Debunking the Gospels of Dr. Harrison Pope
Are you male? Do you lift weights or participate in bodybuilding? Do you want to change your physique … maybe add some muscle or decrease your body fat? Do you lift weights for more than a few hours a week? Do you pay attention to your diet? If you said yes to any of the above questions then you could have a psychological illness – one that the field of psychology believes is a growing ‘secret crisis’ and epidemic among men who workout.
A variant of Body Dysmorphic Disorder (BDD), Muscle Dysmorphia (MD) - also known as bigorexia, megarexia or reverse anorexia nervosa - is formally defined as a pathological preoccupation or obsession with muscularity and leanness. In other words, it is that constant drive to get jacked. The official list of criteria includes a range of characteristics such as feelings of guilt or shame when having to miss a workout, constantly checking one’s reflection to see if they have added size, training “past the pain” or while injured, an “excessively controlled” dietary regime, and anabolic steroid use.
Hold on… from the sounds of it, it seems nearly every bodybuilder that I have ever crossed paths with is considered by psychology to be a little unhinged. My goal is not to debate whether or not muscle dysmorphia is a legitimate mental illness or not. As a teen and former competitive ballet dancer I personally struggled and overcame severe anorexia nervosa – a disease that to this day still has lingering physiological health effects. Needless to say, I am the last person who will argue the legitimacy of what defines a mental illness. But I digress. Let us get back to the topic at hand.
Yes, the concept of muscle dysmorphia has some validity BUT there are some big problems with the methodology and theories of the mastermind behind the bigorexia phenomenon. Ladies and gentlemen, I let me introduce you to Dr. Harrison “Skip” Pope.
Published in 2000, Pope and colleagues introduced the world to muscle dysmorphia (MD) in their book, The Adonis Complex: The Secret Crisis of Male Body Obsessions. Like with any new sexy scientific finding, the media quickly swallowed up Pope’s new diagnosis of MD without much criticism. In fact, during the firestorm of the Major League Baseball drug scandals in the early years of the new millennium Pope became the media’s go-to ‘steroid expert’ tasked with explaining why anyone would ever go to such dangerous lengths to improve their sporting performance.
For Pope, the motives behind anabolic steroid use are not about a desire to achieve athletic excellence but rather are solely fueled by a culturally induced desire to improve personal appearance. In other words, Pope claims that (and I’m not exaggerating here) men take steroids to get bigger. Performance enhancing drug use is less about becoming a better athlete and more about achieving the ultimate muscular appearance.
Pope links this relentless desire for size through AAS use back to the Adonis Complex that he declares “afflicts millions in our society” and has been brought on by “modern society’s and the media’s powerful and unrealistic messages emphasizing an ever more muscular, ever more fit, and often unattainable male body ideal.” Said best by former powerlifting world record holder and Sport Historian at the University of Texas, Dr. Jan Todd, if that is truly the case then “perhaps we should rename gyms – if there are truly millions of such folks – Body Dysmorphic Centers.”
I agree that there has been a sort of steroid driven metamorphosis since the 1940s in how the male body is depicted within popular culture. Whether it is in action figures and comic books, professional wrestling and bodybuilding, in magazines and movies or even just in advertisements, there has been a remarkable transformation of the muscular male body over the past 75 years. But can we really boil a supposed male need for anabolic steroids and automatic diagnosis of a MD down to this? Could the development of new techniques of athletics and strength training have anything to do with this unquestionable growth in muscularity and strength? What about the countless new findings within the fields of kinesiology, sport science, nutrition and medicine? Are women immune to developing muscle dysmorphia? What about athletes? Where do you draw the line between obsessive behaviour and doing simply what is needed in order to excel in elite sport?
Due to an overwhelming lack of scientific detail, the complete absence of a bibliography, questionable research methods and overall weak scholarship, there remain countless questions that could be further discussed regarding Pope’s Adonis Complex – however the most problematic of his claims we haven’t even got to yet.
Measuring Steroid Use.
Possibly the boldest and most absurd of Pope’s claims is not only the discovery of a “natural limit” of muscular development without steroids but also that a simple formula could be used to detect anabolic-steroid use. The formula, called the Fat Free Mass Index (FFMI), can “predict” steroid use by combining a series of mathematical calculations to determine a person’s lean muscle mass determined from height, weight and body fat percentage. Pope believes that the higher your FFMI is, the more likely it is that you are using anabolic drugs.
Wait a second. Could the FFMI really be a new cheap and non-invasive alternative to drug testing? Think about it. Natural bodybuilding federations can just weigh and measure competitors, throw some numbers into a free online body composition calculator and within minutes know exactly who is juiced up. To some this may sound like a promising development, however the reality is the FFMI is not only dangerous but pretty darn idiotic.
First, let us look at exactly how Pope and his colleagues have come to find this “sharp upper limit to how muscular you can get by natural means.”
The FFMI uses a subject’s height, weight and body-fat percent to gauge overall muscularity. This score is then compared to a scale in order to determine anabolic steroid use. Sound simple enough?
To create this scale the researcher took data from 84 AAS users and 74 non-users. In this same study, FFMI estimates were derived from photographs of Mr. America winners (1939-1959) from the “pre-steroid era” and compared to estimates obtained from pictures of modern bodybuilders featured in bodybuilding magazines from 1989 to 1994. It was found that the average Mr. America had the FFMI average of 25.4 but the modern bodybuilders had much higher FFMI results.
What does this all mean?
From these two data sets the researchers created a score to represent the highest level of muscularity that one could potentially achieve naturally. With an estimated FFMI score of 25.7, former Mr. America Steve Reeves was cited to exemplify this new natural limit of muscularity.
Pope was so confident about this natural limit that he stated “any male scoring 26 or higher who is not visibly fat, and claims that he has achieved this physical condition without the use of drugs … is almost certainly lying.”
While there are many different issues with the FFMI, for the sake of brevity, let us focus on three:
1. The issue of using young male amateur bodybuilders to further demonstrate this ‘upper limit of muscularity’ that can be achieved naturally.
Is it not just a little problematic to be classifying young males who have yet to finish puberty and only have a few years of lifting experience as recreational bodybuilders? Or what about the fact that to obtain the subject’s FFMI score Pope used skinfold caliper measures – a method that has many sources of error, not only with the technique of ‘pinching’ but also with the formula that is used to predict body density. When it comes to tracking change over time skinfolds testing can do a pretty good job – but when it comes to predicting body composition there can be as much as a 5% or more range in results even when computed by the same person. Sounds like a great method to me… NOT!
2. Using photographs to predict FFMI in bodybuilders.
There are some major discrepancies in the methodology used by Pope and colleagues to obtain the FFMI results. Furthermore, although Pope cites Steve Reeves with a FFMI of 25.6 as the upper limit, he fails to recognize that two-time Mr. America John Grimek (1940, 1941) has an estimated FFMI of 31.99. Why wasn’t Grimek used then to demonstrate the highest level of muscularity that could be achieved naturally? Your guess is as good as mine.
3. Pope’s lack of understanding of the history of physical culture and development of sport training over the past century is appalling.
Pope selected his sample of Mr. America winners from the 1939-1959 timeframe simply because he believed that they competed in a time before steroids were used by athletes and bodybuilders. Hmm… really?
Before WWII bodybuilders didn’t specifically train for physique competitions. In 1939, the sport of bodybuilding was still in its early years. During this time, competitors were most often weight lifters who would strip down after a meet to have their physiques judged. This was a time before specific machines were used to isolate set muscle groups – before specific bodybuilding resistance training techniques were invented, or knowledge of how diet and proper supplementation could help ‘build’ a body. Needless to say, the use of bodybuilders from this era as exemplary of the ‘natural’ ideal or a steroid-free maximum is utterly misleading and a prime example of poor research. If Pope had had a more thorough understanding of the iron game might he have been able to develop a more accurate measure of muscle mass?
Overall, it saddens me deeply that an unsupported claim such as this can be made and disguised as ‘science’, distributed to the general public and accepted without any critical thought. It is because of this and more that I fear the FFMI has and will continue to fall into the wrong hands. I fear we will see the false naming of individuals as steroid users and the continued profiling of those with hyper-muscular bodies.
Yes, anabolic steroids have been a contributing factor to the development of bigger bodies over the past 100 years but there have also been astronomical advances in medicine, sports science, nutrition and coaching. Such advances have forever changed not only bodybuilding but all of sport more broadly.
For some, all of this may seem irrelevant. Why should we even care about some silly formula used to estimate anabolic steroid use? The answer is simple. Pope’s work has become embedded in contemporary physical culture. Within recent years, Pope’s FFMI has already made media headlines and the Adonis Complex has become a go-to theory in the field of psychology. Pope is hailed as one of the foremost leading experts on steroid use and has even testified before Congress on the issue - all of this without any critique or inquiring into his methods. Rather than question his research or explore the impact of his unproven claims, Pope continues to receive attention and funding, recently receiving a grant of nearly 2.5 million dollars to study the long-term dangers of steroids.
It is no wonder that popular perception of anabolic steroids is not one of fact but rather a fictional story of mentally disturbed mass monsters. As one of the most cited psychiatrists of the 20th century, the impact of Dr. Pope approaches the “biblical proportions” range. In a world where there is a preoccupation for athletes to continue to push the limits of athletic performance, Pope’s will to set ‘natural’ limits to muscular development is more than just problematic, it is an example of literal ‘natural’ selection. Except rather than allowing the big, strong and fast to excel, an overly simplistic math equation and psychological diagnosis may have the power to undermine the evolution of human potential.
Originally Published: Feature, Muscle Insider Magazine, 26: Dec/Jan 2016