PANEL REPORT

AFTER OUR BODIES OURSELVES

The panel After Our Bodies Ourselves, organized by Section III (Women, Gender, and Psychoanalysis), focused on the trajectory that feminism took since the publication in the early 1970s of Our Bodies Ourselves. Each of the ve panelists had her own approach to the broad topic. Papers covered a historical overview of some of the societal changes effecting women in the past few decades in the United States; the psychodynamic impact of elective bodyaltering surgeries on adult women and adolescent girls; an introduction to a new construct object orientationand its implications in the rethinking of the construct of gender; and a case study about a woman with a snake phobia. Keywords: cosmetic surgery, eating disorder, gastric bypass, object orientation, snake phobia
Section III (Women, Gender, and Psychoanalysis) presented a panel at the Annual 2005 APA Convention in Washington, DC, entitled After Our Bodies Ourselves, an intentional reference to the popular book from the early 1970s that focused on womens relationships to their bodies. The panels broad subjectthe trajectory that feminism took since the publication of Our Bodies Ourselves (1971)included the surgical penetration of the body, elective surgeries that permanently alter the body. The chair of the panel, Batya Monder, framed the discussion that followed with brief introductory remarks about aesthetic surgery. Modern aesthetic surgery, now called cosmetic surgery or plastic surgery, is celebrating its centenary, as is our own discipline psychoanalysis. While psychoanalysis was helping us to better understand our inner lives, aesthetic surgery was perfecting new techniques to change our appearances in a myriad of ways. Aesthetic surgery focused rst on the face, the part of the body that has always been exposed in the West. As early as the 1890s, it was commonplace to hear the shape of the nose associated with social status and with weakness or strength of character, with a too-small nose seen as undesirable. From noses, aesthetic surgery moved on to breasts, buttocks, and bellies, as surgeons were better able to control pain and sepsis. But it hardly

Panel presented at the Annual Convention of the American Psychological Association, Washington, DC, August 20, 2005. Panelists: Batya R. Monder, MSW, BCD (chair); Nancy McWilliams, PhD; Devon Charles, PhD; Deborah Blessing, PhD; Lynne Harkless, PhD; and Judith Logue, PhD. Correspondence concerning this article should be addressed to Batya R. Monder, MSW, BCD, 157 East 86th Street, Suite 2A, New York, NY 10028. E-mail: bmonder@gmail.com
Psychoanalytic Psychology, 2007, Vol. 24, No. 2, 384 394 Copyright 2007 by the American Psychological Association, 0736-9735/07/$12.00 DOI: 10.1037/0736-9735.24.2.384

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stopped there. Sander Gilman (1999) lists 24 other areas of the body that are being altered by cosmetic surgery and notes that this is only a partial list! Monder referenced two articles that appeared in the New York Times in 2004. The rst, Beyond Baby Fat (Santora, 2004) was about gastric bypass surgery on adolescents. Despite disturbing questions about the long-term effects of limiting nutritional intake on still growing bodies, the article noted that gastric bypass surgery was becoming ever more popular for adolescents, as it has for adults. One of the panelists, Devon Charles, focused on the aftermath of this surgery in an adult female and how little prepared psychologically the patient was before undergoing this procedure. A second article, suggestively entitled The Most Private of Makeovers (Navarro, 2004), covered genital plastic surgery for women, or what the Times called a new frontier. This included tightening vaginal muscles, plumping up or shortening labia, liposuctioning the pubic area and even restoring the hymen. . . . Procedures that once were reserved for . . . congenital malformations . . . are now being marketed by some gynecologists and plastic surgeons as vaginal rejuvenation. As with the earlier article on gastric bypass, no reference was made to the psychological impact of, or preparation for, the genital surgery. The panel did not address genital plastic surgery, but Deborah Blessing discussed two 18-year-old patients who underwent breast-reduction surgery and raised the unsettling question about who actually decides when body-altering surgeries are performed. In the past three decades, there has been an enormous increase in elective surgeries of all kinds that women (and men) subject themselves to. Some of these surgeries are important and healing; some are motivated by a wish to look better, however that is dened by the individual; some are motivated by a desire to please, or appease, a parent, a lover, a spouse, or even a physician. Each of the ve panelists had a different approach to the panel title. Nancy McWilliams addressed the historical context. She noted the passage of time since the rst edition of Our Bodies Ourselves was published by the Womens Collective (1971) and that the panelists themselves represented three different eras of psychoanalytic feminists: baby boomers like herself, women in midlife, and women in the rst few years of their careers who had grown up in substantially different cultural, emotional, and assumptive environments. McWilliams then set the stage for the papers that followed by recalling the era when the 20th-century womens movement rst ourished. In the 1950s and early 1960s, said McWilliams (2005), the voice of ofcial, nondomestic authority was virtually always male. The rare female voice of authority was inevitably subjected to snickering observations about that womans ugliness or frigidity or sexual orientationand the era was hardly friendly to sexual diversity. As we participated in the political movements of the 1960s, women became aware of the ways in which we had internalized those voices. McWilliams went on to note that many women in the late 1950s and 1960s were in therapy and that psychoanalytic treatment was an exciting way for middle-class women to individuate from their families of origin. It was often the rst way, said McWilliams, that we tried to deal with our vaguely depressive and anxious feelings about what kind of adulthood we could have in a world in which we perceived our mothers as culturally devalued and stied by domesticity. The unlucky ones among us got therapists who said they had penis envy and that this meant they should get over their resistance to having a purely domestic role. The lucky ones got [analysts] who, whether or not they examined our symbolized envy toward men, helped us to struggle to nd our voice and nd ways not to be dened by patriarchal assumptions.

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Women in the 1950s and 1960s, continued McWilliams, wanted to accept themselves and each other without constant reference to the male gaze. We wanted to be appreciated as we were, without girdles, cosmetics, and falsies, and rued what we came to see as a craven effort to transform ourselves into the images of female perfection that had dominated the new mass medium of TV. Although we experimented with not shaving our legs and not wearing bras, few of us were ideologues or purists about being totally natural. Most of us made concessions to the esthetics of the time, but we did have a sense that there was something called natural beauty. Equally important was the need to be empowered in terms of our health care. Women had been conditioned to defer to the authority of the medical profession, which in most instances meant the male physician, who, like the 1950s Father, knew best. The main concern of Our Bodies Ourselves was to enable women to take an active role in their own health care. Surprisingly, commented McWilliams, the rst edition of the book omitted any exploration of childhood sexual abuse, domestic abuse, rape, eating disorders, self-cutting, plastic surgery, or aging. From the vantage point of 1971, we could not have foreseen the prevalence of these serious problems. Self-cutting, for example, was then frequently assumed to be a suicide gesture. Nor could we have foreseen other kinds of self-mutilation, tanning salons, cosmetic surgeries, gastric bypass surgeries, or the incredibly powerful economic juggernaut of the beauty industry. We were reacting, to some extent, against the stereotyping of feminine attractiveness by a mass culture, and in retrospect, it is clear that mass culture had only begun. Does the concept of natural still exist, wondered McWilliams in an era in which one can clone human beings, affect their genetic make-up, give a short boy growth hormones or a at-chested girl breast implants. She noted the contrast with the 1970s, when we were trying to embrace our bodies without objectifying them, to feel that who we were physically was ne, that our feminine sexuality was as important to respect as the sexuality of males that had tended to dene sexual relationships. In some ways we were successful, but in others, we seem to have been abject failures. We could not have imagined an era in which 12-year-old girls, desperate for popularity, give oral sex to numerous classmates and in which female high school graduates in afuent communities receive from their parents the graduation gift of breast implants. Nor could we have imagined a time when men, too, would start to develop eating disorders, seek cosmetic surgery, take hormones, and make a fetish of bodybuilding. In fact, our bodies have become much more fetishized than they were in 1971. In the 1970s, we were self-consciously trying to appreciate different types of beauty, black and white, thinner and fatter, taller and shorter, even older and younger. Then, Mama Cass was an icon while now, says McWilliams, we have a remarkably narrow denition of beauty. In closing, McWilliams commented that we are living at this point in a very adolescent culture, burdened by the omnipotent fantasies that characterize the teen years. We want to believe that anything is possible, that there are no natural limits that must be recognized, mourned, accepted, and accommodated. Devon Charles (2005), the next panelist, spoke about the psychodynamic implications of gastric bypass surgery, noting that this surgery has become an acceptable weight-loss method, an alarming idea for anyone interested in psychoanalytic understandings of obesity, weight-loss, body image, and surgical methods of altering ones appearance. Gastric bypass, an invasive procedure, has been gloried in the media and is being used ever more frequently in less severe cases of obesity. The health risks of major surgery aside, this procedure has important psychological implications that interplay with what we

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know about obesity itself. Obesity and bypass surgery are both on the rise, underscoring the need to better understand the psychological causes of obesity, including but not limited to overeating (consciously or unconsciously driven), malnutrition, and lack of activity. Charles work as an intern and postdoctoral candidate involved providing preoperative psychological evaluations for people who were pursuing gastric bypass surgery. The evaluations took up to two hours and assessed dieting and weight-loss history as well as psychological functioning. This was a relatively new program at the hospital where she was working and though a step in the right direction, it did not allow for a period of therapy to help those who were planning on having this procedure understand more about what it could and could not change and what their fantasies were about their postoperative selves. For example, said Charles, it is often assumed that individuals who have experienced boundary violations (either as young children or later in development) use excess weight to serve as a barrier against the threat of future imagined or actual boundary violations. [For those individuals] gastric bypass surgery adds another dilemma by threatening this protective layer. Despite the clear need for therapy, it is not on the agenda of surgeons or patients. A common theme found in the literature on obesity and in the authors work with preand postoperative bypass patients is the idea of masochism and restrictive/punitive behaviors and their relationships to the parent child dyad. Roberta Shafter (1985) suggests that masochism in relation to obesity may be viewed as a character defense. The process of overeating, followed by deprivation and then the failure of dieting, may be seen as reconstructing the feelings of being rejected and abused. Although most of Charles work with gastric bypass patients was brief and preoperative, she had the opportunity to see one woman in weekly psychotherapy for two months following her gastric bypass surgery, and she presented her work with this woman. This particular patient had her surgery before presurgical evaluations were required. The patient was a 45-year-old divorced female, and the therapy began on the heels of a thigh lift that had resulted in lymphodema. The patient had lost 270 pounds after her gastric bypass surgery and needed the second surgery to remove excess skin. Despite the considerable weight loss, the patient still appeared obese, in part due to the lymphodema and in part due to not having met her weight loss goal following surgery. The patient initially presented with depressive symptoms including hopelessness, tearfulness, decreased motivation, and increased isolation. Although she linked her symptoms to the long road ahead regarding the treatment for the lymphodema, it soon became clear that she was struggling with many dynamic issues and had been pushed over the proverbial edge by her new medical problems. Charles described her patients mother as critical, demanding, manipulative, and draining, both emotionally and nancially. The patient appeared to feel so small and insignicant in the presence of her devouring mother, suggesting to Charles that this patient may have taken up excessive physical space to compensate for what she perceived as the limits on her personal space. The patients history was characterized by chaotic romantic relationships, the rst of which ended in her early twenties and culminated in a lengthy inpatient psychiatric stay due to suicidal ideation (but no attempt). Her ex-husband had been abusive, as had her most recent boyfriend, a relationship that had begun with a date rape and had ended in less than a year. The patient reported that she never would have left her husband to escape from the abuse if he hadnt been sexually inappropriate with one of their two adopted sons. The patient wondered why she repeated this destructive pattern. If the obesity had been the problem and not the symptom, observed Charles, then gastric bypass may have

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been the cure-all. However, once the surgery was over, the fantasy was revealed: her masochistic character structure continued to manifest itself as the same drama in a different play. In summation, Charles addressed the need for follow-up care as patients transition their lifestyle and lose a primary coping strategy. Given the complicated and lifethreatening nature of obesity and subsequent surgery, it is incumbent on us as health care providers to offer follow-up care, both medical and psychological. If not, we are colluding in what can be a very destructive fantasy. Deborah Blessing also spoke about body-altering surgeries but with a very different patient population. She treats eating disorder patients and has worked over the years with three young women who underwent elective breast-reduction surgery before their therapy. Blessing was struck by the similarities in these three cases: each had surgery the summer before she entered college at age 18, each suffered from bulimia, and each ones parents had initiated the course of action. Two of the three deeply regretted the surgery, and the third was highly ambivalent. Blessing presented two of these cases at the meeting, one of which is summarized in this panel report. While details differ for these three patients, said Blessing (2005), the sadomasochistic underbelly of their internal and external relationships was strongly present. Boundaries were blurredthe whos who and whats what were confused as a result of ongoing and massive projections and introjections. With little differentiation between self and other, inside and outside, love and hate, no thinking took place, only drastic action commensurate with the intensity of the anxieties that threatened to overwhelm. The conicts central to an important developmental milestoneleaving the family home, becoming more independent, addressing adult sexuality could not be thought about, let alone worked through or mourned. Blessing commented that eating disorders have as little to do with food or weight as my patients breast reductions had to do with the size of their breasts. Both are concrete representations of unmentalized issues that are most intense in times of transition to a new developmental stage. The clingy lack of differentiation and collapse of thinking illustrated by the case vignette below suggest a lack of containment across generations. The case of Jody is a poignant example of the heartbreaking consequences that can emerge when thinking is supplanted by action and when fantasies are responded to as if they were real. Without adequate emotional containment, integration of psyche and soma does not take place. Eating disorder patients use their bodies in concrete ways as conveyors of their unarticulated fantasies, anxieties and conicts. Bodies are sites of action, rather than reection. Anxieties that, with help, could be contained and symbolized are instead acted out. Patients with eating disorders present treatment challenges in part because of their reliance on various forms of splittingmind from body (thought from feeling), black and white thinking, and action as a defense against a feeling of falling apart. Worries about the body are about preventing feelings in general, but most specically feelings of dependency or aggression and their counterparts, jealousy and envy. In the concrete world that eating disorder patients inhabit, concern about appearance is about holding ones insides together and about not being too big (too needy or too greedy) and about being in control. Blessing presented the case of Jody, a petite, blond, curly haired 24-year-old from an afuent family, who was struggling with bulimarexia. In addition to her eating disorder she wanted help with her intimate relationships. On a supercial level her Ivy-league boyfriend seemed appealing. He was, however, verbally and emotionally abusive, and a

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cocaine dealer. The bleakness of her emotional landscape came sharply into focus when she told Blessing I cant leave him because no one else will want me. When Blessing pursued this, Jody told her, haltingly, about her keenly regretted surgery. While xing her eyes on the oor, she described in detail the scarring of her breasts that made her feel ugly and undesirable. The scarring, she reported in a low, soft voice, was so extensive because of the radical nature of the surgery. Her shame and disgust were palpable. Jody explained that she had been on vacation with her father and family friends a few weeks before moving away for college. The group had gone horseback riding. The weather was hot; she was wearing jeans and a bikini top. After the ride her father took her aside and told her that shed have to do something about those boobs. He said they were too big, and shed better get them made smaller. Father made an appointment with a surgeon. Jody, hurt and embarrassed by her fathers response to her, went along with his directive. Jodys sado-masochistic relationship with her boyfriend mirrored her relationship with both father and older brother. As youngsters, she and her brother cruelly tormented each other, including hurting each other physically. No one intervened then, just as no one intervened to prevent or forestall the surgery. Her parents divorced when she was 13. Father was a tyrant who ruled by threatening to withhold love, attention and money. She saw him infrequently. Mother was depressed and passive, often away from home. A few months after her parents divorce, Jody was sent off to a distant high school for girls where her eating disorder started, but, noted Blessing, the genesis of eating-disorder disturbances begins in the cradle when the very processes of containment, or the lack of it, have profound implications for how the mind develops and whether mind and body are integrated. The questions of who was doing what to whom came up as Blessing and her patient tried to sort things out. Was she being provocative and if so, was she responsible for what her father felt? In her mind he was disgusted with her. The boundaries between them were so blurred. . . . Whose body, whose breasts were they anyway? Jody felt that she was too muchtoo needy, too nasty, and too sexy. Not only did she accept her fathers decision about her body, but she asked the surgeon to make her breasts as small as possible. Her masochism was clearly evident. Was she hurting herself to make her father feel guilty or to win his love and approval? The end result was close to mutilationwith lifelong consequences. Jody said, sadly, that she wished she knew before the surgery that she would never again have sensation in her nipples, or be able to nurse her baby. The urgency for action drastic actionspoke to the intensity of feelings that had to be gotten rid of, demonstrating how little capacity for containment, or thinking, existed in each member of the family. Blessing closed her paper with a plea to the room about the need for clinicians to help their patients explore the underpinnings of their motivations for cosmetic surgeries. She also stressed our responsibility to educate the general public as well as cosmetic surgeons about the implications and consequences of such invasive procedures, especially during the vulnerable time of adolescence. Lynne Harkless (2005) expanded the panels exploration to include sexual orientation. She began her presentation by restating the panels stated goal of reexploring womens relationships to their bodies three decades after the publication of Our Bodies Ourselves, which implied womens relationship to their bodies appearance, the place that that occupies in womens psyches, the meanings and behaviors that go along with that as well as the external social and political forces that inuence it. . . . Harkless focus was on the

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role of gender dynamics in shaping body image difculties. She noted that the dynamics underlying body image concerns and associated behaviors are often conceptualized in some sort of gender terms, such as gendered power dynamics, womens oppression, or the effects of patriarchy. She stated that many of these analyses are very powerful and appear to capture much of what is involved, but that it might be possible to enhance gender-based conceptualizations by adding sexual orientation to the considerations. She elaborated on this idea, grounded it in early development, and proposed a new construct object orientationas an alternative explanatory frame. Harkless began by discussing empirical ndings from the body image and eating disorders literatures, demonstrating that there are often differences between lesbian and heterosexual women on certain dimensions of body image difculty, and differences between gay and heterosexual men as well. Conversely, data show that on other dimensions, there are similarities between the two groups of women and between the two groups of men. Further, some dynamics have been found to manifest similarly in gay men and heterosexual women, almost as a group, while others manifest similarly in lesbian women and heterosexual men, almost as a group. To illustrate, gay men have been shown to be more likely to binge, purge, and diet (French, Story, Remafedi, Resnick, & Blum, 1996); to show greater preoccupation with food and weight (Mishkind, Rodin, Silberstein, & Striegel-Moore, 1986); and to report more dissatisfaction with body build, waist, biceps, arms, and stomach than heterosexual men (Silberstein, Mishkind, Striegel-Moore, Timko, & Rodin, 1989). Heterosexual women have been found to place more importance on their appearance and to be more concerned with dieting and thinness than lesbian women (Wagenbach, 2003), and lesbian women have been found to have more positive attitudes toward their body and to feel more t (Bergeron & Senn, 1998) than heterosexual women. Gay men and heterosexual women, comparably, have been found to show higher levels of concern over body image, to be less accurate in their body-weight estimations, and to be more likely to suffer from eating disorders than heterosexual men and lesbians (Siever, 1996). These data are just a sampling of a larger body of empirical ndings suggesting that in terms of concern about the bodys appearance, and behaviors associated with those concerns, gay men seem to manifest similar dynamics to heterosexual women. Harkless position was that given data such as these, it no longer appears tenable to conceptualize certain body image issues as effects of being socialized as a woman, in other words, as effects of gender. In considering alternative ways to adjust conceptualization to accommodate these data, Harkless proposed that both heterosexual women and gay men are people sexually attracted to men and therefore seeking to be sexually attractive to men. She advanced the possibility that behaviors and traits that they have in common relevant to appearance concerns may say something about the effect on ones relationship with ones own body, of seeking to be desired by men. In other words, certain body image concerns may be less related to ones own gender, and more to the gender of ones sexual object. She linked this to early development and suggested that there may be a central aspect of identity for all of us that has to do with ones orientation toward men or toward women, or both, as sexual objects. She proposed that ones identity as a person attracted to men or a person attracted to women is unrelated to ones gender. She called this aspect of identity object orientation, and dened object orientation as ones orientation toward males or toward females, or both, as sexual objects. She suggested that ones object orientation toward men or toward women results from a combination of hard wiring,

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neuroendocrine inuences in utero, and developmental experience, just as gender identity does, and that object orientation is an organizer of personality just as gender is. She proposed that in development, just as children look to the parent of the same gender as a model of how to be a person of that gender, they may also look to the parent of the same object orientation as a model of how to be a person of that object orientation. Also, they may look to the parent of the gender they wish to be desired by as a model of what that gender desires. She stated that from very early on in our development, as part of forming and consolidating ones identity as a person wishing to attract a particular gender, we may seek to perceive the desires of that gender, and shape ourselves to t what we perceive they desire. This shaping would include our personalities, our mannerisms, our bodies, and so on. From this frame of reference, she suggested, developing a sense of the importance of being physically attractive to men, for example, would not be thought of as a part of feminine gender identity, but as a part of male-oriented identity. She took the example of developing gay boys and stated that they may tend to internalize certain characteristics of their mothers or women in general. The current tendency is to think of those characteristics as feminine and therefore to think of gay men as being feminine in some ways. She suggested that gay men may not be feminine at all. Her position was that the particular characteristics of mothers or women that are most readily internalized by developing gay boys may have to do with aspects of the mother that they perceive as being more relevant to her being a person in relationship with a man, than they are to her being a woman. And, that the particular characteristics internalized also have to do with the characteristics of the mother or women that they perceive that their fathers or men in general value in a sexual object. She stated that gay men as a group, statistically, do not manifest all the characteristics stereotypically associated with women or femininity, only some of them. They manifest others associated with men or masculinity. She asked us to consider why they take in some but not others and why they do this relatively consistently as a group. Her proposition was that they take in the characteristics of women that they perceive as being relevant to tting with men. She closed with a discussion of some of the implications of this paradigm for rethinking the construct of gender. The nal contribution was a case study that Judith Logue (2005) described as having sociocultural roots and implications that connected it with the earlier presentations of the morning and with Our Bodies Ourselves. Her case vignette demonstrated the psychogenesis of a snake phobia in a high functioning professional woman in her late fties. This phobia had not been resolved in an earlier analysis. The conict, said Logue, reected internalized and introjected sociocultural roots and manifested in the patients conicts about her intense curiosityshowing and hiding her intelligence, knowledge, independence, and competence. The patient reported being comfortable with her body and her sexuality, hard won in a previous treatment, and discounted any phallocentric notion of a snake representing a penis. But what did emerge in her work with Logue was the trauma she experienced in a preteen Bible class when forced by a punitive male teacher to read and reread Genesis and The Story of Creation. Her associations led to her own sense of evil. When Logue inquired about what evil meant to this patient, she responded that it was her curiosity, her intense desire to know. She added that she had been taught that being angry was bad and evil and was punishable by strong disapproval and abandonment. The patient then made the connection that her traumatic experience in Bible class had been followed by poorer grades in school and a learning inhibition. What the patient

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discovered is that deep within her psyche, encapsulated in her phobic neurosis about snakes, was heretofore unanalyzed guilt and shame . . . which she associated to her own curiosity and intelligenceand to her aggression and anger and wishes to criticize those close to her. The early childhood relationship of this patient with her mother laid the groundwork and vulnerability for internalizing The Story of Creation into a phobic neurosis. She wanted to please as a child and so idealized her mother that it was as if mother were God. . . . In her work with Logue, the patient came to understand she had internalized The Story of Creation as an impressionable 11-year-old. Until the Bible classes, the patient had been protected from being or feeling shamed for her wishes to know about people and things. She was taught, however, to be a good girl and never to whine or to express direct anger. The treatment involved considerable work with negative transference feelings, allowing the patient to experience with Logue how much she wanted to avoid direct anger and conict. But by becoming more able to own her hostile feelings, the patient was freer in her personal life and less ambivalent about using her wisdom and knowledge to exert inuence and power. In concluding her comments about this patient, Logue made a connection between her patients struggles in the 1970s for equality of women and men and the acceptance of womens rights and bodies as described in Our Bodies Ourselves. This patient is critical of the sociocultural attempts to perfect womens bodies through surgery and to denigrate equal rights for women. At the same time, she says she is grateful for the medical advances that are allowing women to maintain their health with medications, breast reconstruction, and surgery of all kinds. This panel took shape over a period of many months as several distinct ideas were merged into one workable topic, organized around the title After Our Bodies Ourselves. What began with an exploration of the direction feminism had taken over the past 40 years expanded to include an examination of elective surgeries that women subject themselves to, as well as the introduction of a new construct, object orientation, and its implications in the rethinking of the construct of gender. The panel title, After Our Bodies Ourselves, provided a starting point and a direction. Nancy McWilliams historical perspective supplied a framework for the ideas presented by the other panelists. McWilliams reviewed the alarming changes that have taken place in the past 30 years, many of which could not have been foreseen from the perspective of the early 1970s, and the effect they have had on women. These changes include the increase in eating disorders, self-cutting, the popularity of cosmetic surgery and gastric bypass surgery, and the inuence of the incredibly powerful economic juggernaut of the beauty industry. Both Deborah Blessing and Devon Charles focused on the disturbing aspects of invasive body-altering surgeries where patients were not prepared for the aftermath, such as Blessings patient who had no awareness that her breast-reduction surgery, initiated by her father, would leave her feeling mutilated, with no sensation in her nipples and no ability to nurse her yet unborn child, or Charless patient who underwent gastric bypass surgery with unrealistic hopes of how it would transform her life. Therapy before surgery was neither suggested nor deemed necessary for these women. Both papers raised disturbing questions. How susceptible are people to the inuence of physicians, the media, and family members who recommend life-altering surgeries with no regard to the psychological impact of the permanent change? Too often, little is explained to the patient about what she will experience and what the long-term limitations may be. Both Blessing

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and Charles commented on the need for follow-up care, and Blessing argued for the necessity of enlightening both the public and the medical community about the impact of such surgeries, especially on adolescents. Cosmetic surgery has increased exponentially in the past two decades. And as recently as 2004, the American Society for Aesthetic Plastic Surgery reported an increase of 44% over the previous year (Ditmann, 2005). An article in the New York Times in December 2005 highlighted the craze for cosmetic surgery and its acceptance among a large part of the population (Singer, 2005). Attributing the increased interest to the makeover shows that have been so popular on TV in the past few years, the writer described procedures that were now gift items between family members (e.g., a daughter gave a present of a face lift to her mother). The cosmetic gifts were seen as uncomplicated by the realities of the risks of surgery. Gifts of cosmetic surgery were also noted by McWilliams. Hence, Blessings point is further underscored: the need to educate the public and the medical community about the psychological aspects of body-altering procedures and not allow the pressure of a gift to be the determinant of surgery. Lynne Harkless proposed a new constructobject orientationand discussed how critically important it is as an organizer of personality, as important, says Harkless, as is gender. This totally new construct expands our understanding of development and includes in that understanding the impact on ones behavior of the gender of ones sexual object. In her carefully thought out discussion, Harkless shows us how she arrived at her conclusions. This original contribution expands our thinking about gender and the role of gender dynamics in shaping body-image difculties. Judith Logue presented an interesting case study of a woman with a snake phobia. By helping the patient appreciate the psychogenesis of her phobia, Logue was able to widen the exploration. The patients suppressed anger and aggression came under the analytic lens, and in time the patient was better able to own these feelings and consequently become more comfortable with her assertiveness and her intellectual abilities. It was unfortunate that there was insufcient time to address the questions from the oor, but many people spoke to the panelists after the session ended.

References
Bergeron, S. M., & Senn, C. Y. (1998). Body image and sociocultural norms: A comparison of lesbian and heterosexual women. Psychology of Women Quarterly, 22, 385 401. Blessing, D. (2005, August 20). Bodily enactments of unmentalized conicts: Breast reduction surgery in two adolescents. Paper presented at Annual Convention of the American Psychological Association, Washington, DC. Boston Womens Health Book Collective. (1971). Our bodies ourselves. Sommerville, MA: New England Free Press. (Later editions published by Simon & Schuster, New York.) Charles, D. (2005, August 20). Pyschodynamic implications of gastric bypass surgery. Paper presented at Annual Convention of the American Psychological Association, Washington, DC. Ditmann, M. (2005). Plastic surgery: Beauty or beast [Electronic version]? Monitor on Psychology, 36 (8). French, S. A., Story, M., Remafedi, G., Resnick, M. D., & Blum, R. W. (1996). Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviours: A population based study of adolescents. International Journal of Eating Disorders, 19, 119 126. Gilman, S. L. (1999). Making the body beautiful. Princeton, NJ: Princeton University Press. Harkless, L. (2005, August 20). Body image disturbances and the construct of object orientation. Paper presented at the Annual Convention of the American Psychological Association, Washington, DC.

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