Clinical significance of clothing

My previous post raised a bit of a discussion. On the one hand, I had a couple of reactions from clinicians who were telling me that patients’ attire can give significant clinical information, on the other hand, one of the tweets reposting the blog gave rise to a discussion about pathologisation of clothing and other aspects of visual appearance. And so, I think it’s worth taking stock. So, let me go back to the ‘theory’ and consider how a popular clinical guide proposes tackling clothing. What does the author ask clinicians to pay attention to?

1. It seems that the patient’s clothing must be ‘professional’, suitable for office.

What irritates me in this pronouncement is not so much the fact that while there is probably a prototypical ‘office attire’, but that quite a lot of people and businesses give up on it.  I often go to ‘the office’ in jeans, in hot weather in shorts (oh yes, some brows are raised). I don’t wear ties. But what really gets me in all this is that the construction of the patient/client as a ‘professional/office identity’. I don’t come as me. I come as a ‘professional’ to a professional. This raises more issues that I can deal with in this post.

Let me just say that I suppose, I should be grateful that my GP hasn’t yet called the police when he saw me in  shorts (though I do have nice legs!).

2. It seems the patient should be dressed in an age-appropriate way.

But it’s always one way, isn’t it? The clothing I wear cannot be suitable for a younger person. I can, however, wear clothing suitable for an older person with impunity. So, Ralph Lauren out, Marks and Spencer anytime. The deal is never cool, always frumpy. Please!

3. It seems clothing should be ordinary.

No red jeans or Kangol hats worn a la Samuel L. Jackson, no bracelets, no Nasomatto perfume…Bloody hell, half my wardrobe in nigh gone…..Give me a break, hey?

The whole notion of clothing being ‘bizarre’ or ‘attention-seeking’ (I will never understand how clothes can seek attention, but I’m a linguist) is so contextual that either we assume that the clinician is just about ready to write a monograph such as Dressed society, or it is really just a way in which, as I said in the previous post, a clinician can say: “I like that person” or “I don’t like that person”.

Now, here is one final thing about the Thesaurus. At the beginning of the discussion on clothing it very specifically says about the assessment that

The relevant perspectives are not fashion, cost, or newness, but what clothing means about the client’s ability to care for her-/himself and her/his judgment of appropriateness.

Fair enough, I hear you say. Except that the scale on which the attire is to be assessed includes such criteria as

Plain, out of date, old-fashioned, regional/foreign designs.


Stylish, fashionable, elegant, dandified, immaculate

And I thought it was not about fashion, for pity’s sake! I will not even begin to comment on the idea that regional or foreign clothing is necessarily plain. This is because I don’t know what’s more important – that such a proposition is discriminatory or completely ignorant. It might be surprising to an American writer that a lot of haute couture is actually foreign. You know, Paris,  Milan….

Incidentally, all this above is simply to be assessed on the basis of the person’s appearance. The wonders of psy insight seem to have no bounds. You look and you know whether my red jeans do or do not seek attention (I do have red jeans), though I assume that you would not have thought to look twice at my Zegna blazer (it’s deceptively plain), because it’s not red. I do not walk flashing the label, and yet, it is the blazer that cost me an arm and a leg.

Time for a story, a true story, in fact. I was doing a series of lectures for clinical psychologists and one morning I came in wearing a bright red jumper, which was greeted with something like “Somebody is in a good mood today.” I enquired about the assumption (or was it a conclusion?) and was told that the bright red jumper was unmistakably telling them about my current ‘mental state’. The group agreed.

I must admit that the simplicity of this pronouncement swept me off my feet.  It never occurred to those practicing clinical psychologists that I was doing ‘guest lectures’ and stayed in a hotel, which meant limited clothing. As it happens, during the previous night’s dinner I had stained my other jumper and the red one was the only clean one I had. The choice of bright red had nothing to do with my mood (and I find the assumption that it could quite problematic in any case) and all with the state of the clothes I took with me. Moreover, I explained further (against my better judgement), I was hung over, didn’t sleep well, and got up way too early to make it to the lecture, which made me pretty grumpy, although I was trying not to show it.

A perfect opportunity to explain context in psychology? To my utter bewilderment, they didn’t believe me. Basically, those, to stress, practicing psychologists basically decided that my ‘mental state’ trumped all possible contexts and if I did not feel well and upbeat, I would not have put the jumper on, winter or not.  I was simply not in touch with my mood. I collapsed. Obviously, the fact that my father used to wear bright accessories, expectations of what a professor wears or does not wear, or that I might only have red jumpers simply never crossed the psychologists’ minds. No, my bright red jumper was a simple window for the psychologist to look right into me.

But then their assessment reflected the simplicity with which clothing is looked at in the abovementioned Thesaurus. It simply reflects a ‘state of mind’ and has nothing to do with the society in which we live. It seems psychology and psychiatry are happily oblivious to socialness of clothing (have a look at Corrigan’s Dressed Society which I quoted above), let alone to its ideological dimensions. Yes, clothing is also about power and I recommend a wonderful (although somewhat unsettling) essay by David Graeber on the tie – a piece of garment that serves no apparent function. A health warning is needed, though – ever since I read the essay I have not been able to decide whether my long-term dislike of ties is a good or bad thing.

Now, in his response to the previous post Allen Frances tweeted:

I’m no fashion plate- for decades was 4th worst dressed psychiatrist in US. But patient dress does reveal important clinical information.

That may well be true and it is not so difficult to imagine contexts in which it does. What I have a problem with, however, is how exactly it is ascertained. Judging by the state of their clothing half of my (sometimes very eminent) professors, many colleagues, and, in fact, often myself would have qualified for psychiatric care. This is because some soooo didn’t care about what they were wearing (gosh, it sometimes showed and smelled) or because others cared so much that it became a statement.

So, what are you looking for, doctor? Do tell, so I am prepared, just in case.


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