I've reached an age where I try and avoid mirrors - particularly ones in bright, glaringly lit shop changing rooms. It often gives me pause for thought - thinking how it may be if you're also dealing with cancer, and its myriad of treatment side effects.
We live in a world where youth, ‘perfect’ airbrushed bodies, looks and appearance are rated highly, and that can bring its own pressures. However for many people, particularly those having or who have undergone cancer treatment, body image becomes a bigger issue – for many, affecting day to day confidence, and causing anxiety, depression, isolation and a reduced quality of life.
What is body image?
What is body image, and its companion, self-esteem? There is much in the media and journals about how cancer can impact on how we feel about ourselves, but it may help to have a definition to guide my discussion today. I like the simple explanation given in The Cancer Survivor’s Companion (2013) by Dr Frances Goodhart and Lucy Atkins. In their chapter ‘Self esteem and body image’ (p107 – p137), they suggest that ‘your body image is the picture you have of your physical self’. This can be evidenced by measurable things like weight changes, muscle strength, physical changes…but is also influenced by how you interpret and judge what you see. Body image dovetails into self esteem, which the authors describe as ‘basically, how you feel about yourself’.
Cancer treatment can bring about many physical changes, many temporary but some permanent. These include:-
- Surgical changes – for example breast surgery, including mastectomy, formation of stomas, amputations, head and neck surgery and skin grafts, etc..
- Weight and muscle mass changes due to medications, loss or gaining of weight, body shape changes due to hormonal treatments or steroids
- Hair loss, skin rashes, scarring and lymphoedema, voice loss and changes.
- Changes in posture due to treatment, perhaps needing walking aids, requiring a wheelchair, can also impact on your view of yourselves – feeling self conscious and uncomfortable. Visual prompts such as feeding tubes, portocaths, etc.
What it does to your confidence
Some body image issues be barely visible, but still affect your confidence – it’s how you feel about the changes which creates the emotional and psychological turmoil. The crisis of confidence about how your body and appearance has changed can affect relationships, particularly with a partner, as it can impact on physical intimacy – feeling self conscious about bodily changes and fearing rejection. Your partner may feel equally uncomfortable and awkward… wanting to reassure you, but not sure of the words to say, or how they might cope with the ‘new’ you.
Going out into the world, with outwardly visible changes can be a little daunting too – and it’s tempting to withdraw from society’s gaze. Isolation is a lonely experience though, and can make you feel lower in mood, and further affect your self esteem.
Sometimes it’s tempting to avoid the issue…not looking in the mirror, taking steps never to see your scars, not touching or acknowledging that part of your body which has been affected. However, it takes time for the mind and heart to catch up with the body image changes, and learning to get used to the changes can be part of the recovery process.
Whilst we think of body image as being primarily a female issue, research shows that men have an equally tough time. With women it may be weight issues, and loss of physical attractiveness, whilst research shows that men equally struggle with weight issues, but also focus on muscle mass and strength…so loss of power, and muscles can have a major impact.
What can you do
- Check what you’re feeling is normal. If it’s early days post surgery, or during treatment, and the changes are temporary, it may be reassuring to check with a health care professional if what you’re feeling is OK. If you’re concerned about, for example post op swelling, scarring, etc, sometimes just checking with your GP or specialist nurse that things will settle down can be a reassurance in itself.
- Prepare some conversation sound bites, for those people who are meeting you for the first time since your physical appearance has changed…’I’ve been having cancer treatment, so I might look at bit different at the moment, but I’m ok…’ lets them acknowledge the changes and move on, or open the discussion further if you and they wish...
- You’re allowed to feel sad…it’s a loss, temporary or permanent, and you may need to grieve. If the sadness remains, and you’re finding you’re feeling panicky, anxious or depressed, then seek help. It might be through your GP, counselling, or through your hospital services. Many specialities in cancer care have access to psychology input, particularly where physical changes occur – for example head and neck surgical departments, etc.
- If you find you’re repulsed by, or avoiding your scars or body changes, again speak with your specialist nurse, consultant and/or GP. The longer you avoid accepting the changes, the more it can become an emotional and psychological minefield. There are strategies to come to terms with the changes, but you may need help and guidance, to help you through.
- Learn to like the body you have…the way it works, flaws and all. You’re more than a physical being, with qualities and attributes that will outlast and outshine the physical. Trying to look outward, rather than inward…try new things to build your confidence. Letting go of the way things were, and living for the present…
- If you live near one of our Maggie’s Centres, or have a local cancer site specific support group, it can help to meet other people who have experienced what you are going through. ( we have links to support groups, listed under specific cancer type, in Maggie's CancerLinks). Taking control back, through good nutrition, exercise and stress management, can move you forwards, and help re-build your body confidence. Ask about ‘Look Good, Feel Better’ workshops in your area, to boost your self esteem and learn skills to draw attention away from the impact of cancer treatments on skin and eyebrows etc.
- Talk openly with your partner, family and friends about your vulnerabilities, and invite their support and positive feedback . Acknowledge your vulnerabilities about your body changes, sharing laughter and gentle humour can help break the ice, about the subject. You’ve all been through a great deal together, and seeing you re-emerge, maybe in slightly different form, but with increasing confidence will help them as well as you.
I’ve listed some useful links to websites in a resource list below. You are also very welcome to drop into one of our Maggie’s Centres, or join in our online forums - where you can be supported and feel less alone. We look forward to meeting you,
The Cancer Survivor’s Companion (2013) Lucy Atkins and Dr Frances Goodheart
Body image and Cancer (Macmillan Cancer Support)
How cancer can affect your sexuality and sex life (Cancer Research UK)
Self-image and cancer(Cancer.Net)
Body image(Livestrong Foundation)
Body image during and after cancer (young people) (youthtalk.org)