Meeting the Psychosocial Impact of Facial Disfigurement: Developing a Clinical Service for Children and Families

Abstract

A B S T R A C T This article reviews a child and family service addressing the psychosocial impact of facial (and other visible) disfigurement. The stigma of disfigurement poses considerable challenges in maintaining self-esteem, building self-confidence and coping effectively with the intrusive (and often negative) reactions of others. The charity, Changing Faces, addresses the psychosocial impact of facial disfigurement, promotes better health care and seeks to raise public awareness about the impact of disfigurement. Its clinical service has evolved a model of care including a social skills training component and methods of social skills training, specifically for this client group. Evaluation suggests that this model is helpful and practical, enhancing coping skills and increasing confidence.

The Social Limits of Reconstructive Surgery: Stigma in Facially Disfigured Cancer Patients

“…These analyses stress the social importance of the face, the problems that affect those who display visible facial blemishes and indicate that the face represents one of the most notable physical attributes and a significant source of social information prior to, and during, social interaction (Anderson and Franke 2002;Cole 1998;Furness et al 2006;Goffman 1963;Hawkesworth 2001;Hughes, 1998;Macgregor 1974) Accordingly, people possessing an attractive face are not only considered physically pleasing, but they are often viewed as endowed with intellectual and emotional characteristics such as intelligence, kindness, and high morality and better treated by others than less attractive individuals (Bull and Rumsey 1998;Cash and Pruzinsky 2002;Feingold 1992;Kish and Lansdown 2000;Macgregor 1990). Facially disfigured individuals commonly engender negative responses by other members of society (Callahan, 2004;Hagedoorm andMolleman, 2006: Kish andLansdown 2000). Stigma is further divided into felt stigma and enacted stigma (Jacobi 1994).…”

“…Accordingly, it is important to recognize that attention paid to the adaptation of patients to their condition of facially disfigured is only one component of an otherwise much more complex process in which "others" are often the source of stigma. In this respect, and while evidence indicates that society as a whole is the primary source of stigma (Callahan, 2004;Hagedoorm and Molleman, 2006;Kish and Lansdown 2000;Pruzinsky et al 2006;van Doorne et al 1994:325), the manners through which stigma emerges in interaction between the patients and "others" requires further investigation (Bonanno, Choi and Esmaeli 2008). More specifically, because stigma does not occur homogeneously, it is important to identify the circumstances in which it appears in interaction and the ways in which interaction can be directed to avoid the occurrence of stigma.…”

“…Because of the importance of the face in social relations -a central element of communication (Kish and Lansdown, 2000;Macgregor, 1990), and an item employed to attribute both "normality" and ownership of socially desirable characteristics (Furness, Garrud, Faulder, Swift 2006;Goffman, 1963;Hawkesworth, 2001;Hughes, 1998;Ishii, Carey, Byrne, Zee and Ishii. 2009;Macgregor, 1974) -individuals with the abnormal face experience stigma and are treated differently than the rest of the members of society.…”

Mapping out the social experience of cancer patients with facial disfigurement

“…It is a central element of communication [10,11], an item employed to attribute both "normality" and ownership of socially desirable characteristics [12][13][14][15][16] and a feature that defines interaction as individuals endowed with a pleasant face are better treated than other and less attractive members of society [17,18]. Owing to the social importance of the face, facially disfigured individuals are stigmatized and experience difficulties when interacting with other segments of society [11,12,[14][15][16][19][20][21].…”

“…Research on social issues pertaining to facially disfigured cancer patients remains sparse and attracts even less attention than the already limited research associated with other forms of acquired and congenital disfigurement [10,15,[22][23][24]. Additionally, analytical problems have limited the accuracy of available research results [25].…”