Practical wisdom: The role of the body image in medical contexts

The conceptual structure of the body image discussed in this chapter comes together as a very distinctive yet manifold idea in light of the three disciplines explored here. In health care settings, that manifold idea contributes to the practical wisdom needed to guide the practice of assessment and treatment. The shape of the manifold idea, however, differs from the structural- functional interpretation of the body image widely held within the discipline of psychology. The structural-functional concept and its dichotomous organization, however, do not influence or inform practice in medical settings as directly as they do practice in psychology.

1.5.4.1 Psychiatric settings

Guimon (1997b) described a broad range of techniques used in the assessment of body experience and body image, and his discussion was based upon his expertise in psychiatric contexts. The techniques he discussed, he classified according to the formative structure of each. For example, he suggested that body image assessment techniques are classified according to aspects such as “…methodological orientation (objective and subjective questionnaires), the focus of the data (diachronic and synchronic), the time perspective of the data and the ‘structure of relevance’” (Guimon, p. 37-8). Further, he noted that techniques of assessment might also be categorized according to the way they structure the relationship between the researcher and his or her participant in the assessment. His review described interview techniques that induce

subjective information such as “body biographies” and “body scenes” (p. 38). He also identified scales used in diagnosis and designed for the assessment of individual cases. Further he identified more distinctive scales used in population studies, and techniques designed for use as standardized questionnaires and repertory grids. Semi-structured and open-ended interviews, he added, have also been designed for use in clinical settings, and lastly, he described the application of projective methods, drawings, modelling and projective tests in the evaluation of the body image.

Guimon (1997b) presented these assessment techniques in the context of a very broad theoretical and epistemological interpretation of the body image that included the identification of conscious and unconscious experience. He associated the techniques in his review with the task of advancing the accuracy of formulations made by practitioners, of the personal experiences described by patients. His review certainly identified the task of assessment as that of identifying abnormal experience, but his acknowledgement of the relationship between conscious and unconscious experience couched the assessment task within a specific theoretical framework. Guimon’s review was thus founded upon theoretical foundations and through them, he demonstrated the relevance of theory to the assessment of body experience. Guimon’s discussion highlights the interpretive function of theory when assessing the distinctions and similarities between abnormal and normal experience. His review thereby underscored the role of theory in practice, but more importantly, the relationship that theoretical assumptions have to the internal validity of psychological assessment.

1.5.4.2 Nursing and rehabilitation settings

The practical wisdom of theory pertaining to the body image has been applied in nursing and rehabilitation settings. Nursing practitioners in these settings do not conceptualize the body image according to a dichotomous model, nor do they seek to diagnose it the body image in terms of its relationship to psychological disturbances. Rather, these practitioners are interested in the versatility of the body image concept for the management of patients in the recovery stages of surgery or chronic illness. To do this they use the body image as a humanistic framework

through which to conceive the patient’s bodily and psychological self-experience whilst in care. For example Ebbeskog and Ekman (2001) described how the concept enabled health practitioners to understand patients’ physical and psychological experience in the context of illness, hospitalization and recovery, and thus highlighted how changes in self-experience may result from medical interventions.

A range of authors in this field has explored the versatility of the concept for health practice and allied treatments. Vamos (1993), for example, posited body image as a concept through which patient experiences of chronic physical disorders can be monitored. Salter (1997) suggested a similar idea, but supported its application in health settings in the context of an altered body. Norris (1978) described body image like a tool through which the health care professional can attribute interiority to the patient and, like Vamos, suggested that it provided a suitable framework when reviewing expectations about treatment or recovery. She added that it also supported the formulation of the patient’s history, physical assessment, examination and diagnosis, because it offered a broad perspective through which to interpret body experience. Her perspective included the social context and culture, maternal-infant development, sexual experience and sexual health, and conditions afflicting the experience of the body such as aging, obesity and body dysmorphic disorders.

In nursing and rehabilitation settings, body image is a lens through which health practitioners can reflect on their clinical style. The practical wisdom that can be gleaned from this is that the actual presence of the body is an integral part of the body image in normal psychological experience. For example, the health practitioners in these examples conceptualized body image as a further dimension on patients’ overall health status. The relationship between physical health and the body image has not been represented in the structural-functional research within the discipline of psychology, although it is the basis of psychoanalytic treatment. The exceptions to this, presented Section 3.3.4 below, highlight the importance of this relationship, and of the importance of theory, if the concept is to have the same versatility in psychology as it has in medical settings.