Book Review

Adonis Complex: The Secret Crisis of Male Body Obsession

N Engl J Med 2001; 344:146-147January 11, 2001

Article

Adonis Complex: The Secret Crisis of Male Body Obsession
By Harrison G. Pope, Jr., Katharine A. Phillips, and Roberto Olivardia. 286 pp., illustrated. New York, Free Press, 2000. $25. ISBN: 0-684-86910-1

This interesting and provocative book describes a form of obsession in which otherwise healthy men become absorbed by compulsive exercising, eating disorders, body-image distortion, and ultimately, abuse of anabolic steroids. In a manner analogous to the course of anorexia nervosa, the social norm of male “fitness” turns, in these sad men, into an insatiable obsession with growing “bigger” and more muscular. When exercise and dieting rituals, no matter how fanatical, fail, recourse to drugs, mostly anabolic steroids, appears to be an easy transition. Body-obsessed men find that drugs are readily available from underground suppliers who gravitate to gyms like moths to the light. Gripped by unshakable fat phobias as well as dietary and drug-related rituals, these pathetic men lose touch with reality and become isolated, socially dysfunctional, and sometimes even dangerous.

The authors, two psychiatrists and a psychologist, describe vividly a wide repertoire of strange forms of behavior, extending well beyond the merely eccentric, undertaken by men who are driven to grow bigger muscles, to reshape their disappointing bodies. This book comprises a welter of personal stories written in a style best described as relentless montage. It includes more than 185 vignettes, two thirds of which quote verbatim from pseudonymous men, exhibiting a potent mixture of narcissistic drug abuse and self-abuse. This cavalcade of anecdotes makes for a vivid and personalized narrative, but the scientific analysis is, by contrast, very limited. The narcissistic self-absorption of these men seems to be a conflation of Veblen's conspicuous leisure and conspicuous consumption in which the vigor and stoicism of the warrior metamorphoses into a hollow emulation, a comic-book satire consisting of somatic sculpting in mock-heroic posture. Although 200 slightly different anecdotes are hardly more persuasive than 1 anecdote repeated 200 times, the slight differences curiously give the narrative an illusion of multidimensionality.

The strength of this book is its eclectic but effective historical review of the changing fashions in the male physique, charting the progressive distortion of male body images. The art of deception in the media and marketing is well highlighted by a judicious compilation of images. Although the underlying message rests on a wafer-thin surface of credibility, the marshalling of a variety of sources of evidence provides an uneven but ultimately persuasive survey of trends over recent decades. Whether the male physique is depicted in action toys, professional wrestling and weightlifting champions, beefcake magazines, or advertising, there is a remarkable consistency in the patterns of distortion. There has been a progressive rise in the muscularity in these depictions to pathologic and unattainable proportions increasingly at variance with reality. Few will be able to resist the book's conjunction of systematic distortion of the body image with the parade of body-obsessed men undertaking extreme rituals of dieting, purging, and drug abuse to meet delusional and self-destructive ideals. The linkage of such ritualistic obsessionality with youth suicide seems tantalizing but surprisingly little considered by the authors.

The magnitude of male somatic obsessionality is dealt with less well by the authors. With justification, discoverers of “secret crises,” like the chroniclers of vast hidden conspiracies, are more likely to be considered deluded or exaggeration-prone than prescient. Disregarding the oft-repeated clarion calls about a secret crisis, this book does not clarify the frequency of such extreme somatic obsession. Although the only reasonably reliable estimates come from systematic surveys of high school students as a captive population susceptible to valid sampling, the prevalence of anabolic-steroid abuse is modest compared with abuse of most other licit and illicit social drugs. Accurate estimates of the prevalence in the adult population are unavailable, but common sense suggests that such abuse is restricted to distinct subpopulations.

Disappointingly, this book contributes little to our understanding of the origins of this disorder. Is it a new condition or a new manifestation of an old condition? By highlighting the media and advertising, the book encourages the belief that these disorders are driven, if not caused, by propaganda. The authors offer no argument against the alternative possibility that this is merely a variant of obsessive–compulsive disorder that expresses new features due to a novel social framework. To be fair, these issues remain largely unresolved in the similar disorder in girls and women, which has been well defined for much longer. Although it does not resolve the significance of men's obsessions with the body, this book does have the virtue of bringing the question to public attention.

The book's approach to therapy is not enlightening. The authors' approach of cognitive behavioral therapy and medication with selective serotonin-reuptake inhibitors is hardly surprising, but it would not be feasible in the sort of large-scale epidemic they claim is under way. Among the least convincing aspects of this book are the self-help questionnaire and the body-image checklists for self-diagnosis. This populist approach, although de rigeur for do-it-yourself health care books, lacks validation even for use in individual counseling or diagnosis by experts, let alone self-diagnosis by the “worried well” or for use by concerned friends and relatives.

Perhaps the boldest and most important claim the authors make is to have discovered not only a “natural limit” to muscular development without steroids but also a simple formula to detect anabolic-steroid abuse. The hubris of this unproven assertion recalls the equally naive claim of the original Frisch hypothesis that puberty occurred at a threshold body weight, which was inconsistent with the continuing existence of the African Pygmy population. Disseminating to the general public such an unsubstantiated claim masquerading as proven science risks encouraging the misuse of science, undermining its credibility, and misleading the public.

Among the book's weaknesses are its scholarship. Curiously, the authors unhesitatingly question received medical wisdom but seem to lack similar courage when it comes to street folklore about anabolic steroids, much of which they tacitly accept. A prime example is their lack of rigorous analysis of an “entity” called “roid rage.” This memorably alliterative epithet, a street description serving mostly as an excuse for bad behavior, is too journalistically good not to be true. Disappointingly, given their backgrounds in psychological medicine, the authors do not question whether this “entity” is really due to drug abuse or is an epiphenomenon of disturbed behavior by men who abuse steroids in the hope of improving their self-image. If ever there was a semiotic argument for the power of naming things, it is the ability of felicitously named entities such as “anabolic steroid” or “roid rage” to outgrow their foundations and outlive their usefulness.

The book contains well-referenced footnotes but no specific bibliography, making it hard to examine its scientific background. The perfunctory and uncritical analyses of published studies presumably also reflect the book's targeting of a popular rather than a professional market — an impression strengthened by the publisher's description of the book as a “frank and explosive look . . . for millions who suffer in silence.” It would be a pity if this targeting deterred physicians who work with young men from becoming familiar with the book. At the least, it can preemptively forearm physicians whose patients come armed with reams of information from the Internet. For physicians interested in the intersection between media propaganda and public health in modern society, this book is interesting and provocative; for some, it is essential reading. Even those dismissive of its subjective methodology will find its description of a group of men strangely hobbled by this culture of the body beautiful sad, and even moving.

This book's scientific and scholarly weaknesses are also its journalistic strengths. It will form a useful part of the backdrop for doctors in their efforts to deal with the ever-changing facets of drug abuse. This intriguing but flawed book leaves room for a more critical and scholarly appraisal of the modern epidemic of male somatic obsession and its medical dimension of anabolic-steroid abuse. For the expert, however, this book represents more specimen than evidence. Despite its repetitiousness, it is a book that anyone with an interest in the way changing fashions affect health-related forms of behavior cannot afford to ignore.

David Handelsman, M.D., Ph.D.
University of Sydney, Sydney, NSW 2139, Australia

Citing Articles (1)

Citing Articles

1. 1

   (2001) Review of The Adonis Complex. New England Journal of Medicine 344:20, 1557-1558
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