Academic journal article American Journal of Psychotherapy

The Role of Body Image in Pediatric Illness: Therapeutic Challenges and Opportunities

Academic journal article American Journal of Psychotherapy

The Role of Body Image in Pediatric Illness: Therapeutic Challenges and Opportunities

Article excerpt

The body image is the individual's mental representation of his own body, a representation that encompasses both perceptual and ideational components. In this paper I will explore the concept of body image, its development and its relationship to self-image and object relations in children with chronic medical illness. From this discussion and with the help of specific cases of medically ill children I have treated for a variety of psychological symptoms, I will recommend an approach to the assessment and treatment of this challenging group of patients.

Keywords: body image; chronic pediatric illness; psychology; object relations; adjustment

I. INTRODUCTION

j'aurais dû être heureux: je ne l'étais pas. Il me semblait que ma mère venait de me faire une première concession qui devait lui être douloureuse, que c'était une première abdication de sa part devant l'idéal qu'elle avait conçu pour moi, et que pour la première fois, elle, si courageuse, s'avouait vaincue. Il me semblait que si je venais de remporter une victoire c'était contre elle, que j'avais réussi comme auraient pu faire la maladie, des chagrins, ou l'âge, à détendre sa volonté, à faire fléchir sa raison et que cette soirée commençait une ère, resterait comme une triste date.

Du Cote de Chez Swann

Marcel Proust, 1913, p. 47

I ought to have been happy; I was not. It struck me that my mother had just made a first concession which must have been painful to her, that it was a first abdication on her part from the ideal she had formed for me, and that for the first time she who was so brave had to confess herself beaten. It struck me that if I had just won a victory it was over her, that I had succeeded, as sickness or sorrow or age might have succeeded, in relaxing her will, in undermining her judgment; and that this evening opened a new era, would remain a black day in the calendar.

Swann's Way

Marcel Proust

(Scott Moncrieff and Kilmartin, Trans. 1981, p. 41)

This passage comes from the first book of Marcel Proust's sevenvolume biographical novel, A La Recherche du Temps Perdu (Remembrance of Things Past or, alternatively, In Search of Lost Time). In this passage, the young Marcel, aged approximately ten years and a long-time sufferer of crippling asthma, describes the first occasion when his beloved mother accedes to his life-long attempt to have her stay with him at night, to assuage his terrible fear of the dark and solitude. Presumably, the life-long cries of respiratory distress mingled with anxiety had led to this ultimate concession on the part of his mother. Her ministrations over the years had soothed and secured the young Marcel during these episodes of physical and emotional suffering. These crippling bodily sensations derived from early physical illness and emotional suffering, and his mother's pained response to them had resulted in a much more profound outcome: they had contributed to the formation of his sense of self and to the object relations he had formed. This is most powerfully illustrated by his mother's deflated resignation and acceptance of his physical and emotional frailties and his fathers grudging, resentful abdication of his belief in the primacy of his son's independence and self-sufficiency. In this passage, the young narrator expresses his own defective and vulnerable sense of self by imagining what his mother experiences, "abdication from the ideal once held", at the moment that she concedes defeat and remains in her ailing son's room.

In this chapter I will explore the concept of body image, its development and its relationship to self-image and object relations in children with chronic medical illness. From this discussion and with the help of specific cases of medically ill children I have treated for a variety of psychological symptoms, I will recommend an approach to the assessment and treatment of this challenging group of patients.

IL THE CONCEPT OF BODY IMAGE IN CHILDREN AND ADOLESCENTS: PSYCHOANALYTIC AND COGNITIVE THEORY

The past is never dead. …

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