Self-image and well-being are linked

Self-image and well-being are linked

By Terri Apter

LONDON: The relation between a woman and her body is often seen as problematic. She is aware of herself as a "physical object", someone seen, assessed and known as a body.

This self-awareness begins at an early age. Diaries of girls as young as eight show that they engage in what the author and academic Joan Jacobs Brumberg calls "the body project" - seeing themselves as something to change, mould, perfect. They form resolutions to pare down through dieting and build up through exercise. Being body beautiful becomes a moral mission.

The female as object can be traced throughout the lifespan: from puberty, when she becomes aware of her sexuality through others' responses, to midlife, when many women report becoming invisible socially, women note a link between being attractive and being significant.

Of course, men are not impervious to how they look. At the launch of a book of his collected essays, a university professor was asked whether he had any regrets. Caught charmingly off- guard, he blurted out, "I would have liked to be four inches taller." A retrospective of a brilliant career was clouded by a constant sense that he was "too short".

Men may objectify their bodies in other ways. They sometimes emphasise the body's performance more than their pleasure. They experience pain as something to be contained rather than expressed. They try to look strong, rather than as they are. Such objectification may go some way to explaining the current debate over the existence of the male menopause, dismissed by some clinicians, which was raging in the British Medical Journal last month.

Critical awareness of our own bodies in terms of how they look rather than in terms of how they work is an impediment to a good life. If we look in the mirror and despise ourselves because of our breasts or cellulite, or if we flare with envy for another woman who looks the way we think we ought to, then we collude in a way of seeing that diminishes us.

But recent research has highlighted another aspect of women's special body awareness: they may also be more aware of the body as subject. In other words, they are more attuned to what they feel, and have higher standards for feeling well.

Men and women have different bodies and different body chemistry. It should not be all that surprising that female and male pain follow different pathways to the brain. In all probability, the different pathways are a result of evolution. Men had to learn how to endure the traumatic pain of sudden injury while hunting, and women had to endure the more visceral pain of childbirth.

Some people find this argument compelling, and some find it infuriatingly speculative. But while the differences between the sexes, in terms of pain, are really very small, we can still learn much from looking at the different ways different people read their bodies.

The menstrual cycle teaches women how their moods are affected by their hormones. Few women need a pregnancy test to tell them they are pregnant: there are other, clear signs, such as the tenderness of their breasts - and acute irritability. They key into the different physical messages of different days, and are much quicker to know when something's wrong.

Whether what we feel is seen as intelligent or fantastic is a matter of constant revision. Women have fought hard to revise on their own terms. Menopausal symptoms now are widely recognised, but this wasn't always the case. Hot flushes may have been recognised as "real" (that is, as a symptom of lower estrogen levels), but other menopausal effects were until very recently classified as symptoms of mental disturbance.

Dr Eleanor Birks, who now runs a menopause clinic in Cambridge, remembers being told by a patient that she felt "as though ants were crawling under my skin". Examining her, and finding nothing, Eleanor tranquillised her. Only years later, when she experienced menopause herself, did she realise her mistake: the itching, crawling sensations were, she now knew, associated with menopause. It was another lesson, she says, in valuing women's awareness.

Women tend to be precise and thorough in their descriptions of pain. Ask a man when his back gives out, and you will be told he was digging in the garden or manoeuvring a lawn mower. Ask a woman, and she will explain that her back gives out when she is under stress. She will tell you what she was thinking about as well as what she was doing. The current medical focus on the close links between psychological and physical wellbeing comes as a surprise to men and a confirmation to women.

Hence, men may be slow to link the midlife hormonal changes, in which testosterone levels are lowered, with their mental turmoil. Instead of addressing the body problem, sometimes called the "male menopause" or "menopause", they disrupt their families and their careers. Ignorant of body messages, they buy fast cars and pursue young women - or stick with what they have but lapse into depression. Certainly, they are slower to seek help and to put the problem in context.

Women do not have to be ill to seek medical advice. Hence, well- women clinics are proliferating in GP surgeries and some workplaces, while men's health clinics are few and far between. This can viewed in two ways. One is that women's natural conditions are somehow seen as abnormal, in need of medical intervention. Another slant says that men are reluctant to seek help. With an interpersonal perspective geared to hierarchy, they don't want to put themselves in a "one- down" position.

But if body knowledge becomes valued by everyone, then this could change. It would, indeed, be an immense social change, for then macho endurance loses its point. This could mean the end of any glorification of the soldier, but it would certainly mean that men would be quicker to seek medical treatment for all those embarrassing conditions (such as prostate and colon cancer) that women have never had an option to avoid.

As the medical profession becomes more interested in what and how people feel, they will help both men and women gain power over their lives and their bodies. After all, women may be quick to locate their pain, but they need new education in locating their pleasure. Between 1994 and 1997, 836 practices were tracked. Areas of social deprivation had high rates of teenage pregnancy. But these rates could be cut by a staggering 25% where the practice had a female doctor under the age of 36.

-- Guardian News Service