Paradoxically, the patients express gratitude to those who are in fact responsible for perpetuating their torment. They thank the physicians, psychiatrists and surgeons because they know that they were well intentioned - and often they were doing what the patients themselves most fervently requested - but they may, one and all, be deluded in believing that these "treatments" could ever work. They simply cannot. the problem is in the mind and the mind must be helped, not drugged or confused by allowing consequence to be separated from cause.

Successful treatment of body dysmorphia has to be directed towards the perception defect itself. As with alcoholism, drug addiction and other addictive or compulsive behaviours, the perception defect is the central psychopathology: the damaging behaviour is secondary. We have to work to change the "why" of the illness rather than the "what" or "how much" or "when". This principle shows the fallacy of

"sensible drinking" programmes for alcoholism and "harm-minimisation" programmes for addiction. Correspondingly, the treatment of patients suffering from eating disorders has to look behind the "what" and "when" and "how often" to the "why". The "why" of body dysmorphia is generally as much misunderstood as the "why" of truancy. Children who run away from school are often not running away from something - such as bullying - but running towards something else. Some of them may be running away from unpleasant circumstances in school but all of them will be running towards a feeling of safety or a sense of need to do something (such as helping to protect mother) that is considered more important than staying at school.

On this same principle, patients with body dysmorphia are not running away from a bad image but trying to run towards a sense of perfection. Seen in this light, it is