Body image in tokothanatology

That morning, two patients came to see me—one carrying new life, the other preparing to let go of it.
The first was a young woman in her third trimester, radiant and restless. She sat awkwardly on the exam table, her belly taut and high. “I don’t recognize myself anymore,” she said, laughing a little too quickly. “I used to be fit. I had abs. Now I can’t see my feet.”

An hour later, an older man arrived, thin beneath his jacket, the skin along his jaw loose where weight had fallen away. His voice was soft. “I catch sight of myself in the mirror,” he said, “and I think—who’s that old guy? That’s not me.”

Both were startled by what their bodies had become. Both felt betrayed by the pace of change. And both, in their own ways, were living inside a body that no longer obeyed them.
One of the first things a woman notices in pregnancy is that her body is no longer fully her own. The waistline thickens, breasts swell, skin stretches. Often she looks in the mirror and wonders: Who is this? Where did I go?

Pregnancy is, in many ways, a rehearsal in surrender. No amount of discipline, diet, or exercise prevents the body from changing. It grows according to the needs of another being. Some women describe feeling beautiful and radiant. Others feel heavy, awkward, and dismayed. Most feel both—sometimes within the same hour.

The language of body image—too fat, too thin, too swollen, out of proportion—is one I heard often in my office. And not only in pregnancy. It comes up when illness or age reshapes the body in ways that cannot be resisted. Weight loss from cancer. Muscle wasting in frailty. The puffiness of steroids. The gauntness of advanced disease.

A body altered in dying provokes the same disbelief and grief: This isn’t me. I don’t recognize myself.
I see a parallel. Both pregnancy and dying are marked by an involuntary letting go of control. The body, once governed by conscious choice, becomes subject to biology and mystery.And in both cases, people wonder if the self they knew was vanishing along with the body they knew.

My pregnant patient fretted about her swelling ankles, the dark line on her abdomen, the breasts that leaked without warning. “I can’t seem to control anything,” she said. “My body just does what it wants.”
My older patient said much the same. His appetite was gone, his trousers slipping from his hips. “No matter how much I try to eat,” he told me, “the weight just keeps falling off. I feel like I’m disappearing.”
And then there are the reactions of others. Pregnant women quickly learn that their bodies are public property—invited or not, hands reach to touch their bellies, and strangers feel entitled to comment on size and shape. “You’re huge!” or “You’re so tiny—are you eating enough?” Every remark is a small reminder that the body is on display.

Similarly, people who are visibly ill notice the gaze of others: pity, avoidance, or unhelpful cheerfulness. Compliments become clumsy. “You look great!” we say, when both parties know it isn’t true. Society has rules, spoken and unspoken, about what kinds of bodies are acceptable, desirable, or worthy of attention. When we fall outside those boundaries, we feel it in every encounter.
My pregnant patient complained, “Everyone touches me,” she said. “Like I’m not even me anymore—just a vessel.”

My dying patient said quietly, “People look at me, then look away. Like I’m a warning.”
Each, in different ways, felt erased by how others saw them—or didn’t.

To live inside a changing body is to confront impermanence. The pregnant woman must trust that her body knows how to make room for another life. The dying person must trust that the same body knows how to let go. Both are acts of faith, undertaken with uncertainty and often with fear.

What helps is compassion—toward oneself and from others. To acknowledge that these changes are not failures of discipline, but expressions of life’s deepest processes. To recognize that dignity is not erased by altered appearance. To affirm that identity endures, even as the body transforms.

When I think of my two patients, I realize how close their experiences truly are. Each carried a story written in skin, flesh, and bone. Each learned that the body cannot be held still, no matter how tightly one tries. And each, in a quiet way, was preparing for a threshold: one into life, the other out of it.
We speak as if those thresholds were opposite, but they are really mirrors. The body knows how to open, and it knows how to close. It knows how to make space for arrival, and how to make space for departure. The self that moves through these changes—confused, astonished, sometimes unwilling—is the same self that seeks meaning in both.

Later that week I thought again of them: the young woman tracing the curve of her belly, the old man adjusting his shirt over the jut of his ribs. Each body, carrying its own mystery. Each one teaching that we belong to something larger than ourselves.

Perhaps this is what the body has been telling us all along—that it is not a possession, but a place we visit, a vessel of transformation. That beauty is not found in symmetry or youth, but in the willingness to stay present as the body becomes what it must.

Pregnancy and dying, it turns out, are not opposites at all. They are parallel invitations to humility, to surrender, and to love.