The Anatomy of Disgust

William Ian Miller
Cambridge, Mass, USA: Harvard University Press, 1998; £9.95
ISBN 0674031555

Disgust is an every. day experience (last night's dishes look pretty disgusting piled up in he sink, and the overnight arrivals in the cat litter tray made a good attempt at putting me off my breakfast this morning). Miller's excellent book plunges us into the minutiae of all things disgusting in an attempt to find the causes and effects of this universal experience. With examples from psychology, sociology, and literature, both ancient and modern, Miller raises a wide range of points throughout his book, sometimes as questions and sometimes simply to illustrate the thin, fashionable line between acceptability and disgust.

Miller kicks off with a quick attempt at distinguishing disgust from its neighbours including horror, shame, hatred, and contempt (returning to the latter in greater detail later). Then he squelches into disgust peculiar to each of the senses, teasing out many a contradiction in our selection of what's disgusting and what's not. Having joyfully splashed through eating, defecation, fornication, generation, death, rot, and regeneration he makes an attempt at a collective theory of disgust. He suggests that there are two types of disgust: a Freudian disgust that acts as a barrier to satisfying unconscious desires ("Sex is either too disgusting to engage in or, when engaged in, not disgusting enough to gratify") and a disgust of overindulgence, of surfeit, one that is supposed to stop us from suffering the effects of excess. Chapters on disgust in ancient times and disgust in moral life precede the last two chapters where Miller pushes his ideas on disgust and contempt, democracy, and the social classes.

Disgust is a base emotion, argues Miller, although which things an individual person finds disgusting is more a matter of nurture than of nature. Communal disgust allows us a sense of shared values and therefore of social identity. Failing to react in an appropriate manner to an offensive experience sets one apart, which the medical profession uses to its advantage. As doctors we are expected to suspend our "normal" reactions to all things offensive. This "superhuman" effort is the basis for a patient revealing the presence of foul smelling discharges and leaks, sour odours, and itches. Without this affected and demonstrated immunity to all things stomach churning, patients would not allow doctors to question them and act with the intimacy of lovers. But take away the professional mantle, and doctors are just as grossed out as the rest. Great book, not exactly light reading, but well worth the effort.

Ben Mills final year medical student, University of Glasgow


studentBMJ 2000;08:45-88 March ISSN 0966-6494