Throughout this healing process, I am not sure who has been rougher on me-myself or others. I may be my own worst critic. I am tuned in to the subtle and not so subtle changes my body and mind and spirit have undergone. As we heal and deal, our self-image may be impacted by three components: how we see ourselves, how others see us and how we perceive others as seeing us. We may have encoded some negative beliefs about ourselves throughout this process. Our, otherwise usually robust self-image, can take quite a hit as we deal with Cushing’s, grieving our losses and reconstructing our lives. This article seeks to offer some ideas for enhancing our self-image as we cope and heal. I’ve grouped the ideas into three categories: cognitive, behavioral and emotional.

Cognitive:

“Be who you are and say what you feel because those who mind don’t matter and those who matter don’t mind.” – Dr. Seuss

1. 1. As Dr. Seuss said “..those who matter don’t mind.” This may be difficult to keep in mind, particularly if you’re feeling judged by others and not understood. What Dr. Seuss is referring to is known as “positive self-talk.” This demands a certain level of discipline to first identify any “negative self-talk” and second, to consciously challenge it with something more accurate, that we would like to believe instead. I recommend making a list of 3 negative (usually repetitive) thoughts about ourselves (often our internal critic) and, on paper, challenging them with three more positive thoughts. An example may be “I’m healing SO slowly.” That could be challenged with, “Everyone heals at a different rate. There is no right nor wrong length of time.” Here is a recent, personal example: I was in the gym and noticed a stunning woman in her hot pink, matching work-out gear and her fit body with an ample mane of hair. She was perfectly coiffed and appeared to be watching me move from machine to machine. I became quite aware that my work-out “gear” did not match, I had NO make-up on and, relative to others, I appeared to be wasting time on machines with what little weight I use. I became uncomfortable, wondered if I looked funny, wondered if she was criticizing me or if I was getting in the way of her work-out regimen as I slowly moved from machine to machine, barely lifting any weight at all. As I became increasingly self-conscious, negative self-talk abounded! “I look unattractive,” “I am never going to get back in shape.” “I’m getting in the way of others’ work-outs,” “I’m just taking up space at the gym.” Before I left the gym, I walked into the restroom and there she was. She smiled at me and said, “I just want you to know that my friend and I were talking about you. You have a great body.” I am sure my mouth fell open. I stammered a “thank you” and, as I left the gym, I was shocked as in my mind, my body does not look or function like it used to! But, more importantly, notice that all she had done was look at me and the rest of my work-out was impacted by my negative self-talk, specifically categories called “jumping to conclusions” and “mind reading.” My energy then became directed toward beating myself up rather than building myself up. Had I not talked with her, I would’ve left the gym and had to challenge my negative self-talk by saying “People think lots of things, Dawn. Many are positive.” “I am doing the best I can in this moment.” “I am proud that I even GOT to the gym!” When already struggling with our self-image, it is easy to feel vulnerable. When feeling down on ourselves, one helpful hint is to ask ourselves what we would say to a friend struggling with these negative thoughts? We can become our own best friends and treat ourselves this gently. “I am healing every day.” “I am so proud of myself.” “I am doing the best I can today.” “My best will change daily, based on lots of things.” Or we can just quote Dr. Seuss!
   2. Create a list of symptoms that have improved and add this to or create a gratitude list. As symptoms abate, write down these changes. I referenced the idea of a gratitude list briefly in the article on stress management. While this is a cognitive exercise, it also has huge emotional impact as the feeling of gratitude is good for our self-image.
   3. As Carl Rogers once said, “The curious paradox is when I accept myself just as I am, then I can change.” This statement exemplifies the concept of radical acceptance. Radical acceptance has a mindfulness component and may be very useful when we feel overwhelmed and down. This concept asks us to just notice what we are thinking and feeling in the present moment without having to act on any of it. The key is non judgment. Can we just notice and breathe and notice? Every feeling and thought will have a beginning, a middle and an end. Can we let go of how we feel we or others should be and accept things in this moment as they are? No feeling state nor situation has ever lasted forever. From that place of acceptance, we can begin to make changes in areas in which we have control. The Serenity Prayer, I think, is an excellent example of radical acceptance.

Behavioral:

1. 1. For those still struggling with weight, one of the most important things I have done is to NOT wear clothes that scream at me. When my clothes are too tight, I feel as though they are constantly saying negative things all day! My wardrobe therefore, has several different sizes of black dress pants so that I don’t have to start the day feeling tight clothes. While I’m still aware of the size I put on, as the day unfolds, I am able to go about my day without the constant stress of tight clothing. While today’s weight may certainly not be my desired weight, my radical acceptance has made living in the moment much easier.
   2. Redefine which physical activity can give you a sense of accomplishment. When I work out, it is not to lose weight as much as it is to sweat, to give my body the opportunity to “move it, move it”! “Accomplishment” may need redefining. My hip replacements are not fond of strenuous activity so they guide the way. Some days, just changing into work out clothes and doing something IS my sense of accomplishment. This may not be forever but it is reality today.
   3. Make a list of behavioral changes you have made to better your health. Don’t forget the little things! I cut down my salt intake. I didn’t lose weight but my blood pressure improved. We all have made numerous health changes throughout this process. Some, I would not have made without having this diagnosis. In some ways, we may be healthier than our peers!

Emotional:

1. Be mindful of the messages we receive from the media, both written and visual about how we should look, dress and conduct ourselves. Rarely, does the media have our best interests at heart. Feel proud of your story, write it, tell it, draw it.
2. Asking ourselves what gives us purpose and meaning is important so that we can navigate the storms and still keep the shore in sight. What gives you purpose? Are you doing it? Our self image may have taken a hit if what used to give us purpose was a career that we are no longer able to do. We may be challenged to redefine this. What and who do we find now that gives us purpose to get up in the morning?
3. Spend time doing what brings you joy. Engaging ourselves emotionally is crucial to healing as well as a positive self-image. Dancing, singing, playing an instrument, painting, writing, working on cars, wood working. Rewiring the house! What is your favorite hobby? Notice the sense of joy you experience when doing this. Notice any sense of accomplishment it brings. Do you have a favorite song that you can play over and over that helps you feel joyful, strong, happy, sexy, alive, confident? We must engage our emotional selves to ramp up our self image. Before large speaking engagements, I play music to inspire me and ramp up my confidence. Music has power to create immediate changes in our self esteem, in our energy level, and in our confidence. All of this will impact our self-image. Purpose and meaning and joy are often inextricably linked and can fuel one another.
4. Whatever you do to bring you joy, purpose and meaning, remember to sometimes involve another. A loving, supportive and fun friend, family member or partner goes a long way toward supporting our positive self-image. Because we are wired for attachment and our self worth comes to us, in part from the mirroring others give us, we must find and keep closest to us, those who are positive and loving toward us. As Brene’ Brown, PhD, L.M.S.W wrote, “Share with people who have earned the right to hear your story.” I would add to that, play with people who have earned the right to be held in your confidence.

In sum, our self image will be impacted by our thoughts, our behaviors and our feelings, and to the extent we allow, our experiences. The good news is that we are able to consciously change our self image for the better if we do not like how we are feeling. Cushing’s may have impacted our past but we are taking back our present. I’d like to end with another quote by Brene’ Brown:

“Loving ourselves through the process of owning our story is the bravest thing we’ll ever do.”

Your thoughts and feedback are invaluable. It is an honor to share this journey with you and we look forward to hearing from you!

By Dawn Herring, LMFT and Cushing’s survivor, Spring, 2016