05—Page 2

05SCIENCE, PRACTICE AND EDUCATION head and neck neoplasms are psychologically devas- tating, due to their visibility 11 ; as a result, BI theories have become valuable frameworks for understanding the BI and body image disturbances (BID) among this group of patients. This review explores Schilder’s seminal conceptual framework of BI, examines the significance of the face in relation to BI and the im- plications of BID of the face. The application of the BI framework and BID are discussed in relation to individuals with HNC. Conceptual Framework: Body Image A number of conceptual frameworks for BI have been proposed 3,4,12,13,14 , reflecting the challenges and complexities inherent with the BI construct. However, research has paid only limited attention to Schilder’s model as a framework for BI in individuals with HNC. This discussion will focus on Schilder’s model (1950) 3 , contrasting it with Kolb’s model (1975) 14 and Price’s BI care model (1990). 13 There is an increasing recognition of BID in individuals with HNC 15 or other physical diseases. 4 Schilder’s model attempts to elucidate and interrogate the influence of the various elements of BI in such individuals and thus has the potential to be applied in an oncology setting. Schilder‘s conceptual framework of BI Schilder‘s conceptual framework of BI 3 is grounded in Head’s postural model of the body 16 and explores domains that he referred to as physiology, the libidi- nous structure and sociology of BI. In Schilder’s opin- ion, these reflected the construction of an individual’s BI. Whilst Schilder did not define BI explicitly, there is an assertion that his definition of BI is embodied in the opening sentence of his book 17 : vidual’s life. 3,pg105 therefore, BI is a dynamic con- struct. He maintained that the aforementioned three facets contribute to BI development in a parallel, simultaneous, yet interactive and reciprocal fashion. Schilder described how, physiologically, the sensory and motor systems and the face (as well as other or- gans) facilitate physiological function and people’s interactions with the world (social function). The libidinous structure of BI entails, for example, the love for oneself and the formation of the personality (ego), which is formed through tactile sensations and the psychogenic impressions thereof. Although scholars of BI do not make direct inferences to Schilder’s model, the model remains contempo- raneous with current views of BI. An extensive body of knowledge affirms that BI is a dynamic multidi- mensional construct, as Schilder proposed. 18 Fur- thermore, there has been a paradigm shift wherein the functionality of the body (or dysfunctionality), as opposed to the emphasis on the physical appearance of the body, is recognised as an integral element of BI. 15,19 Interestingly, Thompson 20 was of the opin- ion that an inclusive and integrated framework is required. He also proposed the biopsychosociocul- tural framework, which has elements similar to those proposed by Schilder. 3 People with HNC have numerous BI concerns that include perceptions and emotions related to altered physical appearance and functionality 21 and chal- lenges with social adjustment post-treatment. 15 Thus, Schilder’s model highlights the role of physiological, psychological and sociocultural elements that could potentially influence the development of BID in people with HNC. The image of the human body means the picture of our own body which we form in our mind. 3,pg 11 He also argued that BI is not a mere sensation or imagination, as it also encompasses experiences that are stored in the cerebral cortex but are not necessarily part of one’s central consciousness; further includ- ing our personalities and emotions influence our BI. He also contended that BI is a dynamic construct characterised by perpetual inner self-construction and self-destruction. 3,pg15 As a tri-dimensional con- struct, Schilder explored the physiological basis of BI, including its libidinous structure and sociological aspects. Additionally, he proposed that BI begins to develop in utero and changes throughout the indi- Kolb’s model of body image Like Schilder’s work, Kolb’s model is also built on Head’s work. 16 Kolb 14 proposed that body percept should be a term associated with BI, as observed from a neurological perspective. Body percept en- tails the sensory integration of past and present sen- sory experiences of the body in the sensory cortex. In contrast to Schilder’s tri-dimensional construct, Kolb’s construct of BI has two attributes: the body percept (physical body) and body concept (cognitive and emotive elements). The body concept includes a person’s thoughts, feelings, attitudes and memories and evolves as the individual (the ego) views and ex- periences their body with others. The body ego is the perceiving aspect of the personality as it concerns the 32 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATIONPage 1Page 3