April 9, 2009

In September 2004, Dove did something radical for a player in the beauty industry: it launched an ad campaign that didn’t feature the typical size 0 model. Instead, it featured real women who clearly defied the starlet-skinny chic that had come to represent the media “ideal” of the female form. Dove also encouraged women to share their ideas about the campaign on their Web site, hoping to stimulate discussion about beauty, whose definition had become narrower than the pencil skirts displayed in fashion magazines.

“Low self-esteem among girls and young women has reached a crisis level,” said Dr. Ann Kearney-Cooke, a psychologist who collaborated on Dove’s Real Girls, Real Pressure national report on the state of self-esteem. The report, released in October, revealed that seven in 10 girls feel inadequate about their looks, performance in school, and/or relationships. Most disturbing, girls with low self-esteem are engaging in harmful and destructive behaviors that can leave a lasting imprint on their lives. These include disordered eating, cutting, smoking, drinking and bullying.

“This report confirms the dangerous consequences arising from hang-ups about looks, academics and popularity on a girl’s sense of self-worth and self-acceptance,” Cooke said.

Dove’s research doesn’t come as a surprise to anyone in the field of mental health today. Dr. Barbara Becker Holstein, author of “The Truth: I’m a Girl, I’m Smart and I Know Everything” and “The Enchanted Self,” notes that in her 25 years as a practicing psychologist, the pressure on tweens and teens to look sexy has intensified greatly. She also sees a corresponding decrease in girls’ ability to access positive thoughts about themselves and their skills. Too often, she says, girls and women have a warped view of how they really look.

“I counseled a 17-year-old girl who was tall and gorgeous, but she felt gawky. She hid under long hair that covered her face, and needed her mom to speak for her. If girls somehow get the message that they don’t ‘rate,’ they can really suffer from body image problems,” Holstein said.

Holstein believes that females suffer more acutely from media influence than boys because they internalize messages around them more easily, whether those messages come from home or outside. As a result, the trend of young girls dressing in risqué clothing that a generation ago would only have been worn by streetwalkers exacerbates the problem.

“We’ve lost that feeling that a woman is a queen in her own right,” she said.

Lyn Mikel Brown, professor of education at Colby College in Waterville, Maine, has documented the confusing and negative messages that marketers send to girls in her book, “Packaging Girlhood.”

“They want to sell a message of ‘girl power,’ but the products and clothes aren’t about changing the world, they’re about the look of the girl, which is increasingly ‘pinkified’ and sexualized,” Brown said. “‘Tween’ is a marketing term used to encourage younger and younger girls to self-objectify, often aiming for a model of a girly Paris Hilton or Brittany Spears.”

Brown says that while many parents worry about protecting girls from being bullied, they are also purchasing the very merchandise that undermines a girl’s sense of self. “The pinks quickly turn into hot pinks and reds, which are used to sell everything, even pink energy drinks that contain an herbal appetite suppressant,” she said.

When speaking to parent groups, Brown tries to raise awareness about the subversive impact of current marketing on girls’ self-esteem. This includes not only the sexualized clothing, but also popular books for tweens and teens featuring “mean girl” motifs.

“‘Sisterhood is powerful’ is a slogan that is so in the past,” Brown said.

Her organization, Hardy Girls, Healthy Women, hopes to foster a healthier sense of self for girls, and includes resources and suggested questions for parents to ask their daughters to help them both think more critically about media influence.

“We can’t stop the media, but parents have a lot more control over this than they realize,” Brown said.

Holstein agrees, and urges parents to talk frankly with their daughters about how some of the current fashions make them feel. If a girl just shrugs and says, “That’s the way everybody dresses,” she advises parents to counter, “Let’s find the very best choices so you can be comfortable.”

“You have to give girls a true base from which to make good decisions about what they wear and what media they consume,” Holstein said. “Parents may shy away from these discussions because they fear sharing too much, but there are ways to share what is right and true without over-exposing your own feelings or your own past.”

In fact, the Dove report validates the hunger that girls have for parental input: In their survey of more than 1,000 girls, 67 percent of girls ages 13-17 said they turned to their mothers as a resource when feeling badly about themselves, while 91 percent of girls ages 8-12 do so.

But according to Gila Manolson, a Jerusalem-based speaker and author of “The Magic Touch,” “Outside Inside” and “Head to Heart,” “Body image is a red herring. The real issue is soul image, because when a girl feels good about herself as a person, her body image will fall into place.”

Manolson considers it striking that some young women with whom she has spoken and who are average looking and even “Rubenesque” in figure consider themselves beautiful, even sexy.

“These girls exude the confidence that comes from having a healthy soul image,” Manolson said. “And confidence is very attractive.”

Manolson admits that it’s far easier to develop a healthy soul image in Jerusalem than in Los Angeles or New York. Still, “I believe that parents influence a girl’s self-image more powerfully than all the media,” she said. “The media project images of non-existent women. Any woman who had Barbie proportions would have died of malnutrition.”

Her prescription for healthier body images among girls is more drastic: “Disengage from the media,” she said. “Fashion and women’s magazines are toxic to female self-esteem.”

Because these magazines only feature “perfect-looking” women (whose images have all been airbrushed and digitally manipulated), having these magazines in the home “is like an IV dripping heroin in a girl’s veins. Many studies have shown very clearly that the more exposure women have to these magazines, the lower their self-esteem falls, while men’s satisfaction with their wives also drops after viewing this material.”

When Manolson speaks to women on these topics, she’s often asked about how to deal with men, who now have unrealistic and shallow expectations about female beauty. “It’s a painful subject, and men need a huge re-education about this. With every part of the body so readily available to view, we are losing the ability to have true intimacy, because women feel inadequate and men have unrealistic expectations. We need to recreate the idea of true intimacy based on appreciating another person’s unique beauty, both inside and out.”

Manolson believes that the Jewish concept of tzniut (modesty) is the most powerful antidote to this problem.

“Tzniut means deeply knowing who you are. It’s an internal self-definition that frees you from any need to flaunt yourself physically,” Manolson said. “Women who possess tzniut have their physical privacy protected; they are simply not on display for ogling or judgment by the public’s critical eye. The beauty industry feeds off women’s insecurities, so the biggest enemy to that industry is a woman who has a healthy soul image and who carries herself with modesty.”

All agree that true self-worth must come from within. In her practice, Holstein helps patients think of times in their lives when they felt good about themselves and asks them to bring in things they have written or made that show their talents. She then helps patients build on this base to create a foundation of inner worth.

“Too many women are only able to tune into messages they have gotten from the outside world, which too often do nothing to affirm their worth,” Holstein said. “It takes more work to access the positive messages they’ve received in their lives.”

Manolson also prescribes a steady diet of altruistic activity, being with friends and reading worthwhile books to fill the time that women might have otherwise spent watching television or reading women’s consumer and fashion magazines.

“There’s nothing better for self-esteem than doing something for someone else. After a while, you’ll be able to radiate happiness,” she said.

Kaye Kent eats oatmeal or Cream of Wheat for breakfast most mornings. If she actually liked hot cereal it wouldn’t be so bad, but she doesn’t have a choice.

She can’t eat anything harder than bread without the crust or foods that are acidic, spicy or seasoned. She can’t have salt, pepper, ketchup, mustard, onions or relish. They all cause her intense pain.

Last year she was diagnosed with pemphigus, a rare, life-threatening genetic disease most common among Ashkenazic Jews. The disorder, which is not contagious, causes blistering on the skin or the mucous membranes, especially in the mouth, which Kent likens to burns that won’t heal.

“I cannot believe how my eating habits have changed, but somehow you do it automatically,” said Kent, who eats a steady diet of plain vegetables, meats and tofu.

Most people, including many doctors and dentists, have never heard of pemphigus, an autoimmune disorder. But on the weekend of April 24-26, experts in the field will discuss treatment options and new research in a public forum during the International Pemphigus & Pemphigoid Foundation’s 12th annual Patient/Doctor Meeting at the Hyatt Regency Century Plaza.

While diagnosis for pemphigus is not common — .61 out of 1 million people in the general population — 2.7 cases per 100,000 can be found among Jews with Eastern European ancestry. The condition also afflicts people of Mediterranean, Northern Indian and Persian decent.

The symptoms — sores or blisters in the mouth or on the face, scalp, back and chest — can appear at any age, but occur most often for Ashkenazic Jews in their 50s and 60s.

Kent, 61, was diagnosed last year in January.

“I had this feeling for months. I knew something was wrong with me. You know your own body, and I just wasn’t feeling right,” she said. “If I got a little cut or something, I would bleed way too long.”

Symptoms appear gradually over time, according to Dr. Sergei Grando, a professor of dermatology who studies pemphigus at UC Irvine Medical Center. Most patients only seek help when their eating habits are affected or skin lesions become pronounced, he said.

“Because it comes on slowly, people don’t seek medical attention aggressively. If it’s in the [mouth], they go to the dentist, and the dentist has no clue about it,” Grando said. “On average in the United States, there’s a six-month lag time before a correct diagnosis after the onset of the first lesion.”

What makes pemphigus deadly is that the top layer of skin cells become “unglued,” leaving patients susceptible to infection. “It’s similar to a burn patient,” Grando said.

The corticosteroid drug Prednisone has proven effective in mitigating the symptoms, Grando said, but pemphigus itself can’t be cured. To stop it from spreading and to provide a better treatment outcome, Grando said, it’s important to begin an intense but brief Prednisone treatment as early as possible, followed by tapering the drug to a lower dose.

Because of the drug’s side effects — which can range from weight gain and mood swings in the short term to type 2 diabetes, osteoporosis and cataracts in the long term — Grando is focused on finding other treatments for the disease.

“My goal in life and medicine is to develop a steroid-free treatment for pemphigus,” he said.

For patients who can’t use corticosteroids because the side effects could prove deadly, Grando and others are turning to Rituxan — an immunosuppressive drug approved for non-Hodgkin’s lymphoma and rheumatoid arthritis whose side effects include respiratory problems, hives and aching joints. Rituxan has not yet received FDA approval for use for pemphigus, but doctors are hopeful that will be forthcoming.

“What got me almost in remission is Rituxan,” said Lynn Glick, 61.

Glick was first diagnosed for teeth grinding and then lupus pemphigoid before a dermatologist correctly identified the disorder as pemphigus through a blood test in 2000.

Glick, a Cheviot Hills resident, said she had to battle with her insurance company to get the Rituxan treatments covered.

“They said it was experimental,” she said.

When the Rituxan was finally approved, it was because her rheumatologist diagnosed her with rheumatoid arthritis.

She has had four treatments since May 2005 — each given once a week for four weeks, through an infusion that lasts five hours. The drug, however, did nothing for her arthritis.

“It did not help my arthritis at all. After the first two treatments, I got it in my feet,” she said.

But she said the change in her mouth was immediate. Suddenly, foods like popcorn, oranges and other favorites were back on the list.

“It cleared up my mouth,” Glick said. “It was amazing. I could eat things I couldn’t eat before.”

For more information about the 12th annual Patient/Doctor Meeting April 24-26, visit Mouth, Skin Sores Could Be Sign of Something More Read More »