恶人谷

Too Beautiful for Suicide
Anne Dohrenwend, PhD

Arch Pediatr Adolesc Med. 2009;163(11):976-977.

Sara (not her real name) had been withdrawing from friends and school activities, and her parents encouraged her to see a psychologist. She was a straight A student and popular. There was no history of trauma, and family dynamics were well within the norm of a loving, supportive household. She had high expectations of herself, but blamed no one for imposing undue pressure on her. She couldn't explain her ambivalence with friends and school. From her perspective, there was nothing wrong except, perhaps, boredom.

But I haven't told you my first reaction to meeting Sara, the first thing that occupied my mind, and the thing that needed unraveling before I could take the next step with her. I thought she was stunning. Not attractive, not pretty, but stunning in skin, features, shape, and movement.

I ran through the typical transference and countertransference questions that a psychologist asks in these moments. Was I attracted to her? Was she seductive? Was she histrionic? The answer was "no" to each of these questions. She was simply one of those individuals who occupy the extreme of the bell curve, and there was no way for her to play it down and no way for me not to notice.

I suspected that there was no way for anyone not to notice, and that suspicion was confirmed by the way people looked at her each time we walked from the waiting room to my office. I tried to imagine the kind of reactions from others that she likely managed on a daily basis, probably everything from mild discomfort to babbling platitudes. I wondered if the high expectations she had of herself reflected what she saw in others' eyes when they looked at her. I wondered if people gave her room to feel anything other than the way she looked: perfect.

I told her what I was thinking, and we talked matter-of-factly about the consequences of her appearance. People were always going to be jolted by her looks, at least initially, and it would be a rare thing to find someone who didn't see her, first and foremost, as beautiful. I remember the relief on her face when she admitted that it was a burden to be so beautiful. It wasn't a secret, but it was a truth that seemed to have lost its voice. After all, who has sympathy for the queen when she complains about the weight of her crown?

Great beauty is the stuff of fantasy. Sara had won the lottery in looks. If she complained about it, what would most of us say to her? Probably something like, "I wish I had that problem."

Our time together was brief. In several months, she’d be leaving for college. I thought I’d helped her. Overall, she seemed to me to be a well-functioning, healthy kid with difficulty transitioning to college, likely owing to pressures associated with culturally imposed expectations. She was used to high school and she passed every test it had to offer. She was afraid of college because it was yet another testing ground. She was exhausted from living up to perfection, and we worked together to find other, less exhausting options.

Four years passed before I heard from her again. Her voice was frail and unrecognizable. She told me that she had swallowed half a bottle of diltiazem hydrochloride and had just woken from a coma. She said she had to talk about something, and asked if I would please come to see her.

I called the nursing station, and they filled in the rest. Sara had gone into cardiac arrest. For the past week, she had been on a ventilator in an induced coma. She survived, barely, thanks to the heroic efforts of specialists, some of whom worked late into the night to monitor her condition. Sara refused to say why she had taken the pills.

On the ride up, I prepared myself for what I’d see and feel when I saw her. I was aware that I was angry with her. What permanent damage had she done to herself? What a waste! And I had to ask myself, was I reacting more strongly because of what she looked like? Was it, in my mind, more incredible for her to try to kill herself than if an unattractive girl had committed the same act? Was I shocked that someone who looked like she did could ever find her life unbearable? If you look like that, what can't be fixed that needs fixing? Isn't the battle half won? I was surprised to find these biases still pulsing beneath my rational thoughts, but they were there, alive and well.

I asked everyone to leave the room and pulled a chair up to the hospital bed. I saw the hallmarks of survived medical crisis: dry lips, IV bruising, the red outline of tape that must have held a tube in place. It sounds ridiculous, but even under these conditions, she looked great, like a sick person on a soap opera who might draw our protection but not our pity. She smiled nervously and said again that she had taken a bunch of pills and had almost died. With a sense of urgency, she told me why. She had contracted a sexually transmitted disease, and she couldn't tell her boyfriend. She couldn't tell anybody. That was her secret and her unbearable shame. She went on to describe what her life had been like, and it was clear to me that the girl I had known 4 years ago had eroded. Her life's focus had constricted to respond to that which was most reinforced by those who met her. Keeping her boyfriend, who was handsome and successful and whom she thought she might love, was more important than her schooling, her interests, and her life. Genital herpes was a stain, and it was not okay for her to be stained.

After we’d talked for some time, I invited her family back into the room. While I stood at the end of her bed preparing to leave, her gastroenterologist walked in and did a quick exam. I thought I saw a bit of awkwardness when he palpated her belly and asked how she was feeling. He summed up the plan, then walked toward the door, hesitated, and looked back. Shaking his head, he said to her, "You are so beautiful . . . don't do this again." Sara shot me a fatalistic look and rolled her eyes.

Before I left the hospital, I made a point of talking with her nurse. I asked the nurse to tell Sara's providers not to comment on her looks but instead, ask her how she's feeling. Ask her about her interests. Ask her what she thinks about the latest topic in the news, but don't focus on her appearance. The nurse's jaw dropped. "I’ve been calling her ‘my pretty patient,’" she said.

At a time when Sara most needed to be seen, she was not seen. Even though her inside screamed out, her outside managed to steal the attention time and time again.

Though I encouraged it, she never followed up with therapy, so I don't know how she's doing. I think about her sometimes. I think about the waste of someone who goes unseen. Maybe her suicide attempt will be the scar she needs to set her free, to make her finally seem real to the rest of us, but I doubt it. I think she’ll need to find an internal solution. I have little faith in the ability of humanity to resist making Marilyn Monroe out of Norma Jean Baker. Most of us will never understand what it's like to live in Sara's skin. I do know this perhaps more clearly than I did before. It is a burden to be terribly ugly, but it can also be a burden to be terribly beautiful.

CAVA wrote:这个应该也跟个性有关，好看的人多了，好看而空洞无聊的人也很多，并不是谁都象Sara这样逼着自己live up to expectation的。当然，不拥有stunning beauty的人只能想象一下

幻儿 wrote: 也有人说，抗抑郁症的药吃的多可不代表抑郁的人多，因为犹他州同时也是最快乐的州。

摩门教是教众人均收入最高的教，我觉得很有可能也是最美貌的教 。

Jun wrote:

幻儿 wrote: 也有人说，抗抑郁症的药吃的多可不代表抑郁的人多，因为犹他州同时也是最快乐的州。

It was a poll. So perhaps Utahians felt more compelled/pressured/obligated to report that they are happy.

Knowing wrote:根据长年累月跟美女hangout 的观察，我语重心长的说：美貌能带来的额外好处多的是，远远超过坏处。你们别瞎操心了。

putaopi wrote:普通美貌跟绝代佳人是两个概念， 年轻女孩子懂得打扮，走出去都可以叫美女。可是文章中Sara这种，让医生护士都忘了职业操守，感觉就是倾国倾城的那一类的。

笑嘻嘻 wrote:可是，住院护士不是对谁都宝贝、甜心、蜜糖、娃娃地叫？包括90岁的老太太。

Knowing wrote:美貌是有效的催化剂。它不能使事情发生，只能促进事情发生。比如你看见个大美女，即使下巴掉地上，魂魄飞天外，也不会主动走上去，掏出五块钱塞在她手里。但是如果该美女走过来，含羞带怯的说：我丢了钱包，你能借我五块钱么？你八成想，哎呀，这么美的女人，怎么会来骗我区区五块钱？然后乖乖掏出来。要是换个丑人这么说，你肯定想，靠，怎么骗子专骗我，我看上去很傻么？

从来不主动问父母要任何东西（零食玩具之类）

Jun wrote:
哆嗦一下，这是童年不幸福的典型症状。

笑嘻嘻 wrote:是啊，不过也的确不能否认社会的人经常能在跟邻居的比较中得到满足感。

mirrorflower wrote:我觉得更大的问题是如果你内化外在的标准——比如说你脚丫子好疼，可是你觉得漂亮更重要——已经不仅仅是为了听到别人的赞美，而是你内化了这种对漂亮的追求——于是你就继续穿着。从那一刻的幸福感上来说，你也许是幸福的；可是从长远来说，你的脚丫子可能报废掉。到那个时候大概痛苦更深：放弃什么呢？放弃脚？放弃漂亮？

Jun wrote:

笑嘻嘻 wrote:是啊，不过也的确不能否认社会的人经常能在跟邻居的比较中得到满足感。

If it's not a problem, it's not a problem. 就好象喝很多酒的人，如果不觉得有什么不良后果，就无需治疗。

笑嘻嘻 wrote:安慰一下镜花。过去的反正你已经战胜了，展望未来更有意思些。