Contributor: Wyona M. Freysteinson, PhD, MN
Theory: Neurocognitive Model of Mirror-Viewing

At the age of two, I decided I was going to be a nurse. My great grandmother, my first patient, taught me my colors while testing urine for ketones, how to give insulin, and that when I combed her hair, she looked in a mirror.

I thought all nurses used mirrors.

The quest to understand the mirror-viewing experience began in the 1970s-1980s when I practiced bedside nursing, with a small mirror my uniform pocket. I wondered why the mirror was soothing to so many of my patients (e.g., seeing how I had re-taped a nasogastric tube)? In some patients, I witnessed a look of terror (e.g., viewing a scalp incision)?

When I suggested a mirror-viewing study in my master’s program in 1990, the dean called me into her office. The dean said I could not study mirrors as sick people do not want to look in mirrors. Upon deep reflection, I realized that I had not caused severe psychological harm to thousands of patients with my pocket mirror. I turned to the philosophy department where a professor who had been a student of Paul Ricoeur joined me in my quest. The mirror research journey had begun.

This research trajectory continued with studies of the mirror-viewing experience after a terminal illness diagnosis, amputation, mastectomy, and military sexual trauma. This mirror knowledge base helped me understand the experience of mirroring.

This knowledge base, however, did not explain the mirror phenomenon. Why did some participants tell stories of severe mirror distress (e.g., I wanted to run out on the road screaming)? Why did other participants say they felt no emotions when seeing their bodies for the first time after disfigurement? Why did so many participants remember a terrifying mirror image that occurred several years earlier, and I struggled to remember my mirror image from this morning?

A deep dive into the literature unearthed MRI studies demonstrating self-recognition occurs in the pre-frontal cortex. Together with memory and the autonomic nervous system theories and my research, this information formed the foundation of the mid range nursing theory: Neurocognitive Model of Mirror-Viewing. Although mirrors have a tenuous historical and mythical past, and to some individuals are considered taboo, mirrors are simply tools. For example, mirrors are useful for self-assessment (e.g., diabetic foot care, skincare), self-incision and wound care, colostomy care, prosthetic alignment, and pushing during birth. Many individuals use a mirror to brush their teeth and other activities of daily living. Only in mirrors can we see our faces and whole bodies. However, Initial mirror-viewings in the aftermath of visible disfigurement, sexual trauma, or bullying may be distressing or traumatic. Ongoing mirror discomfort and mirror avoidance may occur.

Sensitive, supportive nursing mirror interventions are needed to mitigate mirror trauma. Since my visit to the dean, I cannot count the number of individuals who have considered my work absurd, frivolous, or inconsequential. Nor can I calculate the countless numbers of cheerleaders who have had traumatic mirror experiences and wished a nurse had been there for them. My hope is that my work expands nursing science to the extent that nurses do use mirrors.