Question: What should I do when a friend exhibits severe body dysmorphia on social media? At several points in my life, I had a valued friend who seemed otherwise rational and grounded, but who also exhibited dangerous body dysmorphia on social media. In these cases, the friend would first go through a several-month phase of confessing to several psychological problems, such as fantasizing about suicide and of cutting herself with a blade. This friend would then sternly add that she has since recovered, but would admit to still feeling that her natural physical features are ugly and deformed. Then, months later, the friend would go into another phase. On social media, in front of many other people, she would make brazen gestures indicating body dysmorphia, such as uploading photoshopped pictures of herself as a corpse ready for burial or saying that she planned to starve herself to achieve her ideal of being skeletally thin. A major problem was the reaction from our online mutual acquaintances. Some admitted that they saw these problems, yet they acted like the friend was behaving normally. Others outright complimented the dysmorphic imagery and statements. In these cases, I think that my friend knew that her body dysmorphia was dangerous. She put it on display so that others would normalize her pathology, because then she could more easily rationalize her behavior as harmless. That seems really dangerous, but what is the proper alternative? How should people respond when a person puts his pathological self-destruction on display?
Question: How does a person cultivate a healthy body image? Suppose that a woman realizes that she has been unconsciously influenced by unrealistic body images – as portrayed in movies, magazines, and so on? She is basically healthy, and so it would be good for her to feel good about how she looks. But a person can't always change everything about herself: she can't change her height, however much she dislikes it. Even if a person can make changes, most people need to accept that they will never look like movie stars. So how does a person cultivate a healthy body image? How might a person notice and combat an unhealthy obsession with appearance?
Question: Is "body acceptance" rational and healthy – or dangerous? Many people are divided on the issue of accepting one's body for whatever it is. Some think that a person should be proud to be "healthy at any size" (or even just a larger-than-average size). Others say that such views perpetuate unhealthy lifestyles and destroy standards of beauty and health, perhaps out of envy. What is a rational view of body acceptance? Is "fat shaming" or "fit shaming" ever acceptable? More generally, what are the boundaries of morally acceptable comments on such matters between acquaintances, friends, and strangers?
Question: How is a person's appearance related to self-esteem? Should a rational person care much about his body – including height, weight, musculature, beauty, and so on? Is that second-handed somehow? How much effort should a person exert to make himself look the way he wants to look? Should a person's looks affect his self-esteem?
Question: What advice should I give to a friend considering breast implants? A friend of mine is considering breast implants, purely for cosmetic reasons. In other words, she's not having reconstructive surgery after a mastectomy: she just wants larger breasts. Do you think that purely cosmetic breast implant surgery is moral? Is it wise? What advice should I give her, if any?