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 Review - Disgust and Its DisordersTheory, Assessment, and Treatment Implications by Bunmi O. Olatunji and Dean McKay (Editors) American Psychological Association, 2008 Review by Roy Sugarman, Ph.D. Jul 21st 2009 (Volume 13, Issue 30) Emotions are best described as those forces within us that prepare us for action. These non-conscious drivers are faster off the mark than the rest of the brain, manifesting their influence in the first few hundred milliseconds, and only perceived as feelings after that. Our thinking and self regulation comes far later in real terms, as we dissect and try to make sense of what happened. In essence though, our conscious functions are largely janitorial after the emotions have made determinations as to the level of threat. The physiological responses are rapid and prepare us to face our threats or run, or alternatively, to not worry, back off, and rest or digest what happened or nearly happened.
These emotions are described as largely basic, and include fear, sadness, anger, and disgust. These are of course the major negative ones; happiness is an easier emotion to recognize, but gives less direction as to the organism's pathology.
This book singles out disgust as its target, largely because of its involvement in some behavioral conditions that prove troublesome, and enlightening at the same time.
One of the most intriguing is Huntington's Chorea. Even prior to the eventuation of the condition, the brain begins to struggle with the emotion of disgust, as if suppressing its expression and recognition to prepare the victim for what is to come. Obsessiveness and eating disorders are also the playground of this emotion, and act as markers for the perfectionism and obsessions of OCD and Anorexia Nervosa. Objective measurement of this and other emotions thus provides clues as to what the person might conceal on subjective instruments such as questionnaires.
Facial recognition tasks are used, where a face with an emotion is given as a provocative target, to which the subject must give a correct label. Intrasubjective neurons enable the slowness or inaccuracy of response to give a vision of what negative emotions might prove problematic for the subject brain to analyze and work with.
See my review of On Being Moved: From Mirror Neurons to Empathy in this regard, and also my review of Social Neuroscience: Integrating Biological and Psychological Explanations of Social Behavior for more on social cognition in social science.
The book thus dissects the extensive literature that has emerged on disgust, given its emerging importance in psychopathology (Introduction to the book) and then looks at the historical views on the non-integrated historical view of body and soul emotion, and a psychometric overview of its assessment using various instruments, largely rating scales, but of course there are also many instruments such as those developed by Reuben Gur which prompt labels of facial expressions. There is a short discussion on evolution, as Darwin of course was one of the first who wrote about the universality of facial response to emotions, such as disgust, mouth open, tongue protruded, nose and upper lip wrinkled and so on.
Disgust in these contexts played a major role in early homo primates, and occurs as a warning to others that the consumed vegetable or animal may be toxic. Most plants develop their nutrition as toxins to kill off unwanted consumers, or put them off consumption. In this way, we evolved so vegetables could create resilience in us, but only those that taste good enough, as mediated by watching facial expressions. Children learn this quickly, and their taste buds often persuade them to avoid vegetables which to them may be bland. Children of course are more prone to self poisoning because of this.
Cognitive approaches are next examined, namely examining the beliefs and appraisals associated with disgust and the information processing biases associated there as well. In particular, fear and disgust may be co-associated with anxiety and similar disorders and interact through linked pathways to develop and maintain disorders such as OCD, both being negative in affectivity. This means that those prone to such conditions may not process new information that is inconsistent with their cognitive emotional biases, given the screening that occurs non-consciously to all forms of incoming information. This attentional bias is given a large showing in the Fear-related literature, but less so in Disgust, especially in disgust related fears such as for contamination, small animals, spiders, needle-stick phobia and so on. Disgust in these contexts may cause a negative interpretive bias that is similar to that reported for fear and anxiety. Disgust may also thus be more amenable to cognitive mediation.
The next sections of the book look at the acquisition and maintenance of disgust during human development and during learning occasions in this process. The previously mentioned universality is discussed in the context of cross cultural perspectives and then the psychophysiology of disgust looks at motivation, action and autonomic support, given that the psychophysiological response to an emotional situation can be largely accounted for through the motivational dimension of the emotional situation, namely aversive versus appetitive, as well as the behavioral requirements of the context, the specific tactical actions required, and the perceptual and cognitive requirements of the later processing of the emotion in thoughts and self regulation activities. Emotions are thus pervasive entities, and thus the functional anatomy is quite critical in determining its weight in the brain's repertoire.
If it is accepted that there is a strong bioevolutionary valence for this emotion then it is likely it is well represented in the brain. This may be more so than just the predictable amygdala, given its focus on negative valenced events, with such areas as the insula with its self referential bias, and the basal ganglia as well, as part of the feedback loops to the basal and mesial forebrain. This is because disgust has three components in terms of response, one being the facial representation of emotion, the other being the experience of nausea, and the human response, of repugnance, revulsion or loathing. The areas most implicated include the insula, especially the anterior insula, the inferior frontal gyrus, the postcentral gyrus, inferior and middle occipital gyrus as well as the cuneus. The insula versus amygdala argument seems to hold only when a fairly major electrodermal response is elicited, when the bias is to the amygdala for fear, and the insula in disgust. Some emotional judgments about disgust may have to be made, and this may then involve other areas apart from the insula. Many of these experiments may be confusing, as they evoke both fear and disgust, such as mutilation, contamination, animals entering mouths and so on.
Finally, attention is paid to the disorders, namely animal phobia, blood injury and injection phobia, contamination fears, eating disorders, sexual dysfunction, and then of the treatments of disgust and the next steps for the future. The sexual disgust is the most interesting of these, given the multiple levels that can exist, including sociomoral disgust, avoidance, animal-reminder disgust and so on.
The editors have set out a massive textbook for a single emotion, a book that is most unique, in that it is comprehensive without too much repetition, and covers a vast field of research into an important emotion in an intelligent way. There are many contradictions in the literature on the subject, given the complexity of measuring a non-conscious physical set of responses that have a downstream cognitive and intellectual value, and emerge in pathology as well as normality in evolutionary terms. Another variable that makes the literature confusing is the Tower of Babel effect of everyone examining a phenomenon in any way they choose, the lack of standardization is thus a barrier to effective pooling of information and ruling on such issues as localization and function of brain activity during and prior to the conscious experience, and both automatic and then conscious responses.
The book is a fascinating insight into a very complex human attribute, and something few psychologists in practice ever confront.
© 2009 Roy Sugarman
Roy Sugarman, Ph.D., Consultant Clinical Neuropsychologist and Clinical Psychologist, Human Performance Institute, Sydney, Australia
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