1588

The Motorcycle Syndrome

BY ARMAND M. NICHOLI, II, M.D.

The author presents findings of an in-depth automobiles, accounts for 100 percent more
study of nine accident-prone motorcyclists injuries(9).
and outlines a previously undescribed syn- Provoked into action by these casualties,
drome in an attempt to elucidate the psycho- state and federal governments are passing
logical causes of the rapidly rising rate of laws aimed at reducing these alarming facts.
motorcycle accidents and deaths. Examining Medical and safety authorities, also strug-
the reasons why the motorcycle is partic- gling to curtail the accelerated rise in casual-
ularly dangerous to these patients, the author ties, have focused research primarily on
explores the specfic ego defect common to safety devices and other preventive measures.
them, their adaptive and defensive use of the The recent medical literature abounds with
cycle, the cycle’s symbolic meaning, and the articles dealing with types of injuries, treat-
unconscious conflicts it reactivates. He also ment of injuries, and the need for crash
suggests that this syndrome gives clues to helmets and other protective equipment(3-7,
understanding accident-prone drivers of 11-16). The American Medical Association
other motor vehicles. recently published a guide on motorcycle
safety “to help all physicians cut down this
T HE MOTORCYCLE, a pervasive symbol of tragic
death”(2).
and increasing toll of injury and
the “now” generation, has become a
lethal instrument of destruction. The emer- But this tragic toll of injury and death will
gence of the motorcycle in current films, continue as long as research focuses on the
television programs, books, and magazine vehicle only and neglects the driver. Physi-
articles, and in the parking lots of college cians thus far have paid little attention to
dormitories attests to its rising popularity. what is undoubtedly the most significant
Five million motorcycles will be in use this causal factor of all-the psychological. Al-
year, compared with fewer than a half mil- though recent research into automobile acci-
lion registered as recently as 1956(2). dents indicates an increasing interest in
As motorcycle sales have increased, how- emotional and psychological causes(1, 8, 17,
ever, so too have motorcycle injuries and 19-22, 26-30), virtually no such research has
deaths. Injuries and fatalities have escalated been carried out in reference to the motor-
to what physicians now refer to as “an epi- cycle, even though the motorcycle is 16 times
demic of trauma”(lO, 18, 23). Two years more dangerous than the automobile and
ago 2,000 people were killed and 250,000 causes five times more deaths per mile(9).
injured in motorcycle mishaps; this year A review of the world literature reveals a
5,000 people will be killed and close to a mil-’ marked poverty of research into the person-
lion injured in such accidents(2, 9, 25, 31). ality and character features of the accident-
A leading cause of death among college stu- prone cyclist.
dents, the motorcycle, driven by only ten Over the past few years I have observed
percent of the number of students who drive a group of patients manifesting unusual emo-
tional investment in the motorcycle and
sharing a number of general characteristics.
Based on a paper read at the 125th anniversary meet-
ing of the American Psychiatric Association, Miami One or more serious motorcycle accidents
Beach, Fla., May 5-9, 1969. was common among them. The motorcycle
Dr. Nicholi is with the department of psychiatry,
Harvard Medical School. His address is 872 Massachu- obtruded into their daily activities, their
setts Ave., Cambridge, Mass. 02139. repetitive dreams, and their conscious and
The author wishes to thank Drs. Carl Binger, Joel H.
Feigon, and Robert Gardner for their review of the
unconscious fantasies. The emotionally
manuscript. charged presence of the motorcycle in the

(64] Amer. J. Psychiat. /26:11, May 1970

ARMAND M. NICHOLI, II 1589

behavior and mental processes of these indi- syndrome are thefollowing:

viduals, the striking similarity of the symbol- I.Unusual preoccupation with the
ic meaning of the motorcycle, their tendency lnotorcl’cle. When the patient is not actually
to use the vehicle as both an adaptive and riding a motorcycle, he tends to daydream
defensive means of dealing with emotional continuously of doing so. The mere sound of
conflict, and the remarkable number of other a distant motorcycle stimulates vivid fanta-
characteristics common to these patients sies. Repetitive dreams involving motor-
document a recognizable clinical disorder cycles-some pleasurable, some terrifying-
that I have designated the “motorcycle syn- occur frequently. During therapeutic sessions
d ro iii e.” the patient associates freely to the pleasures,
This paper briefly outlines this syndrome fears, and fantasies related to cycling.
and attempts to elucidate the emotional and 2. A histor of accident-proneness ex-
psychological determinants of motorcycle tending to ear/v childhood. A tendency to
accidents. The syndrome comprises a cluster self-injury contributes to a long history of
of symptoms, the combination of which may lacerations, fractures, and concussions
be specific to those motorcyclists most sus- extending into the early years and, more
ceptible to injury. recently, to the occurrence of one or more
The findings presented here are from an serious motorcycle accidents.
in-depth study of nine motorcyclists, all col- 3. Persistent fear of bodily injury. Con-
lege students, most of whom were seen in scious and unconscious fears of mutilation
intensive, analytically oriented psychother- and death haunt these patients when talking
apy from one to three years. These patients, about or riding the motorcycle. They openly
suffering a serious ego defect stemming from discuss fear of castration. As with most
a distant and difficult father-son relationship fantasies, this one has some basis in reality:
and resulting in a tenuous masculine identifi- The loss of a testicle in a cycle accident is
cation, perceive the motorcycle as an essen- not unknown.
tial part of their body image. Satisfying an 4. A distant, conflict-ridden relationship
intense need to test a shadowy masculine with the father and a strong identification
self-image and to strengthen a fragile ego. with the mother. The relationship with the
the motorcycle becomes a highly charged father is characteristic. The patient sees the
object, with significant conscious and un- father as all-powerful, critical, and one with
conscious representation. whom it is hopeless to compete. Each pa-
The conscious attraction to and fear of the tient within my sample feared his father and
motorcycle parallels unconscious conflicts as a young boy learned to avoid him. The
relating to an ambivalence toward expres- fathers of these patients were in reality
sion of what the patient considers the mascu- highly successful in their careers. Several had
line part of himself. The relationship of the the unusual quality of being outstanding
vehicle to these unconscious conflicts com- both as athletes and scholars, making them,
pounds the driver’s anxiety, increases his of course, more formidable competitors.
tension, lessens his control, and makes him
As a child, the patient experienced a close
more susceptible to accidents. Although the
relationship with his mother but a gradual
motorcycle may be used adaptively, helping
alienation from her once he left home. I-Ic
the patient cope with certain types of diffi-
culties, the primary use of the cycle is de- continues to confide in his mother but also
fensive and maladaptive, interfering with sees her, like himself, as inadequate.
effective functioning. 5. Extreme passivity and inability to com-
The recognition and treatment of this pete. With the exception of motorcycle
syndrome may be an effective step in re- riding, little physical or intellectual activity
ducing the rapidly rising rate of motorcycle prevails. Although endowed with obvious
accidents and deaths in this country. potential, these patients, because of an in-
ability to risk failure, refuse to compete-
Characteristics of the Motorcycle
academically, athletically, or socially. They
Syndrome
study only under pressure of exams, partici-
The essential features of the motorcycle pate only in noncompetitive athletics, and

A mer. J. Psychiat. !26:/ /. May /970 (651

1590 MOTORCYCLE SYNDROME

form relationships only with those taking 8. Fear of and count erphobic involvement
the initiative. with aggressive girls. These patients charac-
These students seldom participate in extra- teristically depend on and fear tall, broad-
curricular activities. When they do engage in shouldered, sexually aggressive girls, girls
political activity, they adhere to the more who initiate relationships by expressing
radical, extreme, irrational, and defiant part admiration for the motorcycle or by asking
of the group; unexpressed hostility toward to ride it. With these girls the patients often
the parents, especially toward the father, is assume the passive role.
displaced onto the college or other institu- 9. impotence and intense homosexual
tion. More commonly, however, anger is concerns. An inability to maintain erection
directed inward, causing apathy, withdrawal, or experience orgasm is present in varying
and depression. Passivity and refusal to meet degrees. The sexual history ranges from a
any demands are the usual means of express- few traumatically unsuccessful experiences
ing aggression. for some to promiscuous activity for others.
Insomnia, sometimes accompanied by When sexual activity is mechanically suc-
fantasies of going blind, disturbs the late cessful the promiscuous subjects describe
hours. The resultant anxiety may lead to the experience as physically and emotionally
masturbation or a sudden motorcycle ride ungratifying. They rationalize impotence
through the night. Many spend the entire away on the basis of fatigue, alcohol, and
night “talking in the Bic” (a local cafeteria) drugs. They often attempt to alleviate anxi-
or “drinking beer in front of the tube.” ety resulting from failure to perform sexually
They go to bed at dawn, wake about three by riding the motorcycle.
in the afternoon, and then begin a routine Poor heterosexual performance raises
of aimless wandering. They attend few if any persistent doubts of masculine competence
classes, getting through courses with bor- and nagging fears of homosexuality. Al-
rowed lecture notes. Sleep, drugs, television, though not overtly homosexual, these pa-
and alcohol provide escape from a monot- tients feel uneasy with both sexes and with
onous, painful reality. The alcohol and all age groups.
drugs, of course, increase the risk of motor-
cycle accidents. Psychological Meaning of the
6. A defective self-image. In their associ- Motorcycle
ations and dreams they reveal deep-seated,
What symbolic meaning does the motor-
often unconscious, feelings of being ugly,
unintelligent, fat, weak, feminine, and de- cycle have for these patients? What conscious
feelings does this vehicle evoke and what re-
fective and frequently express a sense of
lationship does the machine have to uncon-
having “something missing.” They choose
to be passive, to avoid competition, lest they scious conflicts?
The motorcycle is a highly charged object
fail and confirm their negative self-image.
The motorcycle serves to compensate for with many levels of emotional appeal. At
this defective picture of themselves. first glance the noise, the dirt, the exhaust,
and the loud, angry roar of the engine sug-
7. Poor impulse control. Aggressive and
gest anal elements as the primary clue to the
sexual impulses are difficult to express.
machine’s symbolic meaning. Other aspects
Anger, especially anger toward the father,
-the appeal of the thrusting of the rider’s
is turned inward and accounts in part for
body into space, the intrusion of the deafen-
the patient’s passivity, depression, and ten-
ing noise into other people’s ears, the prac-
dency to self-injury. Early memories are re-
tice of keeping motorcycles in girl friends’
counted where unsuccessful attempts to
garages-suggest genital or phallic elements.
express anger resulted in loss of control,
Clinical evidence, however, proves such ap-
self-injury, and frustration. The self-destruc- proaches to be limited in scope and far too
tive tendencies contribute to the high inci- superficial. To call the motorcycle a phallic
dence of motorcycle accidents and fatalities symbol or to say that it demonstrates the
in this group, the motorcycle serving as an anal character of the driver adds little to
outlet for pent-up rage the patient can ex- our understanding.
press in no other way. Clinical material does make clear, how-

[66] Amer. J. Psychiat. /26:1!, May /970

ARMAND M. NICHOLI, II 1591

ever, that the motorcycle serves as an ex- like suddenly being free the noise is all you
...

tension of what the patient considers his hear ...there is a strength and power in it-
masculine self-the assertive, active, aggres- 52 horsepower. It’s masculine and makes me feel
sive, competitive parts of his psychological strong. I approach a girl on a cycle and I feel con-
fident. Things open up and I am much more at
makeup. That is to say, the motorcycle func-
ease.
tions as a powerful emotional prosthesis.
The patient’s lifelong avoidance of and While fully conscious that the motorcycle
tenuous identification with a highly compe- provides pleasures of full expression of
tent and critical father have left him inhibited masculinity, even to the physical sense of
and unable to effectively exercise the asser- orgasm, the patient also acutely senses its
tive components of his emotional makeup. potential danger. The machine both pleases
When he feels weak the motorcycle gives him and terrifies. It gives exhilarating pleasure,
a sense of strength; when passive, a “sense but pleasure always tinged with underlying
of doing something and getting somewhere”; anxiety. The vehicle is “an incredibly dan-
when effeminate, a feeling of virility; when gerous machine.” Whenever the motorcycle
impotent, a sense of potency and power; looms into the therapeutic hour, the patient
when withdrawn, a sense of assertion and inevitably mentions, as though to remind
himself, that there are grave dangers in
thrusting forward. These positive feelings,
motorcycling.
however, are never free from the haunting
awareness of danger. Fears of the Motorcycle
Physical Pleasure As the pleasures and thrills are described
in remarkably similar terms (from patient
Patients’ comments illustrate vividly the
to patient), so too are the anxieties and fears.
similarity in the conscious feeling produced
Two basic fears prevail: the fear of bodily
by the motorcycle. A 23-year-old graduate
injury and the fear of loss of control. Associ-
student who had suffered two serious motor-
ations to anxiety experienced while riding
cycle injuries within six months explained
the cycle lead to earlier fears, especially to
his recent purchase of a third cycle.
fears of physical illness or injury. Fantasies
Driving it is a very physical, almost sexual feeling of going blind are common. Fears of castra-
you accelerate fast and there is nothing be-
tion lie close to awareness. One patient
tween you and nature ... the wind blowing in
describing his motorcycle anxiety recalled
your face is a marvelous sensation it has ...

tremendous appeal my new machine

... has a
that whenever he rides he fears losing his
huge motor a big black
... bike with this ...
wallet and continually checks his pocket to
under me, I feel I can do anything I want but ...
see if it is still there. He associated to the
I treat it with a great deal of respect because it is masculine symbols of money and contra-
a powerful and dangerous piece of machinery. ceptives he carried in the wallet.
It’s an incredibly dangerous machine because Early difficulties with loss of control are
there is no such thing as a minor accident. also recalled frequently. The patient’s ten-
A bearded 22-year-old undergraduate who dency to “blow up” whenever in a threat-
purchased his first bike when a freshman ened situation forces his withdrawal early in
proffered a similar description. “Riding it life from all competitive activity. Other early
is doing something, getting you somewhere. memories revolve around his inability to
There is something new around the corner express anger, especially toward the feared
and you always have the feeling that things father; loss of control, killing the father, or
are about to happen. You can feel the cycle the father himself losing control and injuring
between your legs like a girl when she is next the boy are frequent fantasies. Recall of
to you.” Patients often describe the motor- specific early experiences with the father is
cycle as if it were alive. common: One patient, discussing his motor-
cycle anxiety, associated to a fishing trip
You sit as tightly on it as you can and all of a ...
with his father when a small b9y. He caught
sudden it responds to you. It’s a throaty, gutsy
kind of sound. To go from 30 to 70 miles per hour a fishhook in his eye and was left with per-
sends a quiver through you most people treat ...
sistent fears of blindness and mutilation.
a motorcycle as an animal they’re almost ... The key to understanding the psycholog-
human, you know it’s a thrill,
... a joyous thing, ical meaning of the motorcycle to these
Amer. I Psychiat. /26:/I, May 1970 [67]
1592 MOTORCYCLE SYNDROME

patients is this: Although the pleasures and to the curb and talk to any girl.” “I like the
fears of the motorcycle hover close to aware- image the motorcycle projects, and the ease
ness or obtrude into full consciousness, the it puts me at socially.” “I know I should sell
patient is unaware that these conscious fears the bike, but if I get rid of it, I know there
are the same but fully unconscious fears that would be nothing but me, and I fear that’s
have all of his life inhibited expression of not enough.” Inasmuch as the motorcycle
what he perceives as the masculine part of helps these patients feel more adequate and
himself. His inability to assert himself, in- helps them overcome their passivity, it serves
ability to express anger, and withdrawal an adaptive need.
from all competition into complete passivity The harmful, maladaptive, or defensive
can be traced through his associations to use of the cycle involves replacing construc-
infantile anxieties. tive use of time with relatively unconstructive
Fears of the motorcycle therefore relate activity. Charging through the streets on a
directly to long-term unconscious fears of motorcycle may give one a sense of moving
loss of control and of physical injury, which ahead, of doing, and of exerting oneself, but
in turn relate directly to an inability to ex- a false sense and a poor substitute for con-
press anger to what the patient perceives as centrated effort. Racing a motorcycle into
an overwhelmingly competent and highly the night may relieve the anxiety of rejec-
critical father. (It is interesting that the tion, failure, or a feeling of dissipation, but
motorcycle is often purchased against the it effects little change in conditions causing
father’s wishes. “Perhaps,” explained one the anxiety.
student, “he [father] forbids me to have a A loud, noisy, breathtaking ride on a cycle
motorcycle because he is envious of it.”) The may relieve apprehension over exams, but it
motorcycle, while helping to express the helps little in preparing for them. The cycle
assertive, competitive, and aggressive com- may simulate sexual feeling or even help the
ponents of the patient’s personality, also re- patient approach a girl, but it contributes
activates long-term unconscious fears that little to forming a meaningful relationship
have long inhibited and paralyzed these with that girl. The cycle may help express
components. Thus the peculiar ambivalence anger, but the self-destructive tendencies of
-i.e., the attraction to and fear of the these patients make a machine that can
motorcycle-that characterizes these pa- travel 120 miles per hour less than an adap-
tients. tive means of doing so.
Adding to these maladaptive aspects, the
Adaptive and Defensive Uses
patients’ conscious fears of the motorcycle,
The motorcycle serves both a helpful often based on a realistic awareness of its
and a harmful function-i.e., it is used both dangers, reactivate unconscious fears, in-
adaptively and defensively. The helpful or tensify anxiety, and lessen their control of
adaptive function involves attracting atten- the vehicle. These psychological factors
tion, giving a feeling of virility, and improv- make the motorcycle especially dangerous
ing, if only transiently, the patient’s inner to these patients and contribute to the high
definition. The cycle helps him express the rate of serious accidents among them.
more assertive, more active part of himself, The syndrome does not, of course, affect
the part that, having been inhibited and everyone who enjoys riding a motorcycle.
paralyzed, cannot otherwise find expression. Riding a cycle can undoubtedly be fun.
To this part the motorcycle serves as a Furthermore, it is a fast and economical
powerful emotional prosthesis. mode of transportation. But the difference
The patients speak freely of their need for between a healthy cyclist and one suffering
attention. Megaphones replace mufflers, the from this syndrome is a difference in ego
loud noise being a means of assuring atten- integrity. The latter, having a serious ego
tion. The powerful engine, the boots, leather defect, perceives the motorcycle as an essen-
jacket, and beard engender a feeling of tial part of his body image. He cannot give
strength and virility otherwise unattainable. it up. Without the motorcycle he experiences
“The only time I can really approach a girl a sense of “having something missing,” an
is when I’m on a motorcycle. I can roar up acute awareness of inadequacy. This partic-

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ARMAND M. NICHOLI, II 1593

ular ego defect and the specific use of the Discussion

motorcycle to compensate for it delineates
Space limitations permit only a cursory
this syndrome.
description of the essential features of this
Treatment syndrome, an allusion to the genetic and
dynamic features, and a brief sampling of
Because of their susceptibility to injury clinical material on which they are based.
and death, people suspected of suffering One disturbing question raised by the
from this syndrome ought always to be given phenomenon described here, however, bears
psychiatric evaluation. Severity of illness, mentioning. What makes the motorcycle,
degree of incapacitation, and risk of injury a relatively old-fashioned mode of trans-
from suicide or vehicular accident will estab- portation, suddenly so popular? And does
lish whether psychiatric treatment is neces- the high casualty rate merely reflect in-
sary. creased usage? Perhaps both the increased
Psychotherapy of patients with this syn- popularity of the motorcycle and the high
drome presents a challenge. The patient’s toll of injury and death result from an in-
severe passivity may pose a problem of mo- creasing number of people in our society
tivation. The patient often sleeps through afflicted with this syndrome. The conflict-
a therapeutic hour. However, the pain of his ridden relationship with the father, central
loneliness and purposelessness will usually to both the genetic and dynamic formulation
deter his leaving therapy. of this syndrome, may be but one facet of the
His depression may become severe enough increasingly fragmented family structure
to precipitate suicidal thoughts; the necessity that characterizes our culture.
to discourage him from using the motorcycle In a household obsessed with materialistic
during these periods is evident. With the acquisition, dominated by television and
patient’s homosexual concerns lying close other electronic gadgets, and confused as to
to the surface, care must be taken to avoid limits and basic priorities, meaningful rela-
homosexual panic. Because of the patient’s tionships between parents and children are
tendency to use the motorcycle for sudden exceedingly difficult to maintain. The time
departure to other parts of the country (one demands on the highly successful father,
of his primary defenses being avoidance), or on the many less successful fathers hold-
the level of anxiety during the hour must be ing two jobs for economic gain, result in a
carefully regulated. My experience indicates number of homes virtually without fathers.
that optimum therapeutic progress requires The sense of rejection, pervasive anger, and
a minimum of two sessions a week. An out- brooding resentment fostered by such an
going, nonthreatening male therapist may environment characterize not only the pa-
be preferable. tients described in this syndrome but a large
proportion of young people today.
Five-Year Follow-Up The question of specificity also bears
brief mention. Is this cluster of symptoms
The syndrome gives no clue to severity of specific simply to accident-prone motor-
illness. The degree of illness in this sample’ cyclists? Although only further research can
varied considerably. Duration of treat ment, answer this question, clinical data now being
consisting of two or three sessions per week, assessed indicate that this syndrome may
extended from six months to three years. provide helpful clues to understanding acci-
The patients’ gradual decathexis of the dent-prone drivers of automobiles and small
motorcycle and investment of emotion into aircraft as well as motorcycles.’
other objects and activities accompanied
progress in treatment. A five-year follow-up Summary and Conclusion
revealed that each patient went on to grad-
The motorcycle will kill 5,000 people this
uate work and, with one exception, married
year and injure close to a million. The emo-
a girl also in graduate school. The exception
dropped out of law school to undergo analy- ‘It has been reported that there is a similarity be-
tween the patients described here and a group of pilots
sis. All the patients had some difficulty in now being studied who have a history of multiple small
committing themselves fully to a career. plane crashes(24).

Amer. I Psychiat. 126.’!!, May 1970 (69]

1594 MOTORCYCLE SYNDROME

tional and psychological determinants of machine alleviates some forms of anxiety,

these accidents must be understood before it intensifies others, making it extremely
prevention of this carnage can be achieved. dangerous.
The motorcycle syndrome, a cluster of’ Poor impulse control, unexpressed anger,
psychiatric symptoms, may be specific to self-destructive tendencies, a propensity to
accident-prone cyclists. The syndrome in- use alcohol and drugs, and, most important
cludes the following: I) unusual preoccupa- of all, the patient’s unconscious fears that
tion with the motorcycle, 2) a history of the machine reactivates increase enormously
accident-proneness extending to early child- the hazards of the motorcycle. All of these
hood, 3) persistent fear of bodily injury, factors intensify anxiety, heighten tension,
4) a distant, conflict-ridden relationship with and lessen driver control.
the father and a strong identification with Early recognition of this syndrome by
the mother, 5) extreme passivity and inability physicians, prompt psychiatric evaluation,
to compete, 6) a defective self-image, 7) poor and psychotherapy when indicated will sig-
impulse control, 8) fear of and counterphobic nificantly lower the rapidly increasing num-
involvement with aggressive girls, and 9) im- ber of motorcycle accidents and deaths.
potence and intense homosexual concerns. Evidence exists that the motorcycle syn-
Suffering a serious ego defect that stems drome may provide clues to understanding
from a distant and difficult father-son re- accident-prone drivers of other vehicles.
lationship and results in a tenuous mascu-
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ARMAND M. NICHOLI, II 1595

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A stereotyped but unconscious despair is concealed even under what are called the
games and amusements of mankind.
-THOREAU

Amer. I Psychiat. 126.’!!, May 1970 (71(