Normalisation and the Psychic Life of Cosmetic Surgery

Click to increase image sizeClick to decrease image size Notes * The author would like to thank Marguerite Deslauriers, Meredith Jones, participants in the 2006 symposium ‘Cosmetic Surgery: Feminist Engagements’ at the University of Western Sydney, and two anonymous reviewers for Australian Feminist Studies for their helpful dialogue and feedback on earlier drafts of this essay. 1. In 2005 physicians certified by the American Society of Plastic Surgeons (ASPS) and other US medical specialty licensing agencies performed 1,813,542 million invasive cosmetic surgeries, of which liposuction, nose reshaping (rhinoplasty), breast augmentation (mammoplasty), eyelid surgery (blepharoplasty), and tummy tuck (abdominoplasty) were the most popular, in that order. Since 1992, the number of cosmetic procedures performed by ASPS members (including both surgical interventions and non-surgical procedures such as dermabrasion) has increased 775 per cent. See the American Society of Plastic Surgeons website (2006). As ASPS certifies plastic surgeons in both the United States and Canada, these are rough figures for surgeries performed across North America. They exclude, however, procedures performed by non-certified practitioners, and are thus certainly a significant underestimate of the total number. The ASPS also divides surgeries into ‘cosmetic’ and ‘reconstructive’. The latter category includes procedures in which cosmetic considerations are significantly implicated, including male and female breast reduction, breast reconstruction, and scar revision. 2. I am grateful to Meredith Jones for suggesting this way of making the point. 3. This is made most clear in Foucault's lectures published as Abnormal (2003), especially the first lecture, pages 1–26. In the world of cosmetic surgery, this function is exercised through the discourse of excluding from surgery (in theory if not in practice) those would-be patients who are allegedly too mentally disordered to benefit. See the allusion in Blum (2003, 15–16) and Heyes (2006 Heyes , Cressida J. 2006 . Psychopathology and normalization: The case of cosmetic surgery and body dysmorphic disorder . Paper presented at The Body: Ethos and Ethics, New School for Social Research, New York City, 6–7 October 2006 . [Google Scholar]). 4. A similar point is made in Jones (2006, e.g. 41–42), whose own Australian interviewees offer decidedly different rationales for their decisions to have cosmetic surgery. 5. Elizabeth Haiken argues that cosmetic surgery made early use of the concept of the ‘inferiority complex’ in its psychological self-justifications. The inferiority complex was first mooted by Austrian psychologist Alfred Adler in the 1910s (see Haiken 1997 Haiken , Elizabeth . 1997 . Venus envy: A history of cosmetic surgery . New York : Johns Hopkins University Press . [Google Scholar], esp. 108–30; see also Gilman 1997 Gilman , Sander . 1997 . Creating beauty to cure the soul: Race and psychology in the shaping of aesthetic surgery . Durham, NC : Duke University Press . [Google Scholar], 263–65). According to Adler, the natural helplessness of the young child must be transformed into feelings of competence and personal adequacy by correct parenting and, hence, a healthy maturation. Continuing failure at the daunting tasks of growing up cultivates a timid and insecure personality, which may in turn be over-compensated for by an aggressive or defensive style. Either way, unless the child can successfully adapt to the challenges of gaining independence and mastery in the face of an initial and inevitable sense of inferiority, that feeling will be sedimented in the psyche. Most Americans, Haiken implies, did not need to know even this much about the inferiority complex to invoke it as a justification for all manner of technologies of the self, or for it to be a common idiom in media and advertising, and in selling the services of cosmetic surgeons (Haiken 1997 Haiken , Elizabeth . 1997 . Venus envy: A history of cosmetic surgery . New York : Johns Hopkins University Press . [Google Scholar], 111–23). The very vagueness and patient-relativity of the concept enabled surgeons to move away from universalising justifications for cosmetic surgery and towards psychological rationales rooted in the psychological needs of the individual prospective patient. 6. The major contributor to this project is Suzanne Fraser, in her 2003 book Cosmetic Surgery, Gender, and Culture. Fraser develops a theory of intertextuality, however, rather than pursuing the position indebted to Foucault and to Butler that I am gesturing towards here. 7. Lori Floyd and voiceover on Extreme Makeover, Episode 3, season 2, first aired 2 October 2003 on ABC TV. 8. Dan speaking on Extreme Makeover, Episode 1, season 2, first aired 18 September 2003, ABC TV. 9. In a recent talk, Alex Edmonds quoted the tongue-in-cheek slogan that ‘the cosmetic surgeon knows nothing and changes everything, while the psychoanalyst knows everything but changes nothing’, as epistemically central to supporting the vast state-subsidised cosmetic surgery industry in Brazil. When I asked him on what empirical basis the argument had been made, he replied that, to his knowledge, the claim is invoked as ‘common sense’, without systematic supporting evidence (Edmonds 2006 Edmonds , Alex . 2006 . Aesthetic medicine: Reproduction, sex, and cosmetic surgery in Brazil . Paper presented at the Cosmetic Surgery: Feminist Engagements symposium, University of Western Sydney, Centre for Cultural Research, 24 February 2006 . [Google Scholar]). 10. Also see Honigman, Phillips, and Castle (2004 Honigman , R. , Phillips , K. , and Castle , D.J. 2004 . A review of psychosocial outcomes for patients seeking cosmetic surgery . Plastic and Reconstructive Surgery 113 ( 4 ): 1229 – 37 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). 11. See, for example, Hasan (2000 Hasan , Jafar S. 2000 . Psychological issues in cosmetic surgery: A functional overview . Annals of Plastic Surgery 44 ( 1 ): 89 – 96 .[Crossref], [PubMed] , [Google Scholar]); Sarwer and Crerand (2004); Sarwer et al. (1998 Sarwer D.B. , Wadden T.A. , Pertschuk M.J. , and Whitaker L.A. . 1998 . The psychology of cosmetic surgery: A review and reconceptualization . Clinical Psychology Review 18 ( 1 ): 1 – 22 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]); Schofield et al. (2002 Schofield , Margot , Rafat Hussain , Debbie Loxton , and Zoe Miller . 2002 . Psychosocial and health behavioural covariates of cosmetic surgery: Women's Health Australia Study . Journal of Health Psychology 7 ( 4 ): 445 – 57 .[Crossref], [PubMed] , [Google Scholar]) (the latter is an Australian study). The prevailing wisdom in contemporary psycho-social analysis of cosmetic surgery is that someone who is suffering ‘unbearably’ over the appearance of a particular ‘normal’ body part likely has Body Dysmorphic Disorder (BDD). BDD is increasingly considered (in theory if not in practice) a contraindication for cosmetic surgery. Thus Davis's interviewees become poor candidates for cosmetic surgery—not good candidates—within this more recent psychosomatic discourse. 12. Clearly this problem could be approached in a more nuanced way by distinguishing philosophical models that connect suffering, self-identity, and politics, which may be, for example, Buddhist, Nietzschean, Arendtian, or existential. 13. Foucault's ambiguous recommendation that we take care of ourselves is an ethical project I explore elsewhere as a possible antidote to the psychic life of normalisation I describe in this essay. See Heyes (2007b, esp. chap. 5).