Cosmetic surgery and ethnicity

The Atlantic has featured a couple of good articles about this topic recently,  so I put together a roundup of related pieces:

The K-Pop Plastic Surgery Obsession from The Atlantic (24 May 2013).  This thorough article includes some quotes from anthropologist Eugenia Kaw and a reference to her work Medicalization of Racial Features: Asian American Woman and Cosmetic Surgery.  From the article: “Dr. Kang’s philosophy is about helping nature along. ‘I always try to copy the natural look, give face the ideal shape it should have been born with,’ he said.”

SBS Dateline (Australia) had a segment on the K-pop cosmetic surgery phenomenon a couple of months ago:

This Reddit thread about the 2013 Miss Korea contestants is interesting as some comments come from people living in Korea, trying to give a perspective from inside the culture.  They also reference this story from China in which a man sued his beautiful wife for marrying him under false pretenses, after she gave birth to a less-than-lovely child and then revealed she had had about $100K worth of surgery before meeting him (sounds like an urban legend to me).

Looking beyond Korea, in 2011 the New York Times published the article Ethnic Differences Emerge in Plastic Surgery. It’s not an academic or researched article;  it basically groups together a bunch of generalizations by surgeons about immigrant surgery preferences.

The Atlantic went back to the cosmetic surgery topic for today’s article Bringing Beverly Hills Cosmetic Surgery to the Middle East.

And to return to my home country, I offer you this Gawker post from 2011: A Guide to the Fake Faces of Real Housewives.  Perhaps there’s something to be said about trying to look like those seen as successful  trendy role models among those of your subculture — whether they be pop stars, actors, or trophy wives — and the dominant story isn’t that people are trying to look Caucasian, at least not anymore.

What it means to have a culture-bound syndrome

If you tell a distressed woman that her suffering is a culture-bound syndrome, perhaps citing examples that she would find bizarre, you shouldn’t expect a pleasant and understanding response. It sounds dismissive, like saying it’s “all in her head” or a manipulative tactic to garner sympathy.

There have been a flutter of articles about culture-bound syndromes in the wake of the DSM-5 publication, and a piece on the The Guardian (Are mental illnesses such as PMS and depression culturally determined?) seems to have inspired this one on Jezebel and then this one on Slate.  There are many good links in the articles and I recommend clicking if you’re interested in the topic.  But what comes through to me in some sections of the writing and definitely in the comments is the attitude that if an illness is culture-bound, it’s not real.  Many of the comments are defensive, daring others to say that what they’re experiencing is a lie.  This can be complicated by a mainstream understanding that something “cultural” is something shared, yet (to use the main example from the articles) not every woman in Western cultures has PMS or experiences it in the same way. Does this mean that those who do are exaggerating for effect or making it up?

No.  However, we start to wade into the swamp of the “really real” where I so often find myself lost. I know I’m not alone in struggling to understand what it means for someone to have a culture-bound syndrome and I’d make a mess if I tried to unpack a lot of theory.  However, I think it’s a common mistake to see these syndromes as only a way of expressing emotions that don’t have another path of release. I’m more inclined toward the notion of local biologies, where societal and cultural expectations play a role, but so can genetics and epigenetics, diet, and environment.

We do a disservice by pointing out the culture-bound syndromes of others without inclusively evaluating those that might be our own (not at higher levels of study, but certainly in lower levels and mainstream articles). It wrongly puts Western culture in a position of rationality and superiority, smiling at the quaint confusion of others, rather than questioning our own socially accepted conditions that are proving to be non-universal and WEIRD (Western, Educated, Industrial, Rich, and Democratic).

Surgery as prophylaxis

The world buzzed yesterday with the news that Angelina Jolie underwent a double mastectomy to greatly diminish her risk of breast cancer. I’ve been a fan for a long time, but she has my respect for the editorial she penned for the New York Times revealing her procedure. It’s intelligently written, explains the tests and procedures she went through, acknowledges other treatment options and choices, and thanks her loving family. It can be difficult to understand having such a dramatic procedure done with no sign of current illness, but as one woman who made the same choice put it, “If someone said your flight was 86% likely to come down, you wouldn’t get on that plane.”

With better knowledge about risk factors and a decrease in the cost of  genetic testing, an increasing number of people are proactively seeking surgery with no evidence of disease.  A presentation at the American College of Surgeons Annual Clinical Conference last year analyzed data on this trend from 2004-2009.  The number of hospitalizations related to genetic susceptibility increased 16-fold during that time, and prophylactic surgeries more than doubled. Insurance plans are increasingly covering these surgeries as a cancer risk reduction strategy based on family history, pre-disease symptoms, and/or genetic testing. This policy sheet from provider Priority Health is one example; it describes criteria not only for prophylactic mastectomy but also removal of the ovaries, stomach, uterus, or thyroid.

Jolie isn’t the only public figure in the news recently for surgery to reduce illness risk.  New Jersey governor Chris Christie revealed last week that he had undergone bariatric surgery in which a band is used to section off part of the stomach, reducing the quantity that can be eaten at one time. Though some have questioned his motive, Christie made this decision at age 50 and while morbidly obese, at increased risk for heart disease, stroke, some cancers, and concerns from joint problems to sleep disorders. Though the surgery isn’t a cure-all (I was told recently by a specialist in this area that more than 50% of the procedures now performed are revisions to previous surgeries; not because of a problem with the surgery, but to increase effectiveness for a patient who has stopped losing or started regaining weight), Christie has a good chance of dropping enough weight to make a significant difference in his risk of disease.

There are many issues to consider here and many frameworks that can be applied, but I’ve been thinking about identity. People who undergo major surgery as a risk reduction strategy will wear the scars and/or have lifestyle changes forever. Their lives are different because of a disease they feared, which becomes part of their embodied identity nonetheless. I think there must be an identity shift that precedes that, from seeing oneself as healthy to envisioning the body as vulnerable and imminently diseased.  The presentation mentioned above noted an association between surgery-seeking and level of anxiety about disease. I wonder if that anxiety marks an identity borderline, from a woman who sees herself as fine but at risk and chooses vigilance and lifestyle alterations, for example, and one who sees herself as having a disease that hasn’t yet surfaced and seeks surgery to remove tissues already considered unhealthy.

More thoughts on unnecessary gluten avoidance

I was going to respond directly to Kristen’s post, but I don’t think WordPress lets you put hyperlinks in response comments.

It’s an interesting question, worth unpacking a little. If we agree that it’s important to respect phenomenological and subjective experience, does that mean that individuals should be free to adopt any medicalized identity as long as it doesn’t cause them harm (there are no clear negative health effects of avoiding gluten unnecessarily)? This is complicated by the way that illnesses do important work of identity formation, with illness subjectivities providing potential access to valuable forms of community and social capital- particularly in the age of internet fora and support groups (we’ve looked at this a little bit in class with Nguyen). It’s a fascinating new world of bottom-up creation of categories that are simultaneously illness and empowerment- Gillick’s analysis of jogging is a kind of precursor to this new proliferation of medicalized subcultures that are only taken up by the DSM once they reach a critical mass online. Are these conditions counterhegemonic, or just another example of technologies of the self ultimately serving the interests of governmentality? Lots of good possibilities for future research here.

Just to be provocative, if you’re OK with claims of gluten intolerance whether or not there’s a biomedical justification, how do you feel about pro-ana? Or about body integrity identity disorder, the conviction that one is healthy apart from the burden of a limb that does not feel like it belongs on your body?

The bioethicist Carl Elliott (always worth reading) wrote a great essay on BIID several years ago, and pointed out that the disorder really grew only once people were able to discuss it laterally on the internet, unmediated by the medical establishment. It’s as if the discourse actually created the symptoms in people’s bodies, in a kind of Sapir-Whorf effect.

There are lots of examples of this. This American Life just did a nice piece on the strange world of ASMR, a condition (labelled and given its properly medical-sounding acronym not by doctors, but by the online community) that makes videos like this intensely pleasant to watch. Do new illness communities develop because individuals first have symptoms, and can now discover similarly-wired people on the internet, or does the category to some degree create their somatic experience?

Can two people share a mind?

This article is mind-blowing: there’s no hard proof, but a lot of intriguing evidence that two little girls are in some way sharing each other’s consciousness.

Born with an extremely rare (the rarest- there are no other cases in medical history) form of conjunction at the head (craniopagus), Krista and Tatiana Hogan seem to share mental and physical experience through a thalamic bridge.  Their neurosurgeon hypothesizes that when either of the girl’s bodies experiences sensory input, the signal passes to both brains.

It’s hard not to speculate on the big questions this medical anomaly engenders: on the nature of the self, and on the nature of consciousness.  And these big philosophical questions are ones that Krista and Tatiana have to negotiate continually at a very practical level: what pronoun should the girls use to refer to themselves, and what does it mean?  What if their connectivity extends beyond basic sensory input, to higher-order thoughts and preferences?  There are some good links in the article to philosophers and neurobiologists who had been thinking about these kinds of problems before the extraordinary case of Krista and Tatiana.

What kind of artefact is the lived body?

I found the description of the theme of this conference and the questions raised to be thought provoking and worth sharing:

Practices and their Bodies. What Kind of Artefact is the Lived Body?

  • Transdisciplinary Conference, April 25th-27th 2013, University of Mainz (Germany)
  • Keynote Speakers (confirmed): Chris Shilling (University of Kent), Annemarie Mol (University of Amsterdam), Paul Stoller (West Chester University), Gesa Lindemann (University of Oldenburg) und Martin Dinges (University of Mannheim).

The human body as the subject of research still sits very firmly in the grasp of the natural sciences. Nevertheless, cultural studies and social sciences have put forward two fundamental insights on the body vis-à-vis established biomedical knowledge. Firstly, both anthropological and phenomenological approaches have delved into the inner perspective of our inhabited bodies by viewing the ‘lived body’  as the foundation of all cognition and as the fundamental site of sensory perception, personality, and subjectivity. Secondly, ethnological and historical semantic studies have shed light on the extreme variability of ‘the body’ subject to societal knowledge regimes. Human bodies span an infinite plurality of cultural classifications and historical discourses – a bundle of linguistic categories, medical imaging, interpretation and explanation patterns. Our natural scientific knowledge of the body is part of historically and culturally specific ethnosemantics.

This conference proposes a third fundamental sociocultural way of viewing the body, namely as a component of material culture. In recent years the term practices has oftentimes been used to express this perspective – a conception of human action and behaviour that places controlled bodily movement at the centre of social life. As a part of material culture the body is without doubt an artefact. It has limited capabilities, is practically shaped by food, medicine, and socialisation, and wears out through practical use. However, it is a special material thing: it can learn, i.e., through usage it is materially (re)shaped, disciplined, and is impregnated with habits, and it can specialise in body techniques: instrumental music, handicraft, sports, martial arts, and sex, to just name a handful of such specialisation possibilities. Continue reading