The Best Australian Science Writing 2013 (27 page)

Sober scholarship on flatulence has been less abundant. With barely concealed sadness, gastroenterologists Michael Levitt and Julie Furne remark that flatulence ‘has been the province of lay conjecture and scatological humour rather than serious scientific investigation'. For more than 35 years they have tried to remedy this state of affairs with an energetic program of physiological research on flatulence, coining the term ‘flatology' to dignify their quest. The term has failed to catch on, but before we can tackle the psychology of flatulence we must review some elementary flatology.

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Flatulence is primarily composed of five gases: nitrogen, oxygen, hydrogen, methane and carbon dioxide. Of these, hydrogen, methane and carbon dioxide are produced by the fermentation of poorly absorbed carbohydrates in the gut by hundreds of species of microbe, known collectively as the ‘colonic flora'. The mixing proportions of these gases vary widely between people and over time. Smaller quantities of sulphur-containing gases
– primarily hydrogen sulphide, methanethiol and dimethyl sulphide – are responsible for the foul smell of flatulence, a finding confirmed by two brave judges who judged the odour intensity of farts collected via rectal tube from 16 healthy participants fed scientifically controlled quantities of pinto beans and lactulose. The same three sulphurous gases account for the offensive smell of morning breath, a finding first reported at the 4th international conference on breath odour.

Large scale studies of flatus production have not been undertaken, but existing research suggests that on average people pass gas about 10 times per day and about 100 millilitres at a time. Passing gas 20 times per day has been suggested as the threshold of abnormality. Flatulence frequency changes appreciably in response to dietary alterations, but there is a good deal of consistency in people's levels of flatus production: some people reliably fart more than others.

At the quantitative extreme are some people whose flatulence is prodigious. Michael Levitt and colleagues described the case of a computer programmer who complained of excessive flatus and painful abdominal gas. He also observed that his stools effervesced, like aspirins in a glass of water. The patient kept meticulous records of each passage of gas, with frequencies usually exceeding 50 times per day and reaching a peak of 129. Levels such as these may be exceptional, but complaints of flatulence are very common in the general population. Elevated rates have been found to occur in many physical and psychological conditions, including irritable bowel syndrome, mental retardation and autism.

Not surprisingly, it was the psychoanalysts who first took the psychology of flatulence seriously. Freud's biographer Ernest Jones speculated on the relationship between farting and musical ability, and his close associate Sandor Ferenczi addressed the reasons why patients might pass wind during psychoanalytic
sessions. Generally, he argued, this act was not motivated by a desire to insult the analyst – although it was often done when the patient was being difficult and resistant – but rather as an attempt to claim the prerogative of adulthood. In effect, the patient is simply expressing in a rebellious and nonverbal manner the desire to be treated as a grown-up. Sandor Lorand discusses a young man whose flatulence, often performed for the amusement of his friends, represented a similar form of rebellious aggression that was linked to a penchant for ‘dirty' language. Lawrence Kubie confirmed the similarities between flatulence and swearing, pointing out the aggressive gaseous suddenness of both.

Other analysts report cases in which flatulence was a key clinical problem. Horacio Etchegoyen discusses the case of a man who presented for treatment suffering from flatulence and gastric discomfort, and had a tendency to burp and fart during sessions, at times with apparent pride. The analyst interpreted the man's gaseousness as an unconscious identification with a pregnant woman, although the patient had an unfortunate tendency to fall asleep following interpretations such as these. The analysis took a total of nine and a half years, not counting three years of prior treatment that ended with the death of the patient's previous analyst. Ronald Baker describes a more leisurely, 15-year analysis of a fetishistic cross-dresser for whom flatulence was the most intractable symptom. This treatment ended successfully upon the patient's rejection of his ‘idealization of the anal universe that he inhabited'.

The most thorough psychoanalytic investigation of flatulence was conducted by Bruce Merrill, who describes a series of patients that, he argued, reveal a particular character type. The patients, all men, were arrogant, boastful, impulsive and quicktempered. They under-achieved and had troubled relationships with women and with their fathers. They also tended to be drawn to foul language, dirty stories, sadistic and scape-goating wit, and
exhibitionistic public displays. One patient was renowned in college for farting loudly (a ‘stertorous roar') and for lighting his farts for the amusement of friends. (The flammability of intestinal gas has its serious side, with 20 reports of patients suffering explosions during surgery or colonoscopy, including nine colon perforations and one death.)

Another of Merrill's patients mastered the art of swallowing air, enabling him to produce at will farts so loud that they once awakened fraternity brothers sleeping on a third-floor balcony. Another bragged about being able to play tunes with his anus. As a child he revelled in the masculine power flatulence gave him to shock women such as his nursemaid, whose nose he learned to assault when she bent to tie his shoe-laces. He refined this power in adulthood to the point that in bed he would break wind in his wife's face while he slept and would become more flatulent when her conversation bored him. Merrill concluded that these men had failed to identify adequately with their fathers and as a result lacked self-control and the capacity for personal achievement. Their flatulence was a malodorous attempt to achieve adult masculinity.

Links between flatulence and depression have long been suggested. The Greek physician Aretaeus of Cappadocia, who practiced in the 1st century AD, associated melancholy with flatulence in a very literal fashion, proposing that excesses of black bile, from which melancholia gets its name, directly cause depression: ‘If it [black bile] be determined upwards to the stomach and diaphragm, it forms melancholy; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding'. In joining flatulence and belching (eructation) Aretaeus anticipated the association between flatulence and aerophagia that was scientifically established about two millennia later. His clinical observation of the adverse effects of flatulence on mental focus backs up the
dietary restrictions of the Pythagoreans, who according to Cicero were forbidden to eat beans ‘for that food induces flatulence and induces a condition at war with a soul in search of truth'.

Robert Burton, the British scholar who wrote
The Anatomy of Melancholy
in the early 17th century, also drew attention to a correlation between melancholia and wind. Referring to a hypochondriacal form of depression, he wrote: ‘In this kind of Melancholy one of the most offensive symptoms is wind, which, as in other species, so in this, hath great need to be corrected and expelled'. One radical treatment that he described for those troubled by ‘flatuous melancholy' was to ‘put a pair of bellows' end into a Clyster [enema] pipe, and applying it into the fundament, open the bowels, so draw forth the wind; nature abhors a vacuum'. Writing a century later, George Cheyne, a Scottish physician who treated such notables as David Hume, Samuel Johnson and Alexander Pope proposed in
The English Malady
that depression-like diseases were associated with flatulence and a sense of oppression and anxiety. He describes a distemper of ‘vapours' in which ‘the symptoms … besides lowness of spirits, are wind, belching, yawning, heart-burning, croaking of the bowels, (like the noise of frogs), a pain in the pit of the stomach' and so on. Such an association between depression and flatulence has yet to be demonstrated by contemporary researchers, although there is ample evidence linking depression to a range of gastrointestinal symptoms.

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Flatulence appears to be linked to diffuse anxiety and other forms of neurotic misery, but it is also associated with highly focused fears. Several writers have reported cases of individuals suffering from profound fears of flatulence, which sometimes reached delusional intensity. These fears take interestingly different forms.
Some people obsessively fear the social offence that public flatulence would cause and suffer anxiety attacks and social withdrawal. Others are afflicted by ‘automysophobia', the pathological fear of being dirty, and see flatulence more as a way of soiling themselves than as causing affront to others. Several published cases present with a delusional conviction that they emit an ‘alimentary stench' (flatulence or bad breath). Cases of this sort are sometimes traceable to specific smell-related events, such as being teased after breaking wind. After the delusions first develop they are frequently reinforced by the patient's continual misreading of other people's behaviour, for example seeing their innocent gifts of perfume as not-so-subtle hints, or taking their sniffing or coughing – and even the barking of nearby dogs – as evidence of their foul odour. Patients often compensate for their imagined stench by avoiding social situations, compulsively checking their smell and over-using deodorants and soaps. These fears can be treated by exposing sufferers to situations they avoid and preventing them from engaging in their habitual compensatory behaviour. An alternative treatment involves encouraging farting rather than preventing it. Psychologists Michael Milan and David Kolko, using this ‘paradoxical intention' method, instructed a female patient to pass wind as soon as the urge to do so arose, and succeeded in reducing her ruminative thoughts about flatulence.

Depression and fear play their roles in the psychology of flatulence, but the emotion of disgust is perhaps the most intimately related to it. Disgust is a basic emotion evolved in response to stimuli that threaten contamination and disease, such as excrement and decaying food and bodies. It is easily evoked by the chemical senses of odour and taste, and its typical facial expression involves wrinkling the nose to close off the nostrils. Psychologists have recently begun to harness the power of smell to induce disgust in their experiments. The preferred tool for this purpose is fart spray, which is commercially available from novelty
stores and more commonly purchased by 13-year-old boys than older scientists.

In one of the first scientific uses of flatulent technology, Simone Schnall and colleagues exposed their participants to different intensities of spray: unlucky participants were randomly assigned to a ‘strong stink' condition and luckier participants to ‘mild stink' and non-stink ‘control' conditions. The former reported higher levels of disgust than the latter. Participants then rated how objectionable a variety of morally questionable acts would be, such as marriage or consensual sex between first cousins. Participants who were exposed to the fart spray expressed stronger moral condemnation for several of the acts, just as people have been shown to become more morally judgmental when disgust is induced by hypnosis. It seems that when a strong feeling of distaste is evoked, even by a purely sensory experience, a variety of social violations come to be seen as more distasteful or disgusting as well. This creates a special problem for anyone who farts in public: the evidence of their offence is likely to magnify the perceived offensiveness of the act in the eyes (or nose) of a witness.

It is not only the smell of flatulence than can have psychological effects. Recent work has experimentally induced disgust with a mixture of fart, vomit and burp noises, combined with images of a filthy toilet. These researchers found that disgust created a negative bias in people's judgment of ambiguous situations, leading them to interpret these situations as more threatening than do people who are placed in neutral or happy moods.

The disgusting quality of flatulence generally motivates people to inhibit it in public places and to condemn those who fail to do so. It is this fear of embarrassment and blame that minimises the passage of gas when other people are present. But might there be cases where people harness the disgusting power of farts to keep people at a distance? Just as skunks use foul odours to
defend and protect themselves, might people do the same?

There is only one clinical report of apparently deliberate skunk-like behaviour in a human. Mara Sidoli, a Jungian psychoanalyst, presented the case of a young boy who, she argued, used flatulence to form a ‘defensive olfactory container' or envelope to protect himself from fears of disintegration. Peter had been born to an alcohol-abusing teenage mother and fostered out at an early age. He had severe feeding problems as an infant, was neglected and abused as a child, and underwent numerous surgeries for a variety of ailments. His main symptoms upon entering therapy at age seven included manic hyperactivity, confused speech, conversations with imaginary beings and loud farts and (oral) farting noises. Sidoli inferred that Peter had profound abandonment fears and fantasies of persecution, the latter often represented in his play as attacks by space aliens. His farting intensified during times of anxiety and anger, a symptom that Sidoli interpreted as an attempt to emit a ‘protective cloud of familiarity', creating an invisible barrier preventing harm as well as communication with the world outside.

A turning point in Peter's analysis occurred when Sidoli, presumably departing from normal psychoanalytic practice, began to make loud farting noises back at him. Peter's initial response was surprise followed by intense anger, during which he called Sidoli crazy, but he soon began laughing himself. Sidoli argues that by showing Peter how crazy and annoying his behaviour seemed to others and interpreting to him that by acting in this way he had been trying to drive people away by acting crazy, she helped to loosen his defences. Sure enough, his flatulence began to subside and his aggressiveness began to give way to greater warmth and engagement with others: ‘Instead of enveloping me with farts, he was able to show me his pain'.