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Health Care Analysis
Published in: Health Care Analysis 4/2011

Open Access 01-12-2011 | Original Article

The Meaning of Body Experience Evaluation in Oncology

Author: Jenny Slatman

Published in: Health Care Analysis | Issue 4/2011

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Abstract

Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily wholeness or bodily integrity. Since this experience is contextualized by a person’s life story, evaluation should also focus on narrative aspects. I finally suggest that the interpretation of body experience is not only valuable to assess a person’s quality of life after treatment, but that it can also be useful in counseling prior to interventions, since it can support patients in making decisions about interventions that will change their bodies. To apply this type of evaluation to oncology practice, a rich and tailored vocabulary of body experiences has to be developed.
Footnotes
1
Van der Steeg [59], by contrast, claims that the importance of ‘body image’ is overestimated with respect to quality of life in breast cancer patients. This claim, however, is based upon an inadequate conception of ‘body image’. Her study starts from the assumption that body image is the same as physical appearance. As I will explain, body image implies a relation to one’s physical self.
 
2
Medical psychologists have established that body image disturbances are often associated with specific psychic problems such as poor self-esteem [34], social anxiety [10] and depressive symptoms [54]. Cancer survivors often suffer from these kinds of psychic troubles. Cognitive and behavioral therapy, aiming at the reinforcement of one’s body image, therefore supports the general condition of one’s psychic well-being [63].
 
3
It is not my intention to provide a literature review here. While summarizing the essential features of what is meant by body image, my explanation rather aims at providing some clarity in the hotchpotch of current body image literature.
 
4
Gallagher [23] notes, however, that specific neurological disorders can disintegrate the relation between body image and body schema. For instance, he describes the case of IW, a male adult who lost his sense of prorioception and touch below the neck due to an infectious mononucleosis. IW does not experience his own body from within. In fact, he has lost his body schema and compensates for this loss by means of his body image, which means that he has to consciously monitor all his movements.
 
5
It should be noted that not all bodily feelings and experiences can be related to one’s body image. Feelings like nausea, fatigue and fear of death, which occur frequently in cancer survivors, refer to the experience of one’s body ‘beyond image’ [11].
 
6
This BIS is designed to be used with any group of cancer survivors. But it should be noted that it was developed on the basis of interviews with female breast cancer survivors only. Also, its French version is used exclusively for the assessment of women who have survived breast cancer (Brédart, Swaine Verdier and Dolbeault, 2007).
 
7
It is worth noticing that French researchers who translated the English Body Image Scale into French had quite some difficulties with item 8. Provisionally they translated ‘have you been feeling the treatment has left your body less whole?’ into ‘Avez-vous ressenti que le traitement avez affecté votre intégrité corporelle?’ This resulted in the English contra-translation ‘Did you feel that the treatment affected your body integrity?’ It was noted, however, that the concept ‘bodily integrity’ was not comprehensible enough since it involves an elevated style. Hence, the item was finally translated as ‘Avez vous ressenti le traitement comme une atteinte à votre corps ou une mutilation’, which harmonizes with ordinary French usage [7].
 
8
By the same token, quality of life does not simply coincide with physical (dys)function or appearance. It rather involves a person’s valuation of function and appearance. This implies that the restoration of physical functions does not automatically result in an increased quality of life. It is unfortunate that in the quality of life questionnaire for breast cancer survivors (BR-23), not all items reflect this aspect of valuation. Item 34 (‘Have you lost any hair?’) and item 49 (‘Was it difficult to raise your arm or to move it sideways?’), for instance, only query appearance and function and not a person’s valuation of it [17].
 
9
Or, as Merleau-Ponty [37] argues in his interpretation of the mirror stage: “the image in the mirror prepares me for another still more serious alienation, which will be the alienation by others” (p. 36).
 
10
It goes without saying that the way one valuates his or her scarred body, the degree to which one can identify with it, is also dependent of social and cultural norms. Indeed, physical ‘deviances’ or ‘stigma’s’ only come into being in social relations [24]. Social (and cultural) interaction is thus constitutive for the meaning of appearance in breast cancer survivors [58]. This paper, however, is not the place to dwell upon the social and cultural aspects implied in body image and bodily integrity. My hypothesis that bodily integrity involves a process of identification on both a personal level and an intersubjective and cultural level (and that these levels are interrelated), will be elaborated and researched in another study.
 
11
Although more and more attention is paid to the articulation of patients’ personal values and attitudes in the process of decision making [12], a specific focus on body experiences is lacking in most conceptions of shared treatment decision making.
 
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Metadata
Title
The Meaning of Body Experience Evaluation in Oncology
Author
Jenny Slatman
Publication date
01-12-2011
Publisher
Springer US
Published in
Health Care Analysis / Issue 4/2011
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-010-0153-9

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