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obvious that perfection can never be achieved through pharmaceutical or surgical intervention: the treatment has to be psychological. However, even psychological treatments can be misguided. Currently the form of psychotherapy favoured by most doctors tends to be cognitive-behavioural. In this approach the doctor or therapist calmly explains to the patient what he or she has misconceived and tells him or her what would be better. It sounds sensible and it flatters doctors and therapists who think that they always know the answers. However, for exactly those reasons, it can be patronising and ultimately totally ineffectual. One cannot treat an irrational problem with reason: it would not be an irrational problem if one could. The solution is to get inside the patient's madness, not to try to reason with it. I believe that the only people who can do this are those who have been there themselves: other people who have had the same problem and come through it.

When the blind lead the blind they understand each other's difficulties: when the sighted lead the blind there is an inevitable divisive gulf between them. Successful treatment of body dysmorphia comes from the awareness that one is not alone. In a group of similar sufferers one can see the distortions of other people's thinking and hence deduce one's own. This is the exact principle that underlies Alcoholics Anonymous and all the Anonymous Fellowships, including Overeaters Anonymous, Bulimics Anonymous and Anorexics Anonymous. Individual sufferers see themselves reflected in the mirror of the group and, by working the Twelve Step programme of recovery, gradually help themselves from the inside to change their perceptions and, as a result, change their behaviour.

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