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Inside Therapy: The Overselling of Body Disorders

Tuesday, March 20, 2012


When is looking in the mirror a reflection of mental illness?

“Do you compare your appearance to that of other people?”

“Do you frequently check mirrors?”

OK. Then go ahead and answer the next couple of questions, too:

“Do you frequently change your clothes?”

“Do you diet?”

Tabulate your answers, please, before I deliver the weighty news: If you answered yes to any of the above questions, you may have “a serious mental illness.”

Yes. It’s true. At least that’s what the medical experts are saying. The above quotations are taken directly from Web sites and print ads of local hospitals.

Like so much advertising, there’s a trickle of truth here: if you answered "yes" to the above questions then there is indeed a possibility—a very small possibility—that you have what the experts who paid for these ads are studying: an affliction they call Body Dysmorphic Disorder.

Then again, you may just be like everyone else.

BDD is serious business

We shouldn't take BDD lightly; it’s a recognized psychiatric syndrome. The Diagnostic and Statistical Manual of Mental Disorders does not, however, identify it by how often its sufferers change their clothes. Mental health professionals bestow the diagnosis of BDD only on people who suffer from a “preoccupation with an imagined defect in appearance” that is “markedly excessive” and that “causes clinically significant distress or impairment in social, occupational or other important areas of functioning.”

But asking someone if she has a 'markedly excessive preoccupation with an imagined defect in appearance' makes for decidedly unsexy advertising copy. And it’d only get the attention of a small percentage of the local population. In fact, A Brown University study published in the journal Psychosomatics in 2005 shows that BDD occurs in .7% – 1.1% of community samples—but I’m guessing that a few more than .7% - 1.1% of the people in our community would answer “yes” to the questions the hospitals ask in these ads.

One of the things this kind of advertising wants you to believe is that you have reason to be concerned. Really concerned. In fact, if before you were merely concerned about your appearance, then now you ought to be concerned about your sanity instead. After all, your appearance you’re pretty much stuck with. But we, the experts—the mental health professionals of the world—we can do something about your sanity.

And the institutions that employ us need your business pretty badly. In the United States, emotional suffering is no longer a human reality to respond to, it’s a human industry to streamline. It’s big business. In 2002—the last year for which the National Institute of Mental Health provided figures—the total costs associated with serious mental illness were over $300 billion dollars per year. That’s about $200 billion more than Apple brought in selling iMacs, iPhones, iPads and everything else.

Advertising and mental health

In a market that size, even the well-meaning experts you look to for guidance are often drawn into the dubious work of creating consumers where none existed before. That means being advertisers, not healthcare professionals. Caring for the vulnerable is about giving attention. Advertising is about getting attention. And in the world of healthcare, advertising too often involves instilling fear. Ads like the ones I quoted are symptoms of a broken health care system that is pushed around by the strong hand of capitalism, and that makes a profit preying on the anxieties of people it’s here to serve.

This is not to disparage the extraordinary work done at hospitals every day by people who try their best to relieve suffering—psychological and otherwise. Over the last 12 years, I’ve travelled throughout the country consulting to senior leadership teams across the healthcare industry, and I can tell you that hospitals remain places where genuinely well-intentioned people do their best to help others who are in pain. I can also tell you that healthcare organizations are fighting for market share like everyone else. If hospitals refused to play by the rules of the marketplace, they wouldn’t be around for anyone to complain about.

But behaving responsibly means drawing the line somewhere, and those of us who spend our lives trying to relieve suffering have to draw the line. We do damage when we resort to fear tactics. It’s an abuse of our power, and of the trust that people place in us.

By all means, if you have concerns about your appearance that feel overwhelming and as though they’re curtailing your life, by all means talk to your doctor or therapist about it. If your doctor or therapist doesn’t take you seriously, find another one.

But if you frequently change your clothes, check your look in the mirror, and wish you were better looking, you’re probably OK.

Or a lot like me, anyway.

Archie Roberts is a psychotherapist, professor, and writer. He's consulted to organizations around the world and makes his home in Providence. www.archieroberts.net


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