Zoobiquity

  Isolation can also provoke it. Simply providing companionship is one fix that veterinarians try. Birds—even ones that seem to want to be alone, that attack and drive out cage mates—have stopped injuring themselves when their enclosures were moved closer to those of other birds. And self-harm plummets in many species of monkeys and apes when they are caged with a companion of the same species. Many stallions stop hurting themselves when they’re allowed to graze in the company of mares—their natural grouping—instead of being housed in a stall alone. Animals of many kinds, from cheetahs to racehorses, are sometimes paired with other species, like donkeys, goats, chickens, or rabbits. Part of the reason this works seems to involve the larger animal’s fear of stepping on the smaller ones … as if a sense of purpose itself diminishes the need to self-harm.

  Boredom really rings alarm bells for vets. Free-ranging horses, for example, graze many hours a day. But when a stable hand straps on a feedbag and sates a horse’s hunger with an easy hit of tasty, calorie-dense grains, the animal is left with an overfull stomach and time for its idle hooves and teeth to fill.

  Boredom is such a risk factor for stereotypies that animal behaviorists in zoos have developed a whole science around it. As mentioned earlier, environmental enrichment creates psychological and physical well-being in animals by fostering behaviors naturally present in the wild. Zookeepers excite carnivores with frozen balls of blood and the scent of their favorite prey. Enrichment can be as simple as a new dirt mound to explore; logs, feathers, and pinecones to play with; and different sounds to hear.b

  When vets notice animals engaging in stereotypies, they increase or vary the environmental enrichment. When the coyote handler at the Phoenix Zoo watched two coyotes pacing the same pathway in a tight-limbed, ears-back gait, she gave them frozen blood popsicles to play with, hung pigeon wings on branches to encourage them to jump, spread giraffe and zebra urine around bushes to entice them away from their pathway, and filled burlap tubes with peanut butter to get them to work for their treat. After a few weeks, the coyotes were trotting calmly with upright ears.

  Trainers give horses a variety of toys to play with, but the most surefire solution for preventing this confirmed herd animal from getting bored and stressed is to … give it a herd. After all, horses evolved to live in groups. They generally don’t even sleep well unless one of their own stays awake as a sentry. It’s no wonder solo living can be stressful for them.

  And here’s where recognizing our deep connection with other animals may shed some light on the issue of human self-injury, both by putting what we already know into a new context and by suggesting innovative ways to treat the problem. It takes us to a story of a gorilla, some gum, and some nail polish.

  Several years ago, a handful of veterinarians wearing face masks and scrubs hunched over a mountainous male gorilla in the gleaming white treatment room of the Birmingham Zoo. Babec was suffering from congestive heart failure, a condition I treat in humans almost every day. It leaves apes of both species weak and lethargic. In the most severe human cases of it, patients feel short of breath and exhausted doing even the simplest activities: walking from the bed to the bathroom, putting on their clothes, sometimes even just talking. The sickest human heart-failure patients lose their appetites and drop muscle and weight. Babec, too, had slowed his eating; at 320 pounds, he was a shadow of his former 400-pound self. The ailing gorilla was about to be fitted with a high-tech pacemaker—the same kind that’s put into human patients suffering from the most advanced cases of heart failure.

  While the technicians anesthetized and intubated Babec, the doctors scrubbed their hands, swabbed disinfectant on his chest, and shaved a large rectangle of silvery-black fur over his heart. Under anesthesia for medical procedures, gorillas can seem uncannily human. Their leathery palms, whorled with familiar-looking fingerprints, relax open at their sides. Their scary bulk and prominent brow ridges, which can look so intimidating when the animal is awake, seem vulnerable, pensive, and even wise when they’re under anesthesia.

  The doctors made a careful incision with a sterile scalpel and got to work installing the pacemaker. The six-hour operation went well. They closed the wound, bandaged it, and cleared the room so the vet techs could get Babec ready to wake up.

  But a couple of things happened during the operation that would send the charge nurse in a human OR into hysterics. In the middle of the procedure, an assistant gave Babec a manicure, painting his normally darkish nails Ferrari red. Down by his feet, another zoo staffer shaved little patches of fur from his legs and sewed loose “decoy” stitches into skin the doctors hadn’t even approached with the scalpel. Meanwhile, several of the vets did something that is strictly forbidden in a human operating room. Behind their masks, their jaws wrestled large wads of gum. And every so often, they sneaked a marble-sized ball out of their mouths and, inexplicably, worked it into Babec’s fur.

  The attending veterinarian later explained to me that these human health-code violations were, in fact, clever patient-care strategies. Specifically, they were designed to defend the delicate stitches holding together the true incision in Babec’s chest, which, if left unguarded, Babec would pull out in a matter of minutes. But how to protect it? My human patients can generally be cajoled into avoiding the urge to fiddle with their sutures, at least for the thirty-six hours it takes for scar tissue to emerge. But all the lectures in the world won’t stop a gorilla from probing at the wound.

  So the vets developed an ingenious subterfuge. They would protect the stitches by distracting the patient. And they would do it by harnessing the same instinctive urge that propels the gorilla to pick in the first place: the impulse to groom.

  Babec’s vets told me he awoke from his surgery the way my human patients often do: groggy, disoriented, and uncomfortable. Peering around the recovery area, he started to move his hand toward his chest, with its new incision, then froze with it in midair. The Ferrari-red fingernails gleamed like hard candies. They held his attention for a good few minutes. When he moved his hand back toward his chest, he didn’t get far before his fingers found a wad of gum. He picked and pinched and pulled at the offending material and had only just finished extracting it when his fingers touched another (the veterinarians had heat-treated it after chewing, to kill germs). The fake stitches in his ankles would be next. Every time he finished with one task, another was waiting to grab his attention—distracting him from the most important thing: his chest sutures.

  This is a place where human medicine and animal medicine are already converging, although without either side realizing it. Some therapists counsel self-injurers to try a less invasive, distracting “hit” of pain when they get the urge to cut, burn, or bruise. Plunging a finger into a carton of ice cream, squeezing a piece of ice, or snapping a rubber band around the wrist sometimes does the trick. Cutters who crave the bloom of fresh blood can draw a red marking pen instead of a blade across the places they’d like to cut. They can drag ice cubes made with red food coloring over the skin to produce a satisfying crimson trickle. Or they can swipe their fleshy canvas of choice with henna paint (this has the added advantage of drying to a pleasing scablike consistency, which can be picked off the next day). These distractions all deliver the release … relief response, just in safer ways.

  But the vets also point out that animals need both immediate physical distractions and more long-term social changes—in other words, they need solutions to their stress, isolation, and boredom. And when you think about it, that might go for people, too. Young adults in the age of our distant ancestors didn’t have anything like the spare time and painless abundance of modern America. The typical middle-class teen is a little like the horse alone in its stall, with most of its needs—especially food but even entertainment and physical activity—provided in easy-to-digest chunks. He’s left with lots of extra time and few activities as invigorating as a daily struggle for survival.

  The problem may be worsened by technology that isolates even as it ent
ertains and informs. Even those of us who love these activities recognize that watching television, playing video games, and “social” networking alone in a room can leave us feeling disconnected from real people. A survey comparing free-time activities and contentment found that the only pastime that consistently left people of all ages and socioeconomic groups feeling unhappy was watching TV. While bird owners and others with common problems can find solace in online gatherings of people with the same issues, this phenomenon also has a dark side. The Internet provides cutters (and those in other self-injuring subcultures, including anorexics) with the wrong kinds of peer groups—ones that enable and support the behavior, offer tips for “improving technique,” post poetry praising it, and describe tactics for hiding it.

  Zookeepers make animals forage. Should we explore getting teens involved in growing and preparing their own foods, an activity that can produce feelings of profound calmness and satisfaction … and purpose? Just as an animal’s stereotypies decrease when it has a companion, a pet can provide company, responsibility, exercise, and distraction to a human. Like a lonely horse reintroduced to a herd, isolated cutters could be encouraged to find herds of their own. Whether in more mainstream pursuits (sports, theater, music, volunteering) or more niche passions (medieval reenactment, making YouTube videos, competitive Scrabble), the company of other flesh-and-blood human beings depending on one another can bring a deep sense of belonging.

  Psychotherapy, the traditional (and often very effective) treatment for extreme self-harm, may actually combine the two approaches vets use for self-injuring animals. Supportive counseling gives a cutter the beginnings of a herd: a person to talk to, sit near, and be responsible to (by showing up for appointments). Psychotherapy can also be viewed as a form of social grooming, calming and “touching” another person through voice, language, response, and presence. Actual touch and massage therapy with literal physical contact (repetitive tactile stimulation) between healer and patient might also be useful ways to release … and relieve feelings of isolation and stress.

  But zoobiquity also raises a deeper question about self-injuring behavior in humans. If someone is burning himself with cigarettes, we certainly need to find a way to stop him. But can we and should we accept or tolerate less extreme forms? In fact, we already do.

  The recent rise in self-injury coincides with the popularization of a form of controlled bodily injury. While examining my patient who showed me her cutting scars, I couldn’t help but remark on her nearly head-to-toe collection of tattoos. She told me she’d gotten most of them during a five-year hiatus from cutting. Now she was doing both. “I think the reason I’ve been doing so much more tattooing is that I really want to cut,” she told me. “People say a tattoo doesn’t hurt. But it does.”

  Needless to say, tattooing is not the same as self-injury. It’s an ancient and, in many places, sacred cultural art form. But it is a kind of grooming that bears many similarities to the practices of our primate cousins. It’s an intimate interaction between two individuals. It often confers social status. The pain involved in getting a tattoo releases endorphins.

  The zoobiquitous notion that self-injury is a form of grooming gone wild opens up a whole new way of looking at our society’s increasingly painful and invasive preening rituals. We subject ourselves to full-body waxing, genital bleaching, acid peels, repeated electrolysis, cuticle shaving, adult orthodontia, ultraviolet tooth whitening, laser microplaning, and Hollywood’s injection of choice, Botox.

  Whether their tool is a tattooist’s ink gun, a plastic surgeon’s needle, a cutter’s razor blade, or their own talons and beaks, sometimes humans and animals simply cross a line. And when this line is crossed, healthy self-care may shift toward significant self-harm. We may not be able to define exactly where that line begins, but we can easily spot when someone has crossed it.

  All of us—from full-blown cutters to secret hair pluckers and nail biters—share our grooming compulsions with animals. Grooming represents a hardwired drive, one that’s evolved over millions of years with the positive benefits of keeping us clean and binding us socially.

  Parents, peers, physicians, and vets should take notice when stress, isolation, and boredom appear. Combating these triggers with the fellowship of a theater group, the primal satisfaction of backyard gardening, or the grooming challenge of a carefully placed wad of gum does more than create a distraction. It uses an evolutionary tool set to repair an evolutionary short circuit.

  *Twenty-five years ago, when I was a medical student on the inpatient psychiatric unit at U.C. San Francisco, self-mutilation was thought to be uncommon in general populations. It was typically diagnosed in conjunction with a developmental or psychotic disability—for example, eye gouging or genital cutting with schizophrenia or head banging with autism. Indeed, self-mutilation occurs in association with certain disorders, including Tourette’s syndrome, Lesch-Nyhan syndrome, some forms of developmental delay, and borderline personality pathology.

  †Lack of suicidal intent is a relatively new notion when it comes to self-injury—in fact, some of what just twenty years ago we called “hesitation marks” (scars or shallow wounds) on the wrists of a suicide might actually have been evidence of previous cutting.

  ‡In the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), self-harm is listed as a symptom of borderline personality disorder. Other psychiatric texts classify it as an impulse-control disorder, along with exhibitionism, kleptomania, and the compulsive tics and vocalizations of Tourette’s syndrome. The much-anticipated DSM-V will likely recategorize acts of nonsuicidal self-harm, including cutting, based on our expanded understanding of the neurobiology and genetics that underlie them.

  §Besides hair twirling and nail biting, many of us chew gum when we’re stressed out. Zoobiquitously, some nonhuman primates in the wild pick gum arabic (the springy, saplike base of natural chewing gums) out of trees and chew it. Zoo behaviorists sometimes give their primates this substance as a way of combating stereotypies. Some nonnutritive chewing has, indeed, been shown to have a calming effect, at least depending on which teeth you use (one group of dentists claims that chewing with the rear molars is more relaxing, while using the front teeth or canines perks you up).

  ‖Before addressing these common causes, vets rule out underlying medical conditions. Psychiatrists do this, too, when a new symptom presents. For example, when a patient has a new presentation of depression, the physician may consider hypothyroidism, Cushing’s syndrome, or even pancreatic cancer. Similarly, when an animal (human or otherwise) presents with self-injury, organic causes, including physical pain, must be excluded first.

  aMost reports of animal self-harm come from captive populations, and in some circumstances, captivity itself may exacerbate the triggers. But captive settings aren’t the only places animals experience stress, isolation, and boredom. Comparable behaviors may well occur in the wild, too—but given the difficulties and limitations of observing free-ranging animals, wild versions are probably underreported.

  bIn 1985, the USDA laid out six elements it deems critical to the psychological well-being of captive animals: social grouping; structure and substrate (meaning the environment of the cage and its flooring, bedding, perches, etc.); foraging opportunities; toys or manipulables; stimulation of all five senses; and training.

  NINE

  Fear of Feeding

  Eating Disorders in the Animal Kingdom

  The eating disorders unit of a psychiatric hospital takes on a charged atmosphere around 6 p.m. every day, when leaf-thin patients float anxiously into the dining room. Many are draped in a concealing uniform of baggy sweatpants and oversized shirts with sleeves so long only their fingertips peek out. They glance around warily, eyeing one another and slyly sniffing the air to predict what food they will be challenged to swallow. The meals have been calibrated down to the last calorie and garnished to entice the most reluctant eater. Kind but guarded, the nurses, doctors,
and ward assistants (including the janitors) are on high alert for food avoiders, food hiders, and food purgers. Sometimes they lock the bathroom doors before serving time to make sure no one slips away for a mid-meal regurgitation.

  As a psychiatry resident in the late 1980s, I spent six months rotating through the eating disorders unit at the UCLA Neuropsychiatric Institute. I remember a meal with one particular patient, a fourteen-year-old I’ll call Amber. Pale and gaunt, she sat next to me at the round faux-wood table, fixated on the green plastic plate in front of her. On it sat a simple turkey sandwich and a red apple. She stared at the meal. And she stared. Finally she looked up at me. I was surprised to see something like terror in her eyes. “I can’t do it,” she whispered. “I just can’t. I am scared to eat this food.”

  Scared to eat. I remember thinking to myself how disordered that seemed. How unnatural. Even before I had become used to taking a comparative approach to human medical conditions, I thought, here is a mental disorder that is completely antithetical to the principles of evolution. In the wild, animals that starved themselves on purpose would be on a collision course with extinction.

  And yet this form of self-starvation, called anorexia nervosa, strikes 1 in 200 American women. It’s surprisingly lethal. Killing up to 10 percent of the afflicted, anorexia is considered to be the deadliest psychiatric disorder among young females. Bulimia nervosa, the well known binge-purge disorder, affects some 1 to 1.5 percent of women at some point in their lives and .5 percent of men. And there’s also a rapidly expanding category of varied eating disorders that get lumped together in a broad diagnostic category called, simply, “disordered eating.” It includes troublesome behaviors such as binge eating, night eating, secret eating, and food hoarding.

  Eating disorders are often dismissed as being mild, even trivial, an affliction of the wealthy and privileged. However, because of their worldwide prevalence, the World Health Organization has declared them a priority disorder. And as W. Stewart Agras, a Stanford psychiatrist, points out in The Oxford Handbook of Eating Disorders, eating disorders of all kinds are on the rise around the world.