crédit photo Aga-Paàyska



Is the concept of « aesthetic disability » really of interest or does it not serve the people concerned?


How can we help without making things worse? That’s what it’s all about!

Isn’t the « Aesthetic Disability », a new concept that has been trying to emerge lately, just a classic phenomenon of conditioning? Here is the equation, as it could be stated and in accordance with the universal law of conditioning:

On a particular terrain, which here is the congenital aesthetic difference of the child, with a personal and family history, conditioning can take place through situations of stigmatisation, exclusion, mockery, iterative and painful surgical interventions and the way the other person looks at him or her.

 This conditioning leads in some children to: induced suffering, inappropriate behaviour, the installation of a possible traumatic memory and pathological cognitive patterns which are feelings of vulnerability, guilt, fragility and inferiority.

The reactions of this conditioning are reinforced and maintained, in duration, intensity and frequency by negative reinforcement mechanisms (RF-) such as denial, flight, avoidance and sometimes experiential avoidance and/or positive reinforcement (Rf+) such as over-investment, over-exposure, superheroes.

 It is known in behavioural and cognitive therapy that stopping RF+ and RF- extinguishes behaviour (reactions).

Asking the question from this angle opens up considerable perspectives and I think that this avenue deserves to be explored. Wouldn’t this answer a number of important questions?

Wouldn’t denial and avoidance explain the discretion of the complaints shown by the families and their difficulty in raising it?

The constitution of a traumatic memory exposes the child to reactivation, at any time in his or her life when he or she appears to be doing well, by a stimulus that he or she will associate with his or her traumatic memories. So isn’t fighting against the constitution of this traumatic memory a major issue for these children?

Can we totally exclude, in certain extreme cases, the emergence of authentic PTSD type 2 pathological pictures as described by Terr, and sometimes even complex psycho-trauma (DESNOS) These are avenues to be seriously explored, it seems to me! But we will still have to make sure that such diagnoses are worthwhile for the people concerned because diagnostic labels are dangerous if they do not bring anything concrete.

 In view of these mechanisms, is it not wise to abandon and outlaw the concept of « aesthetic disability » and even « aesthetic vulnerability », as maintaining them and resorting to them would be a factor in reinforcing the phenomenon through the stigmatisation and exclusion they induce?

On the other hand, does not a return to a simple and clearly identified framework of classic conditioning leading to inappropriate but explainable responses open up prospects for appropriate care and treatment?

And does it not also explain why we are not all equal in terms of our capacity for resilience, which is directly linked to our history, to the events and elements that make it up?

Listening to the stories of terribly anxious and traumatic births during family reunions, wouldn’t it also be wise to specifically train medical teams in this type of birth?     



Asking the question from this angle allows us to understand that aesthetic particularity would be one risk factor among others but not a fatality in the field and that everything is a matter of measurement on this delicate subject, as families and professionals are often aware. How to help without making things worse? That is the challenge!

Understanding this mechanism will be the very first step to help.

On the other hand, does creating this new concept of aesthetic disability really contribute to a good understanding of the phenomenon or does it not freeze the reflection, while aggravating the factors of stigmatisation and exclusion of these children? 

The creation of a new concept is of interest only if it allows a better understanding of a phenomenon in order to provide answers and effective help, but certainly not to make people suffer and freeze diverse and rich experiences in a sterile box!


Let’s keep measure in all things! Neither too much nor too little!


                                                                                 Doctor Béatrice de REVIERS

                                                                                            November 24, 2020