Anyone familiar with psychotherapy work with adolescents knows perfectly well that feeling ugly is very common in boys. Boys who would have absolutely nothing to reproach themselves with regard to their aesthetic appearance.
It is a symptom, dysmorphophobia, that we find in various clinical pictures. It is often present in depressive states of adolescents, and in these situations shame is imbued with guilt and seeing oneself ugly is still mixed with “feeling” ugly. But this symptom can be found in far more severe clinical pictures where seeing oneself ugly is supported by a lucid delusional certainty. Here the feeling of guilt disappears and the cause of one’s discomfort is attributed without uncertainty to a certain physical detail that is “seen” by the boy. In fact, in such cases, one frequently comes to resort to cosmetic surgery except for then opening endless disputes with surgeons accused of failing to solve the problem.
Actually what immediately jumps out at us is that this seeing oneself as ugly does not refer to physical reality at all, but it is as if the boy, while telling us about his physical appearance, is actually telling us about a much deeper ugliness, which concerns his inner reality. Already because the boy actually has something ugly about him. Something that is not about his external figure but about his internal image. And to the extent that he shifts the problem to a physical plane, he is able to de-emphasize himself, to move further and further away from the real problem with respect to which he could and should do something.
It is a dynamic very similar to the one described by Oscar Wilde in “The Picture of Dorian Gray” in which the boy’s face remains beautiful and unchanged over time while it is his portrait that takes on increasingly monstrous features.
It is clear, in my opinion, that in situations such as these the cure can only concern the inner image, the unconscious, because that is where the real problem from which the patient suffers lies: the guilt of those who did not have the courage, the strength, the imagination to rebel against the one who denied him the original inner beauty, and the ugliness of those who have now become themselves a denier of the (inner) beauty of others.
Instead, if we go to Google we find this:
“Treatment for this disorder is mainly based on a combination of psychotherapy and, in some cases, drug therapy. According to specialists, psychologists recommend that cognitive-behavioral psychotherapy (CBT) is the treatment of first choice. Guidelines for the treatment of body dysmorphism disorder suggest the use of antidepressant medications (SSRIs) and cognitive behavioral intervention strategies such as psychoeducation, cognitive restructuring, behavioral activation, and mirror exposure.” That is, all interventions that are limited to the conscious aspects.
It seems to me that we are now witnessing in recent years a degradation of everything we continue to call psychotherapy even though there is no trace of therapeutic because it addresses only conscious reality. The idea of a possibility of transforming and curing deep reality now seems to have disappeared to give way to a more or less friendly supportive and supportive intervention that cures absolutely nothing, leaves only a sense of relief and venting from having had a nice chat with those who have benevolently listened to us for 45 minutes.
This may be one reason why cosmetic surgeries have grown exponentially in recent years, especially among younger people. Today one of the most common gifts to girls for their 18th birthday is breast augmentation surgery! All this hides the thought, which is increasingly developing thanks in part to the ineffectiveness of current psychotherapies, that mental reality cannot be changed while the only thing where one can intervene is the body. I mention only how many cases of gender transition are due to this thinking.
How long this state of affairs will last is unknown. The pharmaceutical companies have every interest in maintaining it, and even training so-called psychotherapists who have to learn techniques is much easier than complex and time-consuming training that involves understanding and transforming one’s own and others’ nonconscious dynamics.
Certainly damage is being done not only on the clinical level of treatment proper, but also on the cultural level. Centering everything on the body is reminiscent of that “mens sana in corpore sano” so dear to the fascists. A beautiful, healthy, homologated exhibited body that makes bad thoughts disappear and makes us obedient forever preventing us from understanding and knowing that certain problems have arisen because we did not have the courage to rebel, to say NO!
Marco Michelini
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