogether.

575
00:34:10,970 --> 00:34:14,120
Being perfect requires
a certain amount of

576
00:34:14,120 --> 00:34:19,060
self-control, and you may recall
the sort of wash of

577
00:34:19,060 --> 00:34:22,410
hormones that accompanies the
onset of puberty is not

578
00:34:22,410 --> 00:34:25,280
particularly good for
self-control.

579
00:34:25,280 --> 00:34:29,420
So the sense of control is
not what it used to be.

580
00:34:29,420 --> 00:34:32,570
Your body is changing in ways
that you don't control.

581
00:34:32,570 --> 00:34:36,410
And you're in this family where
the set of ways that you

582
00:34:36,410 --> 00:34:39,250
can act out is very limited.

583
00:34:39,250 --> 00:34:47,170
There are lots of ways to act
out in adolescence, but you're

584
00:34:47,170 --> 00:34:51,580
in a family where most of them
are sort of not sanctioned.

585
00:34:51,580 --> 00:34:57,200
So one way to sort of re-exert
a sense of control, a very

586
00:34:57,200 --> 00:35:00,600
culturally endorsed one,
is well, let's

587
00:35:00,600 --> 00:35:02,850
go on a diet, right.

588
00:35:02,850 --> 00:35:06,090
The percentage of women in this
country on diets at any

589
00:35:06,090 --> 00:35:11,920
time is huge and that goes
down to school-girl age.

590
00:35:11,920 --> 00:35:15,390
And if you ask --

591
00:35:15,390 --> 00:35:24,270
you go and talk to middle
school boys about diet.

592
00:35:24,270 --> 00:35:26,600
Ehh.

593
00:35:26,600 --> 00:35:28,030
They sort of grunt at
you or something.

594
00:35:28,030 --> 00:35:31,160
You go and talk to middle school
girls about diet and

595
00:35:31,160 --> 00:35:32,700
they can talk your ear off.

596
00:35:32,700 --> 00:35:34,840
Whether or not they're on some
sort of a diet, they

597
00:35:34,840 --> 00:35:36,390
know all about it.

598
00:35:36,390 --> 00:35:39,010
This and the that.

599
00:35:39,010 --> 00:35:39,990
It's there.

600
00:35:39,990 --> 00:35:43,090
In fact, you might go on
a diet endorsed by mom.

601
00:35:43,090 --> 00:35:45,700
Mom might say, you're looking
a little chunky.

602
00:35:45,700 --> 00:35:47,640
And, you know, we can
do it together.

603
00:35:47,640 --> 00:35:49,150
It's a mother daughter
kind of thing.

604
00:35:49,150 --> 00:35:52,270
Well, you know, particularly
since, you know, we're really

605
00:35:52,270 --> 00:35:54,780
enmeshed here anyway.

606
00:35:54,780 --> 00:35:55,230
All right.

607
00:35:55,230 --> 00:35:58,940
Well, you can sort of imagine
that a perfectionist on a

608
00:35:58,940 --> 00:36:04,950
diet, under the right
circumstances, could be a

609
00:36:04,950 --> 00:36:09,830
recipe for disaster, you know.

610
00:36:09,830 --> 00:36:13,350
It's sort of like MIT
and sleeping.

611
00:36:13,350 --> 00:36:17,340
People out there say, all right,
I need to do a little

612
00:36:17,340 --> 00:36:19,530
extra work so I'll stay
up an extra hour.

613
00:36:19,530 --> 00:36:23,570
MIT student says, I don't
need to sleep.

614
00:36:23,570 --> 00:36:25,020
You know.

615
00:36:25,020 --> 00:36:28,700
Most people out in the world
say, diet, oh, OK, we'll cut

616
00:36:28,700 --> 00:36:34,470
out the double dip, you know,
double-stuffed Oreos and, OK,

617
00:36:34,470 --> 00:36:36,650
we won't deep fry the pizza.

618
00:36:41,120 --> 00:36:46,180
And this hypothetical
perfectionist says, water.

619
00:36:46,180 --> 00:36:48,050
Lettuce and water.

620
00:36:48,050 --> 00:36:49,640
That'll work.

621
00:36:49,640 --> 00:36:53,050
So anyway, you can imagine
that the diet could --

622
00:36:53,050 --> 00:36:56,910
that what happens when this is
spiraling downwards, this diet

623
00:36:56,910 --> 00:37:00,920
can become increasingly
severe.

624
00:37:00,920 --> 00:37:05,230
And at some point it becomes
a real issue.

625
00:37:05,230 --> 00:37:08,720
It becomes a source of conflict
in the family because

626
00:37:08,720 --> 00:37:11,000
it becomes clearly unhealthy.

627
00:37:11,000 --> 00:37:13,000
It's clear to anybody except
for the patient

628
00:37:13,000 --> 00:37:14,180
that this is unhealthy.

629
00:37:14,180 --> 00:37:19,520
But at that point, if you regard
this as some sort of an

630
00:37:19,520 --> 00:37:23,460
assertion of autonomy, this is
the last place where this girl

631
00:37:23,460 --> 00:37:25,850
has managed to find a place
where she can carve out

632
00:37:25,850 --> 00:37:28,570
someplace where she
is in control.

633
00:37:28,570 --> 00:37:32,770
Now the family is saying, you
can't do that either.

634
00:37:32,770 --> 00:37:34,460
And she draws the line.

635
00:37:34,460 --> 00:37:36,370
This is where I'm going
to make my stand.

636
00:37:39,000 --> 00:37:47,600
And it can become a clearly
pathological state.

637
00:37:47,600 --> 00:37:51,760
People in full blast anorexia
deny that they are hungry in

638
00:37:51,760 --> 00:37:56,750
spite of being strongly
malnourished.

639
00:37:56,750 --> 00:38:00,040
The rituals around eating, the
rituals that get built up

640
00:38:00,040 --> 00:38:02,415
around eating can be extremely
elaborate and

641
00:38:02,415 --> 00:38:04,050
extremely time consuming.

642
00:38:04,050 --> 00:38:08,050
Along with, for instance,
very vigorous exercise

643
00:38:08,050 --> 00:38:11,090
regimens that --

644
00:38:11,090 --> 00:38:12,700
basically it takes
over your life.

645
00:38:12,700 --> 00:38:16,990
Plus being starved not only
tends to make you depressed,

646
00:38:16,990 --> 00:38:20,210
but it also can make
you delusional in

647
00:38:20,210 --> 00:38:22,160
a variety of ways.

648
00:38:22,160 --> 00:38:24,640
So it's clearly not a
good place to be.

649
00:38:24,640 --> 00:38:26,510
So that's the sense in which
it's a disaster.

650
00:38:26,510 --> 00:38:28,670
It's also in a sense --

651
00:38:28,670 --> 00:38:31,700
the sense in which it's a
success, this notion of it

652
00:38:31,700 --> 00:38:34,660
being a successful disaster,
the sense in which it's a

653
00:38:34,660 --> 00:38:40,590
success is if you regard this as
an issue about control, in

654
00:38:40,590 --> 00:38:48,660
some sense, the patient, the
daughter, has managed to take

655
00:38:48,660 --> 00:38:50,060
control over the family.

656
00:38:50,060 --> 00:38:54,500
That wasn't her goal, but
there's nothing like a

657
00:38:54,500 --> 00:38:57,920
life-threatening condition
to galvanize the

658
00:38:57,920 --> 00:39:00,570
attention of a family.

659
00:39:00,570 --> 00:39:06,460
And here in this clearly
pathological way, the daughter

660
00:39:06,460 --> 00:39:10,930
has become the center of
the family's attention.

661
00:39:10,930 --> 00:39:15,490
This quiet, never caused any
trouble, you know, bury the

662
00:39:15,490 --> 00:39:19,470
problems elsewhere daughter
has now successfully taken

663
00:39:19,470 --> 00:39:21,830
over the family.

664
00:39:21,830 --> 00:39:25,480
The problem with that success
is it's clearly desperately

665
00:39:25,480 --> 00:39:27,990
maladaptive and potentially
dangerous.

666
00:39:27,990 --> 00:39:31,230
Well, what do you do?

667
00:39:31,230 --> 00:39:41,060
As you can imagine, virtually
every major psychotherapeutic

668
00:39:41,060 --> 00:39:44,930
regimen has been tried
in some fashion.

669
00:39:44,930 --> 00:39:50,410
The punchline, the bottom line,
is that my understanding

670
00:39:50,410 --> 00:39:54,080
of best practice is that
nothing by itself works

671
00:39:54,080 --> 00:39:59,910
terribly well and that what you
do is some of everything.

672
00:39:59,910 --> 00:40:01,640
Now, what is everything?

673
00:40:01,640 --> 00:40:07,530
Well, one bit of everything
is you've got to get

674
00:40:07,530 --> 00:40:09,100
the patient to eat.

675
00:40:09,100 --> 00:40:13,160
Often by the time you've got an
eating disorder patient who

676
00:40:13,160 --> 00:40:19,690
has reached the point of being
in medical care, this is a

677
00:40:19,690 --> 00:40:21,680
potentially life-threatening
situation.

678
00:40:21,680 --> 00:40:24,530
And the patients often
get hospitalized.

679
00:40:24,530 --> 00:40:27,350
Under hospital settings, one
of the things that works

680
00:40:27,350 --> 00:40:29,390
really well, and one of the
things that was once upon a

681
00:40:29,390 --> 00:40:34,520
time touted as a magic silver
bullet cure, comes straight

682
00:40:34,520 --> 00:40:41,210
out of Skinner boxes and
behaviorist theory, you know,

683
00:40:41,210 --> 00:40:42,470
learning theory.

684
00:40:42,470 --> 00:40:47,810
And that is to set up the ward,
well basically as a

685
00:40:47,810 --> 00:40:49,370
giant Skinner box.

686
00:40:49,370 --> 00:40:51,830
OK, there's stuff
you want, right?

687
00:40:51,830 --> 00:40:54,210
You want to be able to
call your friends?

688
00:40:54,210 --> 00:40:54,660
Good.

689
00:40:54,660 --> 00:40:56,200
Here's what you've got to eat.

690
00:40:56,200 --> 00:41:00,460
You want to be able
to watch TV?

691
00:41:00,460 --> 00:41:01,490
Good.

692
00:41:01,490 --> 00:41:04,460
Here's the weight standard
you have to reach.

693
00:41:04,460 --> 00:41:09,220
And so you set up a clearly
defined set of rewards in

694
00:41:09,220 --> 00:41:11,660
response for eating behaviors.

695
00:41:11,660 --> 00:41:15,750
And it works very nicely
in many cases.

696
00:41:15,750 --> 00:41:19,540
You can get people back up to
weights that are appropriate

697
00:41:19,540 --> 00:41:23,200
for, you know, age and height.

698
00:41:23,200 --> 00:41:24,880
Works just fine.

699
00:41:24,880 --> 00:41:26,890
Why isn't it a magic bullet?

700
00:41:26,890 --> 00:41:29,410
Well, what happens when you
go out of the hospital?

701
00:41:29,410 --> 00:41:33,340
You go out of the hospital,
you're back in the environment

702
00:41:33,340 --> 00:41:37,950
that produced the disorder
in some sense.

703
00:41:37,950 --> 00:41:39,360
And it tends to fall apart.

704
00:41:39,360 --> 00:41:44,570
The problem was that relapse
rates were very great.

705
00:41:48,560 --> 00:41:51,670
So one of the things you're
going to want to do is not

706
00:41:51,670 --> 00:41:54,480
just treat -- people
aren't pigeons.

707
00:41:54,480 --> 00:41:57,600
You don't want to treat
them just as pigeons.

708
00:41:57,600 --> 00:42:00,820
You can train your pigeon to
do whatever with a nice

709
00:42:00,820 --> 00:42:03,380
schedule of reinforcement and
probably that doesn't work too

710
00:42:03,380 --> 00:42:06,440
well when you release the pigeon
into the wild either.

711
00:42:06,440 --> 00:42:09,110
With a human, it's nice
to talk to them.

712
00:42:09,110 --> 00:42:12,880
So psychotherapeutic approaches
have been --

713
00:42:12,880 --> 00:42:15,530
you know, various forms of talk
therapy have been tried.

714
00:42:15,530 --> 00:42:19,270
Freudian therapy centered
around the idea that --

715
00:42:19,270 --> 00:42:24,570
the core issue here was a fear
of growing up in the sort of

716
00:42:24,570 --> 00:42:31,160
typical Freudian tendency to
sexualize everything under the

717
00:42:31,160 --> 00:42:37,780
sun, this gets described as a
fear of pregnancy, that, well,

718
00:42:37,780 --> 00:42:42,460
you know, if you manage to
suppress menstrual cycles and

719
00:42:42,460 --> 00:42:45,540
things like that, you're not
going to become pregnant.

720
00:42:45,540 --> 00:42:50,090
And by starving yourself, your
body will be more like that of

721
00:42:50,090 --> 00:42:50,850
a little girl.

722
00:42:50,850 --> 00:42:56,770
It's a little like the sort of
metaphoric senses of trying --

723
00:42:56,770 --> 00:42:59,660
of Snow White's evil stepmother
trying to keep Snow

724
00:42:59,660 --> 00:43:00,820
White as a little girl.

725
00:43:00,820 --> 00:43:04,680
But anyway the Freudian notion
was that there is a certain

726
00:43:04,680 --> 00:43:09,910
terror about getting older, you
know, growing up, that the

727
00:43:09,910 --> 00:43:12,180
patients are dealing with.

728
00:43:12,180 --> 00:43:14,940
Just talking to him about it
didn't turn out to be a huge

729
00:43:14,940 --> 00:43:21,420
success, in part because
patients who are that

730
00:43:21,420 --> 00:43:25,060
undernourished are a little like
schizophrenic patients.

731
00:43:25,060 --> 00:43:28,670
They're not good candidates for
psychoanalysis or for much

732
00:43:28,670 --> 00:43:30,140
other in the way of
talking therapy.

733
00:43:30,140 --> 00:43:32,830
Delusional people are not
great at insight.

734
00:43:36,270 --> 00:43:42,280
So combining some sort of
conversation, some sort of

735
00:43:42,280 --> 00:43:46,830
therapeutic conversation, with
something like the behavioral

736
00:43:46,830 --> 00:43:49,710
modification technique,
that helps.

737
00:43:49,710 --> 00:43:53,970
There is evidence that
pharmacology helps.

738
00:43:53,970 --> 00:43:59,280
There is an obsessive quality
to the thought processes of

739
00:43:59,280 --> 00:44:01,470
anorexic patients.

740
00:44:01,470 --> 00:44:03,640
They're deeply obsessed
with food.

741
00:44:03,640 --> 00:44:06,340
In fact, you get these
fascinating case histories

742
00:44:06,340 --> 00:44:09,240
where the anorexic
is doing all the

743
00:44:09,240 --> 00:44:11,090
cooking for the family.

744
00:44:11,090 --> 00:44:12,830
She loves to cook
for everybody.

745
00:44:12,830 --> 00:44:14,440
She just doesn't eat
any of this.

746
00:44:14,440 --> 00:44:17,670
You know, absolutely obsessed
with food, swearing they're

747
00:44:17,670 --> 00:44:22,780
not hungry and engaging
in elaborate

748
00:44:22,780 --> 00:44:24,810
rituals around eating.

749
00:44:24,810 --> 00:44:29,270
You know, that's an obsessive
kind of behavior that turns

750
00:44:29,270 --> 00:44:35,010
out to be broken up by Prozac
and similar drugs quite well.

751
00:44:35,010 --> 00:44:39,690
So one thing to do is to feed
them an antidepressant like

752
00:44:39,690 --> 00:44:42,150
Prozac, in part because they may
be depressed and in part

753
00:44:42,150 --> 00:44:44,060
because it acts against the
obsessive thoughts.

754
00:44:44,060 --> 00:44:48,940
Just feeding them an
antidepressant by itself has

755
00:44:48,940 --> 00:44:50,820
no great track record.

756
00:44:50,820 --> 00:44:53,130
But, all right, let's combine
a little antidepressant

757
00:44:53,130 --> 00:44:55,350
medication with a little
behavior modification, a

758
00:44:55,350 --> 00:44:58,580
little talk therapy, this
is all working --

759
00:44:58,580 --> 00:45:03,570
this all might have
some meat to it.

760
00:45:03,570 --> 00:45:10,780
One of the things that seems to
be an interesting part of

761
00:45:10,780 --> 00:45:14,080
treatment regimens in eating
disorders, more so perhaps

762
00:45:14,080 --> 00:45:17,430
than elsewhere, is it's often
useful in anorexia

763
00:45:17,430 --> 00:45:20,870
particularly to talk with
the family also.

764
00:45:20,870 --> 00:45:25,740
Because that family,
they're actually --

765
00:45:25,740 --> 00:45:33,160
there are clinicians who argue
that anorexia is a disorder of

766
00:45:33,160 --> 00:45:36,860
the family where it just happens
to be that the girl is

767
00:45:36,860 --> 00:45:42,320
the designated patient, that the
family as a system is sick

768
00:45:42,320 --> 00:45:45,350
and that the daughter is
showing the symptom.

769
00:45:45,350 --> 00:45:51,020
And that if you want to have
this work out, that what you

770
00:45:51,020 --> 00:45:56,790
need to do is to treat the
family and get the family out

771
00:45:56,790 --> 00:46:00,310
of each other's faces a little
more, and more willing to

772
00:46:00,310 --> 00:46:03,370
express feelings to each
other perhaps and

773
00:46:03,370 --> 00:46:05,640
things of that sort.

774
00:46:05,640 --> 00:46:12,600
The prognosis is a little
reminiscent of Anna O., if you

775
00:46:12,600 --> 00:46:16,280
remember that story from
the history of Freud's

776
00:46:16,280 --> 00:46:17,610
development.

777
00:46:17,610 --> 00:46:22,560
Anna O. had symptoms that Freud
and Breuer could treat,

778
00:46:22,560 --> 00:46:26,340
but when those were treated,
something new popped up.

779
00:46:26,340 --> 00:46:29,860
There's a flavor of that when
you read about case histories

780
00:46:29,860 --> 00:46:32,280
of anorexia, that you can --

781
00:46:32,280 --> 00:46:35,130
most patients recover.

782
00:46:35,130 --> 00:46:38,710
They become non-anorexic.

783
00:46:38,710 --> 00:46:42,870
But the population sees more
depression going forward than

784
00:46:42,870 --> 00:46:44,530
a typical population.

785
00:46:44,530 --> 00:46:48,820
The population sees more other
eating disorders than a

786
00:46:48,820 --> 00:46:53,470
typical population, as if
there's something that was not

787
00:46:53,470 --> 00:46:55,030
dealt with.

788
00:46:55,030 --> 00:47:01,590
And exactly what that is, we
clearly don't really know, but

789
00:47:01,590 --> 00:47:04,120
that anorexia was a particular
crisis and that there are

790
00:47:04,120 --> 00:47:07,590
issues that may need
to be dealt with

791
00:47:07,590 --> 00:47:09,640
on a long-term basis.

792
00:47:09,640 --> 00:47:15,750
Now, one of the disorders that
you can, sort of, progress to,

793
00:47:15,750 --> 00:47:19,950
if you like, not infrequently,
or you can manage to generate

794
00:47:19,950 --> 00:47:22,810
it all by itself, is
bulimia, or more

795
00:47:22,810 --> 00:47:24,640
technically, bulimia nervosa.

796
00:47:24,640 --> 00:47:27,200
Though anorexia nervosa gets
called anorexia nervosa,

797
00:47:27,200 --> 00:47:31,920
bulimia often just gets
called bulimia.

798
00:47:31,920 --> 00:47:33,060
Oh, did we just switch?

799
00:47:33,060 --> 00:47:34,370
Oh, look at that.

800
00:47:34,370 --> 00:47:37,640
It's so much fun to watch
everybody go [SWISHING SOUND].

801
00:47:37,640 --> 00:47:41,110
It's glad to know you're
following along.

802
00:47:41,110 --> 00:47:44,650
So bulimia is -- one of the
reasons -- a follow-on

803
00:47:44,650 --> 00:47:47,000
disorder -- well, I don't
know if it's a reason.

804
00:47:47,000 --> 00:47:49,590
It's not surprising it's
a follow-on disorder.

805
00:47:49,590 --> 00:47:53,640
It's characteristic of
an older population.

806
00:47:53,640 --> 00:48:02,090
Typical onset in college age
or twenties and a different

807
00:48:02,090 --> 00:48:06,600
kind of, sort of a
different story.

808
00:48:06,600 --> 00:48:09,190
So one important characteristic
is these are

809
00:48:09,190 --> 00:48:10,890
patients typically
who are outside

810
00:48:10,890 --> 00:48:12,520
of the family situation.

811
00:48:12,520 --> 00:48:13,960
They're not embedded
in their family.

812
00:48:13,960 --> 00:48:15,980
They've gone off to college or
they've gone off to work or

813
00:48:15,980 --> 00:48:18,960
something of that sort.

814
00:48:18,960 --> 00:48:22,070
A bit insecure -- let's go
back to this we're not

815
00:48:22,070 --> 00:48:24,280
necessarily talking
about you thing.

816
00:48:24,280 --> 00:48:25,680
A bit insecure -- right.

817
00:48:25,680 --> 00:48:26,630
Who isn't?

818
00:48:26,630 --> 00:48:29,810
The ones who aren't a little bit
insecure are the people,

819
00:48:29,810 --> 00:48:33,530
you know, near and dear to
us who are insufferable.

820
00:48:33,530 --> 00:48:35,400
So a little bit insecure,
maybe.

821
00:48:35,400 --> 00:48:37,090
Maybe a bit more insecure
than usual.

822
00:48:37,090 --> 00:48:39,300
A bit impulsive.

823
00:48:39,300 --> 00:48:40,660
What's impulsive?

824
00:48:40,660 --> 00:48:43,570
When you get the family history,
sorry, the patient's

825
00:48:43,570 --> 00:48:49,060
history, you get anecdotes
about, you know, dumb

826
00:48:49,060 --> 00:48:50,260
impulsive things.

827
00:48:50,260 --> 00:48:53,970
Oh, on a whim I shoplifted
once.

828
00:48:53,970 --> 00:48:59,040
It's not like I'm a chronic
shoplifter.

829
00:48:59,040 --> 00:49:03,220
You get sort of dumb single
incident kind of things in

830
00:49:03,220 --> 00:49:06,520
these reports.

831
00:49:06,520 --> 00:49:13,250
And self-esteem not great, and
wants to fit in, which of

832
00:49:13,250 --> 00:49:16,060
course qualifies for most of us
also, at least the wants to

833
00:49:16,060 --> 00:49:17,900
fit in part.

834
00:49:17,900 --> 00:49:23,470
So the dilemma faced by this
woman now living independently

835
00:49:23,470 --> 00:49:28,920
is that the fitting in piece
involves socializing.

836
00:49:28,920 --> 00:49:33,830
And the socializing involves a
lot of eating and drinking.

837
00:49:33,830 --> 00:49:39,420
Fitting in also involves, rather
literally, fitting into

838
00:49:39,420 --> 00:49:43,730
those jeans or whatever that
were designed for some

839
00:49:43,730 --> 00:49:47,060
half-starved model in the
fashion magazines somewhere.

840
00:49:47,060 --> 00:49:51,380
And so you've got this conflict
between food and

841
00:49:51,380 --> 00:49:57,010
thinness made quite concrete.

842
00:49:57,010 --> 00:50:00,220
And these are our patients
who, in a sense,

843
00:50:00,220 --> 00:50:02,150
stumble on a trick.

844
00:50:02,150 --> 00:50:07,300
And the trick is that if you
eat and then you get rid of

845
00:50:07,300 --> 00:50:12,330
the food, those calories don't
end up on your hips, right?

846
00:50:12,330 --> 00:50:18,840
So if you eat and then take a
laxative or throw up, then you

847
00:50:18,840 --> 00:50:20,880
don't get the calories, right?

848
00:50:20,880 --> 00:50:22,980
Now, that's a solution,
but it's not a

849
00:50:22,980 --> 00:50:24,160
really great solution.

850
00:50:24,160 --> 00:50:26,500
It's not a great solution for
any number of reasons.

851
00:50:26,500 --> 00:50:28,080
One of them is that,

852
00:50:28,080 --> 00:50:32,620
interestingly, it feels shameful.

853
00:50:32,620 --> 00:50:34,690
That's interesting because you
could go onto a whole thing

854
00:50:34,690 --> 00:50:36,340
about why --

855
00:50:36,340 --> 00:50:37,430
no --

856
00:50:37,430 --> 00:50:39,290
I suppose no is probably
too strong.

857
00:50:39,290 --> 00:50:45,520
A typical bulimic is not going
to have a buddy bulimic who,

858
00:50:45,520 --> 00:50:48,590
you know, let's go off and go
to this party and eat and go

859
00:50:48,590 --> 00:50:50,440
throw up together.

860
00:50:50,440 --> 00:50:53,560
I mean, it even sounds weird
-- oh, by the way.

861
00:50:53,560 --> 00:50:57,830
This is not unknown culturally,
though I realized

862
00:50:57,830 --> 00:51:00,130
talking to my concourse class
this morning that it's

863
00:51:00,130 --> 00:51:03,190
apparently much less known
than I thought.

864
00:51:03,190 --> 00:51:08,030
Because my eight year old can
tell you all about this.

865
00:51:08,030 --> 00:51:15,290
But in Roman culture, sort of
high Roman Empire culture,

866
00:51:15,290 --> 00:51:18,580
there were, I don't know how
widespread this was, but

867
00:51:18,580 --> 00:51:25,600
certainly in the orgy class,
there was a custom of having

868
00:51:25,600 --> 00:51:29,470
these, you know, very elaborate
parties where you'd

869
00:51:29,470 --> 00:51:32,160
eat and eat and eat and then
you couldn't eat anymore.

870
00:51:32,160 --> 00:51:34,240
But you wanted to keep eating so
you went to the next room,

871
00:51:34,240 --> 00:51:38,210
you threw up, and you came back
and you ate some more.

872
00:51:38,210 --> 00:51:45,320
And so there are even villas
with rooms that are designated

873
00:51:45,320 --> 00:51:48,560
as the vomitorium.

874
00:51:48,560 --> 00:51:52,020
And so how many people
knew about this?

875
00:51:52,020 --> 00:51:53,730
All right, so it
is a minority.

876
00:51:53,730 --> 00:51:57,900
It's absolutely fascinating to
a certain round of eight

877
00:51:57,900 --> 00:52:03,880
year-old boys, who think this
is, you know, really very

878
00:52:03,880 --> 00:52:04,390
interesting.

879
00:52:04,390 --> 00:52:07,240
Not something they want to try,
thank you, but you know,

880
00:52:07,240 --> 00:52:09,610
that's really -- well, they
like other gross stuff.

881
00:52:09,610 --> 00:52:13,690
Anyway, the problem is that
first of all it's something

882
00:52:13,690 --> 00:52:15,860
that feels shameful and needs
to be done in private.

883
00:52:22,760 --> 00:52:25,320
It's clearly sort of
an odd solution.

884
00:52:25,320 --> 00:52:28,910
So maybe you try a more
mainstream solution.

885
00:52:28,910 --> 00:52:30,610
Let's go on a diet.

886
00:52:30,610 --> 00:52:32,840
And maybe it becomes a
fairly severe diet.

887
00:52:32,840 --> 00:52:38,520
But unlike anorexics, who deny
their hunger and really don't

888
00:52:38,520 --> 00:52:42,000
seem to feel that hunger,
bulimics feel hungry.

889
00:52:42,000 --> 00:52:43,130
They feel really hungry.

890
00:52:43,130 --> 00:52:45,850
And so the diet doesn't work.

891
00:52:45,850 --> 00:52:48,860
And what you end up with is that
the diet breaks down at

892
00:52:48,860 --> 00:52:49,360
some point.

893
00:52:49,360 --> 00:52:52,090
You go off the diet, perhaps
in some spectacular

894
00:52:52,090 --> 00:52:53,560
bingy kind of a way.

895
00:52:53,560 --> 00:52:57,200
Well, that feels lousy too.

896
00:52:57,200 --> 00:53:00,340
And so, well, you figured
out this trick once.

897
00:53:00,340 --> 00:53:05,400
You go and purge again
in some fashion.

898
00:53:05,400 --> 00:53:07,270
And that gives you some
transient release from the

899
00:53:07,270 --> 00:53:08,780
shame of having broken
the diet.

900
00:53:08,780 --> 00:53:12,840
But again, the purging thing
isn't great either.

901
00:53:12,840 --> 00:53:14,280
But this can become --

902
00:53:14,280 --> 00:53:17,970
and in full-blast bulimia it
becomes a very ritualized

903
00:53:17,970 --> 00:53:19,690
behavior in its own right.

904
00:53:19,690 --> 00:53:28,520
Actually, somebody was telling
me that some bulimics plan

905
00:53:28,520 --> 00:53:33,110
things very carefully so that
they eat the nutritive foods

906
00:53:33,110 --> 00:53:40,150
first in a sort of a binging
session and then finish up

907
00:53:40,150 --> 00:53:44,250
with the half gallon of ice
cream and the jar of

908
00:53:44,250 --> 00:53:45,130
mayonnaise.

909
00:53:45,130 --> 00:53:46,500
I mean, the things you
read people --

910
00:53:46,500 --> 00:53:49,360
seriously, the things you read
the people eating on bulimic

911
00:53:49,360 --> 00:53:52,870
binges are really
quite amazing.

912
00:53:52,870 --> 00:53:55,640
Imagining sitting down and
eating a thing of mayonnaise

913
00:53:55,640 --> 00:53:59,320
is just very odd, but this is
the sort of thing that gets,

914
00:53:59,320 --> 00:54:01,250
that apparently --

915
00:54:01,250 --> 00:54:02,170
anyway.

916
00:54:02,170 --> 00:54:08,290
But you stagger it in such a way
so that you get at least

917
00:54:08,290 --> 00:54:12,460
enough of the nutrients that
you need before you go and

918
00:54:12,460 --> 00:54:15,500
purge that you're not
starving yourself.

919
00:54:15,500 --> 00:54:18,080
And bulimia, unlike
anorexia, can be a

920
00:54:18,080 --> 00:54:19,740
very long-term disorder.

921
00:54:19,740 --> 00:54:24,230
People can maintain
body weight for a

922
00:54:24,230 --> 00:54:27,340
long time doing this.

923
00:54:27,340 --> 00:54:32,030
It's clearly not adaptive.

924
00:54:32,030 --> 00:54:37,280
I mean, it's a success in,
again, in a limited sense.

925
00:54:37,280 --> 00:54:42,280
Let's you eat and lets you
maintain this skinny weight.

926
00:54:42,280 --> 00:54:44,200
But in many other ways
it's a disaster.

927
00:54:44,200 --> 00:54:48,390
First of all, repeated purging
is very bad for, you know, do

928
00:54:48,390 --> 00:54:53,930
a variety of bits of permanent
damage to you physiologically.

929
00:54:53,930 --> 00:54:56,900
It carries with it its own
risk of mortality.

930
00:54:56,900 --> 00:54:59,500
Again, typically from heart
attack from getting

931
00:54:59,500 --> 00:55:04,820
electrolytes sufficiently
imbalanced to stop the heart.

932
00:55:04,820 --> 00:55:12,440
And it does really bad things to
that hunger drive circuitry

933
00:55:12,440 --> 00:55:15,080
in places like your
hypothalamus.

934
00:55:15,080 --> 00:55:20,920
Because what happens is
the body is smart.

935
00:55:20,920 --> 00:55:29,800
It says, we ate a half gallon
of ice cream and a thing of

936
00:55:29,800 --> 00:55:31,540
mayonnaise.

937
00:55:31,540 --> 00:55:37,470
And we got this much caloric
bounce out of that.

938
00:55:37,470 --> 00:55:39,490
You know, that's odd.

939
00:55:39,490 --> 00:55:41,500
I don't know what the problem
here is, but I know how to

940
00:55:41,500 --> 00:55:43,500
adapt to that.

941
00:55:43,500 --> 00:55:47,280
If it is the case that huge
amounts of food are not

942
00:55:47,280 --> 00:55:52,270
providing me with the calories
I need, me up in the

943
00:55:52,270 --> 00:55:55,240
hypothalamus here, well, the
answer is something's

944
00:55:55,240 --> 00:55:56,350
wrong in the gut.

945
00:55:56,350 --> 00:55:58,760
But the answer is I
better eat more.

946
00:55:58,760 --> 00:56:03,470
I've got to make this sucker
hungrier, ramp up the hunger.

947
00:56:03,470 --> 00:56:07,310
Bulimia, the word comes from
to have an appetite like an

948
00:56:07,310 --> 00:56:09,810
ox, like a bull.

949
00:56:09,810 --> 00:56:13,460
Because what happens is that
the body learns that food

950
00:56:13,460 --> 00:56:18,770
isn't doing it for you anymore
and you just keep eating it.

951
00:56:18,770 --> 00:56:19,910
It's a vicious cycle.

952
00:56:19,910 --> 00:56:21,290
You've got to eat
more and more.

953
00:56:21,290 --> 00:56:22,230
Well, this other --

954
00:56:22,230 --> 00:56:25,140
it's two chunks of your
brain fighting.

955
00:56:25,140 --> 00:56:28,950
This hard-wired chunk of hunger
drive is saying, need

956
00:56:28,950 --> 00:56:30,450
this many calories.

957
00:56:30,450 --> 00:56:33,660
If it takes, you know, this many
truck loads of food to

958
00:56:33,660 --> 00:56:35,700
get it, well, go out and
eat that truck load.

959
00:56:35,700 --> 00:56:37,070
And you've got this other chunk
of the brain saying,

960
00:56:37,070 --> 00:56:40,860
we're getting in those jeans,
man, so go and throw up again.

961
00:56:40,860 --> 00:56:42,990
And these two are fighting
with each other in a way

962
00:56:42,990 --> 00:56:46,430
that's clearly at this
point maladaptive.

963
00:56:46,430 --> 00:56:50,160
Now, we have this --

964
00:56:50,160 --> 00:56:53,450
the regular population away
from the eating disorder

965
00:56:53,450 --> 00:56:55,550
population runs into the
same problem, by the

966
00:56:55,550 --> 00:56:58,170
way, with diet foods.

967
00:56:58,170 --> 00:57:00,980
Diet foods don't give
you the caloric

968
00:57:00,980 --> 00:57:03,260
punch of regular foods.

969
00:57:03,260 --> 00:57:05,820
That's the whole idea.

970
00:57:05,820 --> 00:57:11,300
So these little chunks of
the brain say, hey,

971
00:57:11,300 --> 00:57:14,050
eat twice as many.

972
00:57:14,050 --> 00:57:14,840
See the label?

973
00:57:14,840 --> 00:57:17,350
It says half as much fat.

974
00:57:17,350 --> 00:57:22,250
Brain says, eat twice as many.

975
00:57:22,250 --> 00:57:24,420
And the other thing
it says is, you

976
00:57:24,420 --> 00:57:26,280
know, what do you like?

977
00:57:26,280 --> 00:57:28,050
Well, you're built to like --

978
00:57:28,050 --> 00:57:31,050
brain says, we like
double-stuffed Cheerios --

979
00:57:31,050 --> 00:57:31,880
Cheerios.

980
00:57:31,880 --> 00:57:33,070
Oreos.

981
00:57:33,070 --> 00:57:34,170
There's probably double-stuffed

982
00:57:34,170 --> 00:57:34,850
Cheerios now too.

983
00:57:34,850 --> 00:57:37,955
Anyway, we like double-stuffed
Oreos because they've got lots

984
00:57:37,955 --> 00:57:42,030
of calories and this little
piece of my brain is still,

985
00:57:42,030 --> 00:57:45,220
you know, foraging around
on the savannah.

986
00:57:45,220 --> 00:57:47,650
And when I found double-stuffed
Oreos on the

987
00:57:47,650 --> 00:57:49,550
savannah, man, I could live
for a week off of

988
00:57:49,550 --> 00:57:51,340
one of those suckers.

989
00:57:51,340 --> 00:57:52,450
It's great stuff.

990
00:57:52,450 --> 00:57:56,480
Now, you're eating the low-fat
reduced everything version of

991
00:57:56,480 --> 00:58:01,230
this, and the brain is saying,
lousy stuff, man.

992
00:58:01,230 --> 00:58:04,790
You're eating bark
and twigs here.

993
00:58:04,790 --> 00:58:07,880
So it doesn't taste good
to me no more.

994
00:58:07,880 --> 00:58:09,280
Even though it tasted
perfectly --

995
00:58:09,280 --> 00:58:14,500
this is one of the reasons why
diet foods cycle through the

996
00:58:14,500 --> 00:58:19,880
supermarket much more rapidly
than high-fat foods, which is

997
00:58:19,880 --> 00:58:25,510
that any diet food tends to have
a fall off in its appeal

998
00:58:25,510 --> 00:58:30,410
to the population
fairly rapidly.

999
00:58:30,410 --> 00:58:33,680
The Oreos stay there forever
because people love them.

1000
00:58:33,680 --> 00:58:39,630
The reduced fat all-twig Oreos
have to be replaced next week

1001
00:58:39,630 --> 00:58:44,730
by the, you know, low carb,
reduced fat, high cardboard

1002
00:58:44,730 --> 00:58:47,550
Oreos or something, in a
brand-new package so that

1003
00:58:47,550 --> 00:58:48,830
you'll go out and try it.

1004
00:58:48,830 --> 00:58:51,870
Because, well, you know, those
low fat ones, they were OK for

1005
00:58:51,870 --> 00:58:54,840
a while, but my hypothalamus
is now telling me they

1006
00:58:54,840 --> 00:58:56,000
weren't that good.

1007
00:58:56,000 --> 00:58:59,340
So you have to keep churning the
product line in order to

1008
00:58:59,340 --> 00:59:00,800
keep you happy.

1009
00:59:00,800 --> 00:59:02,500
Treatment turns out to
be much the same

1010
00:59:02,500 --> 00:59:08,100
story as with anorexia.

1011
00:59:08,100 --> 00:59:11,200
Nothing by itself works.

1012
00:59:11,200 --> 00:59:12,460
There are a couple of
big differences.

1013
00:59:12,460 --> 00:59:15,160
One is, as I said before, you
can go for a very long time

1014
00:59:15,160 --> 00:59:19,120
without seeking treatment
because it's not as acute a

1015
00:59:19,120 --> 00:59:22,250
disorder as full blast
anorexia is.

1016
00:59:22,250 --> 00:59:24,700
It's not good for you, but
you can maintain this.

1017
00:59:24,700 --> 00:59:27,720
Plus it's a very private
disorder and so you can tend

1018
00:59:27,720 --> 00:59:30,400
to maintain it all by your
little lonesome for a fairly

1019
00:59:30,400 --> 00:59:32,260
long period of time.

1020
00:59:32,260 --> 00:59:34,330
The other thing is that it
no longer turns out to be

1021
00:59:34,330 --> 00:59:37,560
desperately interesting to talk
to the family about this.

1022
00:59:37,560 --> 00:59:38,960
You're outside the family.

1023
00:59:38,960 --> 00:59:41,730
But in place of that what turns
out to be an interesting

1024
00:59:41,730 --> 00:59:44,650
component of treatment
is group therapy.

1025
00:59:44,650 --> 00:59:48,260
This has been a very isolating
disorder, and when you finally

1026
00:59:48,260 --> 00:59:50,570
come to treatment, you say
to yourself in some

1027
00:59:50,570 --> 00:59:52,790
fashion, I am so weird.

1028
00:59:52,790 --> 00:59:55,490
There's nobody else like
me in the world.

1029
00:59:55,490 --> 00:59:58,080
And that doesn't help you.

1030
00:59:58,080 --> 01:00:01,900
That's just depressing and
off-putting in its own right.

1031
01:00:01,900 --> 01:00:03,820
If you're with a group of other
people with a similar

1032
01:00:03,820 --> 01:00:06,560
disorder, you're saying, look,
hey, it turns out there are

1033
01:00:06,560 --> 01:00:07,500
other people like this.

1034
01:00:07,500 --> 01:00:09,850
We'll work through this
thing together.

1035
01:00:09,850 --> 01:00:13,290
And that turns out to have
some therapeutic value.

1036
01:00:13,290 --> 01:00:17,230
Again like anorexia, people tend
to get over this and then

1037
01:00:17,230 --> 01:00:22,030
tend to have, to need to sort
of be vigilant about food

1038
01:00:22,030 --> 01:00:26,400
issues and vigilant about other
such issues ongoing past

1039
01:00:26,400 --> 01:00:31,710
that as if there were some
underlying issue that hasn't

1040
01:00:31,710 --> 01:00:34,160
quite been addressed.

1041
01:00:34,160 --> 01:00:38,780
So, well, I think what I will do
unless there's some -- oh,

1042
01:00:38,780 --> 01:00:40,650
no, I got to all the various
words on the handout.

1043
01:00:40,650 --> 01:00:41,890
Look at that.

1044
01:00:41,890 --> 01:00:44,830
Let's take a break, and then
what I'll do is at least set

1045
01:00:44,830 --> 01:00:50,830
up the problem of coercive
sexual behavior and we'll go

1046
01:00:50,830 --> 01:00:53,440
on from there.

1047
01:00:53,440 --> 01:01:12,170
[PRIVATE CONVERSATION]

1048
01:01:12,170 --> 01:01:17,250
AUDIENCE: Is there any good
evolutionary reason that girls

1049
01:01:17,250 --> 01:01:21,280
get anorexia or is it just that
we idealize the girls --

1050
01:01:21,280 --> 01:01:27,810
PROFESSOR: The mainline argument
I think is the

1051
01:01:27,810 --> 01:01:32,150
pressures are exerted on girls
much more than boys, that if

1052
01:01:32,150 --> 01:01:37,060
the ideal guy had --

1053
01:01:37,060 --> 01:01:40,810
there are sort of muscle
building-ish disorders in guys

1054
01:01:40,810 --> 01:01:41,643
that might be comparable.

1055
01:01:41,643 --> 01:01:42,216
AUDIENCE: Is it

1056
01:01:42,216 --> 01:01:42,790
formally diagnosed?

1057
01:01:42,790 --> 01:01:45,410
PROFESSOR: Is it formally
diagnosed?

1058
01:01:45,410 --> 01:01:46,030
I don't know.

1059
01:01:46,030 --> 01:01:46,500
[INTERPOSING VOICES]

1060
01:01:46,500 --> 01:01:49,640
AUDIENCE: [INAUDIBLE]

1061
01:01:49,640 --> 01:01:53,890
PROFESSOR: I would be amazed
if it wasn't because

1062
01:01:53,890 --> 01:01:57,790
everything is formally
diagnosed somewhere.

1063
01:01:57,790 --> 01:02:02,120
But, you know, what really shows
up there, I think, is

1064
01:02:02,120 --> 01:02:05,200
substance abuse, right?

1065
01:02:05,200 --> 01:02:09,530
In this culture it's much less
that you get somebody who's

1066
01:02:09,530 --> 01:02:11,260
pathologically working out
in the gym, though

1067
01:02:11,260 --> 01:02:12,680
I'm sure that happens.

1068
01:02:12,680 --> 01:02:14,294
They go and pop enough steroids
to get themselves

1069
01:02:14,294 --> 01:02:16,491
into trouble.

1070
01:02:16,491 --> 01:02:21,446
AUDIENCE: What about the cases
where people make themselves

1071
01:02:21,446 --> 01:02:25,410
throw up but not particularly
related to food?

1072
01:02:25,410 --> 01:02:27,860
PROFESSOR: Well, OK, there's a
whole -- and I don't actually

1073
01:02:27,860 --> 01:02:31,390
know much about the whole set
of self-harming disorders.

1074
01:02:31,390 --> 01:02:34,210
Actually I should probably
sometime teach myself

1075
01:02:34,210 --> 01:02:34,910
something about it.

1076
01:02:34,910 --> 01:02:37,300
Because there's another
pathology

1077
01:02:37,300 --> 01:02:43,490
that is new, I think.

1078
01:02:43,490 --> 01:02:47,650
Or if it's not new it was deeply
hidden before, the

1079
01:02:47,650 --> 01:02:49,360
notion of people cutting
themselves

1080
01:02:49,360 --> 01:02:51,300
and things like that.

1081
01:02:51,300 --> 01:02:53,380
So it may be that there's a --

1082
01:02:53,380 --> 01:02:55,790
I don't know anything about it,
but there may well be a

1083
01:02:55,790 --> 01:02:59,420
make yourself throw up in the
self-harming kind of category.

1084
01:03:04,527 --> 01:03:05,030
AUDIENCE: Have you
ever heard of

1085
01:03:05,030 --> 01:03:06,750
the anorexia Web sites?

1086
01:03:06,750 --> 01:03:07,600
Like not the --

1087
01:03:07,600 --> 01:03:07,750
PROFESSOR: The anorexia --

1088
01:03:07,750 --> 01:03:09,930
AUDIENCE: Like, Web sites --

1089
01:03:09,930 --> 01:03:11,600
PROFESSOR: Oh, yes,
yes, yes, yes.

1090
01:03:11,600 --> 01:03:13,870
I read an article about it at
one point, where people are

1091
01:03:13,870 --> 01:03:16,080
busy encouraging each other
in their eating disorders.

1092
01:03:16,080 --> 01:03:18,540
Not wholesome, I wouldn't say.

1093
01:03:18,540 --> 01:03:19,092
AUDIENCE: Yes, clearly.

1094
01:03:19,092 --> 01:03:21,983
But did they change the
[INAUDIBLE] at all, or the way

1095
01:03:21,983 --> 01:03:22,970
anorexia --

1096
01:03:22,970 --> 01:03:23,820
PROFESSOR: I don't know.

1097
01:03:23,820 --> 01:03:24,190
I don't know.

1098
01:03:24,190 --> 01:03:26,650
And I don't know if it's
widespread enough to be --

1099
01:03:26,650 --> 01:03:31,854
I mean, I've just seen a couple
of, you know, I think

1100
01:03:31,854 --> 01:03:34,360
sort of popular press
things about it.

1101
01:03:34,360 --> 01:03:37,160
I just don't know how
widespread that is.

1102
01:03:37,160 --> 01:03:38,260
I know who to ask at MIT.

1103
01:03:38,260 --> 01:03:40,570
There are a couple of
people who are good

1104
01:03:40,570 --> 01:03:43,140
experts on that at MIT.

1105
01:03:43,140 --> 01:03:52,760
Anyway, the dangers of
relatively complete handouts

1106
01:03:52,760 --> 01:03:56,820
or of comparatively complete
handouts is that if I don't

1107
01:03:56,820 --> 01:04:01,530
then hit all the lines on the
handout, there's a danger that

1108
01:04:01,530 --> 01:04:04,790
somebody's going to want to
know what I meant by magic

1109
01:04:04,790 --> 01:04:07,730
cures for imperfections and
the superwoman myth.

1110
01:04:07,730 --> 01:04:13,610
So let's jump back to societal
pressures pushing people

1111
01:04:13,610 --> 01:04:14,860
towards anorexia.

1112
01:04:17,550 --> 01:04:22,580
The magical cure thing is the
notion that we're a culture

1113
01:04:22,580 --> 01:04:25,550
that firmly believes that you
should be able to cure your

1114
01:04:25,550 --> 01:04:29,870
problems right now and without
too much real hard work.

1115
01:04:29,870 --> 01:04:39,490
So that if you are not sexy
enough, here is the mouthwash,

1116
01:04:39,490 --> 01:04:45,870
the clothes, and the six amazing
acts that you can

1117
01:04:45,870 --> 01:04:49,590
perform in the privacy of
your own room that will

1118
01:04:49,590 --> 01:04:50,640
do it all for you.

1119
01:04:50,640 --> 01:04:54,160
And you can read these at the
supermarket checkout, right?

1120
01:04:54,160 --> 01:04:55,050
One of my favorite --

1121
01:04:55,050 --> 01:04:57,060
I mean, you get stuck at the
supermarket checkout --

1122
01:04:57,060 --> 01:05:02,750
I love bouncing down just the
headlines of what are

1123
01:05:02,750 --> 01:05:06,040
described as the women's
magazines, Cosmo being the

1124
01:05:06,040 --> 01:05:07,190
best of these.

1125
01:05:07,190 --> 01:05:10,090
Because Cosmo is always willing
to make you completely

1126
01:05:10,090 --> 01:05:11,490
sexy by next month.

1127
01:05:11,490 --> 01:05:13,820
And amazingly they need to do
it all again the next month.

1128
01:05:13,820 --> 01:05:16,540
But, you know.

1129
01:05:16,540 --> 01:05:23,130
This move will drive your man
wild, once a month on the --

1130
01:05:23,130 --> 01:05:25,170
anyway, it's great stuff.

1131
01:05:25,170 --> 01:05:27,070
At least I suppose
it's great stuff.

1132
01:05:27,070 --> 01:05:28,670
I don't get to read
the journal much.

1133
01:05:28,670 --> 01:05:33,860
It's not one of the technical
journals in my field.

1134
01:05:33,860 --> 01:05:35,830
All right, so there's the
magic cure piece.

1135
01:05:35,830 --> 01:05:41,330
And then the superwoman myth,
which many of the superwomen

1136
01:05:41,330 --> 01:05:46,780
here may relate to, is a --

1137
01:05:46,780 --> 01:05:50,810
I can't remember who coined the
term -- but it's the idea

1138
01:05:50,810 --> 01:05:53,760
of the woman, or the guy for
that matter, who can do it

1139
01:05:53,760 --> 01:05:55,680
all, right.

1140
01:05:55,680 --> 01:05:59,660
She's got the high-powered
career based on

1141
01:05:59,660 --> 01:06:01,740
her great MIT degree.

1142
01:06:01,740 --> 01:06:08,010
And she also is the mother of
fifteen and making it to all

1143
01:06:08,010 --> 01:06:11,060
the school plays and making
the food and of course

1144
01:06:11,060 --> 01:06:14,970
knitting the clothes by hand
and stuff like that.

1145
01:06:14,970 --> 01:06:17,770
There's typically not a similar
superman myth because

1146
01:06:17,770 --> 01:06:22,280
even in these more egalitarian
days, it still remains the

1147
01:06:22,280 --> 01:06:25,400
case that the burden of child
rearing falls more heavily on

1148
01:06:25,400 --> 01:06:33,680
the female than on the male
typically across this culture.

1149
01:06:33,680 --> 01:06:38,430
So if anybody is going to be
massively stressed out by

1150
01:06:38,430 --> 01:06:42,010
trying to balance the home and
career thing, it's more likely

1151
01:06:42,010 --> 01:06:42,890
to be the woman.

1152
01:06:42,890 --> 01:06:47,630
At least, that's the argument
that's being made here.

1153
01:06:47,630 --> 01:06:55,520
All right, let me jump then to
this other topic of coercive

1154
01:06:55,520 --> 01:06:57,400
sexual behavior.

1155
01:06:57,400 --> 01:07:04,450
And let me advocate that you
should take advantage of your

1156
01:07:04,450 --> 01:07:08,380
time in Cambridge sometime to
go to the American Repertory

1157
01:07:08,380 --> 01:07:12,310
Theater just off the Harvard
campus, across

1158
01:07:12,310 --> 01:07:15,930
the street from Radcliffe.

1159
01:07:15,930 --> 01:07:18,340
Because I think -- my
recollection is -- actually I

1160
01:07:18,340 --> 01:07:19,410
haven't checked lately because
I haven't been a

1161
01:07:19,410 --> 01:07:20,480
student for a long time.

1162
01:07:20,480 --> 01:07:23,770
Students used to get in
amazingly cheaply.

1163
01:07:23,770 --> 01:07:25,740
And so you should do this.

1164
01:07:25,740 --> 01:07:29,900
They put on a range plays from
modern to classic, but almost

1165
01:07:29,900 --> 01:07:34,020
always with some kind of out
there attitude about it.

1166
01:07:34,020 --> 01:07:43,100
So I remember this great
production of a Handel opera,

1167
01:07:43,100 --> 01:07:46,910
which they had decided
to set --

1168
01:07:46,910 --> 01:07:54,570
act one was set in a trailer
park in a Florida swamp, and

1169
01:07:54,570 --> 01:07:58,190
act two was set on Mars, neither
of which I believe

1170
01:07:58,190 --> 01:08:01,280
were described as the settings
in the original libretto.

1171
01:08:01,280 --> 01:08:02,600
Somebody --

1172
01:08:02,600 --> 01:08:03,320
that kind of thing.

1173
01:08:03,320 --> 01:08:08,820
Anyway, some years ago, I saw a
production of Shakespeare's

1174
01:08:08,820 --> 01:08:10,880
Midsummer Night's Dream there.

1175
01:08:10,880 --> 01:08:13,600
And at the beginning of the
play, what they had done was

1176
01:08:13,600 --> 01:08:17,820
they staged a practice fight.

1177
01:08:17,820 --> 01:08:25,895
It was clear that these were two
knights practicing rather

1178
01:08:25,895 --> 01:08:27,590
than fighting in an
actual battle,

1179
01:08:27,590 --> 01:08:29,710
sparring with each other.

1180
01:08:29,710 --> 01:08:31,240
And they're whacking
away at --

1181
01:08:31,240 --> 01:08:33,580
the lights come up and they're
whacking away at each other.

1182
01:08:33,580 --> 01:08:39,210
And finally one of them flattens
the other and pulls a

1183
01:08:39,210 --> 01:08:44,500
sword and it's at the neck
of the guy on the ground.

1184
01:08:44,500 --> 01:08:50,000
And at that point, the lines
you hear are, "Hippolyta, I

1185
01:08:50,000 --> 01:08:52,600
wooed thee with my sword;
and won thy

1186
01:08:52,600 --> 01:08:54,080
love doing thee injuries.

1187
01:08:54,080 --> 01:08:57,040
But I will wed thee in another
key, with pomp, with triumph,

1188
01:08:57,040 --> 01:09:00,050
and with reveling."

1189
01:09:00,050 --> 01:09:04,420
What the A.R.T. had done was at
the moment that the fight

1190
01:09:04,420 --> 01:09:10,380
was over, the guy on the floor
is reciting those lines.

1191
01:09:10,380 --> 01:09:15,110
And the other person takes
off her helmet.

1192
01:09:15,110 --> 01:09:18,630
And of course to make it
dramatic, her big hair fluffs

1193
01:09:18,630 --> 01:09:20,290
out all over the place.

1194
01:09:23,440 --> 01:09:28,310
The beginning of Midsummer
Night's Dream is the set up --

1195
01:09:28,310 --> 01:09:30,260
the set up is that there's going
to be a wedding between

1196
01:09:30,260 --> 01:09:33,280
Theseus, Duke of Athens, and
Hippolyta, the Queen of the

1197
01:09:33,280 --> 01:09:38,290
Amazons, who he has conquered
and is now going to marry.

1198
01:09:38,290 --> 01:09:43,300
But the notion of "I wooed thee
with my sword and won thy

1199
01:09:43,300 --> 01:09:49,290
love doing thee injuries" does
not sit well in, at least not

1200
01:09:49,290 --> 01:09:52,790
in a Cambridge academic
kind of setting.

1201
01:09:52,790 --> 01:09:58,450
And so the A.R.T. played this
against type, right, with

1202
01:09:58,450 --> 01:10:01,895
Theseus on the floor saying,
"I wooed you with my -- oh,

1203
01:10:01,895 --> 01:10:10,160
get that away from my neck."
But it's an interesting,

1204
01:10:10,160 --> 01:10:15,330
curious thought that you might
woo somebody with your sword

1205
01:10:15,330 --> 01:10:17,970
and win their love doing
them injuries.

1206
01:10:20,790 --> 01:10:25,440
I suspect there aren't very many
women present who would

1207
01:10:25,440 --> 01:10:27,810
subscribe to the notion that
that would be a marvelous form

1208
01:10:27,810 --> 01:10:32,150
of courtship, and maybe not
even an awful lot of guys.

1209
01:10:35,530 --> 01:10:43,710
But forms of relations that
become coercive are by no

1210
01:10:43,710 --> 01:10:45,250
means unheard of.

1211
01:10:45,250 --> 01:10:48,360
And the place we typically end
up hearing about them is when

1212
01:10:48,360 --> 01:10:50,630
they end up in court.

1213
01:10:50,630 --> 01:10:51,990
How do they end up in court?

1214
01:10:51,990 --> 01:10:53,670
Well, let me tell you
a court case.

1215
01:10:53,670 --> 01:10:57,600
This happened about
ten years ago now.

1216
01:10:57,600 --> 01:11:02,160
This is a court case where
a woman is suing a

1217
01:11:02,160 --> 01:11:03,900
collection of --

1218
01:11:03,900 --> 01:11:04,840
she's suing them?

1219
01:11:04,840 --> 01:11:07,270
No, I think this was actually
a rape case in

1220
01:11:07,270 --> 01:11:09,260
the criminal court.

1221
01:11:09,260 --> 01:11:13,350
They're charged with rape
and she's the plaintiff.

1222
01:11:13,350 --> 01:11:15,400
What happened?

1223
01:11:15,400 --> 01:11:18,360
Well, considerable disagreement
about what

1224
01:11:18,360 --> 01:11:20,090
happened when you
end up in court.

1225
01:11:20,090 --> 01:11:23,770
But what basically seems to
have happened is that the

1226
01:11:23,770 --> 01:11:28,930
woman and one of the guys met
at, I think it was rifle

1227
01:11:28,930 --> 01:11:32,350
practice, some sort of
athletic practice.

1228
01:11:32,350 --> 01:11:38,630
He invited her back
to his residence.

1229
01:11:38,630 --> 01:11:44,750
Alcohol followed and she ended
up having some variety of

1230
01:11:44,750 --> 01:11:49,780
sexual relations with like
six different guys and

1231
01:11:49,780 --> 01:11:55,200
subsequently charged
them with rape.

1232
01:11:55,200 --> 01:12:00,790
She argued that she had been
passing in and out of

1233
01:12:00,790 --> 01:12:03,950
consciousness and that they
had basically abused her.

1234
01:12:03,950 --> 01:12:06,710
They argued that this
was consensual.

1235
01:12:06,710 --> 01:12:10,320
I think what happened in this
particular case, by the way,

1236
01:12:10,320 --> 01:12:13,700
is that there was no conviction
for rape but

1237
01:12:13,700 --> 01:12:18,170
several of the guys ended up
being expelled from school.

1238
01:12:18,170 --> 01:12:20,970
There are lots of things one
could talk about here.

1239
01:12:20,970 --> 01:12:25,340
I'm not in the business for a
psych course of giving a sort

1240
01:12:25,340 --> 01:12:29,360
of an RO week lecture about,
you know, good behavior or

1241
01:12:29,360 --> 01:12:31,670
something like that.

1242
01:12:31,670 --> 01:12:35,800
But the interesting issue --
well, there are lots of

1243
01:12:35,800 --> 01:12:37,040
interesting psych issues.

1244
01:12:37,040 --> 01:12:39,910
The interesting psych issue that
I want to focus on is the

1245
01:12:39,910 --> 01:12:43,430
question of how this could
come to pass given that

1246
01:12:43,430 --> 01:12:45,710
probably nobody wanted
it to come to pass.

1247
01:12:45,710 --> 01:12:51,620
It is extremely unlikely that
she went to whatever it was,

1248
01:12:51,620 --> 01:12:56,000
rifle practice, saying, oh gee,
I think I'll go home with

1249
01:12:56,000 --> 01:12:59,750
this guy, get smashed out of my
mind, and have sex with all

1250
01:12:59,750 --> 01:13:01,680
of his roommates.

1251
01:13:01,680 --> 01:13:03,590
Doesn't seem likely.

1252
01:13:03,590 --> 01:13:08,020
Nor does it seem very likely
that he said to himself, oh I

1253
01:13:08,020 --> 01:13:11,610
think I'll take this friend of
mine home and we'll all have

1254
01:13:11,610 --> 01:13:14,560
too much to drink and
she'll have sex with

1255
01:13:14,560 --> 01:13:16,250
everybody under the sun.

1256
01:13:16,250 --> 01:13:22,160
So it's pretty clear that
this is not what anybody

1257
01:13:22,160 --> 01:13:25,200
particularly had in mind.

1258
01:13:25,200 --> 01:13:26,800
How does it come to pass?

1259
01:13:26,800 --> 01:13:27,510
Oh, look at that.

1260
01:13:27,510 --> 01:13:30,130
I must have said that
on the handout.

1261
01:13:30,130 --> 01:13:33,120
What am I talking about next?

1262
01:13:33,120 --> 01:13:37,290
Lots of questions, most of
which we cannot address.

1263
01:13:37,290 --> 01:13:39,000
All right.

1264
01:13:39,000 --> 01:13:42,250
So let's address some of the
ones we can address.

1265
01:13:42,250 --> 01:13:45,900
As it says there, very
gender-specific problem.

1266
01:13:45,900 --> 01:13:51,980
There are certainly instances
of sexual coercion

1267
01:13:51,980 --> 01:13:54,120
going the other --

1268
01:13:54,120 --> 01:13:56,110
female- on- male sexual
coercion.

1269
01:13:56,110 --> 01:13:58,680
And within homosexual
relationships there are

1270
01:13:58,680 --> 01:14:02,910
certainly instances of
sexual coercion.

1271
01:14:02,910 --> 01:14:06,910
But the great bulk of
these cases are

1272
01:14:06,910 --> 01:14:11,030
male- on- female coercion.

1273
01:14:11,030 --> 01:14:18,650
In fact, the female- on- male
coercion incidents is vastly

1274
01:14:18,650 --> 01:14:23,790
higher in the erotic literature
than it is in

1275
01:14:23,790 --> 01:14:25,150
reality apparently.

1276
01:14:27,660 --> 01:14:31,580
Well, remember the example from
earlier on about imagine

1277
01:14:31,580 --> 01:14:38,440
that you're on the subway and
some member of the sex that

1278
01:14:38,440 --> 01:14:42,050
you find attractive begins to
touch you surreptitiously on a

1279
01:14:42,050 --> 01:14:43,440
crowded subway car.

1280
01:14:43,440 --> 01:14:45,210
Is this a good thing
or a bad thing?

1281
01:14:45,210 --> 01:14:49,270
Women uniformly say this is not
good, and guys, well, not

1282
01:14:49,270 --> 01:14:53,080
quite uniformly, say mmm, OK.

1283
01:14:56,560 --> 01:15:03,880
You can get similar data with
coercive relations.

1284
01:15:03,880 --> 01:15:11,900
You know, the leather-bound
woman who shows up and says,

1285
01:15:11,900 --> 01:15:15,420
"You're having sex with
me right now"

1286
01:15:15,420 --> 01:15:18,090
is a fantasy figure.

1287
01:15:18,090 --> 01:15:20,140
The leather-bound guy who comes
up to a woman and says,

1288
01:15:20,140 --> 01:15:22,740
"You're having sex with me right
now" is not typically a

1289
01:15:22,740 --> 01:15:25,290
fantasy figure.

1290
01:15:25,290 --> 01:15:30,590
So there's this odd
asymmetry there.

1291
01:15:30,590 --> 01:15:41,260
So there are lots of ways
to understand how this

1292
01:15:41,260 --> 01:15:45,210
could come to pass.

1293
01:15:45,210 --> 01:15:48,650
One of the reasons, as I said
earlier, for making this an

1294
01:15:48,650 --> 01:15:52,760
end of the term kind of topic
is it does sort of neatly

1295
01:15:52,760 --> 01:15:56,690
recapitulate an awful lot of
the themes about causality

1296
01:15:56,690 --> 01:16:01,090
that have shown up in the
course of the term.

1297
01:16:01,090 --> 01:16:04,380
And then what I'll probably, oh,
very clearly do next time

1298
01:16:04,380 --> 01:16:07,060
is weave a story that combines
many different

1299
01:16:07,060 --> 01:16:08,590
threads into one.

1300
01:16:08,590 --> 01:16:13,230
Let me just say a word about
incidence today, and then

1301
01:16:13,230 --> 01:16:17,510
we'll go on to etiology when
we pick up next time.

1302
01:16:17,510 --> 01:16:19,810
How common is this
as a problem?

1303
01:16:19,810 --> 01:16:22,920
Well, you've got a real problem
here, which I have

1304
01:16:22,920 --> 01:16:25,550
mentioned before, which
is the data on sexual

1305
01:16:25,550 --> 01:16:28,660
behavior are lousy.

1306
01:16:28,660 --> 01:16:30,680
Because people don't --

1307
01:16:30,680 --> 01:16:32,620
well, first of all we don't
collect that much of it.

1308
01:16:32,620 --> 01:16:34,960
And second of all people lie.

1309
01:16:34,960 --> 01:16:39,730
Recall that if you ask males how
many sexual partners have

1310
01:16:39,730 --> 01:16:43,840
you had and you ask females how
many sexual partners have

1311
01:16:43,840 --> 01:16:46,680
you had, you discover
that there's a third

1312
01:16:46,680 --> 01:16:50,270
sex out there somewhere.

1313
01:16:50,270 --> 01:16:52,220
Because the math
doesn't add up.

1314
01:16:52,220 --> 01:16:55,340
You see that too in --

1315
01:16:55,340 --> 01:16:58,480
well, maybe you see that
in the data on --

1316
01:16:58,480 --> 01:17:01,310
that's gotten basically
from survey data --

1317
01:17:01,310 --> 01:17:02,600
on coercive sex.

1318
01:17:02,600 --> 01:17:12,400
If you ask females, "have you
ever been coerced into sexual

1319
01:17:12,400 --> 01:17:16,680
intercourse?", in at least one
study the answer is 15% of

1320
01:17:16,680 --> 01:17:18,130
women say yes.

1321
01:17:18,130 --> 01:17:23,550
If you ask men, "have you
coerced anybody into having

1322
01:17:23,550 --> 01:17:27,060
sexual intercourse?", only
7% of males say yes.

1323
01:17:27,060 --> 01:17:30,150
Now there are a number of
possible explanations, like

1324
01:17:30,150 --> 01:17:33,820
serial coercers or things of
that sort, but you can see

1325
01:17:33,820 --> 01:17:36,690
that there may be reporting
issues that

1326
01:17:36,690 --> 01:17:38,050
are difficult there.

1327
01:17:38,050 --> 01:17:43,490
One last point on this, on the
incidence point, if you ask

1328
01:17:43,490 --> 01:17:45,500
have you ever --

1329
01:17:45,500 --> 01:17:51,360
25% of women in one study back
from the mid '80s reported

1330
01:17:51,360 --> 01:17:55,650
intercourse because quote "they
were overwhelmed by a

1331
01:17:55,650 --> 01:17:59,420
man's continual arguments
and pressure." That's an

1332
01:17:59,420 --> 01:18:01,270
interesting statistic
in a couple of ways.

1333
01:18:01,270 --> 01:18:03,380
First of all it's interesting
because it's quite high.

1334
01:18:03,380 --> 01:18:07,620
Second of all it's interesting
because it points out the very

1335
01:18:07,620 --> 01:18:10,650
distinct status of sexual
relationships.

1336
01:18:10,650 --> 01:18:15,960
If I am coerced into buying
a used car by the man's

1337
01:18:15,960 --> 01:18:18,580
continual arguments
and pressure,

1338
01:18:18,580 --> 01:18:21,660
that's too bad, right.

1339
01:18:21,660 --> 01:18:26,946
If I decide that I'm going
to strangle -- who

1340
01:18:26,946 --> 01:18:27,490
am I going to strangle?

1341
01:18:27,490 --> 01:18:28,100
Oh, I don't know.

1342
01:18:28,100 --> 01:18:29,580
I won't strangle anybody
particular.

1343
01:18:29,580 --> 01:18:31,070
Oh, maybe I'll strangle Kristin
because she was

1344
01:18:31,070 --> 01:18:33,380
laughing at me earlier.

1345
01:18:33,380 --> 01:18:37,660
I'll strangle Kristin because
I was pressured by Anna's

1346
01:18:37,660 --> 01:18:39,740
continuous verbal demands
or something

1347
01:18:39,740 --> 01:18:41,370
like that to do this.

1348
01:18:41,370 --> 01:18:44,150
You know, I can make the case
that it was her demands that

1349
01:18:44,150 --> 01:18:48,150
made me do this, but I'm
still going to jail.

1350
01:18:48,150 --> 01:18:52,060
It doesn't explain
away my behavior.

1351
01:18:52,060 --> 01:18:54,860
Sexual relations are
interestingly different from

1352
01:18:54,860 --> 01:18:58,120
other relations in that way.

1353
01:18:58,120 --> 01:19:02,350
And, OK, we'll pick up on, at
our last meeting, on how this

1354
01:19:02,350 --> 01:19:04,080
all comes to pass.