The theory of media’s culpability in the spread of social contagions is not a new one. Psychologists studying the developmental psychopathology of eating disorders have led dozens of controlled experiments finding a near-perfect link between mass media and eating disorder symptoms. The question in my mind now isn’t whether media have a part to play in replicating social contagions; if we were able to purge ourselves of certain conduits of influence like media itself, we might have an easier time stopping transmission. Rather, I question just how big a part media actually play in spreading them.
To answer that, Russell refers to an exceptional case that transpired in the Republic of Fiji. By the mid-1990s, he says, bulimia was rampant across industrialized parts of the world, but not so much in developing countries. The Harvard Medical School associate professor Anne E. Becker figured that cultural context likely accounted for this barrier to transmission. To test her theory, she sought out a place completely isolated from Western influence. In all of Fiji’s history, the republic had yet to report a single case of someone suffering from an eating disorder. That all changed in 1995.
“What happened in 1995?” I ask Russell.
Melrose Place, he says. Xena: Warrior Princess. Beverly Hills, 90210.
“That was the year the first television arrived to the island republic.”
After just three years of exposure to shows like Seinfeld and ER, 11 percent of Fiji’s adolescent girls admitted to Becker that they had purged their food at least once to lose weight. In that time, the risk of developing an eating disorder jumped from 13 percent to 29 percent. More than 80 percent revealed that television influenced them or their friends to be more conscious about body shape or weight. By 2007, 45 percent of girls from the main island reported purging their food.
Becker also found that the effect of media exposure went beyond eating disorders. She recorded an increase in personal ambition based on certain characters that viewers watched on television. In one of her studies, 80 percent of the girls said they planned to eschew traditional agrarian jobs for professional careers, specifically those that only wanted thin women. The republic also experienced a rise in the social contagion of emotional strain among teenage girls. Fiji’s society was changing quickly, and psychological problems accompanied these massive cultural shifts as media transmissions carried along even more social contagions.
All of this seems like an awful lot of blame to heft onto mass communication, I comment. Is the answer to understanding and stopping the spread of social contagions really as simple as curbing media and their messages? And if so, why hasn’t it worked for curbing the strange contagion event in Palo Alto?
“As that very elegant Fiji study by my American colleague found, media matters. But the truth often requires us to dig a bit further,” Russell replies, then remarks, with a bit of cunning, “Of course it’s not about media. It’s about awareness.”
Chapter 7
Stumbling upon a Cure and Its Unintended Consequence
The writer Johann Wolfgang von Goethe writes that in nature we never see anything in isolation but everything in connection with something else, which is before it, beside it, under it, and over it. It is a growing awareness of these connections that has me thinking quite a bit about the stark picture Gerald Russell painted of strange contagion events, illustrating the way a little exposure can lead to large effects like a global pandemic of bulimia. I’m finding it difficult to comprehend the full deleterious influence of awareness. Russell has explained that we acquire eating habits by watching characters on television, by noticing the way our friends eat or the images they post online, and by unconsciously registering subtle cues in the culture itself. I can accept that exposure creates opportunity for the spread of social contagions, but how then does one defend against awareness? You can’t go through life closing your eyes and shutting your ears.
In the case of five teenagers jumping in front of trains, I see Palo Alto trying to defend against awareness. In the beginning, students tied memorial ribbons to wire gates. Affixed hand-scrawled messages on folded sheets of paper to the wooden sides of school buildings. Wove bunches of wildflowers into chain-link fences around the baseball field. Drew memorials to their friends in thick chalk lines on campus walkways. Penned essays and published op-eds about the classmates they’ve lost. But mental health experts were quick to point out that acknowledging the suicides risked passing the seed of influence on to others. Commemorations threatened to turn the dead into martyrs and activate in some a desire to achieve the same attention. It seems absurd, but the more we make people aware of the problem, the more we expose others to it. Talking about the suicides is dangerous. If awareness is the biggest vector for a social contagion, a lack of awareness should stop it. And yet, at this suggestion, there’s a tickle in the back of my head, the cynic eager to get out: to say nothing of strange contagion events like bulimia or the suicide cluster is to simply ignore a problem, and problems like these typically don’t go away on their own.
Following my chat with Russell, I seek out a copy of a dissertation written in the early eighties that includes one of the first-ever references to a condition resembling bulimia, as well as an effective treatment for it. The author is the psychologist Deborah Brenner-Liss. She used to work at an eating disorder clinic in New York and is now running a small private practice in San Francisco.
Brenner-Liss’s office is big and bright and staged like the studio set of a television show about a psychologist, with a plush sofa and big armchairs deliberately placed to provoke a conversation, a divulging, a confession. She is lean, with a small chin, pronounced cheeks, and slender shoulders. The lines in the skin of her face run deep.
She recounts a now-familiar story of bulimia’s genesis and its spread, along with her own exploration of the early literature on binging and purging. Like Russell and Becker, Brenner-Liss found that once the condition started appearing in the media, it spread unrestrained. “Our intentions as researchers and practitioners fighting bulimia were good,” she emphasizes. “We wanted to get the word out about it to help professionals understand that this exists, and to rally to find effective ways to treat it.” That was the task: to find a way to halt the spread.
As Brenner-Liss speaks to me about the early attempts to stop bulimia, it calls to mind the story of Marseille, France, in 1720, when the merchant ship the Grand-Saint-Antoine arrived to port with freights of foreign silks and cottons and the body of a Turkish passenger who perished by bubonic plague. Once moored, the ship hoisted a bright yellow flag. Today it’s known as a yellow jack. Ships raise the banner to alert passersby that the vessel is under disease quarantine. Despite confinement, however, within days new cases of plague inundated hospitals and killed thousands of locals. To contain the spread and warn incoming ships of peril, the port raised more bright yellow flags along the waterfront’s docks, piers, and cargo platforms. They fluttered on the Mediterranean wind atop masts of fishing vessels and trade ships. The maritime basin was soon awash in yellow. Still the plague spread as though it rode on the very breeze that stirred them. Believing it moved through heavy vapors, the town stoked perpetual fires to cleanse the air. People sniffed herbs and dosed themselves with paste made from drugs crushed, mixed, and doused in honey. These desperate attempts to counteract the deadly effects of the invisible illness failed to contain it, and so the people of Marseille erected a wall of stone across the countryside and purged the town of its sick. They would hold off the contagion by depriving it of hosts and starving it out of existence. But the wall of Marseille ultimately failed, too. Instead of purging the illness from the town, the protective wall trapped people inside with infected fleas and rats, the true vectors of the illness. Within the quarantined district, 50,000 people contracted the Yersinia pestis bacterium and died.
Thankfully, we’re more familiar with the causes and methods for the spread of communicable disease than we were in the eighteenth century. Unlike the plague, however, catching an eating disorder
has nothing to do with microbes, and we need something more creative than antibiotics to stop it. As Brenner-Liss describes desperate measures to find a treatment for bulimia, she relates some harrowing facts. For instance, today 60 percent of people who receive treatment for eating disorders recover, sustaining a healthy weight and normal diet, she tells me. Another 20 percent make partial recoveries. Brenner-Liss is among them; as Gerald Russell was writing about an ominous variant of anorexia and the University of Chicago was putting out press releases, she was one of the first Americans to both develop the symptoms of bulimia and the earliest to receive treatment for them.
I joke with her that in Silicon Valley we call the people who first try new technology early adopters. “That’s what I am, then,” she says, giving me a fleeting, jaunty look from her sofa chair, the white collar of her blouse riding high up on her neck. She’s an alpha user. A beta tester. A pioneer of early cures designed to stop a strange contagion event.
She speaks with me about her earliest experiences with compulsive overeating and purging, as well as finally encountering a successful treatment. Her personal story tracks remarkably well to the cultural fulcrum toward perfect models, Playboy centerfolds, beauty pageant contestants, and television actresses, as well as the rise of diet products in the seventies and eighties that perpetuated the desire and means to achieve these looks. Not only did the media come to glorify a slender ideal, they also emphasized its importance, and the importance of appearances in general that went into shaping identity, gender roles, values, and beliefs. To treat this perfect storm of catchable body image standards, openness to restrictive eating behaviors, and feelings of despair, pugilists of this pandemic would, in due course, introduce prosocial media campaigns to reinforce healthy body weight, antidepressants, and evidence-based psychotherapies.
In the early days, however, with very few options for treatment available to her, Brenner-Liss sought out support groups, meetings of eight or ten people who exhibited similarly unique eating behaviors as her own. Some members of these groups exercised obsessively. Others dosed their bodies with laxatives. Many presented with chipped teeth, eroded stomach linings, brittle hair. Despite their symptoms, what connected them all was a purposeful act of engaging in that most delicate of equations, seeking the balance between consumption and depletion, impulse and restraint.
“Whatever it was we were doing in those living rooms, I suddenly found I was starting to get better,” she reveals. The curious curative nature of these support groups went well beyond talking, relating personal experiences, and offering empathy. There was something about being in the presence of others who were trying to eat healthfully and also engaging in nourishing activities that began influencing healthy behaviors in her. These tightly knit, highly influential social networks fostered her motivation for positive behavior changes and stoked the stamina in her to stay in the fight.
In other words, she says, members of her support group, by virtue of simply attending the meetings, were catching healthier eating behaviors from each other, along with motivation, resilience, and hope by way of observation and unconscious mirroring. Although they didn’t know it at the time, members of Brenner-Liss’s support group were combating the social contagions contributing to bulimia with other social contagions.
I consider the idea that perhaps we can do the same in Palo Alto. Assuming we can identify which social contagions are in the mix, we can use helpful ones to counteract those contributing to the rise in suicide.
Support groups would go on to gain popularity in the eighties in greater numbers than ever before, as researchers at the University of Illinois found empirical evidence reinforcing what might be considered their contagious benefits. As a practicing psychologist today, Brenner-Liss has incorporated group therapy and peer support networks into treatment for her own patients with eating disorders, with great success. “What I’ve been able to do with our groups is to subtly invite healthy competition toward recovery,” she tells me. Social contagions work in their favor.
And yet, I’ve come across an impassable contradiction. To a layperson, this sounds a lot like exchanging one idea for another—simple enough. But all of this creates a very different portrait about the connection between exposure, knowledge, and cures from the one Gerald Russell presented me. I explain Russell’s theory of awareness to Brenner-Liss, how he believes that even unconscious exposure to an idea, a behavior, and an emotion spreads them. No matter how recovery-focused one keeps support groups, sometimes an unhealthy competition erupts, he said. For every person whom support groups cure, others leave group therapy after having developed worse symptoms than those they had when they entered it. Bulimia is so contagious that support groups and in-treatment facilities designed to help patients are also primary spreading agents.
Further inquiry only seems to justify Russell’s troubling conclusion. In 2004, Great Britain’s National Centre for Eating Disorders reported that inpatient treatment and specialist units serve to create opportunities for exposure to the worst cases, allowing participants to catch more severe eating disorder symptoms, dangerous behavioral modeling, and harmful attitudes toward treatment that perpetuate well beyond the formal group therapy. Peeling back the processes even further, the psychiatrist Walter Vandereycken examined ethnographic reports and qualitative investigations to find that sitting within close range of others exposes people to the worst cases and leads patients to unintentionally contend for the worst symptoms. Treatment, he reported, can do more damage than good by allowing the harsher and crueler strain to jump to new hosts.
Where Gerald Russell finds a threat in exposure, Brenner-Liss finds healing and a road to the remission of symptoms. Are media and group exposure vectors for spread, I continue to wonder, or are they vectors for treatment?
“Maybe it’s a little of both,” she offers. The same processes of mirroring and unconscious competition that allow people to encode dangerous thoughts, behaviors, and feelings from others might just be the very same that spread beneficial social contagions.
“Then what tips the scale?”
“Personal susceptibility. Environment. The unknown.” She shrugs her shoulders.
Riding the train home later that afternoon, I organize the frayed threads of new information into my evolving model to try to best explain the strange contagion at home. I mull over the mechanisms that allow unique people to share universal expressions and similar empathetic responses to one another. Automatic attunement guides us to unintentional mirroring of thoughts, behaviors, and feelings, phenomena that share a language perceptible on a level of the invisible, unknowable unconscious. I consider the findings of Brenner-Liss, who, like others, trusts that awareness is a vessel for treatment and cure. Yet, as Russell and Baker discovered, awareness will exacerbate a strange contagion event the same way that spreading knowledge about bulimia helped to triple the frequency of new cases in ten- to thirty-nine-year-old females between the late 1980s and early 1990s. The rate dipped a bit as treatment caught up with the illness, but the number rose steeply again in 1992, shortly after Princess Diana publically disclosed her battle with bulimia. Her revelation brought tremendous awareness to the condition. It corresponded both with an uptick in people seeking treatment for the first time as well as an explosion of new cases as the strange contagion spread further than ever.
Christakis was right: this scenario, this conceptual template to help guide my investigation, is a perfect model to compare with ours and to help me understand the kind of dynamic we’re facing. But I’ve come away conflicted. Looking at contagious eating disorders has shown me that strange contagion events are far more nuanced and complicated than I expected at first. Stopping a social contagion sometimes means using tools of remission and transmission, exploiting a cure that also spreads the disease. Ultimately, it’s a numbers game: you save some, lose others, and hope against hope that in the end we come out ahead.
Part III
The Frenzied
“I suppose I ha
ve found it easier to identify with the characters who verge upon hysteria, who were frightened of life, who were desperate to reach out to another person. . . .”
―Tennessee Williams
“We find that whole communities suddenly fix their minds upon one object and go mad in its pursuit; that millions of people become simultaneously impressed with one delusion, and run after it, till their attention is caught by some new folly more captivating than the first.”
—Charles Mackay
Chapter 8
A Dilemma of Contagion
An outbreak is imminent.
My son is now six months old. I’ve started dropping him off in the mornings at Google’s infant center, near my wife’s office and just off of the search giant’s Mountain View campus. The playroom is set within a capacious space fashioned with meshed canopies for shade, dozens of organic gardens, and kitchens stocked with all-natural foods. The playroom is lined with baskets of fruit plucked from the center’s orchards, and natural wood toys made of blocks and pegs and wheels. It’s a kibbutz by way of Whole Foods.
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