John Taylor was operating on the marred eyelid of an unfortunate female patient when she started to object vigorously. "The pain was excruciating, and the patient repeatedly shouted, 'You hurt me, you hurt me!' to which Taylor replied, 'Remember, Lady, Beauty! Beauty!' When he was finished, the woman's friends 'were astonished and it looked as if the business had been done by some miracle.'"
This might sound like a refrain from one of thousands of plastic surgery offices across America, but John Taylor was no sun-
"A 'history' of plastic surgery?" you protest, before and after images of Pamela Anderson Lee popping into your head. "Is this really necessary?"
Gilman shows quite convincingly that it is not only a necessary chapter of medical and cultural history, but also a riveting one. Gilman addresses everything from the tedious T&A worries of the present day (complete with quotes from "A Chorus Line") to circumcision and decircumcision (aka foreskin replacement), facial reconstruction after the First World War and transsexual surgery.
But Gilman's book is hardly a simple cataloging of the imaginative -- sometimes ghastly -- ways humans have surgically altered their bodies over the past 400 years. Rather, he uses aesthetic surgery as a window onto understanding what different kinds of bodies mean in the modern world, and how they signify traits held to be undesirable or threatening: inferiority, ill health, racial degeneracy, sexual dysfunction and that hopelessly vague characteristic: un-sexiness. His central argument is that aesthetic surgery evolved to help a person "pass" for a member of a group (or "cohort," in his sociologist's vernacular) to which he or she wants to belong.
Syphilis, the sexually transmitted scourge brought back to Europe with the ships of Columbus, marked the unsavory beginning of the West's attempts to reshape the body. Syphilis ravaged Europe for 300 years, until the turn of the last century, when an effective treatment was developed. The disease, if it didn't kill you, could cause the bridge of the nose to collapse -- or even fall off altogether, leaving an unsettling, gaping hole in the center of the face. Thus syphilis prevented its carrier from hiding his or her "dissolute" sexual behavior (or from hiding the "immoral" deeds of one's ancestors, since the disease was congenital). "The syphilitic nose marked the body as corrupt and dangerous," Gilman asserts. "And this sign of 'bad character' was literally written on the face."
The remedy for this unsightly marker? A nose job. An early modern, pre-anesthesia, pre-antisepsis nose job. I won't gross you out with the details here. For that you will have to read the book -- though I will say the some of the early skin grafts for nose surgery came from "the skin ... off the buttocks of the working poor." But Gilman's point is that even the worst pain, coupled with a highly dubious result, was better than possessing the sign of moral, sexual or social deviancy.
Yet the question remains: Why? Here Gilman gives a simple, perhaps too simple, reason for the desire to transform oneself. Aesthetic improvement became a way for the acquisitive to acquire happiness -- a vague and yet pervasive goal enshrined most notably for Americans in the Declaration of Independence. "Happiness," Gilman writes, "the central goal of aesthetic surgery, is defined in terms of the autonomy of the individual to transform him- or herself." Thus, Gilman shows how plastic surgery cuts to the heart of the modern Western self: the happy, self-creating individual we've aspired to since the Enlightenment. Herein lies the implicit irony: The feelings of happy autonomy only come with belonging to a privileged group or, at the very least, "passing" as a member.
That Gilman's vision is so ambitious should not surprise us. He is, after all, in possession of an astonishing four professorships at the University of Chicago -- in human biology, Germanic studies, comparative literature and psychiatry (two of these are chairs) -- in addition to being a member of the committee on Jewish studies. It is in Jewish studies that Gilman is perhaps most prominent, particularly for his books "The Jew's Body," "Jewish Self-Hatred" and "Smart Jews."
Gilman contends that aesthetic surgery emerged alongside modern ideas about bodies categorized by race. In the 19th century, pseudo-sciences of race like physiognomy (reading the structure of the face as a direct representation of a person's character or "soul") and phrenology (measuring skull capacity as a sign of intellectual vigor) diffused ideas attractive to many Europeans about white racial superiority. Gilman shows how those 19th century notions of race drive 20th century attempts to "make the body beautiful" through aesthetic surgery, to "pass" for a member of the "white race."
"In the latter period surgeons not only tried to correct the ugliness that results from diseases such as syphilis, but they also tried to correct the 'ugliness' of nonwhite races," Gilman writes. "Racial science used appearance as a means of determining who was fit and who was ill, who could reproduce and 'improve' the race and who should be excluded and condemned. [...] Aesthetic surgeons began to offer ways of altering the body to make it appear 'healthy' by making it appear racially acceptable."
Hence Madame C.J. Walker, the first ever African-American millionaire, who hawked skin lighteners and hair straighteners to blacks at the turn of the century. Hence the many Irish -- considered a "black" race by many Anglo-Saxons -- who had nose jobs to correct their too-large (African?) pug noses. And also, hence the fact that the 20th century nose job was pioneered by Jews whose clientele were primarily other Jews, seeking to remove this last obstacle to assimilation.
Although Gilman is persuasive in showing how the desire to "pass" drives much early aesthetic surgery, he falters when it comes to other subjects. He tries to extend the "passing" argument to all forms of self-motivated bodily changes -- decircumcision, breast reduction/augmentation, buttock alterations, face lifts and transgender operations -- but often it just doesn't work. Isn't the desire to be sexy -- or for transgendered people, accurately sexed -- at the heart of most plastic surgery nowadays? Racial, ethnic and class stereotypes certainly shape our notions of sexiness, but they are not the only influencing factors. Because Gilman conflates all sexiness with "passing," he misses out on a great opportunity to explore the phenomenon of beauty in all its complexity.
For instance, Gilman argues that women in late 20th century America get breast augmentations so that they can pass as members of a "large-breasted cohort" (he actually uses this phrase). Is there really a cohort of busty ladies -- outside of the Playboy mansion and the Hooters chain, of course -- in the same way as there are ethnic cohorts? These operations, Gilman claims, help unerotic women "pass" as erotic, but what counts as erotic is just not as clear-cut as what counts as "white."
And what's wrong with the argument that a man wanting to be decircumcised does so in the hopes of enhancing his sexual pleasure? Such a rationale doesn't have anything to do with Gilman's cohort idea. Although there have been times when decircumcision was associated with "passing" as a non-Jew, the argument doesn't always fit.
Gilman dismisses the "feminist" view of aesthetic surgery, which preaches that sweet 16 year olds (and others) like Brittany Spears and Tori Spelling get boob jobs because the dominant masculine imagination desires it. But Gilman's vision, in the end, does not do away with this theory but simply puts it in historical perspective. Yes, women get boob jobs to fulfill a cultural ideal, but that doesn't necessarily make them "pass" -- it may in fact make them stand out as gleefully artificial specimens. After all, Pamela Anderson Lee made a smart business move in getting an upgrade. Her natural C-cup already made her an honorary member of the "large-breasted cohort," so she moved into what can only be called the porn-breasted cohort. Did this improve her sense of eroticism? Perhaps, but it's unlikely that eroticism motivated her more than the lure of fame and fortune.
Modern selfhood, racial sciences and strategies for passing as morally pure? Come on, isn't it really all about vanity? But this question only leads right back to Gilman's point. For the West, beauty has evolved into a characteristic that is indistinguishable from goodness, or at least, often mistaken for it.
Vanity isn't simply one of the seven deadly sins -- a dark patch on our collective souls that we can simply ignore and get over. It's an essential fixture of the modern individual. It dwells inside the very sensitive, fragile structure we have come to place so much stake in -- our identities. Our vanity is simply an amplification of our hunger to live up to impossible social ideals. Such self-reflections, it turns out, have become so precious that we will risk the security of health, the comfort of financial well-being, the familiarity of our own faces and sometimes even our lives -- to gamble that we can come out on the other side of the knife with a body or a face that will make us feel different, and allow others to treat us thus. This is why Gilman's history is so valuable, and so intriguing. Even in the gruesome annals of plastic surgery there is a worthy fable about our "real" selves and our peculiarly modern aspirations. Something that perhaps John Taylor knew all along, even while his clients were pleading for mercy.