Introduction
In the research, and as a phenomenon, the use of illicit performance- and image-enhancing drugs (PIED), such as anabolic androgenic steroids (henceforth steroids) and human growth hormones, has commonly been understood as either a concern for formally governed competitions in (elite) sports (i.e., ‘sport doping’) or a public health issue—thus, as a social/societal problem (Dimeo, 2007; Waddington, 2000). Tremendous investments have been made in researching drug use practices in relation to organized elite sports and how doping can be prevented to ensure the maintenance of highly held ideals concerning fair play (Waddington & Smith, 2009). In recent decades, however, scholars have increasingly recognized doping as both a societal problem and a public health issue (Brennan, Wells & van Hout, 2017; Christiansen, 2018; Van Hout & Hearne, 2016), and it has primarily been associated with strength training at various gyms, and within gym, and fitness culture per se.
It has often been suggested that the social impact of the gym and fitness environment, that is, the kind of mentality nourished and the socialization process occurring there, is key to understanding drug use outside the sphere of formally governed sports. In the late 1970s and early 1980s when gym and fitness culture expanded significantly (Andreasson & Johansson, 2014), reports also began to surface that recreational fitness doping had gained popularity among young people, as a means of increasing muscle size and improving physical appearance, among other things (Parkinson & Evans, 2006; Sas-Nowosielski, 2006). Initial discussions in the research and in the public discourse came to focus on male bodybuilders, their risk behavior, and their willingness to experiment with all sorts of substances in their pursuit of muscles and masculinity (Gaines & Butler, 1974; Klein, 1993; Monaghan, 2001). The cultural studies literature largely described the development of an underground phenomenon and culture, in which bodybuilding men (and some women) used doping to create extraordinary bodies, which were displayed in front of cheering audiences at bodybuilding competitions, or for that matter in front of mirrors at the gym.
Gradually acquiring the status of a mass leisure activity, however, gym and fitness culture has changed, as has the image of the gym since the 1970s (Smith Maguire, 2008). Today, all around the world, people are using these facilities to exercise their bodies and achieve success and health in everyday life (Andreasson & Johansson, 2014). In this ‘new’ culture, the highest goals and aspirations are commercialized and framed in terms of youth and health, and the modern fitness center is seen or displayed as a health clinic for ‘the masses’ (Sassatelli, 2010). Paradoxically, concurrently with cultural fitness trends and the idealization of an active and healthy life, the emphasis placed on the body and its appearance has contributed to persistent doping problems.
Although it is still the case that doping practices in this context are mainly connected to the art and sport of bodybuilding, the fitness geography is changing, and so is the doping demography. With little hope of fame or financial gain, non-competitive bodybuilders as well as ‘regular’ gym-goers are increasingly engaging in drug use practices (Locks & Richardson, 2012). Little by little, women have also entered the realm of fitness doping (Jespersen, 2012; McGrath & Chananie-Hill, 2009; Van Hout & Hearne, 2016). Thus, boosted by an increasing focus on and preoccupation with body image issues among both men and women (Andreasson & Johansson, 2014; Cash & Pruzinsky, 2002), the widespread availability of doping, and the growing prevalence among mainstream fitness groups internationally, the use of doping is still considered a growing public health issue in many Western societies (Christiansen, 2018; Van Hout & Hearne, 2016).
The global development of gym and fitness culture (which we will return to in Chapter 2) has been remarkable and parallels even more widespread processes of medialization and medicalization in Western societies. Extreme and muscular bodies are visualized in popular media, and bodies are trained and molded with the help of high-tech machines, or through franchised and commercially driven training programs. Different products (licit and illicit) have been developed to further boost performance and efforts to achieve fame. Largely, but not exclusively, all these processes boil down to one thing, the body, and how it is to be understood as a contemporary modern phenomenon. Thus, we live in an era of bodies in motion, of performance, muscles, swelling veins, and dreams of the right bodily proportions. Within gym and fitness culture, there has been a revolution of technologies of the self, and extending beyond this cultural context, people’s ways of relating to and understanding the body in contemporary society have changed noticeably during a relatively short period of time. This is not only a story about the development of tools and techniques to shape and show human flesh through exercise. Rather, it is about bodies that are in constant transformation through training, diets, plastic surgery, and the use of licit and sometimes illicit drugs. It is a story about the gradual emergence of a new gaze and way to relate to the human body. Fueled by the development of gym and fitness culture, among other things, the body has come to be perceived as plastic and ever transgressive. Largely, at the core of gym and fitness culture, we thus find a story about a body in becoming.
The development within gym and fitness culture originated from a subcultural and masculine phenomenon. Icons such as Arnold Schwarzenegger, and earlier Eugen Sandow, exemplified how muscles, masculinity, and extreme bodies were made. Today, however, gym and fitness culture have transformed and become an arena for transforming bodies and gender transgressions. The 1990s is something of a dividing line, when female bodybuilders started to challenge public conceptions of binary gender configurations. Bodies are made at the gym, but so is gender. Consequently, women’s gradual integration has helped rewrite the gender of fitness culture, and from being an almost exclusively masculine culture, this arena for working out has diversified in relation to gender, age, and ethnicity. Like a hub in this development of a particular body culture, the fitness revolution (Andreasson & Johansson, 2014), we find the promotion of an interest in developing the body, cherishing its abilities and performance, and its beauty. The question of health and balance is clearly present, but so is the negotiable line that is sometimes drawn between health, on the one hand, and excessive training, bodily disorders, and unhealthy lifestyles, including the use of doping, on the other.
Aims and Methodological Point of Departure
Within the context of recent developments in gym and fitness culture, the aim of this book is twofold. First, we aim to investigate and identify different processes through which a person becomes a ‘fitness doper,’ that is, the trajectories leading to doping. There is currently surprisingly little scholarship available that involves qualitative research on young people’s doping trajectories in this cultural context. To prevent doping, we need to understand the norms, ideas, and networks of people who engage in it, even though they (at least to some extent) are aware that there are risks and potential health costs associated with the practice. To develop effective prevention methods, we also need to understand the longitudinal processes through which the practice gradually becomes an option for the individual.
In what ways can different fitness doping trajectories and the processes of becoming and unbecoming a fitness doper be understood?
In what ways are the processes and cultural patterns of socialization and learning regarding fitness doping affected by demographic variables, such as gender, lifestyle, and age?
In what ways is fitness doping discussed, negotiated, and legitimized/normalized in the context of online communication and communities?
What kinds of perspectives on health, physical training, the body, and lifestyles do fitness dopers adopt, and how are drug use practices related to these perspectives?
What does a changing fitness doping demography entail as regards future challenges and implications in the research and in relation to existing anti-doping work and prevention strategies?
To address the above questions and aims, we have utilized a qualitative mixed methods approach, consisting of qualitative biographical interviews, observations, Internet material from online communications, and an overall ethnographic approach to the research (Fangen, 2005; Hammersley & Atkinson, 1995). As part of a larger project, the empirical material used can be said to derive from two datasets. First, we have conducted a longitudinal ethnographic study in which more than 30 fitness dopers have been repeatedly interviewed and followed over time, in training and everyday life. Second, we have looked into the ways in which doping is perceived and negotiated socially in the specific sociocultural context of an Internet-mediated, open online community called Flashback. In this community, anyone with an Internet connection can learn about doping and comment on their experience and knowledge of it. In our sampling of postings, we have primarily focused on themes connected to doping, in general, and fitness doping trajectories, gender, and health, in particular. In our analysis, these two datasets have been treated and understood as tightly interwoven and guided by the shared, overall aims, as outlined above (see Chapter 10 for further information on methodology and method).
Although the book takes an international approach to fitness doping, our data have mainly been gathered in a Swedish context, which calls for some initial comments. For example, the Swedish Doping Act (1991:1969), adopted in 1991, prohibits not only the possession and trafficking of doping, but also the presence of doping substances in the body. Since the 1990s, fitness doping has been associated with increasingly strict penalties and comprehensive anti-doping campaigns. To this end, and in an international comparison, fitness doping in Sweden can reasonably be understood as a marginalized cultural practice. We will return to this discussion on national variations in fitness doping policy and practice in Chapter 3.
Concepts and Terminology
Engaging in research on doping inevitably means becoming involved in morally loaded discourses (Christiansen, 2018). Within the formally governed sport context, for example, the ban on doping has been constructed in line with strong desires to ensure the value, spirit, and integrity of modern sport, building on the ideal that winning should be the result of honest excellence in performance, and nothing else (Beamish & Ritchie 2007, p. 105). Thus, cheaters in sport have been harshly condemned in the public discourse. In addition, in the gym and fitness context, doping has been described/analyzed in terms of deviance, marginalization, and destructive masculinities (Klein, 1993; Monaghan, 2001). Put differently, when discussing and researching doping, we are entering a specific social and cultural landscape in which our use of concepts and terminology is of great importance.
When talking about doping broadly in this book, we are primarily referring to activities banned by national legislation, including the use, possession, and/or selling of prohibited substances, such as steroids and human growth hormones (Lindholm, 2013). Discussing the use of doping may also be connected to the World Anti-Doping Agency (WADA), whose goal is to protect athletes’ health and safeguard the notion of fair play. Because it operates outside the sport context, however, this organization has a limited impact on doping use in the gym and fitness context.
As a means of stressing the contextual differences between doping in sport and doping in gym and fitness culture, terms such as ‘vanity doping,’ ‘fitness doping,’ ‘recreational doping,’ and the use of ‘performance- and image-enhancing drugs’ (PIED) have sometimes been employed in the gym and fitness context (see, e.g., Christiansen, 2009; Thualagant, 2012). So as not to predetermine the motives underlying different pathways to and from doping, we have chosen to employ the term fitness doping. We also talk about doping using the terms PIEDs. We have made these choices with the intent to explicitly emphasize the cultural context (fitness culture) of the form of doping in question and to, at the same time, not try to pinpoint the reasons for doping (see also, Andreasson, 2015).
Regarding terminology, we prefer the term ‘use’ for describing our participants’ practices, as opposed to the concepts of ‘misuse’ and ‘abuse,’ both of which are contested by scholars and morally loaded (Christiansen, Schmidt Vinther & Liokaftos, 2016, p. 2). Our goal here is to maintain an ethnographic approach to the research presentation, as we consider ‘use’ to be more reflective of the data gathered (cf. WHO, 2015). This does not mean, however, that we are denying that fitness doping may lead to or cause severe side effects in the form of physical and mental health problems. Although not the focus of this book, we are fully aware of the diverse documented side effects connected to the use of PIEDs, including increases in aggressive behavior and depression, acne, hair loss, disruption of growth, and damage to tendons, ligaments as well as the liver (ACMD, 2010; Kimegård, 2015). Furthermore, for women there is a risk of deepening of the voice, clitoris enlargement, menstruation irregularities, and reduced fertility, and for men, we also see gynecomastia, testicular atrophy, and erectile dysfunction (Evans-Brown, McVeigh, Perkins & Bellis, 2012). We are also aware that these side effects should be understood as dose related and to some extent dependent on how knowledgeable and familiar a user may be with different kinds of substances, and whether or not he/she seeks medical advice if needed.
Fitness Doping Prevalence
Although scholars have mainly focused on doping in sport (Dimeo & Møller, 2018; Mottram, 2006; Waddington & Smith 2009), there are also numerous studies of doping and drug use in the gym and fitness context (Christiansen, 2018; Kimegård, 2015; Monaghan, 2012). The results from these studies, however, present a somewhat scattered picture, and the extent of use is thought to vary greatly (Bergsgard, Tangen, Barland & Breivik, 1996; Brennan, Wells & van Hout, 2017; Pedersen, 2010). For example, a study on steroid use conducted in Cyprus showed that 11.6% of the young people at 22 gyms reported using prohibited substances for performance- and image-enhancing purposes (Kartakoullis, Phellas, Pouloukas, Petrou & Loizou, 2008), whereas in Sweden these figures seem to be lower, with 4% of women and 5% of men at fitness centers reporting personal experiences of fitness doping use (Hoff, 2013; Swedish National Institute of Public Health, 2011). The cultural context of gym and fitness has also been emphasized in the research, and in a survey conducted among gym members at 18 gyms in the United Arab Emirates, Al-Falasi, Al-Dahmani, and Al-Eisaei (2008) concluded that as many as 59% of participants believed that the risks of using steroids were outweighed by the possible benefits of the drugs. There are also studies indicating that fitness doping is decreasing. A US-based annual youth survey, for example, suggests that lifetime steroid use dropped to 1.2% in 2017, from being nearly three times as high at the beginning of the millennium (Johnston et al., 2018; Pope et al., 2014). In conclusion, our understanding of and research on the historical development of PIED use in the fitness context is not conclusive and to some extent still fairly rudimentary.
There are of course manifold explanations for why existing knowledge is limited regarding fitness doping prevalence and practices. First, standardized indicators have not proven to be fully reliable in measuring the percentage of doping users in a given population, whether it concerns sport doping or fitness doping, or any other forms of doping use for that matter (Christiansen, 2018). Second, traditional surveys have often been used to gather information on the extent of use in different countries, but just as in other research on sensitive and potentially stigmatizing topics, there are typically low response rates and underreporting, which may make it difficult to draw conclusions regarding, in this case, use of doping in the general population in a given country. Thirdly, we are dealing with a growing arena of online communication in which the handling and trafficking of drugs operate on a supranational rather than national level. In relation to this, researchers, as well as authorities, have found it challenging to grasp and once and for all define a clear sampling pool. This also relates to the fact that doping can be viewed as an umbrella term for a wide range of substances, some of which may be licit in certain countries but illicit in others. Therefore, it is not obvious that researchers and respondents understand the terminology used in the same way (see European Commission, 2014), although they may well understand whether the practice is accepted or viewed as a criminal or marginalized practice in a given society or context.
Analytical Framework
One important theme and focus of this book is the relation between the more subcultural phenomenon of bodybuilding, fitness doping and extreme bodies, and the more general approach to the body found in gym and fitness culture. What we are trying to elaborate on is the relation between a more ‘deviant’ and criminal activity and lifestyle, and the more common and normalized practice of using different means to promote a specific body ideal. This theme will be present throughout the book, and we will pay extra attention to how fitness dopers talk about, understand, and negotiate this relation. We have chosen to elaborate on this using the concept of subculture, and its relation to what can be considered hegemonic culture, that is, the sociocultural context and understanding of everyday life that is embraced by most people in society. We are, of course, aware that this distinction is difficult to make, and our intention is not to define once and for all where the line between the particular and the general should be drawn, but rather to use this gestalt as an intriguing and exciting point of departure.
In theories of subcultures, we often find a more or less clear distinction between subculture and mainstream or common culture . There is, of course, a varyingly complex relationship between what is ‘sub-’ and what is dominant or hegemonic (Johansson & Herz, 2019). Subcultures are frequently spectacular, but there is also a strong affinity between everyday culture and different subcultures (Baker, Robards & Buttigieg, 2015). The visibility, distinctness, and desire expressed in subcultural communities serve to recruit people to these kinds of subgroups. The perspectives on subcultures have also varied over time. According to Hebdige (1979), for example, subcultures are implacably incorporated into and consumed by mainstream culture. At the same time, and in contrast, Hodkinson (2002) argued that there is often a high level of distinctiveness, stability, and durability—in the sense of collective identity—fostered within subcultures. Thus, what we are studying here is the relationship between common and general sociocultural patterns in society and the more specific and distinct sociocultural patterns, communities, and lifestyles in which fitness doping is included. Naturally, defining mainstream or common culture is almost impossible. In a similar vein, what is regarded as subcultural varies greatly. Given this, we must be satisfied with trying to grapple with and understand the ongoing and changing relationship between more general and more specific sociocultural patterns in society.
A closer look at specific subcultures provides a clearer picture of their importance in relation to changing subjectivities (Johansson, Andreasson & Mattsson, 2017). In particular, we can see how subcultures are intimately interwoven with and tied into societal and cultural transformations. For example, ever since the 1970s, bodybuilding has been successively transforming into fitness. In this respect, it has gradually moved in the direction of becoming mainstream. The core values of the hard—bodybuilding—body, focused on muscle training, health, and asceticism, are, for example, very prominent in the contemporary fitness culture, as well as in the more common, dominant sociocultural patterns observed in many Western countries. What is interesting here is the process through which common culture gradually incorporates certain lifestyle attributes and values of the subculture of bodybuilding. Body techniques, discipline, and knowledge about how to transform the body are being transformed, marketed, and commercialized. Yet certain bodies are still labeled as ‘too’ extreme—that is, connected to unhealthy lifestyles, drugs, and narcissism—and are thus being marginalized from the more public domains of gym and fitness culture. The intricate interplay between the subculture and the processes of mainstreaming is a central mechanism in contemporary fitness culture. Some aspects of body ideals and lifestyles are incorporated into more general cultural trends, while other aspects are not.
If we explore the relationship between subcultures and the mainstreaming of certain values, opinions, and practices, it becomes apparent that certain subcultural values and sentiments gradually, and over time, tend to become normalized, accepted, and routinized ways of relating to, for example, the body, health, politics, and societal values. Subcultural expressions and styles become significant and worth studying when they affect the balance between what is subcultural and what is ‘common.’ Listening to people’s voices, narratives, and expressions also reveals micro-transformations of the subjective content found in subcultures and society. Looking more closely at the social-psychological and cultural level in relation to these fundamental societal changes also leads us to interesting analyses of how the more ephemeral aspects of subcultures—such as styles, clothes, values, and artifacts—can be understood as parts of more general transformations in society. At the same time, subcultures seem to—on a regular basis—recreate and reinvent themselves. This is also part of the fascination and desire involved in the constant interplay between subcultures and society, between ‘the extreme’ and ‘the normal,’ health and unhealth, as well as the criminal and legal.
This discussion of subcultures will be used as a way into the book. Adding to this, we will use other conceptual tools in the chapters—for example, gender and the concept of role exit . We prefer to introduce and explain these in the chapters where they are set in motion. Further, we will also develop our own theoretical lens and toolbox throughout the book, allowing us to suggest new conceptual approaches to addressing the relationship between subculture and common culture, which has been prominent in doping studies. Having said this, we will now turn to the structure and content of the book.
Readers’ Guidelines
In its presentation, the book has been divided into four parts. The first part consists of three chapters (1–3) and is intended to introduce and contextualize the subject matter broadly. In this introductory chapter, we have explained the general context and aims of the book, as well as the data underlying the results. We have also addressed some conceptual choices made and the theoretical and analytical framework from which the book starts out. In Chapter 2, we present an extended discussion of the historical development of gym and fitness culture, in general, and contemporary perspectives on fitness doping, in particular. This first substantial chapter is intended to frame the purposes of the book historically and culturally. In Chapter 3, we address fitness doping in a comparative manner, investigating how fitness doping can be understood in relation to, and how it is affected by, different national contexts and welfare state regimes. Situated within the context of a globalized and glocalized gym and fitness culture, we conduct a comparative analysis, focusing on fitness doping in relation to policy, practice, and prevention in the USA and Sweden. Here, we also address the complex interplay between various supranational structures and global systems of anti-doping work and campaigns, on the one hand, and diverse local implementations of prevention policies and the development of national fitness doping cultures, communities, and practices, on the other.
The second and third part of the book constitutes the main empirical contribution, and it is here we explicitly address our twofold aim. The second part, Doping Trajectories, consists of Chapters 4–6. In Chapter 4, we let the reader become acquainted with some of the men and women who have generously shared their experiences and views. Through personal portraits in the form of case studies, we describe a number of fitness dopers and their trajectories to fitness doping, as well as their perspectives on training, muscles, gender, and more. In Chapter 5, we develop the discussion initiated in previous chapters on doping trajectories and employ a cultural and sociological perspective, focusing on the processes of becoming and unbecoming a fitness doping user, and how doping is negotiated in relation to ideas and ideals concerning health, gender, Swedish law, and thoughts about individual freedom, among other things. Here, we also consider the question of sporting background and fitness dopers’ initiation into gym and fitness training. In Chapter 6, we focus on how fitness doping is perceived and negotiated socially in the context of an Internet-mediated, online community. Here, we are interested in the ways in which the risks and health costs associated with drug use practices are negotiated, and in how ideas about the ‘genetic max,’ as well as the ultimate possibility of exceeding one’s limits and creating something special and extraordinary, circulate in the imaginary world of online muscle-building and drug use practices.
The third part of the book, Doped Bodies and Gender, consists of Chapters 7 and 8. In Chapter 7, we describe the gendering of doped bodies in the fitness doping research. Specifically, we focus on the kind of masculinity that historically has been attached to our understanding of the reasons for fitness doping. Here, we dissect and analyze the construction of masculinity and drug use practices in gym and fitness culture. We discuss how our participants in some ways conform to gender fantasies that rest on binary understandings of gendered, doped bodies, but also how different negotiations and inclusive subversions of traditional gender norms are manifested in male users’ narratives and in online communication. In Chapter 8, we also use both interview material and data from various postings on a pro-doping online community, but here, the focus is on female fitness dopers and how they understand and negotiate their use in relation to gender and the body. In the chapter, we discuss to what extent women are increasingly invited to and have become more integrated into a fitness (doping) community and subculture, and the consequences this inclusion may have.
Finally, in the fourth part of the book, Conclusions, we bring the threads together in a concise manner. In Chapter 9, we explicitly address the aims of the book and present some concluding thoughts on fitness doping trajectories and the gendering of fitness doping. Here, we also, in a more speculative vein, approach the question of how a changing fitness culture and doping demography are related to current and future developments in fitness doping and doping prevention. This part also contains Chapter 10, in which we explain the research design and methodology of the project(s) on which the book is based.