“You might not notice it … but I do”: Shame and Cosmetic Surgery
Augmenting the Body: Disability, Care and the Posthuman is an
interdisciplinary research project that explores practices of bodily
augmentation, from caring robots to prosthetic limbs, across the fields of
English, Engineering, Healthcare, Philosophy, and Robotics. The project, led by
Professor Stuart Murray and funded by a Wellcome Trust Seed Award, involves
collaborators from the University of Leeds, the University of Exeter, and
Sheffield Robotics.
In this post, one of the collaborators working on the project—Dr
Luna Dolezal (University of Exeter)—offers a snapshot of her work on the
relationship between bodily augmentation through cosmetic surgery and beauty
demands.
It is only very
recently that elective cosmetic surgery has entered the mainstream as a routine
and socially acceptable way to alter appearance. In the 1950s, for example,
aesthetic plastic surgery was a largely marginal and unknown medical practice.
Just a few decades later, it is a recognized medical speciality, not to mention
a highly lucrative multi-billion dollar global industry. As cosmetic surgery
has proliferated, it has also become more democratic. No longer the privilege
of the wealthy or elite, procedures are increasingly more affordable and
cosmetic surgery is now a pursuit of the middle and more affluent lower classes.
Although
cosmetic surgery is regularly performed on men, it is by and large a female
practice. In 2013, for instance, in the United States, just over ninety per
cent of surgical and non-surgical cosmetic procedures were performed on women,
and only nine per cent on men. (Interestingly, although women are by and large
the primary recipients of cosmetic surgery, eight out of every nine cosmetic
surgeons are male.) These figures are mirrored precisely in the UK, where women
make up about 90% of cosmetic surgery recipients.
It
is widely reported in the academic literature on cosmetic surgery that women
sometimes see cosmetic surgery as a means to take control of their bodies and
lives, exercising their agency in order to alleviate psychological distress. As
a result, despite the (obvious) focus on the physical body in cosmetic surgery
practices and the promise of ameliorating physical flaws, a common
justification by doctors and patients for the medical need for cosmetic surgery is
not about the physical body, but instead related to the alleviation of
psychological distress—significantly, they argue that cosmetic surgery will
alleviate shame, anxiety and suffering arising as a result of perceived flaws
in one’s body and the perceived threats to one’s social standing that this may
incur.
Hence,
it is commonly reported that women see cosmetic surgery as a means to alleviate
or circumvent shame about the body, while ensuring a sense of social acceptance
through impression management. Indeed, medical advocates of cosmetic surgery
argue that as one of medicine’s primary goals is to reduce suffering, insofar
as cosmetic surgery can offer relief to psychological distress then it should
be considered a viable medical treatment. It is by this logic that cosmetic
surgery is sometimes seen as medically justified rather than merely an
enhancement of already ‘normal’ functioning, and is sometimes funded by
national health services, such as the NHS.
In
fact, concerns around appearance management are far from trivial and can indeed
have serious consequences for one’s experience and sense of well being. The
sort of psychological distress that individuals feel when appearance management
comes to be dominated by chronic feelings of body shame can shrink one’s world,
disrupting on-going activities and life projects as the self turns attention
inwards on itself. This may result in a state of confusion or inaction, and
perhaps an inability to engage meaningfully with projects in the world—and
there is plenty of literature that corroborates that when attention is directed
to the body and one is made to feel insecure, then this can have profound
consequences on attention and performance. This sort of experience can lead to
social withdrawal, rendering one fragile, insecure, timid and emotionally
vulnerable.
It
is clear from ample research and anecdotal evidence that cosmetic surgery is
not simply an expression or manifestation of excess vanity in contemporary
Western women, but rather it is sometimes utilized as a means to achieve a
‘normal’ appearance in order to avoid body shame. Hence, it seems that for some
if not many women, cosmetic surgery is not about becoming beautiful or
exceptional, but about merely ‘passing.’ Sought out in response to body shame
that can perhaps range from minor to severe to completely unbearable, these
women hope cosmetic surgery will help them become ‘unnoticeable,’ ‘invisible,’
and ‘ordinary’ to use some of the terms employed by the women in research interviews.
In these contexts, arguably, cosmetic surgery can be seen as something beneficial for the subject where exercising one’s
choice to have surgery can improve one’s quality of life, self-esteem and
psychological functioning.
Transforming
body shame into pride is, in fact, central to the drama of cosmetic surgery:
shame drives women to seek out surgeons; surgeons cultivate it in order to
acquire and maintain their clients; and, ultimately, surgeries are performed in
order to alleviate it. In fact, doctors prey on shame and offer diagnostic
language and a therapeutic narrative to alleviate the shame cycle that many
women feel regarding their concerns with appearance, where the advice and
attentions of a medical expert legitimates what might otherwise feel like a
shameful preoccupation. A reassuring doctor will alleviate your shame,
recasting what you feel might be mere vanity or narcissism into a serious
medical concern. A perceived physical flaw is no longer a shameful secret or a
personal failure, but part of a medical problem.
Diagnostic
language is powerful. As critics writing about gender, race, sexual orientation
and disability, among other embodied states that carry stigma, have noted, a
medical diagnosis can alleviate shame and stigma, empowering and enabling an
individual or group. As against feeling different, ashamed and alone, belonging
to a medically classified group can be a positive and even life-changing
experience, validating and endowing recognition to a subjectivity that was
previously politically or socially marginalized, invisible and ignored. Not
only is one’s shame alleviated, but often the medical model provides avenues
and options for treatment and perhaps even a ‘cure.’
However,
once these diagnoses or classifications are accepted and perceived as reality,
it is difficult to resist the dictates of biomedicine and the normalizing
ideology which underpins it. As a result, although doctors are key in
alleviating the shame and embarrassment that one might feel about the body,
they are also in a prime position to incite it.
There
are numerous accounts in feminist literature on cosmetic surgery of doctors
who, in consultation, routinely make women ‘see’ that parts of their bodies,
for which they had not even considered surgery, are in fact also defective and
in need of intervention. This has profound consequences for one’s
self-perception and self-esteem. Susan Bordo cites this example:
“Writing for New York magazine, 28-year-old, 5-foot 6-inch,
and 118-pound Lily Burana describes how a series of interviews with plastic
surgeons—the majority of whom had recommended rhinoplasty, lip augmentation,
implants, liposuction and eyelid work—changed her perception of herself from ‘a
hardy young sapling that could do with some pruning … to a gnarled thing that
begs to be torn down to the root and rebuilt limb by limb.” (Bordo, 2009, p28)
In this manner,
cosmetic surgeons can play out the common formula of consumer culture: they
cultivate profound anxieties about the body and then present themselves and
their services as the only means to eliminate or alleviate the very shame and
guilt they have themselves helped to produce.
Arising
from the inherent discrepancy in the power relations between doctors and
patients, compounded by the highly gendered landscape within which cosmetic
surgery practices play out, is an endless ground to invent new defects and,
correspondingly, new interventions to correct them, inciting further anxieties
in already existing clients while simultaneously broadening its markets to
younger women, adolescents, men and diverse ethnic groups.
Hence,
what is interesting is that despite numerous testimonials that cosmetic surgery
is sought out as a means to alleviate psychological distress caused by perceived
flaws in appearance, there is ambivalent evidence on the overall positive
psychological and social impact of cosmetic surgery, nor any clear evidence on
how long any reported positive impacts will last. Evidence suggests that
cosmetic surgery may offer a superficial fix targeting a particular
instantiation of body shame, while, at the same time, ultimately exacerbating
overall body dissatisfaction.
In fact, the argument that cosmetic surgery is psychologically beneficial is
extremely problematic and fraught with contradictions. Surgeons are regularly
advised not to operate on those who suffer from mental health issues,
especially Body Dysmorphia Disorder (BDD) which is characterized by chronic
body shame and dissatisfaction with appearance or body image. These individuals
are unlikely to be satisfied with the results of their surgeries, nor to
experience any relief from their psychological suffering, and, moreover, they
are the most likely to become litigious. However, while rejecting those with
BDD as potential candidates for surgery, some surgeons simultaneously encourage
BDD-like behavior in their ‘healthy’ and ‘suitable’ patients who turn to
surgery as a result of dissatisfaction with minor or even imperceptible flaws
in otherwise normal appearance. As a more honest surgeon remarks: “Plastic
surgery sharpens your eyesight … You get something done, suddenly you’re
looking in the mirror every five minutes—at imperfections nobody else can see.” (Bordo, 2009, p26). Indeed,
a common mantra for women who undergo these sorts of procedures is: “You might
not notice it … but I do.” (Wiseman, 2010, emphasis
added).
Luna Dolezal is a lecturer in Medical Humanities and
Philosophy at the University of Exeter. She discusses shame in the context of
cosmetic surgery practices in her recent book The
Body and Shame: Phenomenology, Feminism and the Socially Shaped Body (Lexington Books, 2015). Luna is a
collaborator on the Augmenting
the Body: Disability, Care and the Posthuman interdisciplinary
research project. She is also the co-PI of the Shame and Medicine Project
(www.shameandmedicineproject.com) which explores shame dynamics in all aspects
of healthcare.
References
Bordo, S. (2009) Twenty Years in the Twilight Zone. In C. Heyes
& M. Jones (eds.) Cosmetic
Surgery: A Feminist Primer (pp.21-34).
Farnham, UK: Ashgate Publishing
Wiseman, E. (March, 2010) Would Madam Like a Nose Job with Her
Sandwich? The Observer Magazine
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