On October 24, Richard Ratcliffe began a hunger strike outside the UK Foreign Office. The aim of the protest is to draw attention to the fact that his wife Nazanin Zaghari-Ratcliffe is still detained in Iran and unable to return to her family after five and a half years of separation.
Zaghari-Ratcliffe was convicted in an Iranian court of plotting against the Iranian regime, which she has always denied. She has been held in Iran since 2016 and is under house arrest following a second sentence and failed appeal.
As a psychologist with an interest in the effect of fasting on brain function, I have followed Ratcliffe’s hunger strike closely. Two UCL colleagues and I visited him on day 12 and made a short film (below) of our conversation. I spoke with him about the effect of his hunger strike on his mental state.
He described feeling somewhat slower in his thinking and perhaps less able to switch from one topic to another. But he still struck me as an impressive character, greeting all sorts of visitors – from an MP who dropped by to chat, to an Iranian woman who had been detained in the notorious prison where Zaghari-Ratcliffe spent four years. Although still calm, determined and dignified, it was clear that the lack of food was starting to affect his thinking. For example, his speech was noticeably slower than in previous media interviews.
Four days after our conversation, Ratcliffe was interviewed on Radio 4’s PM programme. While still clearly passionate about his wife’s plight, he sounded increasingly fatigued and, at times, his speech was a little slurred.
Alongside the well-documented physical effects of going without food for this length of time, psychologists and neuroscientists have increasingly taken an interest in the psychological effect of such experiences.
Some aspects of thinking are surprisingly well preserved when people are in a state of starvation. An international review of short-term fasting studies did not find evidence that memory or reaction times were seriously affected.
But executive function, which includes planning, inhibition (holding back a response when it is inappropriate) and flexibility of thinking, seems to worsen when people are starved, although the effects depend on how few calories a person is consuming and for how long this restriction has lasted. Of course, the risk of increased rigidity in a hunger strike is that it becomes more difficult for the person to have the flexibility to decide when it is the right time to end their protest.
Studies of attention also suggest that this is also negatively affected by even short periods of fasting. However, a few studies have even suggested that repeated brief fasts may improve some aspects of concentration and memory and even reduce depressive symptoms. But, of course, this is quite different from the extended hunger strike that Ratcliffe has been undergoing.
Uncharted territory
Part of the difficulty in understanding the effect on Ratcliffe is that research studies have not asked people to starve for longer than about four days, because it would be unethical. The studies we reviewed in our recent paper looked at periods of fasting of between four hours and four days, so Ratcliffe is now in uncharted territory.
Those who fast for spiritual reasons commonly report altered states and feelings of being purified and recharged. A study by our group showed that both positive and negative emotions can increase following a period of fasting. While negative emotional states can include increased irritation, some people also reported an increased sense of achievement, reward, pride and control.
Of course, people’s emotional reactions are likely to depend on the reason they are not eating, whether this is for religious reasons, health reasons, for research or – as in Ratcliffe’s case – for ideological reasons. Ratcliffe’s frustration at his wife’s continuing detention may be enhanced by the hunger strike, but any sense of achievement and pride he may feel at doing something so difficult may be dampened by his discussions with the UK’s foreign secretary, Liz Truss, in which he reports that there was no change in the government’s approach to breaking the deadlock with Iran.
Lucy Serpell is affiliated with North East London NHS Foundation Trust
