Should Psychiatrists Comment on Appearance?

I have a standard Sunday ritual: wake up; make breakfast; drink a pot of coffee; read The New York Times Sunday Main Section and Sunday Review. This past weekend I read an article that really struck a chord with me, “The Dowdy Patient” ( ), written by David J Hellerstein a well-respected Professor of Psychiatry from Columbia University. He details his experience working with a patient who has been unsuccessful at finding a romantic partner. Dr. Hellerstein mentions that changing her “dowdy” appearance is one option, however she is unwilling to try this, and the situation becomes increasingly awkward and he feels as though he has stepped outsize his lane as a physiatrist.

The article goes into detail about why this type of comment is taboo and how psychiatrists/psychologists aren’t supposed to see their patients in a sexual way. By mentioning a patient’s appearance it comes too close to the sexual line. It is as though a therapist should be impervious to the looks of any client that walks through their door. Advising someone to change his or her look in order to attract a mate can be deemed shallow and superficial. However, I disagree that commenting on physical appearance in a professional manner, with the patient’s goals in mind, is harmful, or should be considered taboo in any way.

I know very little about the field of psychology/psychiatry. I have seen both psychologists and psychiatrists, and I have had both good and bad experiences with each. But to my untrained mind, it seems absurd that the idea of helping someone improve his or her quality of life should only be approached clinically. If the patient is having trouble socially, and he or she clearly does not spend time on her appearance, then a change may be exactly what is needed. It is the therapist’s duty to at least propose the option.

Humans are both superficial and shallow…at first. Yes, I’m sure there are some super progressive folks out there who have somehow convinced themselves that looks don’t matter at all. But to most people they do. Not everyone is attracted to the same look, but people are still attracted to looks. For the most part, if someone’s appearance is so out of the realm of attraction, a potential mate won’t even give them the time of day to demonstrate their amazing personality and qualities. There is no need for someone to change his or her personal style. But there are ways to dress nicely within your own style and to be aesthetically pleasing in order to attract a mate.

This needs to be suggested to someone who is clearly unhappy with at least some social aspect of his or her life. People trick themselves quite easily into believing that they don’t care about  certain things. This is especially true when it comes to fashion/appearance. This can be born out of distaste for current fashion trends. Dressing nicely; however, does not mean adhering to ever-changing fashion trends. It just means taking some pride in your appearance. If you don’t, you will deter the majority of potential mates. Your fashion doesn’t have to be what attracts a mate but you definitely don’t want it to deter. The patient has the option to either take or leave this advice. But there is no reason why talking about looks should be banned, especially when it could be directly related to the problem at hand, a problem the patient is paying to get help with in the first place.

Lastly the idea that a psychologist/psychiatrist is never going to view their patient in a sexual way is absurd. Unfortunately, getting a degree doesn’t turn off your biological instincts. The interaction should be human-to-human not human-to-degree. No, they shouldn’t have sex with their patients, but they shouldn’t act like nonsexual beings refusing to offer up their own experiences and opinions either.

When it comes to personal matters, I believe that the field of psychology/psychiatry is deeply flawed. The goal is to make people’s lives better, and in many situations it is necessary to cross over this professionally constructed line. Sometimes the only way for someone to truly improve their life is to step out of their comfort zone and face the realities of their current situation.


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