BDD AND BODY IMAGE: WHAT IS BODY IMAGE?Body image—something we all have—is a complex concept. Researchers have offered various definitions over the years. One offered by psychologists Thomas Cash and Thomas Pruzinsky is the following: Body image consists of the internal, subjective representations of physical appearance and bodily experience. Another useful definition from Paul Schilder, is “the picture of our own body which we form in our mind; that is to say, the way in which the body appears to ourselves.” Body image is our internal self-portrait. BDD is a problem with body image, not actual appearance.Body image is an umbrella term for a large number of concepts. It consists of many dimensions and has been said to include such diverse concepts as the body’s position in space, perception of bodily sensations, and attractiveness. When even more broadly defined, it’s been referred to as body ego, body schema, and self-concept. Body image has been said to embrace our view of ourselves, not only physically but also psychologically, sociologically, and psychologically. Usually, however, narrower definitions (such as those of Drs. Cash and Pruzinsky) are used.The scientific literature on body image has a long and scholarly history. It’s been explored not only by neurologists, psychologists, and psychiatrists, but also by social scientists and philosophers. Luminaries such as Henry Head, Paul Schilder, Sigmund Freud, and Seymour Fisher have investigated such mysteries as how we distinguish self from non-self, and the cause of bizarre body-image experiences such as the phantom limb syndrome (the experience of still feeling the presence of one’s limb following amputation) and neglect (denial of the existence of parts of the body after brain damage).*209\204\8*

DISORDERS OF THE SLEEP-WAKE SCHEDULE (DSWS):  DELAYED SLEEP PHASE SYNDROMEAll of us at times stay up later than we want to or later than we should—cramming for tests, completing projects for work, or enjoying a late-night social event. Usually we have no trouble readjusting to our normal schedule. If our sleep cycle is biologically delayed, however, we may find it virtually impossible to go to sleep at a “normal” or reasonable time. More often seen in young adults, delayed sleep phase syndrome (or, if you’ll permit me yet another acronym, DSPS) often causes its victims to go to bed before they’re really ready to sleep, in a futile effort to operate on a regular schedule. Once in bed, they are unable to drop off for an extended time—perhaps an hour or more. They usually sleep normally once sleep has come, but naturally they find it very difficult to rise and function in the morning. Given a choice, these patients would usually sleep from about three in the morning to about noon the following day. Because they often must be at work by eight or nine o’clock, however, they leave their beds too soon, depriving themselves of necessary rest. This form of sleep deprivation may have other effects which make the actual diagnosis of delayed sleep phase more difficult. One clue, however, is that DSPS sufferers may look forward to weekends because, as one patient put it, “I can get up at the crack of noon.”DSPS is estimated to affect some 7 to 10 percent of insomniacs. Physicians must be careful to distinguish it from difficulty initiating sleep, a different problem whose therapy—hypnotic drugs—is inappropriate in treating DSPS victims. One strategy that does seem to work is called chronotherapy. In this process patients are told to delay their bedtimes significantly—by three hours or so per night over a five- or six-day period. Thus, the first night, the patient might retire at midnight; the next night, at 3:00 A.M., and so on. Eventually, patients “catch up” with their cycles, resetting their internal clocks so that they are able to retire, and fall asleep, on a more normal schedule. One late night, however, can disrupt the pattern and result in recurrence of the disorder.*168\226\8*

The young woman approaching childbirth is in fact subjected to an extraordinary number of

anxiety-producing influences. Other women seem bent on telling her stories of terrible pain and complications. The stories often end with a kind of negative suggestion, “But you will be all right, dear,” which of course conveys the idea that she just might not be all right. Many women tend to talk of their experience of childbirth in the way that others describe their adventures in sports or war. “Of course, I had to have six stitches.” All this has its effect on the young woman. The very fact of going to the hospital makes her feel that there is something wrong. She thus goes with a high level of anxiety to have her baby, and with the clear expectation of suffering considerable pain. Her anxiety not only lowers her threshold of pain, but may tend to make the contractions of the womb less smooth and co-ordinated. And worst of all, anxiety makes tense those parts which should relax, so that they are painfully forced by pressure instead of relaxing easily and naturally.

However, the young woman can guard against these unpleasant eventualities by being secure in her knowledge that childbirth is a natural process, and that older women often gain some strange satisfaction in telling exaggerated stories of their own experiences.

An unfortunate aspect of the problem is that the situation tends to become self-perpetuating. The woman in her first pregnancy is made anxious and expects pain. As a result, she experiences pain. Then with this experience behind her, she is increasingly nervous at her second pregnancy, and the painful experience is repeated, and so on. One of the reasons why this unhappy state of affairs is allowed to persist is that obstetricians are usually very busy people and often short of sleep. They simply do not spend the necessary time with the expectant mother to put these things right.

With these thoughts in mind, do a little preparation for the coming event. Practise the relaxing mental exercises, naturally and easily, so that you can let yourself go into the relaxed mental state when you wish it. This will also help you with the discomfort of the increased weight of the last few weeks. If you like, you can practise the exercises with pain, but this is not essential, because if you really learn the mental relaxation, pain will not be a problem.

When you feel the first contractions—this is what the older women call “the pains”

—remember what is happening. The muscles of your womb are contracting to push your baby down into the birth canal. As the contraction comes on, you let yourself go.—You let yourself go completely.—You let yourself go in body and mind as you feel the contraction.—You feel it good and strong.—It is good, pushing the baby down to be born.—It is strong.—You feel the strength, natural strength.—Natural, so that there is no hurt. —Between the contractions you lie back, easy and relaxed. —And all the time you have with you the calm and the relaxation of the mental exercises.

The baby is pushed down the birth canal slowly and easily and naturally. His head comes to the muscles at the end of the canal. You feel this because there are more nerves in these muscles. Now you relax deeper, deeper than ever, knowing that it is good that he has reached the end of the canal, and in a few moments he will be born.

There is just one other point that I would mention. Some people feel that they do not get themselves deep enough, as it were, in their relaxing mental exercises. They feel,

“This would not be sufficient if I were in real pain.” The fact is that when we are actually faced with potentially painful stimuli, as in childbirth, we can let ourselves go very much more completely. This may seem strange to you, but it is true. The reason is that in practising our exercises we lack real psychological motivation; we only have an intellectual logical motivation, which is not the same thing. So in the actual situation we surprise ourselves by doing much better than we expected.

Just one last comment. Take your obstetrician into your confidence about what you are doing. Remember that obstetricians have different views about this kind of approach, and that some still adhere to a rather mechanistic, drug-oriented way of doing things. Do not let any conflict

develop between you and your doctor on account of this, as such would only cause tension. It is best to find out the obstetrician’s views early in pregnancy, so that if necessary you can find another who will go along with you in these matters. If it is too late for this, go along with him. If he wants you to have drugs or injections, do not fight about it. In any case, you will need very much less than if you had not had the experience of the mental exercises.

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It does not require long periods of meditation to obtain relief from stress. Ten minutes twice a day has produced dramatic relief in some hundreds of people who have consulted me professionally.

To get the full effect of meditation, it is important not to do it when too tired. The effect is greatest when we are alert and frisky.

As we learn to meditate in this way, it soon becomes a pleasant experience. It is something to which we look forward. This comes with the ease that there is about it. There is no making ourselves relax, no making ourselves meditate. It is all very simple and natural. That is why we soon come to like doing it. Then we come to feel less stressed, and our motivation for our meditation is further increased.

Besides, there are many fringe benefits! The effects of successful meditation flow on into our everyday life. Although we may initially have been meditating to control stress or some psychosomatic illness, there are many side-effects, and they are all positive, and all good. They include inner peace, better interpersonal relationships, clearer thinking, increased work capacity – even tycoons agree on this, better sexual relationships due to less tension, absence of disturbing dreams, and smoother physical reactions often shown in better performance in sport.

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It is easy to see how the aggressive response could be a life-saving mechanism in primitive society. The same applies to success. The successful hunter came to survive. So also those who first successfully planted the seeds of grasses and commenced agrarian life. Those who were successful with their children had more to continue the race. So the need to strive for success is within us, not only in specific life-saving areas, but in life itself. This is a biological reality. In a way it is out of step with the Christian ethic of being meek and humble, which looks forward to a more enlightened society than that of the present day.

How does all this come into our discussion of stress? If we have an innate need to be successful, and we fail to attain success, we feel the situation as a problem. Messages about it crowd into our brain and predispose us to stress. The failure to attain success may be in any area of life at all —in marriage, in the job, in our children, in our friendships. The way in which failure to attain success can produce stress is obvious enough. But there is another side to the picture.

There is the simple line of unconscious reasoning. ‘If failure to attain success produces stress, we can counteract the stress that we have by making efforts to attain success.’ Within limits this works well enough. We can make an effort in the marriage to get through a difficult period. We can work to get the children going better by spending more time with them. We can make an effort to get on better with the people at work. However, it is not uncommon for these principles to be pushed too far. In marriage, if we seek success by analyzing every little matter between us, we simply create more stress. If seeking success with our children, we preach to them so much about the importance of their exams, and all the dangers of this and that, that we drive them from us, and our own stress is increased. At work, in striving hard for promotion we may find ourselves in a job which is beyond our capacity.

In the superficial values of our society, a university degree is often valued as a badge of success. ‘My husband has a degree, so have most of his friends and many of their wives. I feel out of it. Out of it all the time. So I have started a course with adult education. Do the exams next month. Terrified I shall fail.’ If she would only aim to improve her educational standard for the love of it, and not in this competitive fashion, she would be doing something to reduce her level of stress.

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Breathing troubles

«Sometimes I can’t get my breath. Breathing won’t come naturally. Talking to someone and I have to gulp. Conscious of my breathing. If I was not conscious of it, I would not be ready to take a breath if it should stop. Does your breathing just sometimes stop? It must when you die. Worry about going to sleep. If I was asleep, and it stopped, I would not be awake to take another breath. Sometimes I breathe too much. Something must be wrong. I made him take an X-ray, but that was all right. »

Symptoms like this are due to the disordered function of the autonomic nervous system which controls the rate and depth of our breathing. The trouble is made worse by the individual’s obvious anxiety.

Disorders of breathing due to stress respond dramatically well to meditation.

Chronic constipation

«It is about three months since I first came to see you about my nerves. I don’t think I ever told you that I had been troubled with constipation for years. Laxatives. Dieting. Enemas. It had all come to be a part of my life. Physiotherapist with special exercises. Massage. Nothing really made much difference. It all became just a part of life and that was that.

The meditation fixed the nervous trouble. But in some strange way this other business has cleared up too. Gone. I’m normal. Not since a child. Can hardly believe it. »

Symptoms of stress like this are by no means uncommon. Just let us be clear about one point. There are many different causes of chronic constipation. Stress is only one of them. Sometimes stress is the prime cause. Sometimes it acts as an aggravating factor to some other condition.

The mechanism by which stress produces chronic constipation is simple enough. In stress the over-alertness of nerve cells comes to involve the sympathetic nervous system which is part of the autonomic system. The sympathetic system prepares us for action. Fight or flight. To achieve this, our heart output is increased, blood pressure is raised, and more blood is directed to the muscles so that they can work more effectively. That is all straightforward. But if we are going to be involved in action, in fight or flight, we do not want to be encumbered by having to use our bowels. So in stress, the sympathetic nervous system switches off the motility of our bowels, so that we will not have to stop and pass a motion when engaged in combat. If the stress is long-lasting, as in people whose coping capacity is not equal to all the problems of daily living, there comes about a general sluggishness of the bowel which we recognize as chronic constipation.

If the action of the bowel is impaired by some organic problem, the condition may be made worse in this way by the advent of chronic stress.

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