The Diagnosis Of Wanting More
Something changed in the room over the three decades I worked. I noticed it without being able to date it precisely—it is not the kind of change that arrives on a particular Sunday. What I noticed was that the men who came in the later years of my practice arrived with a more elaborated vocabulary for their bodily dissatisfaction than the men who came in the earlier years.
The earlier men were often inarticulate about what troubled them in relation to their bodies. They knew something was wrong, or felt that something was insufficient, but the feeling tended to be carried as a wordless quality of apology rather than as a named condition. The later men had terminology. They had categories. Several of them had diagnoses, or suspected diagnoses, or the language of diagnoses that they were applying speculatively to themselves.
I want to be careful about what I am claiming here, because the sample I am drawing on is not representative and the change I am describing is an impression across a long period rather than a documented shift. What I can say is that the vocabulary was different, and that the vocabulary made a difference to the quality of the encounter.
A man who said “I have muscle dysmorphia” was doing something different from a man who said “I don’t like how I look.” He was placing his experience inside a clinical category, with everything that implies: the category validates the experience as real, gives it a name that others can recognise, and implies a cause and potentially a treatment. The category also, necessarily, implies a kind of self—the self that has been assessed and found to have a condition.
I have read about the history of this shift, and the history is recent enough that some of the men I worked with lived through it.
In the early decades of the twentieth century, what I read about physical culture—the magazines, the programmes, the public demonstrations of muscular development—suggests a world in which the male body was celebrated for its size and shape without the psychological overlay that would come later. Early 20th century physical culture magazines celebrated muscularity as aesthetics—no psychology yet, just presentation. The body was a project, and the project was aesthetic. Whether the man was satisfied with the project was between him and his mirror. Nobody had yet developed a clinical language for what happened when the project never felt complete.
After the Second World War, what I read suggests a different account began developing alongside the aesthetic one. The heroic male body—the cinema body, the advertising body, the body of the soldier who had come home and was now apparently required to be both breadwinner and physical ideal—acquired a new quality of pressure. The image was everywhere. The image was specific. And the men who did not match the image were not yet patients, but they were beginning to be legible as a category of people whose relationship to their bodies was somehow insufficient.
By the 1970s and 1980s, psychologists were beginning to document systematically what the earlier physical culture movement had noticed only as an aesthetic problem. Men’s dissatisfaction with their bodies—specifically with leanness and muscularity—was being studied, measured, categorised. The documentation produced its own effect: the experience of bodily dissatisfaction became, by virtue of being studied, a recognised psychological phenomenon rather than just a private unhappiness.
In 1997, Pope and his colleagues described muscle dysmorphia as a subtype of body dysmorphic disorder—a preoccupation with the idea that one’s body is not sufficiently muscular. The category was made clinical. Two years later, the same researchers published “The Adonis Complex”, which brought the clinical terminology into general circulation and documented what they argued were widespread patterns of compulsive weight-training, steroid abuse, and disordered eating among men who could not stop being dissatisfied with the bodies they had made. The action figures that boys grew up with grew 78% more muscular between 1975 and 2000—media ideals outpacing human biology. The impossible standard was being held, and the gap between the standard and the achievable body was producing something that the clinical language was now equipped to describe.
Current estimates suggest that up to 2.4% of the general male population meet diagnostic criteria for body dysmorphic disorder, while approximately 22% manifest muscle-dysmorphic symptoms. These numbers, which I hold at arm’s length because the methodology behind them varies considerably and the populations studied are predominantly Western, suggest that what I was watching in the room was not idiosyncratic. Something was happening at scale.
What I notice is genuinely difficult to answer: does the medicalisation of bodily dissatisfaction help men or harm them? Does giving a name to what they are experiencing validate the distress and open paths to addressing it, or does it pathologise what might be understood as a normal response to an impossible standard?
I do not have a confident answer. What I have is observations from the room that sit uneasily with both possible answers.
The men who arrived with a diagnosis, or with the language of one, were often more articulate about their experience. They had a framework. The framework provided some relief—the sense of being recognised, of having what they felt taken seriously by an institution with authority to take things seriously. But I also noticed that the framework sometimes seemed to close off other ways of thinking about the experience.
If the problem was a condition, the solution was treatment. And the treatment implied—at least some of the time—that the goal was to bring the man’s perception of his body into alignment with reality, to correct the distorted view. What I was not sure about was whether the view was distorted, or whether the view was an accurate perception of a real gap between the body the man had and the body the culture was showing him he should have. If the standard is impossible, and you know the standard is impossible, and you still feel insufficient against it—is that a disorder? Or is it a rational response to an irrational situation?
The research I have read gestures at this problem without fully resolving it. Social media passive browsing increases drive for muscularity, a Brunel University study of 224 physically active men found. The men in that study were not disordered. They were responding to images. The images were producing the drive. The drive was producing the behaviour. At what point in that sequence does the clinical category enter, and what does it add when it does?
I find myself returning to a distinction I have made elsewhere: between the body and the meanings that have been attached to it. The body the men carried was real. The standard against which they measured it was a construction—a construction with a specific history that I have been tracing from the Greek gymnasium through the Renaissance nude through the Victorian regulation through the advertising image and the narrowing visual vocabulary of contemporary media. The dissatisfaction was real. The object of the dissatisfaction was, in some important sense, not.
Whether muscle dysmorphia manifests identically in Mumbai, Nairobi and São Paulo, or whether local ideals produce different presentations, is a question the research is only beginning to address. Most of the foundational studies were conducted on Western populations, and the clinical category was developed by Western researchers. What I have read about preliminary cross-cultural work suggests that the experience of bodily dissatisfaction in relation to muscularity is not unique to the West, but that the specific form it takes—what counts as the desired body, what registers as insufficient—varies with the local ideal. Is the disorder being exported alongside the ideal, which is being exported alongside the supplement industry and the gym culture and the social media platforms and the action figures that are 78% more muscular than they were in 1975?
I spent time, later in my practice, with men who had come from contexts where the dominant bodily ideal was different from the Anglo-Australian one I had been working with for most of my career. What I noticed was not that they were free of the kind of dissatisfaction I had been watching in Western men, but that the dissatisfaction had a different shape. The body they were measuring themselves against was not always the enlarged chest and defined abdomen of the Anglo-American fitness culture. It might be something leaner, or something differently proportioned, or something that combined muscularity with a skin tone or a specific kind of symmetry that the Anglo-American ideal did not emphasise. The gap was real. The gap caused real suffering. But it was a different gap, in the shape of a different ideal, in the body of a man who had been formed in a different place.
What the clinical category of muscle dysmorphia does with this variety, I am not entirely sure. The category was built on specific populations and assumes a specific form. Whether it adequately describes what happens in a man in Mumbai whose body is being measured against a Bollywood ideal, or a man in Lagos whose body is being measured against the Nigerian fitness influencer’s body, or the man from Darwin I wrote about in an earlier essay who is navigating five different frameworks simultaneously—I genuinely do not know. The research is catching up. The lived experience is already there.
The men who came to me in the later years of my practice were not primarily in the room because of the Adonis Complex. They were in the room for the same range of reasons that men had always come. But some of them carried the new vocabulary alongside the old experience, and the vocabulary had changed something about how they related to what they were carrying. They had a word for it. The word provided a kind of company—the community of the diagnosed, the validation of the institutional gaze. And the word also, sometimes, made it harder to feel the thing directly, because the thing had been processed through a category before it arrived in the room.
I noticed both effects, and I cannot tell you which was more common. I can tell you that the body, regardless of what it was called, remained the body. Warm, specific, various, there. The category passed through it without quite landing on it. The category described a relationship. The body remained the fact.
What I keep returning to is the action figure statistic. The figure a child played with in 1975 and the figure a child played with in 2000—the same character, the same name, an entirely different body. Nobody asked the boys who played with those figures whether the change was desirable. The change just arrived, in the hands of children, as what the body was. And then those children grew up and stood in front of mirrors and tried to work out why they felt insufficient.
That insufficiency has a name now. I am not sure the name helps as much as the naming implies it should.
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