Guest Contributor: Jaya Rijal
PhD Student in Nursing Science, Texas Woman’s University

As a PhD student in Nursing Science at Texas Woman’s University, I took several courses with Dr. Wyona M Freysteinson. Her theory, “The Neurocognitive Model of Mirror Viewing,” was particularly unique and relevant to nursing. I am a mother of a toddler who faced various challenges during the postnatal phase, and self-image was one of my concerns, which led me to consider the applicability of her theory in understanding postpartum self-image.

The neuro-cognitive model of mirror viewing by Freysteinson (2020) provides a multifaceted understanding of how our brains interpret visual stimuli when we observe ourselves in the mirror. It begins with the initial visual processing of the reflected image in the visual cortex, where basic visual features such as shapes, colors, and movements are extracted. When we look at our reflection in the mirror, higher-order cognitive processes, including self-recognition and identification, get activated. It involves comparing the visual input with stored memory representations, a function likely governed by regions associated with self-awareness and self-referential processing, such as the prefrontal cortex. Freysteinson explains that curiosity about one’s appearance drives mirror viewing, serving self-care, and monitoring. While minor changes may briefly heighten scrutiny, gross changes can evoke negative experiences, including trauma. These traumatic experiences may be encoded into long-term memory, leading to intrusive recollections and mirror avoidance behaviors. Repeated mirror viewing with support facilitates acetylcholine consumption, gradually restoring mirror comfort. However, repeated mirror viewing without support increases serotonin uptake and excess acetylcholine, resulting in a persistent decrease in mirror comfort or trauma. The model underscores the importance of mirror comfort for overall well-being and highlights the role of nurses in supporting individuals through mirror-related challenges, particularly after perceived or actual disfigurement.

After my C-section, looking into the mirror became a pivotal moment of self-awareness. I encountered my postnatal appearance, which resulted in two opposing reactions. I had not tied my hair properly, changed my clothes, or even remembered if I had brushed my teeth. I realized I was so focused on caring for my child that I had completely neglected my self-care. The realization became a motivating factor for me to prioritize my self-care. On the contrary, the changes in my physical appearance generated overwhelming negative emotions. I felt like my identity and self worth had diminished. I did not want to be confronted with stretch marks, changes in body size, sagging breasts, hanging belly, and facial patches. Therefore, I instinctively refrained from mirrors.

However, I gathered the courage to share my feelings with my partner. His words of reassurance and encouragement t0 embrace the changes brought by motherhood, as we looked into the mirror together, gently guided me back to the mirror. We decided to coordinate our routines for childcare, which allowed me to carve out some “me time” for self-care and relaxation. I eventually reached the acceptance and appreciation phase through my partner’s unwavering support and verbal consolation. It did not happen in a fraction of time but was a continuous process. I experienced the profound impact of a support system in alleviating traumatic experiences, which is what the neurocognitive model of mirror viewing intends to emphasize.

Postpartum mental health and well-being are deeply related to physical recovery, emotional resilience, and social support. In “Maternal Identity and Maternal Experience,” Rubin (1984) describes the extent of motherhood as going beyond physical changes and requiring significant psychological adjustments (Rubin, 1984). As Fawcett (2023) noted on Nursology.net, Rubin emphasized the role of maternal nursing in helping mothers transition into their new identity, which is distinguishable from the more medical focus of obstetric nursing. This reinforces the need for support networks that promote maternal self-image. Based on my experience, supportive mirror exposure therapy, education sessions for partners and families to foster empathy, peer-support groups, and relaxation and stress management techniques offered during postpartum visits or throughout the postpartum phase can empower mothers to understand their self-image. Taking the initiative, nurses can improve mothers’ mental health, overall quality of life, and ability to care for themselves, their children, and their families.

References

Fawcett, J. (2023). Rubin’s theory of clinical nursing and theory of maternal identity. https://nursology.net/nurse-theories/theory-of-maternal-identity/

Freysteinson, W.M. (2020). Demystifying the mirror taboo: A neurocognitive model of mirror viewing. Nursing Inquiry. https://doi.org/10.1111/nin.12351

Rubin, R. (1984). Maternal identity and maternal experience. Springer.

About Jaya Rijal

Jaya has nearly 15 years of nursing experience as an educator, and cardiac and dialysis nurse. Her diverse educational background spans multiple countries, and she is currently a PhD in Nursing Science student at Texas Woman’s University. Jaya’s long-standing passion for mental health and her postpartum journey deepened her understanding of psychological challenges faced by postpartum mothers. Her insight has motivated her to focus her research on postpartum mental health to make a meaningful impact in this critical area.