Body image-is like home base on the love map. Take a good, long look in the mirror, naked if you have the courage, and describe out loud how your body looks and feels. If you really have courage, try this with your partner standing by your side.

“There we stood,” said the wife. “It was surprising. We didn’t get past the hair on our heads. We looked at our own, each other’s,

and talked about it. Maybe it was just safer to talk about that, but I never realized he felt his was too thin. I have always felt mine was too thin. It has bothered me for years.”

How we think we look is a key in our love map, a type of legend and scale for interpreting the map and for reading other persons’ maps, for we tend to pick partners that we perceive as maybe just a few steps up from our own place on the body market. Even children rapidly develop good or poor body images, which sometimes sentence them to the sidelines at dances and to a loneliness that is based on a hypercritical, usually unrealistic self-appraisal.

I have three hundred slides of the work of major artists. These are all nude paintings, and I have my patients pick the one painting they feel most resembles them. This assignment is usually fun and sometimes most enlightening, especially when I also have them select a slide that most resembles their partner. Looking at and discussing these pictures usually helps defuse the anxiety over the body-image issue and teaches about the wide range of human appearance and the perceptions of that appearance.

I help my patients discuss feelings about their genitals and other erotic zones. Most men seem to feel that penises come in one size, too small. Women seldom talk much about genital appearance, but describe their breasts in two sizes, too big or too small. It is helpful to break down the barriers that exist between the body generally and the erotic zones specifically, integrating both into a sensuous gestalt.

When I lectured on this concept of the sensuous gestalt, one woman told me after the lecture that she thought “sensuous hole” might be a better term. She added, “After all, I think I have what I call a ‘grand opening.’ Let me tell you, women do not have penis envy; men might have vaginal awe.” Even in her humor, you can see the anxiety we have about perhaps the least important element of the sexual system, the genitalia.

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The seemingly inherent negativity of the disorder can actually be the most positive experience of our life. How many other people are given such an opportunity! The disorder has done so much of the hard work for us. It has stripped away the image of who we thought we should be, and has returned us to the basis of who we could be.

Life isn’t just about growing up, having a career, getting married, having children and so on. These are things we do during life, but they are not life. Life is continual evolution and development.

Our need to be in control of ourselves and our environment is our unconscious effort to try to stop this change. Although there are many external changes in our life, we fight to control any internal changes and development of ourselves. We need to be in control to keep the image we have, and the image other people have, of ourselves. We haven’t been able to let our image change in case it meant we did not meet the expectations of other people. We are now paying dearly for this.

Our continual suppression of self means we have blocked the ongoing development of our self. Although we have always wanted to be able to express and develop our self, we have never been willing to take the risk. How many times have we ignored the call to self, or not heard its almost silent whisperings? This time it is not whispering. It is shouting.

Anxiety disorders are destructive. They tear away the very fabric of our whole being. They destroy our way of life. The attacks and the anxiety terrify us sometimes to the extent that normal everyday living is non-existent. Yet we do not recognise in this destruction an equally positive force. The destruction can be a positive turning point in becoming our real self.

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Steps can be taken to prevent such a situation from arising in the first place. Your surgeon can greatly reduce the chance of finding something unexpected during an operation by checking you carefully beforehand. This means getting a detailed history of your symptoms, examining you carefully, and arranging, with your agreement, whatever tests are necessary to provide a complete picture. In the example I have described, there would probably have been bladder symptoms such as burning, or passing urine more frequently, and/or in smaller amounts than normal. There may have been obvious blood passed or if not, traces of blood would probably have been found in the urine by testing. Special contrast X-rays or endoscopic examination of the bladder (cystoscopy) could have confirmed bladder involvement by the cancer. If the true situation had been established before operating, this person could have had control over the treatment decision, and surgeon would not have been placed in a dilemma.

Here is how to be as sure as possible that your surgeon will be able to carry out the operation you have agreed to. When your surgeon recommends a certain operation, ask how sure he or she is that this operation will be possible. For example, if the aim of the operation is complete removal and possible cure, ask whether the diagnosis of cancer is definite and the exact type known. Ask whether the cancer has already spread into nearby organs. Have the appropriate tests been done to check this? How does your rpe of cancer usually spread? How sure are they that it as not already spread to nearby lymph glands or through the bloodstream? How can the likely sites for secondary growths be checked? These questions apply in the case of potentially curative surgery. Later in this chapter I will give you some idea of what should be known before attempting surgery that has various other aims.

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