Beauty and good grooming can do much more than to lift spirits; they can also be vital steps in treating depression.
In the family photos from the Christmas that followed my first depressive breakdown, I’m doing my level best to grin for the camera, but I look perfectly horrendous nonetheless. I am gaunt from eating little and badly for weeks on end, and, though one friend had joked that I was lucky to have the kind of depression that made me emaciated rather than the kind that made me fat, I have a drawn skeletal quality that is scary to behold. My clothes hang on me like sacks. I am hollow-eyed from sleeping badly. It was Christmas, so I’d had a shower and freshened up, but to do so had been a tremendous effort; and my hair, which had not been cut in months, seems curiously lumpy and has no luster. I didn’t have the wherewithal to put in my contact lenses, and my glasses look smeary. My fingernails are bitten and ragged. My skin is pasty and slightly broken out. I addition, I am wearing a shirt that doesn’t quite go with my jacket or my pants; all the colors jar.
When you’re depressed, your appearance goes to pieces. While researching and promoting a book on depression, I met with hundreds of depressed people, and I learned to recognize as tokens of the depressive fellowship their dullness of features, their desolate unkemptness, that closed expression of people caught outside time. People with depression often describe battling against the odds to keep up basic self-grooming activities, the first marks of a functional person. Depression steals the pride that keeps people looking bright and fresh and lively. When you’re really depressed, it’s a struggle to put on your socks, and you can’t see how choosing a pair that matches could be of the slightest interest. The opposite of depression is not happiness, but vitality, and a really depressed person finds every move and every action acutely effortful and painful. The daily rituals of cleanliness begin to seem like insurmountable obstacles. To brush all your teeth. To wash both your hands. To wash your face. To turn on the water. To turn off the water. To get a towel. To brush your hair. To shave or put on makeup. The whole thing seems like such a litany of exertion.
But, though depressed people don’t feel like grooming themselves, it’s important that they do so. “Put on your Sunday clothes when you feel down and out,” begins a song from Hello, Dolly! and it goes on to promise that you’ll soon feel as fine as you look. There’s a great deal of truth in the principle: How you look and how you feel are symbiotically related, and altering either one will almost always alter the other. When I was at the worst of my depression, I wanted to do nothing but hide in bed all day or, at best, sit around in my underwear, but I’ll admit (somewhat grudgingly) that getting up and getting myself put together made a huge difference. At my very lowest, I simply couldn’t get up. But once I started getting better, grooming was, along with exercise, the best way to propel myself forward.
How you look is also a measure of your self-respect, and a diminishment of self-respect is often both a symptom and a cause of depression. If you can look at yourself in the mirror and see something attractive, you probably have adequate esteem for yourself. People who have done everything possible to make themselves look good can experience gains in confidence. The New York Times has described an entire movement that focuses on “altering personality through appearance.” Dermatologists and social psychologists have found that people who make the most of their features are often happier than those who do not.
With this in mind, cosmetic salons have been set up in retirement homes, hospitals, and even prisons. They work wonders. In Britain, the Red Cross supplies cosmetic service, such as makeup application and hair and nail care, to indigent elderly people, both for restorative and corrective purposes. In Idaho, an agency for homeless and abused women arranges for cosmeticians to give makeovers to clients in order to give them a feeling of empowerment. A study of prisoners who have had surgery to remove disfigurements showed they were less likely to recidivate. And pioneering work at the University of Pennsylvania has demonstrated that elderly women who are taught to use cosmetics (in the study, by a makeup artist from Elizabeth Arden) are more likely to socialize with others and therefore to have a lower incidence of depression. Elizabeth L. Auchincloss, clinical instructor of psychiatry at New York Hospital-Cornell University, maintains that you can often tell when a depression is lifting by the patient’s attention to herself: “Sometimes the first thing that will reappear is the lipstick, even before the mood gets better.”
Conversely, the loss of attractiveness can have devastating consequences. My very beautiful mother went through two years of treatment for ovarian cancer before she died at 58 — and of all the miseries brought on by chemotherapy, the one that bothered her the most was the loss of her hair. She found herself grotesque when bald, and she wore wigs by day and turbans by night so that no one, not even my father, ever saw her without hair. Internal pain she could always manage, but to have her problem externalized cut her to the very quick. She was not vain, but she was always refined and elegant, and she felt that this ugliness was undignified. Her first wigs looked more like hair than like wigs; but they didn’t look like my other’s hair, and she hated them. Then she had a chance conversation with Evelyn Lauder, who directed her to a different wigmaker, Nicholas Piazza, who made wigs for my mother that were indistinguishable from her actual hair. My mother’s relief was just enormous. I think that those wigs were the most crucial physical gift she ever received. When someone who worked for my parents developed breast cancer, my father helped find a first-rate oncologist, but my mother bought her a set of fine wigs. It was the gift of those wigs that overwhelmed the patient with gratitude and made her cry.
Up through the eighteenth century, people with mental problems were put into hospitals — Bedlam, founded in 1247, is, of course, the most famous — where they were usually consigned to miserable physical conditions, dressed in rags, and seldom washed except for an occasional hosing down. In the nineteenth century, the idea of the humane asylum arose from outrage over patient treatment and the subsequent advocacy efforts of the Lunatic Reform Movement. By the end of the nineteenth century, it was customary for asylums to keep the mentally ill dressed just like other people, and to help patients try to create a version of family and social life for themselves. Musicians would come to the asylums and play concerts; inmates would have dances, teas, and time for sports.
In the twentieth century, ever more careful attention was paid to the appearance of inpatients. In 1928, Essex County Hospital in Cedar Grove, New Jersey, was the first in America to have a beauty salon on the premises; later that year, the magazine Toilet Requisites announced that the beauty parlor offered a revolutionary cure for depression, and proposed that such treatment be made available at asylums around the country. In 1931, 6,236 patients received treatments at Essex County Hospital that ranged from shampoos and sets to Marcel waves, depilation, manicures, and eyebrow shaping. By 1943, there were five career barbers and assistants there, and an additional five patients working in the salon. Right from the start, the presence of these treatments was hailed as a breakthrough in the management of mental illness.
The cosmetics industry exploited this success and created for itself a new language of pop psychology. Vogue’s Book of Beauty declared in 1933 that, when any woman “begins to regard her appearance in her own mind as a fixed, unalterable quantity — that same moment, some vital, shining part of her is extinguished forever.” A cosmetics industry spokesman announced, “Many a neurotic case has been cured with the deft application of a lipstick.” Some went even further in their amateur psychoanalysis. “I believe,” one beauty columnist wrote in response to a desperate letter, “that the dullness of your complexion may have reacted on your subconscious in such a way that your confidence in yourself has become impaired.” The answer, of course, was to treat the complexion, which was more accessible to external influence than was the self-doubt.
While evidence was accumulating that looking good made you feel better, the beauty industry began to advertise how feeling good made you look better. Even before the First World War, a new natural look was coming into fashion, and its proponents maintained that, in order to achieve true beauty, you had not only to regulate diet and exercise, but also to have a correct mental attitude. “If you could keep from tension of any sort, your neck would not be scrawny nor your skin peaked,” one article announced. “Every beautiful thought leaves its impress.” Actress Lillian Russell claimed that her beauty was linked to her mental exaltation; to enhance her attractiveness, she read Marcus Aurelius every day. The conventional Victorian wisdom that beauty was a gift of the gods was overturned; the early twentieth century brought the idea that you could work for beauty, and part of that work lay in the way you treated your mind. Americans in particular, writes Kathy Peiss in Hope in a Jar (Metropolitan Books), her wonderful history of cosmetics, “saw the face not as a transparent window into inner beauty, but as an image of their own making.”
By the 1950s, matters had progressed much further. On the one hand, psychiatrists joined with feminists in rejecting excessively high standards of personal appearance. According to them, maquillage reflected “a misplaced effort to attract father and attack mother”; lipstick and eye shadow were described as “extreme narcissism” that women used to reduce themselves “to a symbol of the genitalia.” Though this rhetoric continued for some time, it was vastly outweighed by the language of a cosmetics industry that believed in the application of lipstick and mascara as part of the passage into female adulthood. A magazine of the time ran an article on “mentally healthy beauty care.” Martin Revson, a Revlon executive and brother of Revlon founder Charles Revson, said that women could escape “lives of dullness, of quiet desperation” by escaping into the pleasure of their own beauty and mutability with cosmetics products. Of course, this tendency toward uplifting cosmetics can get carried to ridiculous extremes; Tony & Tiny produces a lipstick with extracts of Saint-John’s-wort, which is supposed to give your mood a lift. I wouldn’t count on it.
There are, of course, degrees of beauty-related depression. Some depression can manifest itself in a complaint called body dysmorphic disorder. Sufferers, like anorexics, are obsessively focused on their bodies or faces, and usually imagine ugliness or flaws that are not apparent to most people. According to Katharine Phillips, assistant professor of psychiatry at Brown University School of Medicine, up to 30 percent of patients who seek cosmetic surgery suffer from body dysmorphic disorder — and such patients, with their impossibly perfectionistic aspirations, are most likely to be disappointed after cosmetic surgery. Indeed, some become suicidal when interventions fail to turn them into supermodels. Such patients often respond to treatment with antidepressants such as Prozac, which can spare them the expense of the surgeon’s knife with the less expense of a pharmaceutical prescription.
Rituals that involve grooming have been used for depression in societies around the world. I went to Cambodia to visit Phaly Nuon, a survivor of the Khmer Rouge regime who now works with depressed women. She described her techniques for bringing traumatized people back to themselves: She teaches them first to occupy their minds and so begin to forget their trauma; second, to engage in some kind of productive work and to gain a sense of purpose; and third, to give and receive manicures and pedicures, which helps to free them from their physical isolation and helps alleviate their emotional isolation as well. “Grooming one another involves enormous trust,” she explained. “Without transgressing any social or sexual boundaries, you make yourself vulnerable to another person who is approaching your body with sharp instruments. Of course, the feeling of beauty is important here; it is a wonderful luxury to feel beautiful. But what is most at issue is beginning to tolerate an intimacy, to tolerate it for an improvement of yourself.”
Depressed people both withdraw from and are starved for human contact. The split between the mind and the body increases, and, while the mind runs rampant with terrible thoughts, the body seems to fall away into a numb oblivion and sexual feeling is closed down. Massage may return the body to life. After a very rough period in my life, I went to Sedona, Arizona, for a week of spa treatments. I was so preoccupied with my own pain that I could barely tolerate the day, but I found that the treatments — which included three hours of massage every day — made me relax and put some of my intense anxiety at bay. I achieved a serenity I would not have thought possible. I have since insisted on regular massage and I’ve found that a whole range of approaches — from shiatsu to aromatherapy — can make an intense difference, so long as the firm and strong laying on of hands is involved. A friend described the beneficial effects of endermology, an intensive anticellulite treatment she’s had, in which a vacuum-like machine kneaded the fleshy areas of her body, breaking down unattractive patterns of fatty deposits in those areas. It also stimulated blood flow, which was very invigorating. While it wasn’t a hands-on massage, it was a stimulation of the body that helped return her physical vitality; and mental vitality followed in due course.
Of course, personal grooming extends beyond one’s body. It can be important to make sure there is one room in order in your house even if the rest is messy. Making the bed every day helps a lot. When I’m very low, I often do filing: I reshelve all the books in my library or I alphabetize correspondence. I separate my clothes by season or put my sweaters in chromatic sequence. I get a haircut and a manicure and a massage. Establishing an impeccable method to these accessible areas of life can be very helpful. You think, when you’re feeling bad, that your external self might as well mirror your internal reality. If you feel like death warmed over, why try to look or live like anything better? There is a depth of depression where nothing is possible, but ordinarily, even when internal order is hard to achieve, external order is possible. Force your way into it. If you build up external order, you may find you can tolerate or even ameliorate your painful internal disorder.