“To lose confidence in one’s body is to lose confidence in oneself.”
― Simone de Beauvoir
Some of the most distressing issues that people with cancer face are those related to body image. Cancer surgery, in particular, can be extremely disfiguring, most notably when it involves the removal of a body part such as a limb or a breast. And head and neck surgeries, no matter how meticulously performed, also leave patients looking far different from their former selves. Other treatment side effects, such as hair loss, weight gain, weight loss and skin changes, while usually temporary, may also have a profound effect on how a person looks.
Yet, when we talk to people with cancer about their treatment, discussions about body image rarely come up.
Body Image and Self Image Intertwine
Body image is not just about how we feel about our physical appearance. When we look in the mirror, whether or not we have cancer, we make value judgments about what our appearance says about who we are. When we are less than pleased with what we see, we think, “I’m too fat,” or “I’m too thin,” or “My nose is too big” or “My breasts are too small.” And in doing so we are comparing ourselves against some internalized ideal.
And it doesn’t stop there. In every society, attractiveness equates with a host of other attributes — desirability, sexuality, strength and power to name just a few. When we feel unattractive or, worse yet, “damaged,” all of these other attributes come into play. Thus, changes in body image can have a deep impact on our self-esteem that reverberates through every aspect of our lives.
Mary is an attractive, 50-year-old married woman who underwent surgery for colon cancer a little over a year ago. At the time she agreed to the surgery, her doctor said he hoped to be able to remove the cancerous tissue and reattach the remainder of her colon, thus avoiding a colostomy. But the cancer proved to be more invasive than he thought. Mary came out of surgery with an opening on the side of her abdomen through which a piece of her intestine protruded. She would need to wear a colostomy bag for the rest of her life.
“I was in shock,” Mary says. “It was my worst fear…I wasn’t afraid of dying. I wasn’t afraid of chemotherapy. But the thought of having a colostomy terrified me.”
Mary had always been very invested in her physical appearance and proud of the way she looked. And she and her husband had always enjoyed a robust sex life. But she simply couldn’t imagine that any man would find a woman with a colostomy sexy or desirable.
“I couldn’t stand to take my clothes off in front of the man I’d been married to for 30 years,” Mary admits. “I would undress in the bathroom, shut off the light and glue myself to my side of the bed.”
Unlike some cancer survivors who have body image issues, Mary was able to return to work and gradually resume a social life. But despite her husband’s continued reassurance that he loves and desires her, she was unable to overcome her belief that she was “damaged goods.”
Acknowledging Loss and Grief
Finding a way to move past body image concerns can be very difficult. This is especially true for people who place a great deal of importance on physical appearance, as so many people in our society do. Shame, fear, embarrassment, depression and anxiety are just a few of the complex emotions that people whose treatment has left them physically changed or disfigured feel. Moving past these difficult emotions while also dealing with the challenges of ongoing treatment can seem like an impossible feat. Even after completing therapy, many cancer survivors still struggle to find a way to accept what has happened and move on.
For Mary, the answers came after she started seeing a psychotherapist, who helped her understand that her disfiguring surgery was a significant and painful loss. Mary’s self-image was inextricably tied to her physical appearance. And when she felt that she was no longer physically attractive, her self-image crumbled, leaving her feeling vulnerable and alone. “You feel as if you’ve lost the person you once were,” the therapist explained. “And you are grieving that loss. That’s normal and natural. There’s nothing pathological about your grief.”
Mary’s therapist also helped her learn new ways of thinking about her illness and its effect on her body and her life. She helped her realize that much of her emotional pain came from rejecting her body and the person she felt she had become. Like all people who are grieving, Mary needed to find some way to give meaning to her suffering. When she did that, the therapist explained, she would find value in her “new normal” and begin to rebuild her life.
“I’m still grieving,” Mary said the last time I spoke with her. “I guess to some extent I always will be. But I’m healing, too.”
Mary and her husband are going to couples counseling and working on their sexual relationship. And Mary is helping her therapist put together an educational program for women who are facing colon cancer surgery and the possibility of a colostomy.
“I would probably have done much better from the beginning if I had prepared for this,” Mary says. “I was so in denial. Every time my doctor tried to talk to me about the possibility of a colostomy I shut him down. I wish now that I had spent a little time learning what it meant and how to manage it. It’s ugly. And I wish it wasn’t there. But really, it’s not that bad.”
Mary pauses and seems to reflect for a moment. Then she adds, “I want to help other women understand that, even though you’ll never be “whole” again, this cancer thing is really just a part of that screwed up journey we call life. And as long as you’re still breathing, it can still be good!”