Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

Saturday, August 8, 2026

Hikikomori

Hikikomori (pronounced hic-hee-kee-koh-moh-ree)

(1) A mode of behaviour in which an individual becomes a recluse from society, typically remaining isolated, sometimes for decades, in a single room at home.

(2) An individual exhibiting this behaviour for a sustained period.

1990s: From the Japanese noun 引きこもり or 引き籠もり (hikikomori), (literally “pulling inward; being confined”), from the verb hikikomoru (引きこもる).  The construct was 引く (hiku) (to pull, to draw back, to withdraw) + 籠る or こもる (komoru) (to shut oneself away; to remain secluded; to stay inside).  So, the literal translation is something like “to withdraw and remain shut in” but, used to mean “one who has withdrawn into seclusion”, the more common verbal shorthand is “shut in” (in the sense of “acute social withdrawal” or something in that vein).  Although once regarded as a uniquely Japanese phenomenon, it’s not now thought culturally specific, that perception a product of the condition and its extent first being widely documented in Japanese publications.  In Japan, the usual clipping is hikki.  Hikikomori is a noun; the noun plural is plural hikikomori or hikikomoris.

The element komoru is not recent; historically it referred not only to people but also generally to the concept of “being shut away or enclosed” or natural features such as a mountain at times when it was encircled by clouds or a land mass visible only at low tide (a tidal island or tombolo (a sand bar or path of dirt that connects this land to the coastline when the tide falls)).  More typically however it was use of individuals opting for whatever reason to “remain indoors” (such as those who, for religious reasons, might retreat to a mountain hermitage, either for a period of contemplation (that might last a lifetime) or to escape a society they had come to view as in some way “unsatisfactory”.  The concept of hikikomori is different in that those “afflicted” are not deemed to be motivated by a religious calling or philosophical position but instead “suffering” a visceral reaction to the condition of society or their life, manifesting as an urge to retreat from the outside world to a “safe” enclosed space.  This aligns with the modern use in psychiatry.

So use of the verb hikikomoru goes back generations but the noun hikikomori came into use only in the 1990s when the psychiatric sense was popularized in the book Shakaiteki Hikikomori: Owaranai Shishunki (Social Withdrawal: Adolescence Without End, 1998) by Japanese psychiatrist Dr Tamaki Saitō san (b 1961).  For reasons both structural and historic, it’s rare for concepts in psychiatry to have origins in Japan so hikikomori enjoys an unusual place in modern nosology (the characteristics or scientific understanding of a specific disease).  Internationally however, hikikomori “caught on” and became part of the standard jargon; that was not because there was any particular interest in categorizing uniquely Japanese phenomena but because clinicians in other places had for some time been aware the behaviour was not uncommon in their countries.  The Western media soon took an interest in hikikomoru because editors knew stories about “disaffected adolescents locking themselves in their bedrooms for years” would be good productive clickbait, readers likely to be attracted by tales of troubled geniuses or depressed emos.

The companion terms are the English language acronym NEET (Not in Employment, Education or Training) and the Japanese オタク (Otaku).  Otaku (best translated as “geek” or “nerd”, reflecting the bias in use towards computers or other tech) emerged from fandom community associated with Macross (a Japanese science fiction mecha anime media franchise), the use derived from お宅 (otaku) (you), from the honorific form (taku) (home), thus the notion of Macross being “your home” (ie one’s natural environment”).  From the Macross obsessives, use extended to “obsessive interest in something” (especially (and often exclusively) Japanese anime or manga).  While originally a derogatory term, fandom communities “reclaimed” otaku as a self-descriptor although it does continue to be applied disparagingly.  In the West, it tends to be neutral, used to refer to anyone with a strong interest (obsessive or not) in anime or manga.  NEET is applied not to all those “unemployed” but only those thought apathetic or who exhibit the characteristics of a hikikomori but in sub-groups, the play on words with the English “neat” (in the sense “excellent, desirable; interesting; cool”) prevails.

Mental Health Daily's choice of an image capturing the hikikomori experience.

The hikikomori came to be known as “the lost generation” and that it was a thing identified in the 1990s and celebrated (in a sense, that can be the right word) in Dr Saitō san’s 1998 book is interesting because it was the 1990s that came to be known as “the lost decade”).  Although there were of course the inevitable fluctuations in the growth curve, over the 40 years between 1949-1989, the trend for the Japanese economy in most indicative measures (GDP (gross domestic product), GNP (gross national product), RPP (relative purchasing power), AMWE (average male weekly earning), corporate profits, exports, trade surplus etc) tended upwards and while, given the country’s paucity of natural resources, that was an achievement in some ways even more remarkable than the Wirtschaftswunder (“economic miracle”) witnessed in the FRG (Bundesrepublik Deutschland (Federal Republic of Germany; the old West Germany, 1949-1990) over the same period, the stellar performance was not without consequences and some of those consequences triggered reactions.  The strength of Japanese economy was by the 1980s producing notable distortions in the world’s production and trading systems and that of course affected currencies, as aspect of the international system distorted still further by this happening at a time when currencies weren’t allowed to “float” to the extent now familiar, governments and central banks (in some places, for this purpose, the distinction between the two institutions not significant) sometimes literally “setting the rate” by fiat.  All this required trips to Tokyo by the US Treasury Secretary to negotiate the devaluation of the US dollar and it was in the 1970s & 1980s the deindustrialization of the US economy really began, later forces such as automation, computing, the CCP (Chinese Communist Party) proving most adept at capitalism and AI (artificial intelligence) being building blocks in what continues to evolve as the “new model”.  US politicians of course responded to this by inducing Japan, the FRG and others running substantial trade surpluses with the US to shift some production to the US and that to some extent reduced the imbalances but, factories and assembly lines in the 1980s not being what they were a generation earlier, US employment levels or incomes certainly weren't restored.

The Japanese economy continued to flourish and the fear in the US was often expressed as “Japan taking over the world”.  That this might be done by the use of Japanese money was a thought bad enough but to add insult to injury, much of the money was in US dollars gained by Americans paying Japanese companies for the sort of stuff once manufactured in their now shuttered factories.  Against that threat, the world’s most potent military (a chunk of which was allocated to the defense of Japan) and an impressive arsenal of thermo-nuclear weapons able to be delivered anywhere on the planet was not a great deal of help.  What was a help was economic reality because by 1989 one part of the Japanese economy had developed into a disproportionately large bubble; at this bubble’s peak, the notional value of Tokyo real estate market was greater than the entire continental US.  Although obviously not something that could have been realized in the “real world” (ie had every piece of real estate in Tokyo been offered for sale at its nominal valuation), the numbers were indicative of one of economic history’s most notable imbalances.  In a kind of national hubris (an exuberance as “irrational” as anything seen since the Dutch “tulip bubble”), the combination of extreme over-confidence by speculators and ultra-loose credit policies by lenders had resulted in land values in Japanese cities (Tokyo the most extreme example) coming to be decoupled from economic reality (and, because of the “extrapolation effect” by which especially the value of commercial floor-space was calculated within markets), ultimately, basic mathematical reality too.

Hikikomore by 1gorman on Deviant Art.

An (extreme) example of a similar disconnection from reality would be Donald Trump (b 1946; POTUS 2017-2021 and since 2025) applying the metrics and methods of valuation (that for decades have served him well) to news cosmologists had used their new “big telescopes” to discover a “perfect Earth-like” planet (one of the so-called exoplanets (any planet located outside of our solar system)) a “mere” hundred light-years distant.  Obviously, this planet (or at least what it was a century ago). with an ideal climate, ample resources, stable geology etc, would contain much desirable real estate so the valuations attached to this unspoiled paradise would’ in other circumstances, be high.  There might be some uncertainly if it couldn’t be determined if the place had inhabitants (on Earth such folk have proved troublesome in land-grabs) but that’s just something speculators have to “factor in”.  The problem however is that however desirable might be the exoplanet’s lands and seas, they’re a “stranded asset” because of the distance from Earth; we cannot contemplate travelling a single light-year, let alone a hundred.

Safely tucked up: Lindsay Lohan in Hikikomori mode.

So distance can be an intrusive reality, “stranding an asset”.  That’s what the math in 1989 did to Japanese real estate values, the extrapolated numbers meaning floor space in office buildings became at once “the most expensive on the planet” and unrealizable as convertible into cash; the asset became stranded in its bubble.  Still, the frothy days of 1989 must trigger a warm glow of nostalgia among the few able to take their profits and “exit” before the crash of 1990.  When the “bubble burst”, the effects were profound because, unlike the Dutch “tulip bubble” now understood to have had relatively little long-term effect on the wider economy of the Netherlands, in Japan, the crash in the real estate market trigged a cascade of consequences affecting the stock market, over-exposed banks and the wider economy.  In retrospect, that it was a bubble seems so obvious but then, in retrospect, much often does: In 1989, the cumulative value of the Japanese property market was four times that of the US (the latter with more than twice the population and 25 times the land mass); metropolitan Tokyo alone was worth more than the entire continental US and the 1.15 km2 grounds of the Imperial Palace were valued at up to US$5.1 trillion (greater than the entire state of California).  So assets can become “stranded” in a number of ways but the concept is much the same: Whatever may appear the “book value”, if this number can never be translated to “real” economic value (not necessarily cash), that asset is stranded.  The Gaza strip is less distant from New York’s Trump Tower than the desirable real estate on an exoplanet a hundred light away but, with a population tiresomely showing no wish to go somewhere else so sea-front resorts can be built, it may as well be as distant.

Four episodes of Welcome to the N.H.K. (note the “Parental Warning” advisor stickers).

Among the most intriguing of the anime projects was Welcome to the N.H.K., based on a series of novellas by Tatsuhiko Takimoto san (b 1978).  Featuring a very anime-friendly cast of characters (with all that implies), as might be expected in a work about hikikomori, the text explored issues such as social isolation, depression, anxiety and existential dread but the novelty was the appearance of the mysterious N.H.K. (Nihon Hikikomori Kyoukai (Japan Hikikomori Association), a Masonic-like institution responsible for the increasing number of recluses “shut up” in their bedrooms.  The hook is the tale is that the N.H.K. is the shadowy creation of NHK (Nippon Hōsō Kyōkai (Japan Broadcasting Corporation)), the national public broadcaster.

What came to be called “Japan's Lost Decade” of the 1990s was marked severe economic stagnation, a “banking crisis” (bad loans left sitting on the books as if there was a prospect of repayment), a stock market collapse and deflation.  Between 1989-1991 the Nikkei 225 prime index would slump from near 39,000 to around 6,600 and in an era when many governments were fretting about apparently “entrenched” inflation, in Tokyo, what was being observed was deflation.  Central bankers at least know how to “fix” inflation (they engineer a recession), but deflation is a fabulous beast that convinces people not to spend because they know the same commodity will next week likely be cheaper; like the inverse process in an inflation-ridden state, deflation “feeds on itself” in a spiralling “feedback loop”.  Solutions proved elusive.  While central banks fighting inflation could continue raising interest rates until the pain of spending became too much for consumers, the concept of “negative interest rates” (ie one has to pay the bank to store one’s money) was of limited utility because savers’ “work arounds” to evade this would likely make the situation worse before it induced them to open the purse-strings.  Pulling the textbook off the shelf, after blowing off the dust, Japanese governments embarked on “fiscal stimulus programmes” that (with borrowed money) sustained banks continuing to loan to anyway insolvent borrowers, this creating both “zombie banks and “zombie companies”; institutions “not alive yet not quite dead”.  If anything is likely to stifle efficient resource reallocation in an economy, it’s having “zombies at scale”.  In a quirk of the uniqueness of the Japanese economy however, although government debt is now somewhere between 210-240% of GDP (the methods of calculation can vary) this is said “not to be a problem” because so much of the debt is in Yen and locally held (a benefit of all that saving induced by living in deflationary times).  Like the US government debt of US$40 trillion odd (120-135% of GDP), it may take some time before it’s confirmed whether or not these numbers are “a problem”.


Why I Became a Hikikomori (Shut-In), SillyPau explains.  Now we know.

All this happened in conjunction with GDP consistently under 1% and an aging population (a demographic trend that had become structural and continues to this day) and while those “salary men” in employment tended to remain so (although suffering “career stagnation”), the young, despite graduates being the most educated in history, faced what was dubbed the shūshoku hyōgaki (employment ice age), the jobs available for most being low paid, unstable and often non-permanent.  For a generation brought up with high expectations and a sense of unlimited possibilities, it was an unpleasant welcome to the new decade that would come to be called “the lost decade” and even that proved optimistic; by early in the twenty-first century the use had been updated to “lost decades” as the sluggishness persisted.  While it had come to be understood things were not going back to what they were in the happy days of 1989 (because what then was “was not real”), the young in particular still longed for something better.

Some continued their longing and some “just gave up”.  It was in the 1990s the “lost decade” produced the “lost generation” that came to be called the hikikomori, withdrawing from a society that seemed to offer little other than a dreary, meaningless existence.  By becoming recluses hardly ever leaving their bedrooms, maybe that was just another form of meaningless dreariness but at least it was on their terms and lent life some sense of “control”, illusory though that may have been.  According to Japanese researchers, the number of hikikomori had by 2024 grown to over a million and the phenomenon has, on a smaller scale, been noticed in other countries.  In Japan, having a million-odd modern-day hermits sitting in their bedrooms refusing to face the outside world remains unlikely to do much to stimulate the economy or the rapidly declining birth-rate.  Indeed, in mid-2026, the Ministry of Internal Affairs and Communications disclosed the population of domestic citizens had for the first time fallen below 120 million, a 0.76% decrease from the previous year; with 670,467 births against 1,593,475 deaths, deaths are outpacing births by more than two to one.

If something is happening in Japan, there will be anime documenting it in every aspect.  Titles include ReLIFE (2016), Recovery of an MMO Junkie (2017) and the ominous sounding Forbidden Deductions (2023).

Some have argued there is an element of technological determinism is all this.  Whether or not one chooses to label it “internet addiction”, there’s no doubt the ecosystem of the web and apps (especially hyper-realistic gaming) had made it possible as never before to lead a kind of fulfilling life without ever leaving one's bedroom.  With accommodating parents (an ample supply found in Japan) and a good internet connection, the bedroom can become one’s universe, a place without the awfulness one know lies beyond one’s four walls.  There is nothing new about those who either cannot cope with or have no wish to deal with the demands of modern society retreating to the margins but, for the first time in history, it has become possible for these recluses to exist in a rich, diverse, entertaining world that is wholly virtualized; relationships and even love affairs able to be conducted with AI (artificial intelligence) bots.  Because of the dynamics of the ways these bots can be constructed, many users (and by, implication, many hikikomori) probably find these relationships more satisfactory than anything experienced with one with a creature of flesh and blood; in many ways, for the tech industry, the COVID-19 pandemic was a “perfect storm”, contributing to some finding social isolation as “normalized”. The Japanese Government acknowledges hikikomori exists and defines it as something affecting people who have stayed at home for at least six months.

Hikikomori is discussed in the APA’s (American Psychiatric Association) DSM (Diagnostic and Statistical Manual of Mental Disorders) but not as a distinct mental disorder. Instead, it’s listed as a behavioral or psychosocial phenomenon that may occur in association with a variety of psychiatric conditions (and even, in some cases, without any diagnosable mental disorder).  In other words, the DSM treats hikikomori as a symptom rather than a pathology.  That would make sense to clinicians (if not all behavioural sociologists) and in DSM-5-TR (2022), hikikomori is mentioned in the section dealing with “Cultural Concepts of Distress”, the characteristics including (1) marked social withdrawal, (2) remaining at home (often confined to one room) for at least six months and (3) an association with significant functional impairment.  So, in the DSM, hikikomori is not classified as a separate diagnosis and clinicians are encouraged to consider whether the withdrawal is better explained by disorders such as: (1) autism spectrum disorder, (2) major depressive disorder, (3) schizophrenia spectrum disorders, (4) social anxiety disorder, (5) avoidant personality disorder or (6) OCD (obsessive-compulsive disorder).  If a patient seems not a good fit for any of those, helpfully, the DSM includes (7) other psychiatric illnesses and presumably, that cohort will be thought diagnostically the most interesting.  It would not be surprising if the profession settles on an acceptance of hikikomori as something transdiagnostic, a behavioral endpoint that can arise from various causes.

The Hikikomori: The Girl Who Couldn't Go Outside (2022) by Mark Vrankovich.

There is much thematic variation in hikikomori literature, ranging from the hopeful to the nihilistic.  There are also redemption tales.  In The Hikikomori: The Girl Who Couldn't Go Outside, Miko Nishimura san is a hikikomori who has become convinced she is the most insignificant person in Japan.  Crippled by anxiety, she never leaves her bedroom, occupying just about every waking moment playing racing games (she’s a most modern girl) on her computer.  However, a crisis ensues when the batteries in her wireless mouse die during a time when her parents are absent.  It’s made clear not many things could induce Miko san to leave the house but not being able to continue her gaming was such a rare  circumstance.  Miko san should of course have had spare batteries to hand (or, better still, used a wired mouse needing no batteries) but what’s done is done and can’t be undone and she knew she was compelled to make the terrifying trip to the shop to buy new batteries. As courageously she ventures forth, what unfolds is a tale intertwining contemporary Japanese culture, ancient magic powers and the finding of love.

Although in the west there’s a long tradition of “the recluse” (from the briefly installed Celestine V (circa 1212-1296; pope Jul-Dec 1294) to the film star Greta Garbo (1905–1990) and the multi-faceted Howard Hughes (1905–1976)) when in 1998 Dr Saitō san published his book, it seemed in the West fashionable to see hikikomori as something culturally specific, an example of one of the tradition-bound syndromes that delight writers who regard “Japanese weirdness” as the last acceptable form of the “orientalism” that was for decades a standard paradigm of academic and popular analysis of stuff east of Suez.  It’s still claimed (though increasingly unconvincingly) there are many of these “Japanese” syndromes relating to fields such as education, employment the family and attitude to psychiatric treatment but the modern view is that in these matters, between Japan and other cultures (certainly in East Asia), there are as many similarities as differences.  It has also become clear hikikomori–like behaviour exists in clinically significant numbers in a number of countries including South Korea, China, Hong Kong, Singapore, Spain, Italy, France, New Zealand, Canada, the US, Australia, the UK, Brazil and India.  Despite that, it is still most associated with Japan because it was there first identified (a la the “Spanish flu” process of 1919) but there’s no doubt the conjunction of the nation’s “lost decades” and the subsequent overlays of (1) the internet, (2) social media, (3) the COVID-19 pandemic and (4) consumer-packaged AI algorithms that made possible “life-like virtual relationships” created economic and social conditions that made the phenomenon both more prevalent and visible.

Wednesday, July 29, 2026

Agastopia

Agastopia (pronounced agg-uh-stow-pee-ah)

Deriving visual enjoyment from the appearance of a specific body part or parts (some suggesting the attraction must be fetishistic to cross the threshold from admiration to syndrome).

2011: A coining of etymologists Peter Novobatzky & Ammon Shea who included it in their 1999 book Depraved English (sub-titled: "The most disgusting and hilarious word book ever", a title debatably hyperbolic but that adequately captured the intention).  While not exhaustive, there was an entry for maschalephidrosis (runaway armpit perspiration), the construct being the Ancient Greek μασχάλη (maskhálē) (armpit) + hidrosis, from the New Latin hidrōsis, from the Ancient Greek ἱδρώς (hidrṓs) (sweat) + -sis (the suffix in medicine used to form nouns of condition) so there were certainly highlights.  The construct of agastopia was the Ancient Greek γα- (aga(s)-) (very) + -topia (a back-formation extracted from utopia (and other words) ultimately deriving from the Ancient Greek τόπος (tópos) (place).  Utopia was from the New Latin Ūtopia, the name of a fictional island possessing a seemingly perfect socio-politico-legal system in the 1516 book Utopia by Sir Thomas More (1478–1535).  The construct was the Ancient Greek ο (ou) (not) + τόπος (tópos) (place, region) + -ία (-ía) (the New Latin suffix, from the Latin -ia and the Ancient Greek -ία (-ía) & -εια (-eia) which formed abstract nouns of feminine gender.  More’s irony in calling a world in which everything and everyone works in perfect harmony being best translated as “not a real place” is often lost in modern use and the word probably has genuinely undergone a meaning-shift.  Agastopic is a noun & adjective, agastopia is a noun and agastopically is an adverb; the noun plural is agastopias.

Agastopic: Studies of the soles of Lindsay Lohan's feet in three aspects.

Although in non-clinical use there had not previously been a generic descriptor of part-focused voyeuristic fetishism, there’s no suggestion Novobatzky & Shea thought their coining a "serious" contribution to the taxonomy of mental health but some commentators have adopted it, fleshing out the definitional range.  It’s been suggested the condition manifests as (1) a love or admiration of one’s own body part, compelling either a fondness of performing a particular task with it or a preference to cover and shield it with a protective layer or (2) the more familiar admiration of another’s body part(s).  Some sources, without citation, note it’s “…believed to be a rare condition” and (presumably tongue in cheek), one for which there’s “… no cure.  Despite these helpful nudges, when the fifth edition of the APA's (American Psychiatric Association) Diagnostic and Statistical Manual of Mental Disorders was published in 2013 (DSM-5), there was no specific mention of agastopia and this was maintained when the revised version (DSM-5-TR) was released in 2022.  Still, for clinicians who find it convenient quasi-medical jargon, presumably a patient found to be "fond of certain body part" without "fetishising" it (or them) would be found to be "agastopish"; fetishes also intrinsically spectrum conditions, the comparative would be "more agastopic" and the superlative "most agastopic".

In an agastopic moment: The artist moved to despair at the grandeur of antique fragments (circa 1778), drawing in red chalk with brown wash by Henry Fuseli (Johann Heinrich Füssli (1741–1825)).

The notion agastopia is “believed to be a rare condition” might be based on some obscure statistics but certainly is a reflection on (1) the profession no longer regarding (most) such things as diagnosable conditions unless certain criteria are fulfilled and (2) the general consensus most instances of agastopia (being untroubling) are never reported to a clinician.  In other words, "believed to be a rare condition" probably is better expressed a "known to be a rarely reported condition".  Impressionistically, the likely real-world experience is that the prevalence of agastopia in a subset of the population doesn't justify funding the research and agastopia should not wholly be conflated with the various fetishistic interests now listed in the DSM as "particularisms" although overlap obviously must exist.  Nor is agastopia something exclusively either a male preserve or sexually focused, some women known to enjoy (in both senses) an agostopic relationship with their hair or fingernails.  In the days when two of the most significant vectors for the distribution of pornography were magazines (that although with glossy covers should not be confused with "the glossies") and various digital media (tapes and optical discs), both forms provided content devoted to or thematically inclinded towards one body part or another, something carried over to the internet when websites became the default mode.  Among the pornography aggregation sites, it’s not unusual for body parts or attributes (and not just the old "usual suspects") to be listed as categories for consumers with a particular agastopic or fetishistic focus.

Highly qualified content provider Busty Buffy (b 1996, seen here plantar flexing), whose feet seem never to command the attention they deserve.

So, thus compartmentalized, agastopia is a thing existing at a commercially critical mass.  ‘Twas perhaps ever thus but what has in recent decades changed is the attitude of the mental health community.  Before the release of DSM-III-R (1987), fetishism tended to be described as a persistent preferential sexual arousal in association with non-living objects or an over-inclusive focus on (typically non-sexualized) body parts (most famously, feet) and body secretions.  With the DSM-III-R, the concept of partialism (an exclusive focus on part of the body) was separated from the historic category of fetishism and appended to the “Paraphilia Not Otherwise Specified” category.  Although one of the dustier corners of psychiatry, the field had always fascinated some and in the years since the DSM-III-R was published, a literature did emerge, most critics maintaining partialism and fetishism are related, can be co-associated, and are non-exclusive domains of sexual behavior.  There was a technical basis for this position because introduced in the DSM-IV (1994) was a (since further elaborated) codification of the secondary clinical significance criterion for designating a psychiatric disorder, one of the implications of which was it appeared to suggest a diagnostic distinction between partialism and fetishism was no longer clinically meaningful or necessary.  The recommendation was the prime diagnostic criterion for fetishism be modified to reflect the reintegration of partialism and that a fetishistic focus on non-sexual body parts be a specifier of fetishism.

Fetish was from the the French fétiche, from the Portuguese feitico, from facere (to make) which begat factitious (created; artificial).  A fetish in this context was defined as "a thing irrationally revered; an object in which power or force was concentrated".  In English, use of "fetish" to indicate an object of desire in the sense of “someone who is aroused due to a body part, or an object belonging to a person who is the object of desire” dates from 1897 (although the condition is mentioned in thirteenth century medical documents) and it was in the late nineteenth century the lexicon of modern psychiatry began to be assembled.  However, in the literary record, surviving from the seventh century AD are dozens of brooding, obsessive love letters from the second century AD of uncertain authorship and addressed to both male and female youths.  That there are those in whom an object or body part has the power to captivate and enthral presumably has from the start been part of the human condition.

Poster for Der Blaue Engel (The Blue Angel, (1930).  Marlene Dietrich (1901-1992) understood (and exploited) herself as a “fetishized object” but her construct was as knowingly artificial as was Blue Angel of most of Weimar Berlin.

One obvious linguistic virtue of “agastopia” is it can be used as an alternative to “fetishism”, the latter a word with the power to mislead or distort meaning because of the associations vested by popular use although some estimable writers have found “fetish” indispensable while maintaining clarity.  In The Dark Valley: A Panorama of the 1930s (2000), a study of the politics on that troubled decade in Europe and the US, English historian Piers Brendon (b 1940) used “fetish” in the way most familiar when writing of a certain aspect of Berlin during the last days of the Weimar Republic (1918-1933): “Sleazy clubs offered anything from cocaine to fetishism and perversions abounded: one coven of coprophagists gorged a prostitute on chocolate, gave her a laxative and settled down to a feast.  There were so many homosexual bars, transvestite dance halls and nude cabarets that an enterprising publisher issued a ‘Guide to Vicious Berlin’.  Outside the palace at the bottom of Unter den Linden [literally “under the linden trees", a boulevard in the central Mitte district running between the Brandenburg Gate and the Berlin Palace, the name gained from the linden (non citrus lime) trees lining the thoroughfare] were two stone lions, one of which was said to roar whenever a virgin walked by.  If some of what was in the Christopher Isherwood’s (1904–1986) Goodbye to Berlin (1939) was an indication, the lion would not often have had to stir but literature can be highly selective, lives of most of the burghers in Weimar-era Berlin likely as stolid and respectable as stereotypes of Germans suggest.  While Isherwood and Marlene Dietrich painted captivating pictures of a decadent city, generally life was more prosaic.

Brendon however also applied “fetish” to attitudes expressed toward objects, institutions and concepts decidedly non-sexualized including “the Maginot Line” (a French border fortification that proved illusory), “rural conservation”, “the League of Nations” (1920-1945) and “liberalism”.  Of the last, perhaps gleefully, he documented L’Osservatore Romano’s (the daily newspaper of Vatican City) lauding of Benito Mussolini (1883-1945; Duce (leader) & Prime-Minister of Italy 1922-1943) as a man of the same mind as Pius XI (1857–1939; pope 1922-1939) and a “man whom Providence has sent Us (sic)... [who did not believe in the] “villainous fetishes of liberalism. The Holy See’s mouthpiece concluded by saying it was “…thanks to the Duce” that “Italy has been given back to God and God to Italy.  The extent of God’s gratitude can of course only be guessed but as the fate of Italian fascism (with the fall of Mussolini in 1943 it “burst like a bubble” in the unguarded phrase of German Generaloberst (Colonel General) Alfred Jodl (1890–1946, chief of the OKW operations staff 1939-1945)) suggested, the movement never became in Italy quite the fetish the Duce had hoped.

Of Foot Particularism: The DSM-5 Criteria

Criterion 1: Over a six month period, the individual has experienced sexual urges focused on a non-genital body part, or inanimate object, or other stimulus, and has acted out urges, fantasies, or behaviors.

Criterion 2: The fantasies, urges, or behaviors cause distress, or impairment in functioning.

Criterion 3: The fetishistic object is not an article of clothing employed in cross dressing, or a sexual stimulation device, such as a vibrator.

Specifiers for the diagnosis include the type of stimulus which is the focus of attention (1) the non-genital or erogenous areas of the body (such as feet) and this condition is known also as Partialism (a preoccupation with a part of the body rather than the whole person), (2) Non-living object(s) (such as shoes), (3) specific activities (such as smoking during sex).

WikiFeet is a wiki which curates users’ submissions of women's feet with a predictable emphasis on celebrities. The Lindsay Lohan page contains 3639 images with the WikiFeet community rating her feet at 4.7 stars (out of 5) and that means she's in the category: "beautiful feet".  The site includes sections for “feet of the day” and “feet of the week” although the criteria for "making the cut" for these honors are not disclosed.  An illustrative sample from WikiFeet's rating table includes:

Billie Eilish, 97 images, rated 4.1 (nice feet)

Anna Kournikova, 362 images, rated 5.0 (beautiful feet)

Selena Gomez, 1963 images, rated 4.7, (beautiful feet)

Nicki Minaj, 1135 images, rated 3.4 (OK feet)

Mila Kunis, 1131 images, rated 4.6, (beautiful feet)

Janelle Monáe, 486 images, rated 5.0 (beautiful feet)

Nancy Pelosi, 14 images, rated 2.9 (OK feet)

Rihanna, 5663 images, rated 5.0 (beautiful feet)

Emily Ratajkowski, 2571 images, rated 5.0 (beautiful feet)

Paris Hilton, 997 images, rated 3.2 (OK feet)

Emma Watson, 1047 images, rated 5.0 (beautiful feet)

Megan Fox, 1866 images, rated 4.1 (nice feet)

Emma Raducanu 80 images, rated 4.6 (beautiful feet)

Charli XCX, 960 images, rated 5.0 (beautiful feet)

Crooked Hillary Clinton (b 1947; US secretary of state 2009-2013, left) and Donald Trump (b 1946; POTUS 2017-2021 and since 2025, right).

Crooked Hillary Clinton’s feet must convey something of her crooked crookedness because Wikifeet's connoisseurs rate them only at 2.5 stars (OK feet) but politics in the US being so polarized, there may be an element of strategic voting involved and the sample size is anyway small, crooked Hillary's page having only 24 images.  Following in the footsteps of the original, there exists a companion WikiFeet page for men’s feet although, predictably, it’s a mere shadow of the feminine version and that must be emblematic of many things in sociology, sexual politics and fetishism.  On the male site there is a solitary entry on Donald Trump’s page and while it’s not the only known photograph of his bare feet, it is the one with the best angle; with only a single image on which to base an assessment, the rating of 1.3 stars (bad feet) may reflect political bias rather than objective judgment.  That may also have influenced voting on the 32 images on Kamala Harris’s (b 1964; VPOTUS 2021-2025) page though the fact she rated a solid 4.0 (nice feet) clearly wasn’t enough to help her win the 2024 presidential election, feet clearly just not an issue.

Shine envy: Field Marshal el-Sisi (left) and President Trump (right), Riyadh, Saudi Arabia, May 2017.  Military men usually have shiny shoes, the more senior ranks allocated a batman to do the polishing and some branding of consumer shoe polishes reflect (get it?) the tradition, "Parade Gloss", "Military Tan" and "Rollcall Black" all having been sold "in the tin".

There was nothing in the recent testimony of Stormy Daniels (stage name of Stephanie Gregory, b 1979) to suggest Donald Trump has a particular thing for feet but he certainly notices shoes.  When meeting Field Marshal Fattah el-Sisi (b 1954; president of Egypt since 2014) in Riyadh, Mr Trump couldn’t help but be impressed how much shinier were the field marshal’s shoes, his seemingly close to identical pumps dull by comparison.  As they left the room, Mr Trump remarked to him: “Love your shoes.  Boy, those shoes. Man …” but knew he’d lost face and doubtless the White House shoe-shine operative loudly was told: "You're fired!"  The Democratic Party seems never to have drawn attention to Joe Biden's (b 1942; VPOTUS 2009-2017 and POTUS 2021-2025) shoes, presumably because they feared Fox News might have demanded proof he could still tie his own laces.

Noting the definitional model in the DSM-IV-TR (2000), despite the history in psychiatry’s world of paraphilias and a notable presence in popular culture, there were those who claimed the very notion of a foot fetish was false because of that critical phrase “non-living” that would seem to disqualify a foot (unless of course it was no longer attached to a living being) but such an interest would be seriously weird (the "lucky" rabbit foot from another tradition) and a more disturbing condition; although in this context there are deconstructionists who would make a distinction between a depiction of a live foot and the foot itself, clinicians probably regard them as interchangeable tools of the fetishist although the techniques of consumption would vary.  It's a nuanced aspect of "body parts as this and that" because some are, in many religious traditions, venerated as holy relics or icons.  The critics noted many fetishes are extensions of the human body, such as articles of clothing or footwear, but that did not extend to feet and that diagnostically, a sexual fascination with feet did correctly belong in the category of “Paraphilia Not Otherwise Specified,” and thus should be regarded as a partialism: Foot partialism.  While there are those who greatly admire elegant creations such as a stiletto heeled slingback, the interest in these as pieces of design is separate from those who focus on their "associative connections": Thigh-length, laced leather boots with a five inch (125 mm) heel are likely to be "enjoyed" not as stand-alone objects but because of the thighs, calves, ankles and feet of those stereotypically assumed most often to pull them on (and, of course, take them off). 

OnlyFans, a place for agastopics.

A genuine phenomenon, OF (OnlyFans) is a niche player in the gig economy but the niche is big and if not quite the oldest in the world, it's been around a while.  Something of an early-adopter of techniques embracing the implications of AI (artificial intelligence), while "feet" is just one of many genres serviced, OF is able to engage in "category proliferation" at little more than marginal cost because the site works on a "bolt-on" principle.  The business model works because the platform's content exclusively is user-generated with revenue streams provided by PPV (pay-per-view) customers and monthly subscriptions with creators collecting the bulk of the payments, OF essentially "clipping the ticket" on the way through their gateway.  OF was one of the "plague winners" in the disruptions wrought by the lockdowns imposed during the COVID-19 pandemic but the earnings profile of the content creators is a highly exaggerated curve, a relative handful finding it most lucrative while for most it's at best a hobby or side-hustle; for OF that's OK, they still clip the ticket.  Although best known for creators posting sexually explicit content, in 2021 (in response to political pressure) it was announced things would be "sanitized" with NSFW (not suitable for work) material purged site-wide.  Such was the outcry from creators & customers the plan survived not even a week, cynical analysts concluding the original announcement had been made to provoke the revolt, OF's management well-aware nothing quietens tiresome politicians as quickly as mass public discontent.  The OF content creators are an imaginative lot and some are said to make "feet" NSFW so those wanting a purely (in the sense of "knee & lower only") anatomical experience are recommended to search with caution.

Foot Finder

When OF attained critical mass it encouraged the growth of an ecosystem of sites acting as "third party intermediaries" servicing those who for whatever reason preferred their transactions to be handled with a guarantee of anonymity (if curated with care, one’s own feet on an OF page should be similarly anonymous).  Content providers are known as “sole traders” while in the jargon the third party operators run parasitic sites which may sound harsh but that does mirror the analogous use in biology.  Amusingly, although the internet doomed many other platforms with business models dependent on revenue from advertisers (notably the print media, in the West, many magazines and all but a handful of newspapers driven extinct or taking "an unconscionable time a-dying"), FootFinder (above, left) clearly sees value still in physical, three-dimensional mobile advertising and a large fibreglass foot (above, right) atop a Kei car (diminutive, small displacement Japanese vehicles sold mostly in the JDM (Japanese Domestic Market) certainly must draw the eye.  As long ago as the 1950s, there were those predicting there would one day be a world-wide system (at least one encompassing the Western world) of real-time interconnectivity (ie the concept of the internet) but most seemed to envisage it as people having portals (with acid-green screens) through which to look-up stuff in databases or receive text-based content such as news reports or educational instruction.  In short, a world of "few uploaders and many downloaders".  It's doubtful many imagined "mass-upload" models such as YouTube and definitely not OF; while many would have assumed users would become interactive, Foot Finder would not have occurred to many as a template.  How, 50 years from now we'll all (or at least some of use) be indulging our agastopia(s) may be just as unpredictable.

The feet of Ana de Armas, OnlyFans "Feet of the Year, 2023", plantar flexing.

It need not be an expensive hobby, provided one focuses on one's favorite feet.  English singer Lily Allen (b 1985) has an OF page (Lily Allen FTSE500) for her (US size 6) feet and subscriptions are offered at US$10 per month, her hook on an Instragram post titled “La dolce feeta” including a snap of her toes next to Rome’s Fontana di Trevi (Trevi Fountain) in which Anita Ekberg's (1931-2005) feet splashed, all those years ago.  While to those not part of the fetish it can be hard to tell one foot from another, the cognoscenti have eyes as well-trained as a sommelier's palate; in 2023 OF's "Feet of the Year" title was awarded to Cuban-born Spanish actress Ana de Armas (b 1988).  It was Sigmund Freud (1856-1939) who admitted, lawfulness aside, as animals, the only truly aberrant sexual behavior in humans could be said to be its absence (something the modern asexual movement re-defines rather than disproves).  It seemed to be in that spirit the DSM-5 was revised to treat agastopia and many other “harmless” behaviors as “normal” and thus within the purview of the manual only to the extent of being described, clinical intervention no longer required.  Whether all psychiatrists agree with the new permissiveness isn’t known but early reports suggest there’s nothing in the DSM-5-TR (2022) to suggest agastopics will soon again be labeled as deviants.

The washing of feet

Not everything foot-centric is agastopic.  In the New Testament there are three texts describing Christ washing feet, the best known of which is John 13:1-17 (Jesus Washing the Disciples' Feet).  The ritual is explained usually as Jesus demonstrating his humility and mission to serve mankind but it's clear he wished also to set a good example to the not infrequently fractious dozen:

"So after he had washed their feet, and had taken his garments, and was set down again, he said unto them, Know ye what I have done to you? Ye call me Master and Lord: and ye say well; for so I am. If I then, your Lord and Master, have washed your feet; ye also ought to wash one another's feet. For I have given you an example, that ye should do as I have done to you."  John 13:12-15 (King James Version; KJV, 1611)

Pope Francis kisses the foot of a female inmate of Rome's Rebibbia prison, 28 March 2024: Symbolic or a "performative photo-opportunity" depending on one's view. 

One of the set-piece motifs of Christianity, the foot-washing ritual takes place on Holy Thursday (the Thursday before Easter) and seeks to imitate Christ’s washing of the Disciples’ feet the night before he was crucified at Golgotha.  It was on that evening he said to his Disciples: “Verily, verily, I say unto you, that one of you shall betray me.” (John 13:21).  The sight of a pope washing feet is familiar but when Francis (1936-2025; pope 2013-2025) performed the ritual at Rome’s Rebibbia prison on Holy Thursday 2024, it was apparently the first time in the institution’s two-thousand year odd existence a pontiff has washed the feet only of women.  Historians concede records from earlier centuries obviously are incomplete but so remarkable was the event deemed, most seemed to conclude a precedent had been set.  In the past Francis had washed the feet of women, Muslims, refugees and other minorities but never women exclusively.  He certainly cast a wider net than his more conservative predecessor, Benedict XVI (1927–2022; pope 2005-2013, pope emeritus 2013-2022) who sponged the feet only of men and, in the final years of his pontificate, only those of ordained priests.  It’s believed feet proffered to popes, scrupulously are pre-sanitized.

Wednesday, July 22, 2026

Mainline

Mainline (pronounced meyn-lahyn)

(1) A slang term for the intravenous (injected directly into a vein as opposed to subcutaneous (skin popping)) use of injectable drugs (historically associated most with opium and its derivatives, especially heroin);  a principal or prominent vein into which a drug can be injected.

(2) To use, enjoy or imbibe something without restriction.

(3) The normal, established, or widely accepted position; major (a synonym of mainstream although without any of the the negative connotations mainstream has in recent years acquired.

(4) In rail transport (1) of or pertaining to the principal route or line of a railway or (2) of or pertaining to a surface railway as distinct from an underground, elevated or light rail one (originally as main line or main-line).

(5) In computing, to integrate (code etc) into the main repository for a software project, rather than separate forks.

(6) In civil aviation, an airline's main operating unit, as opposed to codeshares or regional subsidiaries (by extension from the railroad use).

(7) As Mainlinie (line of the Maine), a (historical and political) boundary between northern and southern Germany, roughly following the River Main.

(8) In chess, of a sequence of opening moves, the principal, most important, or most often played variation of such (ie the "main line", the orthodox sequence of opening moves considered to be "best play").

(9) In foodie slang, voraciously to consume.

(10) In longline fishing, the central line to which the branch lines with baits are attached.

(11) In plumbing, the pipeline carrying wastewater to the public drains or a septic tank.

(12) In the US and Australia, related but different models of Ford cars sold during the 1950s.

1841 (1933-1934 as applied to injectable drugs): All senses of mainline (sometimes variously as main-line or with initial capital) are Americanisms and a compound of main + line.  Main is from the Middle English mayn, main, maine, mæin & meyn, from main (noun) and related to the Old English mægen (strong, main, principal) and the Old Norse megn & megenn (strong, main).  It was cognate with Old High German megīn (strong, mighty) from which Modern German gained Möge & Vermögen (power, wealth) and akin to the Old English magan (to be able to).  Line is from the Middle English line & lyne, from Old English līne (line, cable, rope, hawser, series, row, rule, direction) from the Proto-Germanic līnǭ (line, rope, flaxen cord, thread) from the Proto-Germanic līną (flax, linen), from the primitive Indo-European līno (flax).  Influenced in Middle English by the Middle French ligne (line), from Latin linea, it was cognate with the Scots line (line), the North Frisian liin (line), the West Frisian line (line), the Dutch lijn (rope, cord), the German Leine (line, rope), the Danish line (rope, cord), the Swedish lina (line, rope, wire) and the Icelandic lína (line). It was related also to Dutch lijn (flax), the German Lein (flax, linen), the Gothic lein (linen, cloth), the Latin linea (linen, thread, string, line) & linum (flax, thread, linen, cable), the Ancient Greek λίνον (línon) (flax, linen, thread, garment), the Old Church Slavonic линъ (linŭ) (flax), the Russian лён (ljon) (flax), the Lithuanian linai (flax) and the Irish līn (lion) (flax).  The oldest sense of the word is "rope, cord, thread"; from this the senses "path" & "continuous mark" were derived.  Mainline is a noun in the sense of railways and a verb (used without object) if injecting drugs; those doing the latter known, inter alia, as "mainers" or "mainliners", the mainlined not infrequently ending up on a pathologist's autopsy table.  Mainline is a noun, verb & adjective, mainliner is a noun and mainlinging & mainlined are verbs; the noun plural is mainlines.

Basic motoring: 1952 Ford Mainline Business Coupe (with after-market whitewall tyres & sun visor, neither of which were standard equipment).

Ford in the US produced the Mainline between 1952-1956.  It was the base-model of its three tier offering (Ford at that time in the US producing a single range of passenger cars), the more highly specified models being the Customline and premium-level Crestline.  The name was dropped for 1957 when the layers in the range was expanded to four (Custom, Custom 300, Fairlane & Fairlane 500) although this had nothing to do with the association of “mainline” with injecting drug users; while that connection had existed since 1933, not until the 1960s did it in that sense come into general use.  In the US, the Mainline was offered as a sedan with two (informally dubbed "Tudor") or four doors (Fordor), a business coupe (the two-door sedan with no rear seat, a configuration aimed at the “business traveller” who travelled alone and valued additional storage space) and (between 1952-1954) a two-door a station wagon (called Ranch Wagon); convertibles were restricted to the more expensive lines.  A classic “stripper” (ie “stripped” of much trim and non-essential accessories so able to be sold at a lower price), as a consumer level product the Mainline was rather obscure, often mentioned only in the small print in catalogues and brochures and rarely afforded the honor of a photograph.  That was because, in an era of rising prosperity, it really wasn’t photogenic, the exterior lacking much of the chrome adorning the Customline & Crestline (although Studebaker would would later go further down the austerity path with its Scotsman” models) while the interiors drably were utilitarian, rubber matting on the floor rather than carpet.  One quirk of production-line meant the Mainline did retain the extravagance of a chrome hood emblem, the cost of a separate run of hoods without the screw-holes higher than that of the emblem and the minute or so of labor required for the fitment.  Mercedes-Benz later (and belatedly) discovered similar math when some chrome trim was omitted from the tail-fins on the lower cost versions of its Heckflosse range (1959-1968), the labor required to hand-finish the metal a more expensive process than fitting the part and its fitting.  The Mainline's equipment levels were similarly spartan, only the driver's side fitted with a sun visor while passengers were denied armrests and unless paying extra to the dealer, no cigarette lighter was included, a painted metal plug (ancestor of the later “switch blanks) covering the hole in the dashboard.  An ashtray was however included and, in a sign of the times, the cigarette lighter was a popular option.

1956 Ford Mainline "Coupé Utility" (Australia).

Australia was a smaller market and neither the three trim options nor all the body styles were offered, sales between 1952-1959 restricted to the four-door Customline (some station wagons were imported in fully-built form) and a locally developed “coupé utility”, created by adding a rear section in the style of a light pickup truck.  A feature of the Australian market since the 1930s, in the Australian way, the six syllable “coupé utility” quickly was shortened to “ute”, remaining a profitable market sector until motor vehicle production in the country ceased in 2017.  The coupé utility used the Mainline name and was built on the station wagon chassis with the addition of the convertible’s X-member to permit a higher load carrying capacity, a further quirk being the Australian Fords continued until 1954 to use the old flathead V8 (introduced in 1932 not in the US used in passenger cars after 1953), the new overhead valve (OHV) Y-Block V8 not introduced until 1955.  The Mainline remained in the Australian line-up until 1959 when the Fairlane replaced the Customline but Ford didn’t develop a coupé utility version of the new car, the body style instead offered on the compact platform (standard-size in Australian terms) when the Falcon (1960-2016) entered local production.  The Australian ute proved influential across the Pacific, Ford in the US offering several generations of Ranchero (1957-1979), the success of which encouraged Chevrolet to adopt the same concept, an El Camino model sold between 1959-1960 and 1964-1987.

Basic military motoring: 1952 Ford Mainline, the teddy bear in sailor suit an alusion to this car once being USN (US Navy) staff car 07-141953.

GM (General Motors) and Chrysler of course also had “stripper” models in their ranges the cheapest and most basic being those offered respectively by Chevrolet and Plymouth but the concept was in every case became corporation-wide although to speak of the cheapest Cadillacs as “strippers” was misleading and it’s better to refer to them as “selectively de-frilled” (something distinct from the more general “de-contenting ” strategy GM would begin in the late 1960s).  For sociological reasons, the “cheapest Cadillac” once had real appeal because in the US it was for decades the ultimate “aspirational brand” appealing very much to those who really couldn’t afford one; the extent of Cadillac purchasing by the “lower middle class” was once of the markers of the “American dream” although caution did need to be exercised: tick to many of the option boxes for a “stripper” Cadillac Calais and the invoice price began to overlap with that of the even more aspirational DeVille.  While the Mainline may not much have been seen in the brochures, in local newspaper advertising, frequently one would appear, usually with its temptingly low price in large bold type (often with an exclamation mark).  That price typically was between 15-20% less than what buyers typically paid for a Customline or Crestline (a “new Ford” in the public imagination) but the advertising copy in the newspaper tended not to dwell on details and in the pre-internet age, the sight of $1,389! was enough to entice buyers to visit the showroom.  Of course, once there they would discover a Mainline business coupe wasn’t all that appealing and the salesman would agree, showing them the better value offered by a two-door Customline sedan at $1,570.  Dealerships really didn’t want to see too many Mainlines because the profit margins were slim compared to the more expensive Fords although the most skilled salesmen (they were then all men) could “add a little fat” by “up-selling” the odd accessory (mudflaps, whitewall tyres, the cigarette lighter etc).

Stripper at speed: 1956 NASCAR (National Association for Stock Car Auto Racing) Ford Mainline, Southern 500, Darlington Raceway, South Carolina, USA.

Darlington was known for the infamous “Darlington stripe”, left on the right side of the cars because the angle of the track made it challenging for drivers to maintain a competitive speed without sometimes “kissing the wall” at turns three & four.  The drivers called the concept “fender prints” (an allusion to the various shades of paint the circulating cars left on an oval’s wall) but Darlington was especially honoured with the notorious “Darlington stripe” because, over the course of a race, multiple “scrapes” were inevitable.  The start-finish line on the unusual egg-shaped track was in 1997 moved so the critical section now starts at turn one and although the guard rails are now less hazardous, the Darlington stripe remains something of a NASCAR rite of passage. 

The sales tactic must have worked because relatively few private buyers chose Mainlines, despite a saving of $180-odd being in 1952 a compelling argument (the method of calculation vary but US$180 expressed in 2026 purchasing power would be over US$2,000).  That was however just side-business for the Mainline.  The real reason the industry built strippers was for fleet sales to corporations and government instrumentalities such as the military, police forces, fire departments and such.  While a saving of $180 might be enough to persuade a few frugal customers to forgo carpets and armrests, for purchasing managers buying by the dozen (or even the thousand), the lower unit-cost multiplied into a lot of money and of course, at those volumes, further discounts were applied.  The other minor career of the stripper came on race tracks or drag strips, buyers for that purpose wanting the cheapest, lightest platform; for them armrests and cigarette lighters were just pointless excess weight and, wherever possible, they undertook further “striping”, discarding anything not absolutely essential.  For them, the Mainline was a good starting-point.

Map of southern England's Great Western Main Line. 

Main Line had since 1841 been used generally to mean "principal line of a railway" and the Main Line was once Philadelphia's most desired suburban district.  Once just another rural hamlet, in the 1870s & 1880s it was transformed by the Pennsylvania Railroad Company that built expensive housing developments and hotels, hence the association of "Main Line" with the meaning "affluent area of residence", noted by 1917 and eventually used in that sense without capital letters and as the unhyphenated "mainline".  Essentially creating a fashionable suburb, the Railroad's urban development project linked Philadelphia to Paoli along the Paoli Local train-line via the station stops Overbrook, Merion, Narberth, Wynnewood, Ardmore, Haverford & Bryn Mawr.  Eventually, the Main Line connected Philadelphia with Pittsburgh via Harrisburg but was later split into two lines, Amtrak's Philadelphia to Harrisburg Main Line and the Norfolk Southern Railway's Pittsburgh Line.

A depiction of Lindsay Lohan's "mainlines" (digitally altered image, left), an illustrative diagram of an urban light-rail system showing the mainlines (thick lines) and branch lines (thin lines) (centre) and a human's entire blood circulatory system, created from a corpse donated (by the subject) for the purpose (right).  The technique used (right) is called “vascular corrosion casting”, achieved by replacing the blood in arteries, veins & capillaries with a specially mixed resin; after the resin has set and cured, all other tissue is dissolved in a highly alkaline chemical (typically sodium hydroxide).  To ensure the resin remains, it needs to be of a specific viscosity, with a chemical composition a-reactive to both natural tissue and the chemical used in the dissolution process.

The original slang among drug users, dating from 1933, was "mainline" the noun, referring the principal or prominent vein into which a drug was most effective if injected.  The verb in the sense of "inject (drugs) intravenously" was noted the following year although the associated verb "mainlining" didn't enter regular use until the mid-1960s and the unfortunate companion verb "mainlined" (dead from a drug overdose) soon followed, referred to in that sense by Mimi Fariña (1945–2001) in the song In the Quiet Morning (1970), recorded by Joan Baez (b 1941) after the messy, drug-related death of singer Janis Joplin (1943–1970).  Joplin's death, although technically caused by an impact injury, happened under the influence of heroin.  Counterintuitively, despite injecting drug-use being so obviously associated with veins and arteries, it seems it was the imagery of main and secondary railway lines rather than the human vascular system (also called the circulatory system) that prompted the simile of mainline in drug-related slang.  It was probably because of the general familiarity with the word being used to describe train tracks and the often-seen graphical representation of them at stations and in carriages.  Even in medicine, mainline appears hardly used by physicians when speaking of arteries, veins or capillaries, specific anatomical names (femoral artery, jugular vein etc preferred), the term apparently not useful within the profession because of the need for precision when discussing such things although it may be handy for pathologists who work mostly "in retrospect".  However, there are citations where physicians and neurologists have adopted a similar metaphor (based perhaps on the "rabbit warrens" that are hospitals) to  explain the process of the brain using the “back passages” to restore blood-flow to areas affected by a stroke which has blocked the “main passage”, again drawing on the idea of primary and secondary lines.

In the Quiet Morning (1970) by Mimi Farina © Universal Music Publishing Group, recorded by Joan Baez.  

In the quiet morning, there was much despair
And in the hours that followed, no one could repair
That poor girl, tossed by the tides of misfortune
Barely here to tell her tale, rolled in on a sea of disaster
Rolled out on a mainline rail
 
She once walked tight at my side, I'm sure she walked by you
Her striding steps could not deny, torment from a child who knew
 
That in the quiet morning, there would be despair
And in the hours that followed, no one could repair
That poor girl, she cried out her song so loud
It was heard the whole world round, a symphony of violence
The great southwest unbound
 
La la la la la la la
La la la la la la la
La la la la la la la la la
La la la la, la la la
 
In the quiet morning, there was much despair
And in the hours that followed, no one could repair
That poor girl, tossed by the tides of misfortune
Barely here to tell her tale, rolled in on a sea of disaster
Rolled out on a mainline rail
 
La la la la la la la
La la la la la la la
La la la la la la la la la
La la la la, la la la