I always feel amused (when I don’t feel annoyed) by therapists of one sort or another telling people to “trust their instincts.”  The truth is, people should not trust their instincts-- if instincts refer to their immediate perceptions and/or their judgment.  The reason why people get into trouble is that they do not perceive things accurately. Their perceptions are colored by their expectations, which, in turn, are determined by their own particular experiences growing up. They have been influenced, in particular, by what their parents thought. For example,  I have treated three generations of one family who felt that all medications are dangerous; and I can think of another family which passed along a peculiar idea of health being dependent on moving one’s bowels once a day. They took notice of all those people who did not move their bowels once a day and had, by coincidence become ill, making it obvious in their minds that there was a connection. In this way their views were confirmed regularly.

 And, as adults, our perceptions are colored further by those of the people around us.  If a whole bunch of people see the face of a religious figure appearing on a piece of toast, or on the bark of a tree trunk, others can often be led to believe that they see the same thing.  Our political views are determined to a great degree by the people we hang out with. We share prejudices with the people we know. There are a lot of people who believe absolutely that their own religious ideas are exactly correct even though they know that there are others who feel just as definitely that their religious ideas are correct, and all others are wrong. All those quaint stories we read about Zeus, the king of the gods, turning into a swan were believed at one time just as firmly as people living today hold to their particular religious beliefs.  Similarly, the way we view other aspects of the world are determined in large part by the particular groups with which we identify.

Whether someone believes strongly in one god or another is not likely to affect his/her adjustment in life. Whatever that person’s religious views, or political views, are, he/she will be able to find many others who think the same way. What is important in navigating all the problems of life, however, is to see the rest of the world—and themselves—accurately, or, at least, as accurately as possible. In conducting therapy, therefore, I am always arguing in favor of questioning one’s perceptions—and memories, also, for that matter. Memories have been tested repeatedly, including in forensic settings, and there is overwhelming evidence that they are unreliable. Eye- witness testimony, for instance, is wrong very often.

 People commonly remember things that did not happen and could not have happened, such as an elephant being brought to nursery school. The “false memory syndrome,” in which people can be convinced that they saw or experienced something that did not happen, has been demonstrated repeatedly.

So, people have to learn not to be too certain. I am always trying to convince patients that it may not be true:                                                                                                                                                                              that everyone hates them, or                                                                                                                                                       that all men are unreliable, or                                                                                                                                       that they are doomed to have bad luck, or                                                                                                            that people are laughing at them behind their backs, or                                                                                                                                   that they have always failed and always will   And so on.   

In particular, people tend to have a distorted appreciation of how they look. There are a few people who look in the mirror and think they look terrific all the time; but they are few. Many more look in the mirror and see an acne scar which they think dominates their appearance—or a prominent nose, or a weak chin, or a receding hairline, or gray hair (even when, sometimes, they have no visible gray hair), or  eyebrows that are too thin or two thick, and so on.  The particular distortions the mirror reflects are especially important in dealing with eating disorders.

The mirror lies.  As people tend to see everything in life as they expect it to be, they see, especially, in the mirror, what they expect to see.  Elderly people looking in the mirror do not recognize that they have grown older, until, suddenly, they find themselves in front of a different mirror and their face is lit up more brightly, or just differently.  It is usually a disconcerting and uncomfortable experience. Some people give up looking at their reflection. They purposely turn away when they walk by a mirror. Sometimes they unexpectedly walk by a full length mirror at night and do not see their accustomed reflection. Rather, they see a parent reflected back at them. All of this seems new to them because they have unexpectedly observed themselves from a different perspective.

Similarly, I have known individuals who started off in treatment weighing over 400 pounds and saw in the mirror a fat person—but, perhaps, not that fat. After losing one hundred pounds, or more, they look in the mirror and see someone who is just as fat!  More commonly, people of normal weight gain considerable weight before they see themselves as fat. They know they are fat but cannot tell looking in the mirror that they look any different than they always did. Sometimes, someone is so fat that that is the first, second, and third thing that anyone notices about them; but they, themselves, spend time putting on eye makeup, as if that small adornment makes a difference.

Most striking of all, however, are the disturbances and inaccuracies of body image reported by men and women suffering from bulimia, and particularly, from anorexia nervosa.

Anorexia is a complicated condition that involves compulsive behavior in addition to disturbances of body image. Such patients may get caught up with the process of dieting, so that in their mind there is no proper weight. Or, to put it differently, they may say that their proper weight is just a little less. Always a little less, until sometimes they starve themselves to death. The act of dieting, itself, provides some perverse satisfaction. Still, the disturbance of body image they suffer from is also important. Thinking that they are fat, they see a fat person staring out at them from the mirror. If everyone around them says they are not fat, they do not believe them. But the disturbance of body image they obviously demonstrate may not be there all the time. It may be only the image in the mirror that is distorted. Although it is thought that body image is a constant, that image can be altered by looking at oneself from a different perspective.           

I once saw a young, demure woman who always dressed in pastels, as if she wanted to blend into the background.  She was five foot, nine inches tall and weighed 87 pounds. When I asked her what she thought her correct weight was, she said 86 pounds. She looked at herself every day in the mirror, and that was what she thought. I dissuaded her from losing more weight in part by threatening her. I told her if she lost any more weight I would hospitalize her. Some people with anorexia nervosa have to be fed forcibly to keep them alive, I pointed out to her.

For the next few months her weight seemed to stabilize, and therapy dealt primarily with her social problems. Her self-image was distorted in more ways than one. She felt that she could not talk to her colleagues on an equal footing. They were physicians and scientists with PHDs, and she only had a Masters degree. She thought they would regard her conversation as uninteresting. This misreading of what others thought about her contributed to the pervasive feeling of inadequacy that seemed to define her personality.  

One summer day, she came to my office holding tightly to a photograph. She had been to the beach the previous day, she told me, and someone snapped this photograph of her.

“I look like a concentration camp survivor,” she said, anxiously, and with obvious surprise.

It was as if she was seeing herself accurately for the first time. Shortly thereafter, she began to gain weight.

I have seen similar reactions in people who have weight problems of one sort or another. If they can be led to see themselves from some unfamiliar perspective—an arrangement of mirrors that allows them to see themselves in profile, or even from behind, or, as in the case of this woman, in photographs—they can sometimes learn to see themselves more accurately. As others see them.  At such a time they should dress scantily, if they can be persuaded to do so. Unfortunately, people who are self-conscious about their appearance are disinclined to look at themselves without clothes. Very often people who have gained weight do not realize how much they have gained unless they look at themselves from a new angle.  But just viewing themselves in a mirror in their accustomed way will only perpetuate the distortion in the way they see themselves. Because mirrors lie. (c) Fredric Neuman  Follow Dr. Neuman's blog at fredricneumanmd.com/blog

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