Stressful Body States in Normal Persons
Existence inevitably brings with it threats to one's body--there is always the possibility of illness, disease, and injury. Numerous studies have documented the universal concern about suffering body damage. A significant component of normal "nervousness" and fearfulness has been shown to involve fears of bodily harm ( Costello, 1982; Strahan, 1974). It is common for themes of body destruction and mutilation to appear in the spontaneous verbalizations of both adults and children ( Fisher, 1970). People must learn to cope not only with actual body damage but also with its unpredictable imminence. The extreme threat represented by body dysfunction is dramatized by the fact that it is not uncommon for people to delay seeking medical consultation for somatic symptoms that are obviously serious (e.g., Andrew, 1972; Hammerschlag, Fisher, DeCosse, & Kaplan, 1964).1 In addition, there is the need to adapt to the long-term decline in the body due to aging. Stresses with direct body-image implications are a normal part of life. This chapter is devoted to cataloguing these stresses and analyzing what is known about how people defend against them. Fisher ( 1970) evaluated the pertinent literature in this area that had appeared prior to 1970. The present review considers the findings that have emerged since then. Such key questions as the following will be asked of the available data: Is the impact of body damage on the body image directly proportional to the amount of damage? Which dimensions of the body image are most sensitive to body damage and threat? What defense strategies are most commonly employed to cope with body damage? Are there significant sex differences in coping strategies?
It does not require much documentation that the need to undergo surgery induces serious alarm. Fisher ( 1970) reviewed a number of studies indicating disturbance incited by the prospect of surgery could be detected in conscious self-reports, in projective test responses, and in dream imagery. There was evidence that even minor surgical procedures mobilized concerns about body damage that were out of proportion to the real nature of the threat. Janis ( 1958) proposed, on the basis of a survey of surgical patients and the illness experiences of college students, that persons typified by either little or very high preoperative anxiety are those most likely to develop emotional distur-