by Naomi Wolf
Liquid fasts have caused at least sixty deaths in the United States, and their side effects include nausea, hair loss, dizziness, and depression. Compulsive exercise causes sports anemia and stunted growth. Breast implants make cancer detection more difficult. Women delay mammograms for fear of losing a breast and becoming “only half a woman.”
The myth is not only making women physically ill, but mentally ill. Attie and Brooks-Gunn in Gender and Stress assert that dieting is a chronic cause of stress in women; stress is one of the most serious medical risk factors, lowering the immune system and contributing to high blood pressure, heart disease, and higher mortality rates from cancer. But even worse, the beauty myth in the Surgical Age actually duplicates within women’s consciousness the classic symptoms of mental illness.
Schizophrenics are characterized by a disturbed sense of body boundaries. A neurotic’s body image is erratic, extremely negative or positive. Narcissists feel that what happens to their bodies does not happen to them. Psychotics have the feeling that parts of their body are falling apart. They display repetitive rubbing, self-mutilation, and fears of sliding into nothingness and disintegration. Surgical expectations and weight fluctuations subject women to weak body boundaries. The stress on appearance gives them erratic, extremely negative or positive views of themselves. A torrent of media images show the female face and body split into pieces, which is how the beauty myth asks a woman to think of her own body parts. A number of beauty practices require of her repetitive rubbing and self-mutilation. When she ages, she is asked to believe that without “beauty” she slides into nothingness and disintegration. Is it possible that by submitting women to the experiences symptomatic of mental illness, we are more likely to become mentally ill? Women are the majority of sufferers from mental illness by a significant majority.
But these facts are not very useful to women, because there is a double standard for “health” in men and women. Women are not getting it wrong when they smoke to lose weight. Our society does reward beauty on the outside over health on the inside. Women must not be blamed for choosing short-term beauty “fixes” that harm our long-term health, since our life spans are inverted under the beauty myth, and there is no great social or economic incentive for women to live a long time. A thin young woman with precancerous lungs is more highly rewarded socially than a hearty old crone. Spokespeople sell women the Iron Maiden and name her “Health”; if public discourse were really concerned with women’s health, it would turn angrily upon this aspect of the beauty myth.
The prime of life, the decades from forty to sixty—when many men but certainly most women are at the height of their powers—are cast as men’s peak and women’s decline (an especially sharp irony since those years represent women’s sexual peak and men’s sexual decline). This double standard is not based on health differences between middle-aged men and women, but on the artificial inequality of the beauty myth. The hypocrisy of the use of “health” as a gloss for the Surgical Age is that the myth’s true message is that a woman should live hungry, die young, and leave a pretty corpse.
The Surgical Age’s definition of female “health” is not healthy. Are those aspects defined as “diseased” actually sick?
You could see the signs of female aging as diseased, especially if you had a vested interest in making women too see them your way. Or you could see that if a woman is healthy she lives to grow old; as she thrives, she reacts and speaks and shows emotion, and grows into her face. Lines trace her thought and radiate from the corners of her eyes after decades of laughter, closing together like fans as she smiles. You could call the lines a network of “serious lesions,” or you could see that in a precise calligraphy, thought has etched marks of concentration between her brows, and drawn across her forehead the horizontal creases of surprise, delight, compassion, and good talk. A lifetime of kissing, of speaking and weeping, shows expressively around a mouth scored like a leaf in motion. The skin loosens on her face and throat, giving her features a setting of sensual dignity; her features grow stronger as she does. She has looked around in her life, and it shows. When gray and white reflect in her hair, you could call it a dirty secret or you could call it silver or moonlight. Her body fills into itself, taking on gravity like a bather breasting water, growing generous with the rest of her. The darkening under her eyes, the weight of her lids, their minute cross-hatching, reveal that what she has been part of has left in her its complexity and richness. She is darker, stronger, looser, tougher, sexier. The maturing of a woman who has continued to grow is a beautiful thing to behold.
Or, if your ad revenue or your seven-figure salary or your privileged sexual status depend on it, it is an operable condition.
If you could make a million dollars a year—the average income of cosmetic surgeons in the United States—by doing so, then female fat can easily enough be called a disease. Or it can be seen for what it is: normal, since even the thinnest healthy women have more fat than men. When you see the way women’s curves swell at the hips and again at the thighs, you could claim that that is an abnormal deformity. Or you could tell the truth: 75 percent of women are shaped like that, and soft, rounded hips and thighs and bellies were perceived as desirable and sensual without question until women got the vote. Women’s flesh, you could acknowledge, is textured, rippled, dense, and complicated; and the way fat is laid down on female muscle, on the hips and thighs that cradle and deliver children and open for sex, is one of the most provocative qualities of the female body. Or you could turn this too into an operable condition.
Whatever is deeply, essentially female—the life in a woman’s expression, the feel of her flesh, the shape of her breasts, the transformations after childbirth of her skin—is being reclassified as ugly, and ugliness as disease. These qualities are about an intensification of female power, which explains why they are being recast as a diminution of power. At least a third of a woman’s life is marked with aging; about a third of her body is made of fat. Both symbols are being transformed into operable conditions—so that women will only feel healthy if we are two thirds of the women we could be. How can an “ideal” be about women if it is defined as how much of a female sexual characterisic does not exist on the woman’s body, and how much of a female life does not show on her face?
Profit
It cannot be about women, for the “ideal” is not about women but about money. The current Surgical Age is, like the Victorian medical system, impelled by easy profits. The cosmetic surgery industry in the United States grosses $300 million every year, and is growing annually by 10 percent. But as women get used to comfort and freedom, it cannot continue to count on profit from women’s willingness to suffer for their sex. A mechanism of intimidation must be set in place to maintain that rate of growth, higher than that of any other “medical specialty.” Women’s pain threshold has to be raised, and a new sense of vulnerability imbedded in us, if the industry is to reap the full profit of their new technology acting on old guilt. The surgeons’ market is imaginary, since there is nothing wrong with women’s faces or bodies that social change won’t cure; so the surgeons depend for their income on warping female self-perception and multiplying female self-hatred.
“The myth of female frailty, and the very real cult of female hypochondria that seemed to support the myth, played directly into the financial interests of the medical profession,” according to Ehrenreich and English. In the nineteenth century, competition in the medical profession rose. Doctors were frantic to ensure a reliable patient pool of wealthy women, a “client caste,” who could be convinced of the need for regular house calls and lengthy convalescences. Suffragists saw through to the real impetus behind women’s invalidism—the doctor’s interests and the unnatural conditions that confined women’s lives. Mary Livermore, a suffragist, protested “the monstrous assumption that woman is a natural invalid,” and denounced “the unclean army of ‘gynecologists’” who “seem desirous to convince women that they possess but one set of organs
—and that these are always diseased.” Dr. Mary Putnam Jacobi traced women’s ill health directly to “their new function as lucrative patients.” As Ehrenreich and English put it: “As a businessman, the doctor had a direct interest in a social role for women that required them to be sick.”
Modern cosmetic surgeons have a direct financial interest in a social role for women that requires them to feel ugly. They do not simply advertise for a share of a market that already exists: Their advertisements create new markets. It is a boom industry because it is influentially placed to create its own demand through the pairing of text with ads in women’s magazines.
The industry takes out ads and gets coverage; women get cut open. They pay their money and they take their chances. As surgeons grow richer, they are able to command larger and brighter ad space: The October 1988 issue of Harper’s and Queen is typical, in pairing a positive article on surgery with the same amount of space, on the same pages, of surgical advertising. In The New York Times health supplement of July 1989, advertising for regulated fasts, fat farms, weight-loss camps, surgeons, and eating disorder specialists fills over half the commercial space. By September 1990, the quid pro quo was solid: a woman’s magazine provided an uncritical piece in an issue supported by full-page, full-color surgical advertising. The time has arrived when the relationship among cosmetic surgery, ad revenue, risks, and warnings is re-creating cigarette advertising’s inhibitions on antismoking journalism before the Surgeon General took his stand. With journalists given little incentive to expose or pursue them (indeed, they are given incentive not to: The premier cosmetic surgeons’ organization offers a $500 journalism prize, 2 free plane tickets included), the surgeons’ status and influence will continue to rise. Tending cultural, not biological, needs, they may well continue to accumulate power over women’s social and economic life or death; if so, soon they should be what many seem to want to be: little gods, whom no one will wish to cross.
If women suddenly stopped feeling ugly, the fastest-growing medical specialty would be the fastest dying. In many states of the United States, where cosmetic surgeons (as opposed to plastic surgeons, who specialize in burns, trauma, and birth defects) can be any nonspecialist M.D., it would be back to mumps and hemorrhoids for the doctors, conditions that advertising cannot exacerbate. They depend for their considerable livelihood on selling women a feeling of terminal ugliness. If you tell someone she has cancer, you cannot create in her the disease and its agony. But tell a woman persuasively enough that she is ugly, you do create the “disease,” and its agony is real. If you wrap up your advertisement, alongside an article promoting surgery, in a context that makes women feel ugly, and leads us to believe that other women are competing in this way, then you have paid for promoting a disease that you alone can cure.
This market creation seems not to be subject to the ethics of the genuine medical profession. Healing doctors would be discredited if they promoted behavior that destroyed health in order to profit from the damage: Hospitals are withdrawing investment from tobacco and alcohol companies. The term for this practice, ethical investing, recognizes that some medical profit relationships are unethical. Hospitals can afford such virtue, since their patient pool of the sick and dying is always naturally replenished. But cosmetic surgeons must create a patient pool where none biologically exists. So they take out full-page ads in The New York Times—showing a full-length image of a famous model in a swimsuit, accompanied by an offer of easy credit and low monthly terms, as if a woman’s breasts were a set of consumer durables—and make their dream of mass disease come true.
Ethics
Though the Surgical Age has begun, it remains socially, ethically, and politically unexamined. While the last thing women need is anyone telling us what we can or cannot do to our bodies, and while the last thing we need is to be blamed for our choices, the fact that no ethical debate has centered on the supply side of the Surgical Age is telling. This laissez-faire attitude is inconsistent for many reasons. Much debate and legislation constrains the purchase of body parts and protects the body from risks posed to it by the free market. Law recognizes that the human body is fundamentally different from an inanimate object when it comes to buying and selling. United States law forbids the commercial barter of the vagina, mouth, or anus in most states. It criminalizes self-maiming and suicide, and rejects contracts based on people assuming personal risks that are unreasonable (in this case, risk of death). Philosopher Immanuel Kant wrote that selling body parts violates the ethical limitations on what may be sold in the marketplace. The World Health Organization condemns the sale of human organs for transplant; British and American law banned it, as did at least twenty other countries. Fetal experimentation is banned in the United States, and in Great Britain Parliament debated the issue bitterly. In the Baby M. case in the United States the court ruled that it is illegal to buy or rent a womb. It is illegal in the United States and Britain to buy a baby. Ethical discussion is raised by the financial pressure on a woman to sell her uterus, or on a man to sell a kidney. Agonizing national debate centers on the life and death of the fetus. Our willingness to wrestle with such issues is taken as a sign of society’s moral health.
What the surgeons traffic in is body parts, and the method of the sale is invasive. Experimental fetal tissue is dead; it still raises complex questions. The women subjected to surgical experiments are still alive. Surgeons call tissues on a woman’s body dead so that they can profitably kill them. Is a woman entirely alive, or only the parts of her that are young and “beautiful”? Social pressure to let old people die raises questions about eugenics. What about social pressure on a woman to destroy the “deformity” on her healthy body, or to kill off the age in herself? Does that say nothing about society’s moral health? How can what is wrong in the body politic be not only right but necessary on the female body? Is nothing political going on here?
When it comes to women and the ethical void opened by the Surgical Age, no guidelines apply and no debate follows. The most violent people set limits for themselves to mark that they have not lost their humanity. A soldier balks at killing a baby, the Department of Defense draws the line at poison gas, the Geneva Convention asserts that even in war there remains such a thing as going too far: We agree that civilized people can recognize torture and condemn it. But in this, the beauty myth seems to exist outside civilization: There is as yet no such thing as a limit.
The myth rests on the fallacy that beauty is a form of Darwinism, a natural struggle for scarce resources, and that nature is red in tooth and claw. Even if one is able to accept the fallacy that women’s pain for beauty can be justified—as generals justify war—as part of an inevitable evolutionary conflict, one must still recognize that at no point have civilized people said about it, as they do about military excesses, that’s enough, we are not animals.
The Hippocratic Oath begins, “First, do no harm.” A victim of medical experimentation quoted in Robert Jay Lifton’s The Nazi Doctors asked the doctors, “Why do you want to operate on me? I am . . . not sick.” The actions of cosmetic surgeons directly contradict the medical ethics of healing doctors. Healing doctors follow a strict code, established after the Nuremberg trials, to protect patients from irresponsible experimentation: The code centers on the ideas of free choice and informed consent.
Cosmetic surgical techniques appear to be developed in irresponsible medical experiments, using desperate women as laboratory animals: In the first stabs at liposuction in France, powerful hoses tore out of women, along with massive globules of living tissue, entire nerve networks, dendrites and ganglia. Undaunted, the experimenters kept at it. Nine French women died of the “improved” technique, which was called a success and brought to the United States. Liposuctionists begin their practice in the absence of any hands-on experience during training. “My surgeon has never done that procedure before . . . so he will use me to ‘experiment,’” reports a surgery addict. With stomach stapling, “surgeons are continuing to experim
ent in order to come up with better techniques.”
To protect patients from medical experimentation, the Nuremberg Code emphasizes that in order genuinely to consent, patients must know all the risks. Though patients are asked to sign consent forms, it is extremely difficult to get accurate or objective information about cosmetic surgery. Most coverage stresses women’s responsibility to research the practitioners and procedures. But reading only women’s magazines, a woman might learn the complications—but not their probability; devoting full-time research to it, she still won’t find out the mortality rate. Either no one knows it who should, or no one’s telling. A spokeswoman for the American Society of Plastic and Reconstructive Surgeons says, “No one’s keeping the figures for a mortality rate. There are no records for an overall death rate.” The same is true in Canada. The British Association of Aesthetic Plastic Surgeons also states that statistics are not available. One cosmetic surgery informational source admits to 1 death in 30,000, which must mean that at least 67 American women are dead so far—though these odds are never mentioned in articles in the popular press. Most available sources omit levels of risk and all omit descriptions of levels of pain, as a random survey of popular books on the subject shows: In About Face, the authors cover five procedures including liposuction, chemical peel, and chemodermabrasion, but mention neither risks nor pain. The Beautiful Body Book covers procedures including breast surgery, dermabrasion, and liposuction without mentioning risks, pain, breast hardening, reoperation rates, or cancer detection difficulties. The author describes breast reduction surgery and “repositioning” surgery (for when, in her words, “the nipple is misplaced”). These procedures can permanently kill the erotic response of the nipple. She does mention this side effect only to dismiss it with the astonishing opinion of one doctor who “told me that it is not unusual for many women with oversized breasts to have little or no feeling in the nipple area anyway.” She goes on to claim that liposuction has resulted in “only four deaths” (The New York Times counted eleven in 1987) and that “to date, no long-term negative effects have been observed.” Typically, the brochure of one West London clinic does not mention in their list of “risks” pain, loss of nipple sensation in any of the five breast surgeries they offer, or the risk of death. Another British brochure contains a flat untruth: Scar tissue development after breast surgery, it claims, “is rare,” happening only “very occasionally,” though estimates for scarring actually range from 10 percent of all cases to as many as 70 percent. One cosmetic surgeon’s approach to informed consent is characteristic: to “give [his] patients a paper designed to provide them with as much practical information as possible without scaring them half to death about the multitude of complications” that, despite what he calls their rarity, “could befall them.” It is also very difficult to tell which sources are impartial: The Independent (London), a respected newspaper, ran a positive article on surgery, ending in an advertisement for their Independent Guide to Cosmetic Surgery (two pounds), which plays down risk and advertises all the qualified surgeons in Great Britain. A woman cannot know what the chances are that a horror story will happen to her, until it does; her ignorance alone puts the cosmetic surgeons in violation of both the letter and spirit of Nuremberg.