I have found appearances a real challenge. The problem – appearance influences how people judge one another; appearances themselves are easily changed. So, although in animals appearances tend to be fixed (the chameleon is an obvious exception), humans can manipulate their appearances through clothing, comportment and a multitude of adornments (from make up, to hair colour and styles, to tattooing, to body piercing, to surgery), and in so doing can present guises designed, for instance, to attract, seduce, conceal, distort, shock and even to deceive.  No surprise then that we humans spend vast amounts of money and energy in an attempt to modify how we look and how we present our image to others.

I am almost certain that my first concerns about the power of appearance began in early childhood. My mother, an actress, used her ‘chameleonic’ skills to make herself mutate in quicksilver succession from, for instance, sadness to warmth, humour to anger, as she manipulated her audiences. While such skill was highly rated in the theatre, it proved difficult for me to handle as a (bemused) child when applied at home. As I grew up I determined that such manipulation was to be resisted, and interestingly, with this decision came a lifelong distaste for mirrors.

Later, and in a very different environment, I realised how appearances were harbingers of prejudice. So, while I recognised it was important (essential) to notice the attire and comportment etc of those with whom I worked, it was also crucial that these features did not distract me. In essence, appearances could not be allowed to distort my judgments, to introduce false beliefs, indeed to spawn prejudice. Here, when dealing with patients, it was essential to ensure that clinical judgements and patient management were based on what the patient said (their clinical histories), on my findings when I examined them, on the results of various tests, and finally on their perceived needs. For students, the need to strip away superficial appearances was similar. In this instance, a professional relationship was to be based solely on the student’s needs regarding their grasp of/achievements in medicine, as revealed by what they said and what they produced. Clothing and any other adornments needed to be noticed, but allowing my judgement to be swayed by such adornment, and tattoos, rings or studs were a particular problem, was clearly wrong.

Whatever difficulties appearance presents to doctors, from the wearers perspective, changing ones appearance in order to express ones feelings and ones autonomy, to be and feel unique, to declare ones preferences, and to establish ones sexuality, are all totally reasonable, indeed a right. Moreover, the capacity to change appearance allows people to experiment, to express originality or togetherness, to dress for special occasions, and to look their best (disguise their worst). But, of course, excessive concern for appearances can, at one level lead to behaviour akin to obsessional preening with repeatedly verifying that all is in order, so checking zips, hem alignment, make up, quiffs and fringes, rucked-up skirts etc. At another, essentially pathological level it can result in people hiding away, staying at home because they have ‘nothing right to wear’, or feel themselves ‘too thin’, ‘too fat, or ‘ugly’ etc.

Notwithstanding all this, there is the matter of fashion. I actually detest the concept of industry-groomed devotees tied into the big business of the fashion machine.  Interestingly, pressure by the fashion industry to replace accessories every year is oddly outmoded as, by its very nature, it fuels consumerism, engenders waste and diverts scarce resources.

Despite all this, now retired I am beginning to feel that there is fun in how we dress, and that it is right and proper for the choice of clothing to change as it gives pleasure, and fulfilment and permits self expression. It should not, however, be allowed to endanger (high heel shoes) or distort, nor be determined by the dictat of industry rather than the whims of the wearer.