The fall issue looks at the recent advances in treatment and ethics in nonsurgical aesthetic interventions and, given this, is an appropriate time to explore the obsession our species has with appearance. We will begin by recalling a fairy tale--an excellent source of cultural data. The study of fairy/folk tales has existed for many years. In fact, the original set of tales published by the Grimm brothers was intended to document oral traditions of storytelling for scholars and not children (Windling, 2007). It could also have been published for nurses.
In Germany during 1812, two brothers, Jacob and Wilhelm Grimm wrote a fairy tale about a beautiful queen, her even more beautiful daughter, and a talking mirror (Grimm & Grimm, 1812).
"Spieglein, Spieglein an der Wand,
Wer ist die Schonste im ganzen Land?
Mirror, mirror, on the wall,
Who in this land is fairest of all? - (Ashliman, 2005).
Many will recognize this as the childhood story "Little Snow-White" or "Sneewittchen," a very popular story. There are more than 400 versions of Little Snow White spanning a 500-year period (Jones & Bottigheimer, 1986). In addition to entertainment value, many believe that there are moral and psychological scopes to this story. Golden and Canan (2004) identified some binary oppositions that are reflected in "Snow White" including good/evil, beauty/not beauty, youth/age, and natural/supernatural. By looking at some of the questions raised about this tale by Vandergrift (1997), nurses may acquire some insights into perception of self-image.
IS IT THE MIRROR OR THE REFLECTION THAT IS IMPORTANT?
Our earliest consciousness about how we look may have occurred when humans first looked into a body of water and saw their reflection. A Greek myth tells the tale of a youth Narcissus, who saw himself in a pool and fell in love with his reflection. The modern psychological term describing preoccupation with oneself and appearance comes from this character (Robinson, 2007). Judgments about how people look compared with others probably came long after the first humans viewed themselves, when survival was no longer the all-consuming priority. (Maslow, 1943). Self-image as a concept has evolved through the work of several individuals, including Henri Wallon. He described the child's need to recognize itself and be recognized by others as emerging during the personalist stage of mental development, which begins at about age three (Wallon & Nicholson-Smith, 2001). The ability to have a self-image occurs when a child can recognize itself in a mirror as opposed to mistaking the image for another person. So what is a mirror? Merriam-Webster (2008) defines it as "a polished or smooth surface (as of glass) that forms images by reflection, something that gives a true representation or description, an exemplary model." The mirror may also allow people to see themselves the way others do. Given this information, it is the reflection and the interpretation by the viewer that is important in not only the story but also in nurses' lives and those of their patients.
DOES THE MAGICAL ATTRIBUTE OF THE MIRROR ADD ANYTHING TO THE STORY?
The magical mirror in the story is seen as an information device and an interesting part of the plot. It is also an insight to the queen's insecurity, journey to madness, and belief in self as the only reality (Windling, 2007a). According to a 2007 University of California, Los Angeles study of people suffering from body dysmorphic disorder (BDD), there may be a biologic reason for people with this condition that prevents them from seeing themselves the way that others see them. (Medical News Today, 2007) Maybe this condition explains why the queen thought she was ugly because "Snow White" was the "fairest of them all." These findings suggest that society's focus on appearance may not be the sole causal factor associated with BDD. In nonsurgical aesthetic interventions, the psychological assessment is an important time to identify any signs or symptoms of BDD. At the preoperative interview, nurses should attempt to identify those patients who seem to be looking for the "magical" treatment that will change their lives.
WHAT DOES THE MIRROR HAVING A VOICE IMPLY AND IS IT SIGNIFICANT THAT IT CAN ONLY SPEAK THE TRUTH?
In Asian and European folklore, a common motif is the clairvoyant speaking mirror (Robinson, 2007). According to Berlin (2002), after 17 years of research, the "Snow White" story may be about a real person in a real place. There is a castle in Lohr, Germany, now a museum, where in one of the rooms can be found a "[horizontal ellipsis]'talking' mirror-an acoustical toy, much in vogue in the 18th century." Just because the mirror can be heard does not mean that it is necessarily telling the truth. The more important concept here may be the process of mirroring as the rhetorical use of what someone else might have said. In "Little Snow White" this process establishes what the truth is by reflecting it (Bacchilega, 1988). The "truth" spoken by aesthetic patients' mirrors preoperatively and postoperatively needs to be in line with the "truth" of who they are. Bacchilega (1988) describes the voice of the mirror as a male voice. She points out that the feminist interpretation of this part of the tale states that the voice represents male authority and echoes the bourgeois cult of 19th-century domesticity. This view of "what's important about girls is what they look like," continues to be the message that boys in our society still get today (Hanafy, 2004).
WHAT IS THE SIGNIFICANCE OF BEAUTY IN THE STORY?
The feminine beauty ideal exists in many children's fairy tales. The concept that physical attractiveness is one of a female's most important assets and that achieving and maintaining beauty is desirable is a primary focus in the story of Snow White (Baker-Sperry & Grauerholz, 2003). Many would make a case that in tales such as "Snow White," the binary opposition of beauty/not beauty is symbolic for good and evil (Hanafy, 2004). In Currie's (1997) study of adolescent girls, they reported "feeling good about themselves" depended on "looking good." Many patients will perceive this message of being beautiful as empowering. If there is nothing of value on the inside of a person, an "empty beauty," then it is difficult to know happy feelings (Coventry, 1991). Patients with a healthy perception of beauty will understand that it is not "empty." In other words, beauty is from the inside out, not just on the outside.
IS AGE OR AGING AN ESSENTIAL ASPECT OF THE STORY?
In a discussion about the "Snow White" fairy tale, Strayer (1996) points out the midlife development psychosocial challenges of the Queen. This seems to come from the Queen's realization that although she and Snow White both get older, the Queen will lose her attractiveness, the King's attention, and consequently her power (Windling, 2007b). An essential aspect of the story as well as patients' motives for seeking beauty through aesthetic interventions is to delay the effects of aging as long as possible. One of the psychological concepts of plastic surgical nursing states that emotional "[horizontal ellipsis]reactions are often intensified in older patients" (Hotta, 2007, p.78). Nurses can make the aesthetic intervention experience a better one by understanding and planning for this as well as other concepts.
In this issue, articles include a summary of the current options for sun-damaged skin and ethics in aesthetic interventions. Also included are chapters from the 3rd ed of Core Curriculum for Plastic Surgical Nurses describing aspects of patient care for dermal fillers, botulinum toxin, sclerotherapy, chemical peels, and microdermabrasion. The Core Curriculum is the definitive resource for nursing professionals in the plastic surgery specialty.
When nurses look at their professional selves in the mirror, what do they see? They should see a patient advocate and a plastic and reconstructive nursing advocate. For their patients, they can help ensure that the patients are seeing their reflection accurately and not just hearing the criticisms of an image-conscious society. This is a major component of making sure that patients' expectations are realistic. For the profession, nurses can keep themselves up-to-date with the rapidly changing advances in the field and contribute to nursing knowledge by sharing their experiences. This could be in the form of oral presentations, poster presentations, and, my personal favorite, writing an article for Plastic Surgical Nursing. Please feel free to forward your comments to me and the editorial board by writing us at Plastic Surgical Nursing, American Society of Plastic Surgical Nurses, 7794 Grow Drive, Pensacola, FL 32514-7072 or send an e-mail to Candise Flippin at [email protected].
REFERENCES