Still+Not+Big+Enough


 * Student Name: Nicolas Chinga**
 * Student Number: 07585624**
 * Tutor's Name: Sophie Miller**

**Still Not Big Enough **

**Cultural Artefact **

The cultural artefact featured in Figure 1 is the collage of pictures of four actors that have played “Superman” since the 1950s. It can be clearly observed that the level of muscularity and leanness of the actors has dramatically increased over this period of time. One the top left the actor is George Reeves in 1950s, on the top right the actor is Christopher Reeves in 1980s, on bottom left corner the actor is Brandon Routh in 2006, and on the bottom right corner is Henry Cavill for the latest superman movie currently being filmed.



 Figure 1. The evolution of “Superman’s” physique over the last 60 years.

**Public Health Issues: Muscle Dysmorphia and Anabolic-Androgenic Steroids ** The cultural artefact is the depictive of the media influences on what the “ideal” male body should be. Media influence is one of the major contributing factors for the development Muscle Dysmorphia (MD), specially in western societies where the media has been progressively pushing male body image for a more muscular and leaner (Grieve, 2007). This essay will focus on the contributing factors for MD and its strong relationship to anabolic-androgenic steroids (AAS).

**Literature Review ** Muscle Dysmorphia is a recognised psychological disorder and it can best described as multidimensional disorder as there is debate where it should categorised under Body Dysmorphia Disorders, Obsessive Compulsive Disorders, and even Eating Disorder (Cafri et al., 2004; Pope et al., 2010). MD leads to severe functional impairment in life, it is associated with lower quality of life, higher rates of suicide, and use of AAS (Kanayama & Pope, 2011). Cafri et al. (2004) research indicates that MD leads to both psychological and physical consequences in the pursuit of greater muscularity including the use of dangerous substances such as AAS and pro-hormones; excessive and strict behaviours including mirror checking, eating, dieting, and exercise. Another important finding by Cafri et al. (2004) is the significant positive correlation between body dissatisfaction with level of muscularity and risk of using AAS, thus greater dissatisfaction the greater the risk of AAS use, although it must noted that AAS was found to improve self-perception of body image.

Grieve (2007) reviewed the current research on Muscle Dysmorphia and derived a conceptual model that identified nine factors that contribute and co-interact to the development of Muscle Dysmorphia. These factors include: body dissatisfaction, feeling unhappy with their level of muscularity although generally everyone would think they quite big and muscular already; Body distortion, these individually don’t just feel small they actually believe they are smaller than they actually are; Body mass, along with their perception of low body muscularity they also believe they don’t weight enough; Media influences, it affects the individual perception of what society expects a men to look like which the media continues to pressure for a more muscular and leaner physique; Ideal body internalization, refers the individual accepting the cultural ideal body shape for men which in the western society it is a strong muscular man; sports participation, especially those that reward having high muscle mass such as rugby and American football; low self-esteem, this especially the case if the individual begins to engage in weightlifting to improve appearance to improve self-esteem; perfectionism, refers to the pursuit for an unrealistic body shape, the “perfect body’; Negative effects, which provides the motivation and negative reinforcement for the behavioural symptoms of MD. MD is contributed by a broad range of factors that co-interact, and it is interesting that AAS use was not recognised a contributing factor.

Kanayama & Pope (2011) conducted a review of the literature on cultural differences in Muscle Dysmorphia, suggesting the causes of MD are the interaction of both biological vulnerability and socio-cultural factors. They suggest that MD is primarily a Western psychological disorder where a significant value is place on man’s muscularity and leanness, whereas in East Asian countries such as Japan MD practically nonexistent as they place almost no significance muscularity on the male body image. This agrees Grieve’s (2007) research with media influence, ideal body internalisation, and sport participations as factors contributing to MD development.

Kuennen and Waldron (2007) conducted research on the relationship between personality traits, level of muscularity, and MD diagnosis on 49 males (white, aged 20-59yo) who weight train at 3 times per week. Personality traits that were analysed were narcissism, self-esteem, and perfectionism. Muscularity was measured by determining their Fat-Free Mass Index (FFMI). The main findings included a negative relationship between body dissatisfaction, low self-esteem, and MD; a positive relationship between perfectionism and exercise-dependence, and between MD and AAS use; also interestingly individuals with FFMI > 25kg/m² (which is also indicative of possible AAS use) reporter significantly higher body satisfaction. The main limitation of the study is that all information obtained via surveys.

According to the review of current research by Leone et al. (2005) the psychological and behavioural characteristics described for recognition of MD include body dissatisfaction, excessive resistance training and use of supplements, strict eating regimen, excessive mirror checking, irrational fear of muscle loss, forgoing social and work commitments, and possible AAS use. Interestingly body dissatisfaction is a symptom and a contributing factors towards MD as identified by Grieve (2007). Leone et al. (2005) also recognised the current treatments for MD, but there is very limited research on this area with the current method being the use of antidepressants alone or in combination with cognitive behavioural therapy, which is unfortunately not always successful. It has also been suggested that the programs that are currently used for anorexia and bulimia nervosa can be modified for MD treatment, although it is questionable whether this exact approach would work as these disorders have various behavioural differences (Leone et al. 2005).

Rothman (2009) reviewed the current research on the association between AAS and MD, and identifies that although MD has low mortality rate but many co-morbidities are associated, especially in combination with AAS abuse. The main finding of Rothman’s (2009) review include MD’s association to low self-esteem; AAS use is associated with individuals with strong traditional masculine belief and attitudes, and the use of other illicit drugs prior; the positive side effects of AAS including increased muscle mass, decreased body fat, and overall improved feeling of wellbeing reinforces their use; MD leads to AAS use but it is rarely reverse effect. AAS is not a contributing factor for MD development which coincides with other research (Cafri, et al. 2007; Kanayama & Pope 2011).

Furthermore on AAS use, Pope et al. (2010) conducted research on a preliminary module for diagnoses of AAS-dependence on 42 males (aged18-65) with history of AAS use and were also assessed for MD. The findings indicated that AAS dependants compared to non-dependants: began AAS use from an earlier age; use more AAS; spend a large percentage of their income on AAS; have higher scores on the MD diagnoses; present more psychological problems; self-reported greater negative effects on various aspects of their functional life due to AAS. The main limitations of this study were that it was not determined whether the psychological problems became present prior or after AAS, and small group sample from a single location. Psychological problems, specifically childhood conduct disorders in addition to also body dissatisfaction during adolescence and MD have been recently recognised as risk factors for AAS use (Pope et al., 2011). These research studies on AAS use have further demonstrated strong relationship between MD and AAS use, with greater AAS use seen by those with greater severity of MD (Pope et al., 2011). Thus, it is an issue that must addressed carefully when treating MD.

**Cultural and Social Analysis ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Muscle Dysmorphia and its co-morbidities, especially the associated AAS use, is heavily influenced by society and culture and thus are crucial for understanding and adequately facing this multidimensional disorder, as these allows for the increased prevalence of the disorder and further affects who already with the disorder.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">In regards to culture and society influence, the main affecters for MD are the belief and attitudes of the Western culture and the media influence on what a man should look like, and what represent masculinity and attractiveness. MD is primarily prevalent in Western cultures but almost not existent in East Asian countries, the difference from a population level perspective is that the value that the culture places on males’ level of muscularity. In Western Society the general view is that men must be “big and strong” and a valuable trait to have, where as East Asian cultures place little value on a man’s muscularity (Grieve, 2007). Media also heavily impacts on the image that males should look, through movie heroes, male models in advertisements and even kids ‘action figures’, these have progressively been getting more muscular and leaner (Grieve, 2007; Kanayama &Pope, 2011). Obviously the continuously bombarding these images of the “ideal male body” will eventually have an effect on the populations’ view, but another important contributing factor to be considered is Ideal body internalization, refers the individual accepting the culturally and media imposed ‘ideal body shape’ for men.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Political forces negatively affect individuals with MD, this is due to the significant association between MD and AAS use. The social theorist Max Weber’ idea of economic rationalism applies to this issue. This theory views how society rationally focus on profit, efficiency, and control, but results in the loss of individual freedom. In both the USA and Australia, AAS only became illegal due to lobbying from major sporting organisation to such the International Olympic Committee to stop their use in sport, and since media gains large amounts of profits from sporting events they also pushed against the “evil” of steroids. Most political parties use sports to further their election campaigns, thus align their position with these sporting organisations. In the USA when the issue of AAS went to congress, the politicians in order to meet their agenda they disregarded the position statements by three major health organisations the Food and Drug Administration (FDA), the American Medical Association (AMA), and the Drug Enforcement Administration (DEA), which indicated that AAS were not dangerous and it was not necessary to be made a controlled substance.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Therefore, due AAS illegal status individuals with MD who are at high risk of use them, are risking further health risks because often the AAS obtained are not pharmaceutical grade (most come from underground laboratories from overseas and some these AAS are actually veterinarian grade). In addition, they are risking severe potential legal issues if caught. Individual MD are obviously affected by these policies, which should not be case because although AAS have side effect (like any other drug every created), they can be use safely. It should also be noted that in many East Asian countries, where AAS are legal to obtain over the counter, there is no AAS abuse problem just like MD is almost nonexistent (Kanayama & Pope, 2011).

**<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Analysis of Artefact ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">The artefact (Figure 1) represents primarily one the main contributing factors for muscle Dysmorphia, media influence which is this case is a popular Western culture hero. But if further examined, it represents the co-interaction of many contributing factors. Western cultures value muscularity, thus the media preys on this values to their advantage resulting in continuing to portray men as being progressively more muscular. This exposure to this belief and media can lead to various other contributing factors for MD development (Grieve, 2007) including body dissatisfaction that can also lower self-esteem, and ideal body internalization of what a men is expected to look like. In addition, the latest superman actor (Henry Cavill) at first glance some may think he used AAS to achieve that physique, especially considering Cavill’s last movie where he was nowhere as muscular. This was good “case in point” artefact of the representation of MD for the reason just discussed, contributing factors of MD, media and cultural influence, and its link to AAS use.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">To me personally the artefact, firstly represents what a superhero should look like but also when I first seen the picture of Cavill I did think he either has amazing genetics for building muscle and/or he did a cycle of steroids to get that big, from knowing what looked like for his last movie. There is a media influence on me, as someone who likes working out and pushing myself to be fitter and stronger, to some extent agree with the media and western culture belief that men should be strong and have some muscle on them. Maybe it is due to the media why I think like that.

**<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">References ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Cafri, G., Thompson, J.K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2004). Pursuit of the muscular ideal: Physical and psychological consequences and putative factors. //Clinical Psychology Review, 25//, 215-239. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Grieve, F.G.(2007). A conceptual model of factors contributing to the development of muscle dysmorphia. //Eating Disorders, 15//, 63-80. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Kanayama, G., & Pope, H.G.Jr. (2011). God, men, and muscle dysmorphia. //Harvard Review Psychiatry, 19//, 95-98. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Kuennen, M.R. & Waldron, J.J. (2007). Relationships between Specific personality traits, fat free mass indices, and the muscle dysmorphia Inventory. //Journal of Sports Behaviour, 30//(4), 453-470. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Leone, J.E., Sedory, E.J., &Gray, K.A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. //Journal of Athletic Training, 40//(4), 352-359. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Pope, H.G., Kanayama, G., Bickel, W.K., Kean, J., Nash, A., Samuel, D.B., & Hudson, J.I. (2010). A diagnostic interview module for anabolic-androgenic steroid dependence: Preliminary evidence of reliability and validity. //Experimental and Clinical Psychopharmacology, 18//(3), 203-213. <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Pope, H.G. Jr., Kanayama, G., & Hudson, J.I. (2011). Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study. //Biological Psychiatry. (Article in Press).// <span style="font-family: 'Times New Roman','serif'; font-size: 16px; text-align: justify;">Rohman, L. (2009). The relationship between anabolic androgenic steroids and muscle dysmorphia: A review. //Eating Disorders, 17//, 187-199.