Thoughts From The Couch – Loving our imperfect body

For many people, their relationship with their body is the cause of much unhappiness. Is it any wonder when we live in a society that steadily and unfairly suggests we should be changing it in one way or another? Chronic body dissatisfaction is an epidemic with negative body image issues impacting both men and women who believe that there is something ‘wrong’ with their bodies. There are four aspects of body image: Perceptual, affective, cognitive and behavioural. How we see ourselves, the way we feel about the way we look, the thoughts and beliefs, we feel about our body and the things we do in relation to the way we look.

I have worked with many clients who despite varying forms of camouflage, feel intense dismay with their physical appearance. To a greater or lesser extent, they are fixated on what they do not like about their body with the sincere desire to alter or hide it. They feel acutely self-conscious and ashamed comparing themselves to others along with the standards that have been shaped by rampant social and cultural ideals. As a consequence, they live with eating disorders, various forms of self-harm, isolation and mental illnesses all driven by the lottery we have all been made to play without ever being asked. For most of us, there is a relatively good correlation between what we think we look like and how we appear to other people, but for others, it is as if there are two different people – the one we see and the one they see when they look in the mirror.

For some people, their appearance becomes the single most crucial aspect in defining them as individuals, and they hold attitudes such as ‘I am my nose’. For my client who was fixated on his nose, his whole life was impacted by how he saw and imagined others saw his nose. From my perspective, there was not anything out of the ordinary about his nose, and yet it prevented him from entering into relationships, making friendships or doing many other things. Each day he battled the crippling shame of his physical appearance that deprived him of achieving his deepest longing – to have an intimate relationship and family.

When feelings of being self-conscious or ashamed become out of control, it often leads to body dysmorphic disorder. This does not mean being vain or self-obsessed. It is a profoundly distressing and life-limiting experience whereby we cannot stop thinking about one or more defects or flaws in our appearance that often cannot be seen by others. We become so obsessive in our belief that some aspect of our body or appearance is seriously flawed that we go exceptional measures to hide or fix it. Clients of mine are so embarrassed, ashamed and anxious about their physical appearance that they find themselves avoiding social situations, friendships and intimate relationships with the impact being devastating to their lives. For some looking in the mirror is so traumatic that their only option is to cover any mirrors that are in their home.

We are not born hating our bodies, and yet we live in a culture that teaches us to do so. Society sends us messages about how we are supposed to look, and as a result, we attach our worth to the size of our body and physical appearance. Young children with access to the internet and social media live in a culture in which peers and the media broadcast the thin and beautiful ideal in a way that negatively impacts how they view their developing bodies and as a result their self-assurance. Suddenly their childlike inhibition is replaced by a cycle of self-shaming thoughts and behaviours. They become preoccupied with comparing themselves to others. Once thoughts have been held long enough and repeated enough times, they become beliefs, eventually, the beliefs become biology. By trying to change themselves to be like others, it starts them on the path of dishonouring their authentic self, allowing how they feel about their bodies to influence how freely they can inhabit it.

Many parents are not aware of how their low self-esteem can be passed on to their children. With the hatred of our bodies profoundly, negative messages about them are passed on unconsciously from generation to generation. Many of us were bought up with caregivers who made negative comments about their bodies. Consequently, in addition to societal messages, what we witness at home dramatically shapes how we see ourselves. We see food being restricted, excessive exercise and endless adverse messages that make us start to examine our own bodies in mostly negative ways. As a result, the attitude that our bodies are in some ways ‘wrong’ gets internalised, often at a very young age, and sets the stage for our future relationship with our body. We unconsciously start our journey of self-loathing as we stare at ourselves in the mirror as part of an ingrained ritual of self-hatred. As we undress for bed, we look in the mirror and zoom in on parts of our body that we dislike the most – the parts we want to change and wish were different, and the descent into self-loathing and shame continues. For some, their friendships are bonded over their shared body dissatisfaction sharing diet tips, and details of surgeons that they hope will ‘fix’ their body, and then their living can begin.

The constant repetition of negative thoughts about our appearance infiltrates how we act and behave. By the time some of my clients come to see me, they are living with the consequences of a life based on how they think they look. For others, they come as a result of an accident or illness that has changed their body image suddenly. I am reminded of a young man who contacted me by telephone as he did not want me to see him as he told me that he had been diagnosed with testicular cancer while at school. He had been too embarrassed to say anything about the changes that were taking place in his body that by the time he went to the doctor, he had to have one of his testis removed. He was so deeply ashamed that it was preventing him from entering into any form of intimate relationship for fear that it would be noticed. Whether the change is permanent or temporary, the impact of an illness or accident will be different on everybody. It can affect all aspects of their lives, including sexuality and intimacy. Body image changes as we get older and in a society that seems to revere the young that can be very difficult for clients who somehow feel unattractive and invisible due to the natural process ageing. Whichever category clients fall into, body changes can be very disconcerting. It can take a fair amount of time before they ‘see themselves’ once more when they look in the mirror. Supporting my clients through both physical and psychological changes such as fear, anger, hopelessness, and sadness is a way of normalising their concerns, thus reducing shame and stigma.

That we have the potential to modify our destructive and unconscious patterns is a truth I see proven in my practice often. Change is possible and self-love should be too, and yet it is not as easy as it sounds. It requires great courage and self-belief not to get swept up in ways of being that unless consciously fought against seem to infiltrate our psyche without us even noticing. A first step towards making a positive change in our lives is to acknowledge that we are co-operating daily with a system that is making us deeply unhappy. Much like someone living in an abusive relationship who finally leaves because one day they realise that if they stay their life will never improve, each of us must recognise when and where we are co-operating with our own persecution.

I have done all sorts of work with clients on their body issues. Depending on what they are coming with, I have used drawing as one way for them to compare how they see their body in relation to how I do. So often being visually confronted by the difference in perception of body shape and size is enlightening. One client spoke of ‘one of the most memorable exercises we did was you getting me to draw how I saw my body. When we went through the drawing together, I could see that it was not a real representation of how I looked. I had drawn myself as if I was an alien being, and it was a profound moment, recognising that the image that I was looking at on paper was the image I had in my head and yet not the reality at all.’

Chair work is always a useful way of exposing our critical inner voice and the messages we give ourselves about our appearance. It can also help us make connections to where this voice may originally have come from. Like the client who always wore shoes that were too small from him remembering the voice of his mother who bought him ill-fitting shoes so that he did not have ‘monstrous feet.’ Another client remembered ‘you speaking about us all having both positive and negative voices in our heads, and it had never occurred to me. You spoke about how the negative voices will probably remain as part of us, but we have a choice as to whether we continue to feed the negative or feed the positive. I saw how out of balance the voices I had in my head were and have since made a conscious effort to be mindful of when I am being negative towards myself and balance it with the positive. My positive voice makes me feel so comforted that I can manage the moments where I find myself inadvertently being critical of my body. I carry you with me every day hearing your voice telling me to be kind to myself.’

With other clients, they have asked me to take photographs of them so that they can see what they look like at different angles and in different moments as they have lost sight of what they really look like. I have worked with women who have felt so ashamed of their bodies that they have attempted to cover them up in varying ways. The look of pride on the face of a client I had been working with for several years, when she turned up in a dress. Prior to that she had lived in fear of other people’s judgements and comments about her ‘too thin’ body. As a way of protecting herself, she used to wear extra layers of clothing, always with a coat, ‘to make myself look bigger’ no matter how hot it was outside. The first time a client who thought her ‘legs were too thin and hairy’ wore a skirt moving through the belief that people would notice and be ‘repulsed’ by her. The tender moments where I have stood with a client as they have revealed a part of themselves that has been left disfigured through illness or surgery or birth disfigurement. Standing firm in awe and tenderness as they moved through the fear of exposing their vulnerability and shame.

Being wholly and genuinely human means standing securely in the knowledge that our physical appearance is only a part of who we are. In accepting that we are imperfect, we can turn our attention to shining warmth and kindness into our dark tender place of self doubt, replacing it with appreciation, acceptance and love.

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