Body image refers to a person's internal picture of his or her external physical appearance. Self image is a
broader category that refers to one's inner perception of his or her physical, mental, interpersonal, and spiritual characteristics and abilities. The distinction is important because cultures vary significantly regarding the amount of emphasis given to body image as one aspect of self image. In Japan, for example, body image is a much smaller part of most people's self-image than it is in the United States. Both forms of self-perception, however, may be affected by cancer treatment.
Specific body image or self image concerns vary according to age and gender. Children being treated for cancer have different issues from adults because their self and body images are still being formed. Children and adolescents with cancer sometimes internalize a picture-of themselves as disfigured or unattractive, or as physically weak and incompetent. Even when the cancer has been successfully treated, the child's self image may still reflect feelings of being "sick" or "damaged." A distorted self image in turn can cause difficulties in social relationships as the child grows older. The Candlelighters programs offer practical advice and social support for children with cancer and their families.
Self image problems in adults tend to reflect (and reinforce) American society's patterns of gender socialization. Studies indicate that many women tend to be openly concerned about damage to their external appearance caused by cancer treatments. For many women, anxiety about losing their looks is directly related to fear of losing their husband or partner. Men's concern about outward appearance is less obvious but may be expressed as a need to look "healthy" in order to keep their job. Although there are not as many studies of men's reactions to cancer treatment as there are of women's, recent research indicates that men are still more concerned about losing physical strength or specific physical abilities required by their work than about their looks as such.
Causes
Cultural context
It is important to situate body image/self image issues related to cancer treatment within the larger context of contemporary emphasis on physical perfection. Advertising in the mass media encourages people to feel dissatisfied with their bodies. One study of the effects of television advertising on college youth found that as little as half an hour of ideal-body commercials has a negative impact on a person's body image. Another study found that a majority of American adults, men as well as women, believe that people are judged on the basis of appearance first and talent or personality second. In a cultural setting in which healthy people often feel they cannot measure up to media standards of attractiveness, it is not surprising that cancer patients are concerned about the effects of therapy on their appearance.
Surgery
Surgery on the face or the parts of the body associated with sexual performance or attractiveness has a more severe impact on self image than surgery on the hands, feet, or back. Breast surgery in women and surgical treatment of prostate cancer in men are often accompanied by changes in the patient's self image, particularly with respect to sexual relations. Sexual responsiveness can also be affected if the surgeon has had to remove tissue containing nerve endings that are sensitive to touch.
Radiation and chemotherapy
Radiation and chemotherapy can affect a cancer patient's body image because they often cause hair loss, radiation burns, and unattractive changes in the patient's complexion. While hair loss caused by chemotherapy is usually a temporary condition, hair loss caused by radiation treatment may be permanent. In addition, both radiation and chemotherapy can cause nausea, vomiting, fatigue, depression, and other reactions that affect the patient's sense of competence as well as their relationships with others. Self image often suffers when a person feels that job performance and valued relationships are being strained by these side effects of cancer treatment.
Treatments
Cosmetic
Since 1989, the American Cancer Society, the Cosmetic, Toiletry, and Fragrance Association Foundation, and the National Cosmetology Association have sponsored the "Look Good… Feel Better" (LGFB) program, which offers classes in a number of medical centers. These classes help female cancer patients with self image issues as well as teaching them special grooming techniques to manage the side effects of cancer therapy. LGFB has been available in Canada since 1992.
Hair loss can be covered by a variety of wigs, partial hairpieces, and scarves or turbans. The American Hair Loss Council offers more detailed information about these and other ways to cope with hair loss caused by cancer treatment. Doctors who specialize in plastic surgery can suggest ways to treat facial scars or other types of surgical disfigurement, including the loss of body parts. A prosthesis, which is an artificial replacement for a missing or damaged body part, can be made to order for the patient.
Counseling and support
Cancer patients who are experiencing serious emotional problems related to changes in appearance may benefit from counseling or support groups. Individual psychotherapy guides people to look at the reasons for focusing on their looks as well as ways to cope with the changes. Pastoral or spiritual counseling can help remind patients that they are more than just their bodies. Support groups for cancer patients are good places to share feelings and useful tips about dress and grooming with others who are in the same situation.
Alternative and complementary therapies
Alternative and complementary therapies may help patients to deal with changes in self and body image through developing a fuller self image, finding new interests, or learning new skills. Meditation and prayer can help patients put physical appearance inside a larger framework of values. Some cancer patients find yoga, t'ai chi, and dance or movement therapy are interesting to learn as well as good forms of exercise. Lastly, massage, calming or uplifting music, and aromatherapy allow patients to balance the side effects of cancer treatment with relaxing and pleasant experiences.
Chapkis, Wendy. Beauty Secrets: Women and the Politics of Appearance. Boston: South End Press, 1986.
Dollinger, Malin, M.D., Ernest H. Rosenbaum, M.D., and Greg Cable. Cancer Therapy. Kansas City, MO: Somerville House, 1994.
Johnston, Joni E., Psy. D. Appearance Obsession:Learning to Love the Way You Look. Deerfield Beach, FL: Health Communications, Inc. 1994.
Peiss, Kathy. Hope in a Jar: The Making of America's Beauty Culture. New York: Metropolitan Books, Henry Holt and Company, 1998.
PERIODICALS
Clark, Jack A., Nelda Wray, Baruch Brody, Carol Ashton, Brian Giesler, and Herbert Watkins. "Dimensions of Quality of Life Expressed by Men Treated for Metastatic Prostate Cancer." Soc. Sci. Med, 45, no. 8 (1999): pp 1299-1309.
Candlelighters Childhood Cancer Foundation. 7910 Woodmont Avenue, Suite 460, Bethesda, MD 20814. (301) 657-8401 or (800) 366-CCCF.
Look Good… Feel Better (LGFB). 1100 Connecticut Avenue N. W., Washington, DC 20036. (800) 395-5665. In Canada: Look Good… Feel Better, 420 Britannia Road East, Suite 102, Mississaugua, Ontario L4Z 3L5 (905) 890-5161. Fax: (905) 890-2607. Web site: <http://www.lgfb.ca>.
National Cancer Institute of the National Institutes of Health. Chemotherapy and You: A Guide to Self-Help During Cancer Treatment. NIH Publication #99-1136. Can be downloaded from <http://cancernet.nci.nih.gov>.
—A term that refers to a person's inner picture of his or her outward appearance.
Prosthesis (plural, prostheses)
—An artificial substitute for a missing or defective body part. Pros-theses are usually designed to look and feel as natural as possible.
Self image
—A wider term that includes a person's perception of his or her talents, character traits, interests, spirituality, and other aspects of their being as well as outward physical appearance.
