Cosmetic Surgery, Gender and Culture

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Cosmetic Surgery, Gender and Culture Suzanne Fraser

Cosmetic Surgery, Gender and Culture

Cosmetic Surgery, Gender and Culture Suzanne Fraser Research Fellow National Centre in HIV Social Research, University of New South Wales, Australia

© Suzanne Fraser 2003 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted her right to be identiﬁed as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2003 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a registered trademark in the United States, United Kingdom and other countries, Palgrave is a registered trademark in the European Union and other countries. ISBN 1–4039–1299–8 hardback This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Fraser, Suzanne, 1967– Cosmetic surgery, gender and culture / by Suzanne Fraser. p. cm. Includes bibliographical references and index. ISBN 1–4039–1299–8 (cloth) 1. Surgery, Plastic–Psychological aspects. 2. Surgery, Plastic–Sociological aspects. 3. Self-perception in women. I. Title. RD118.F68 2003 617.9’5–dc21 2003045178 10 12

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Contents Acknowledgements

vii

Abbreviations

viii

Introduction

Part I

1

Tools

1. Toolkit for a Modest Witness

23

2. The Pressures of the Text: Intertextuality and Preferred Readings

41

Part II

Discourses

3. Glossing Femininity: Women’s Magazines

61

4. Feminist Imaginary Bodies

97

5. The ‘Art’ of Cosmetic Surgery: Medicine, Metaphor and Meaning

122

6. The Regulation of Gender: Cosmetic Surgery, Regulatory Processes and Femininity

153

Conclusion

185

Notes

195

Bibliography

225

Index

237

v

Acknowledgements This book owes an immeasurable amount to the intellectual community in which it was produced. Thanks must ﬁrst go to my University of Sydney doctoral supervisors, Alison Bashford and Denise Russell, for providing attentive and challenging readings of the thesis from which this book was produced. In addition, many colleagues and friends offered invaluable help and companionship. In particular, I want to thank Gill Dempsey, Sarah Howard, Megan D. Jones, Kirsty McKenzie, Celia Roberts, Fiona Rummery, Kerry Sanders and kylie valentine. Other friends and family helped make this book possible as well. Jo Barraket, Jane Caldwell, Michelle Fraser, Louise Fraser, Kathy Grattan and Justine Wilcox all provided friendship, humour and sympathy during the long writing process. Finally, I must also thank my partner of many years, John Jacobs, who supplied unfailing support for this project, intellectually, domestically and technically. If there is a limit to his generosity, patience and kindness, I have yet to encounter it.

vii

Abbreviations ACS ASPS ASPRS FDA HCCC JAMA MJA NH&MRC TDEC TGA

Australasian College of Surgeons Australian Society of Plastic Surgeons American Society of Plastic and Reconstructive Surgeons Food and Drug Administration Health Care Complaints Commission (NSW) Journal of the American Medical Association Medical Journal of Australia National Health and Medical Research Council Therapeutic Devices Evaluation Committee Therapeutic Goods Administration

viii

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Introduction

‘If it ain’t broke, change my nose anyway.’1 A young man conﬁdes in me shyly that during his adolescence, his ears protruded so much he had them surgically ‘pinned back’. In contrast, another man, a friend, tells me deﬁantly that he knows his ears make him look like ‘a car with its doors left open’, but he refuses to conform by having them ‘ﬁxed’. In another context, an older woman, a colleague, informs me, again in conﬁdence, that along with a bladder operation, she opted for a tummy tuck. There is no doubt that cosmetic surgery is by now a well known if not entirely accepted group of practices.2 Advertisements and articles on cosmetic surgery feature regularly in the popular media. Not only found in women’s magazines, this coverage now extends to television current affairs and ‘lifestyle’ programmes,3 radio programmes,4 specially dedicated, magazine-style publications5 and other forms of media.6 Given that cosmetic surgery ﬁnds such rich expression in the media, its impact on culture needs to be understood as extending far beyond the experiences of those who actually undergo surgical procedures. This recognition inspires the two main questions examined in this book. First, what kind of impact is cosmetic surgery, through its representation as much as through medical practice, having on current understandings of gender? Here, various issues regarding gender are important, the most obvious being the pronounced asymmetry in cosmetic surgery practice, in that the great majority of surgeons are male and the great majority of participants female.7 By analysing four discourses – women’s magazines, medical texts, feminist work and regulatory material – this project will draw conclusions about the directions gender is taking through its interaction with cosmetic surgery. Femininity will be the main focus, although questions of masculinity will also be considered. Related to this issue is my second line of inquiry, which deals with current questions around how the media is seen in contemporary cultural studies. Using the ubiquity of cosmetic surgery in the media as a resource, I inves1

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tigate the range of possible readings available in this material as a means of testing current assumptions (detailed later) about the polysemous character of texts and their openness to interpretation by the reader. Using three repertoires – nature, agency and vanity – the book will evaluate empirically the range of options available to readers in critiquing or resisting the intended and/or culturally dominant meanings presented in magazine, medical, feminist and regulatory texts on cosmetic surgery. It will compare the ways in which these repertoires are treated in magazines with how they appear in the three other discourses, in order to look for choice amongst ideas and perspectives. Although photographs and illustrations constitute a signiﬁcant aspect of magazine and some medical discourse on cosmetic surgery, I have chosen to focus only on written and spoken material. This is because I will be undertaking a close comparison between discourses, and while verbal expression is consistent between them, visual illustration is not. Focusing my investigation on texts allows for a consistent approach in analysing content and drawing conclusions about the crossover of ideas and vocabularies.

What is cosmetic surgery? A recurrent theme at the Australian 1999 New South Wales Health Care Complaints Commission Inquiry into Cosmetic Surgery (HCCC Inquiry) focused on the status of cosmetic surgery as interdisciplinary.8 Understood within a regulatory context, this interdisciplinarity poses signiﬁcant difﬁculties for the deﬁnition of cosmetic surgery and the supervision of practitioners.9 Unlike accepted medical specialties which are based on an understood taxonomy of bodily systems – for instance, ear, nose and throat specialisation or dermatological specialisation – cosmetic procedures pertain to almost every part of the body and affect a variety of organs.10 Procedures are frequently undertaken outside hospitals in clinics and surgeries, allowing some cosmetic surgeons to administer their own anaesthesia.11 This is another specialist line transgressed, and is by no means a safe practice as the surgeon is required to monitor the anaesthesia and at the same time conduct the procedure. While many qualiﬁed plastic surgeons undertake cosmetic operations, some participants at the Inquiry argued convincingly that plastic surgery specialisation does not necessarily guarantee expertise in a given procedure. Indeed, appropriate training and regular practice mean that even those general practitioners who have turned their hand to cosmetic surgery can prove to be the most highly skilled. This medical interdisciplinarity offers a valuable perspective through which to examine cosmetic surgery, in that it offers a useful reminder of the fragmentary and heterogeneous character of cosmetic surgery as practice and as cultural artifact. The category of cosmetic surgery incorporates fragments of other medical specialties, and as such, has very ﬂuid bound-

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Introduction 3

aries. Equally, it is a form of medicine that literally treats fragments of the body. This model emphasises not only fragmentation but also the complex transgression and maintenance of professional boundaries, hierarchies and authorities that mark both the practitioners and recipients of cosmetic surgery. The recognition of these factors is timely, in that cosmetic surgery, like many other cultural phenomena such as anorexia,12 has been taken up in recent years by scholars as a means of making general points about social and political relations. While Kathy Davis’s original and valuable book, Reshaping the Female Body,13 analyses cosmetic surgery as evidence of female agency, heroism and self-deﬁnition, Sander Gilman’s history, Making the Body Beautiful,14 takes up cosmetic surgery as centrally about race; as a powerful element in an ongoing struggle over racial issues in the United States and Europe. In each case, alternative perspectives are to a large extent denied in order to assert the presence of the primary and dominant essence of the phenomenon. For example, Gilman argues that the ‘model of “passing” is the most fruitful to use in examining the history and efﬁcacy of aesthetic surgery. Taken from the history of the construction of race not gender, it provides the most comprehensive model for the understanding of aesthetic surgery.’15 This tendency to delineate the origins and meanings of cosmetic surgery along either sex or race lines also tends to neglect the ways in which race and sex construct each other.16 My own model for investigating cosmetic surgery takes its lead from Nikolas Rose’s appropriation of Gilles Deleuze, which I will paraphrase as ‘ask not what the body is but what it can do’.17 Similarly, my questions are focused on what cosmetic surgery can do, though not so much in terms of procedures and their outcomes, but in terms of its role(s) as cultural phenomenon. Perhaps one of the most central but in some ways confounding aspects of discussion around cosmetic surgery to date has been the debate over ‘why women do it’. Couched in these terms, answers have tended to generalise in order to paint a particular picture of women in contemporary society, their values and their capacities. In reading these accounts, most striking is the range of ways in which women speak of their motives and their feelings about themselves. While some emphasise many years of suffering before undergoing a cosmetic procedure,18 others speak quite lightly of their desire to look and feel a little younger or more feminine.19 From this point of view, generalisations about motives are untenable. This is particularly true as more and more people undergo cosmetic surgery. Rather than discover the underlying truth of cosmetic surgery and those who undergo it, which in any case is now a common approach, I use a surface model of investigation, one that can be linked with the notions of interdisciplinarity and fragmentation mentioned above. This model is partly inspired by the recognition that cosmetic surgery was and remains a highly controversial and contested area of human practice, one which carries with it risks of ridicule or censure. From this point of view, statements about

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motives, suffering and satisfaction are necessarily made within a highly deﬁned and scrutinised social context. Here, access to ‘real’ ‘underlying’ meanings and feelings cannot be assumed. Given the very considerable constraints upon acceptable ways in which cosmetic surgery participation can be discussed, I prefer to examine discourse around cosmetic surgery as a way into contemporary constructions of gender, and as a way of investigating options for the production of the self through language. What is said about cosmetic surgery and how it is said indicates a great deal about how femininity and masculinity are conﬁgured in contemporary culture. It also has effects upon these conﬁgurations, acting as a technology of gender through the discourses that circulate around it.20 This is the ﬁrst of the two main aims of this book. As Nikolas Rose argues, following Deleuze and Guattari: It is not a question . . . of what a word, a sentence, a story, a book ‘means’ or what it ‘signiﬁes’ but rather ‘what it functions with, in connection with what other multiplicities its own are inserted and metamorphosed’ – not its depths or hidden semantic weight, but its ‘superﬁcial’ connections, associations, activities.21 The surface model taken up here replaces a familiar binary model of superﬁciality and depth (appearances and underlying truths) with a model that acknowledges only surface. Links in this model are not made between appearances and real underlying truths, or, as Deleuze and Guattari argue, between the roots and branches of the tree (in a conventional ‘arborescent model’), but in articulations between points upon a surface. Nodes and lines are connected, disconnected and reconnected in new ways under differing conditions. This is the means by which culture changes, or ‘becomes’. Becoming, articulation, lines and nodes will be discussed in detail in Chapter 1. At this point, it is important simply to emphasise that the model taken up here is one that sees surfaces not as the corollary of depths, but as all there is. Equally, this surface model is not employed as the ‘true’ means of investigating culture, rejecting depth models as of no value. Rather, it is taken up as particularly appropriate in this context and as something of an experiment to see what is yielded up by this novel approach to cosmetic surgery and gender. If the interdisciplinary, fragmentary character of cosmetic surgery is to be taken into account, it will be clear by now that the collective term itself is somewhat problematic. There can be no doubt that surgical procedures labelled cosmetic undergo rapid change and development, regularly being replaced by more up-to-date options marketed in different ways. Thus chemical peels to minimise lines on the face and neck have been joined by laser resurfacing procedures, while facelifts have undergone a range of variations, including ‘deep plane’ facelifts and more recently partial facelifts, such as the forehead lift. The drawing of boundaries around the category of cosmetic surgery is itself a highly signiﬁcant and political act. Sander Gilman’s

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Introduction 5

history is again exemplary here in that Gilman uses a broad term, ‘aesthetic surgery’, in his work, while feminist writers tend to use the more speciﬁc ‘cosmetic surgery’. Thus Gilman examines the rise of ‘aesthetic’ surgery in the United States. Here, the term ‘aesthetic surgery’ does not distinguish between those procedures which seek to render more beautiful healthy tissues understood to be within the range of ‘normal’ development and those that seek to restore visual ‘normality’ through reconstructing damaged tissues or to reshape features that are perceived to fall outside the range of ‘normal’ development.22 Because Gilman does not distinguish in this way, he rejects feminist commentaries on what is commonly called cosmetic surgery (that is, those procedures that operate on healthy, ‘normal’ tissues), arguing that gender has been overemphasised as a primary, originary feature of the development of aesthetic surgery.23 The confusion is clear here. Gilman’s deﬁnition of cosmetic surgery (aesthetic surgery in his terms) varies greatly from those implied in the work of feminists in this area.24 Perhaps with a common deﬁnition, this apparent disagreement would disappear. As it is, Gilman privileges race over gender as the primary impetus for the rise of aesthetic surgery, focusing on the nose to construct his argument. In order to establish the nose as central to aesthetic surgery, he begins his history with the early reconstruction of noses due to the effects of syphilis. The focus on the nose allows Gilman to link the ‘too small syphilitic nose’25 with nineteenth-century racial stereotypes, which he argues took the fear and horror of the syphilitic nose (as representative of degeneracy) and transposed these feelings onto the ‘too small’ noses of Black people. Eventually, this focus on noses shifted to the ‘too large’ nose of the Jew. In looking at the history of cosmetic surgery it is unlikely that feminists would include the reconstruction of syphilitic noses as ‘cosmetic’. Central to general feminist disquiet over cosmetic surgery26 has been the recognition that the practice involves surgery on otherwise healthy tissue. For feminists, an important question has focused on the reasons why appearance should be so important as to compel women to risk injury, disﬁgurement or death in a procedure on a healthy, and by all accounts normal, body. The syphilitic nose, eaten away and rendered an open wound by disease, cannot be seen in this light. Where individuals were unable to leave the house, earn a living or ﬁnd a partner, and the tissue operated upon was diseased, the same issues do not apply. In one sense, what feminists have struggled to understand and theorise has been what is at stake for women with healthy bodies; what they see as worth risking for what return. All these factors vary when syphilis is brought into the equation. In any case, Gilman’s decision to include the syphilitic nose as aesthetic surgery has another effect in that it allows for the inclusion of procedures that are apparently as well patronised by men as women. In this way, his thesis that aesthetic surgery is more about race than gender, and his utilisation of the notion of ‘passing’ as the central model for aesthetic surgery, can be supported. Clearly, the choice of

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deﬁnition has a powerful impact on what can be argued, and to what political purpose cosmetic surgery may be turned. This is, of course, true of feminist deﬁnitions as much as any other. As I note later, feminists have tended to neglect the importance of racial issues in cosmetic surgery, thereby limiting the complexity of their analyses and positioning cosmetic surgery as purely a women’s issue. My own deﬁnition, therefore, would necessarily depend upon which political services I wish cosmetic surgery to perform. As I have argued, I am primarily concerned with representations of cosmetic surgery, with surface connections and with a view of language not as the indicator of hidden depths but as a means by which connections are drawn and viable selves produced. This understanding of the production of the self owes a great deal to Judith Butler’s work on performativity, which will be discussed in Chapter 1. Here, language is made up not of signiﬁers and their relationship to signiﬁeds, but of signiﬁers and their relationship to each other; the production of meaning through the continual abutting, collision and contrast between signiﬁers ranged upon the surface. Along these lines, this book takes as one of its primary objects of study the interrelation between different discourses on cosmetic surgery, their similarities and differences, and the things they indicate about contemporary versions of femininity and masculinity. Related to this are some particular political investments I will elaborate upon later. To return to my deﬁnition then, cosmetic surgery for the purposes of this project is nothing other than what is taken to be cosmetic surgery by the discourses under examination. One role of this book is to examine how cosmetic surgery is constructed and spoken about, and how gender is produced in the process. It is not to intervene in the debate over what constitutes cosmetic surgery and what does not. In practice, this means that what is discussed as cosmetic surgery in this book corresponds mainly to popularly understood deﬁnitions gleaned from the sources examined. At the same time, attention will be paid to the ways in which the issues around cosmetic surgery are homogenised in the material and how the speciﬁc effects and implications of different procedures are either brought out or neglected. Gilman’s history contains the following list of surgical procedures, which he labels ‘aesthetic’ but which represent current understandings of ‘cosmetic surgery’ equally well. The list is reproduced here both as an indicator of current classiﬁcations around cosmetic (or aesthetic) surgery, and to provide a glossary of cosmetic surgery procedures. Thus, Gilman states that: [a] list of common aesthetic procedures today would include the following operations on the face: • Cheek implants, which use malar implants for the augmentation of the face • Chin augmentation (mentoplasty), which uses implants

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Introduction 7

• Collagen and fat injections, which enhance the lips or plump up sunken facial features • Ear pin back (otoplasty), which brings the ears closer to the head • Eyelid tightening (blepharoplasty), which tightens the eyelids by cutting away excess skin and fat around the eyes, eliminating drooping upper eyelids and puffy bags below • Facelift (rhytidectomy), which tightens the jowls and neck • Forehead lift, which tightens the forehead and raises the brow to minimise creases in the forehead and hooding over the eyes • Hair transplantation, which treats male pattern baldness with a variety of techniques, among them scalp reduction, tissue expansion, strip grafts, scalp ﬂaps, or clusters of punch grafts (plugs, miniplugs, and microplugs) • Nose job (rhinoplasty), which changes the appearance of the nose • Scar revision and the removal of common burn marks (such as capillary nevus and port wine nevus), tattoos and scar tissue (such as keloids, thick scar tissue that forms on an otherwise normally healing wound) – all now undertaken by means of surgery or laser treatment • Skin resurfacing (laser, chemical face peel and dermabrasion – sanding of the skin), which smooths the skin, removing ﬁne wrinkles, minor skin blemishes and acne scars and operations on the body: • Arm-lift (brachioplasty), which tightens the skin of the upper arm • Breast augmentation, which can either increase the size of existing breasts or replace breasts removed through mastectomies • Breast implant removal • Breast reduction (mammaplasty), which reduces the size of the breast • Breast tightening (mastopexy), which tightens the skin of the breast • Buttock-lift and thigh-lift, which tighten the buttocks and thighs • Calf and other implants, which shape the body • Foreskin reconstitution (epispasm or posthioplasty) • Liposuction (as well as lipectomy), which removes fat • Male breast reduction (gynecomastia) • Penile enlargement and implants • Transgender surgery, which alters the form of the primary and secondary sexual characteristics • Tummy tuck (abdominoplasty), abdominal apronectomy, or dermolipectomy, which reduce body size due to obesity, tighten skin and remove fat (adipose tissue).27 This list bears a close resemblance to the kinds of procedures commonly classiﬁed as cosmetic within the material. One exception must be made, however, for transgender surgery which rarely appears in the media under

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the rubric of cosmetic surgery, and certainly did not feature at all at the HCCC Inquiry.28

Researching cosmetic surgery Power is about whose metaphor brings worlds together.29 In considering my role as researcher, I am taken with Donna Haraway’s reformulation of the classic ‘modest witness’ of science. Rejecting the possibility of objectivity, Haraway’s modest witness recognises the inevitability of implicatedness. This recognition involves two points; ﬁrst and most obviously, that a researcher cannot ever dispassionately evaluate from a position beyond personal history or political investments. Second, the modest witness ‘cannot ever be simply oppositional’.30 To be so would imply a location outside the reach of that which is opposed. Haraway’s argument is made in relation to science and technology in general, though it is equally relevant in the speciﬁc context of cosmetic surgery. If it is the case, as I have noted above, that cosmetic surgery is undergone by a range of people for a range of reasons, experiencing differing degrees of pain, elation, success or despair in the process, then simple opposition would seem to erase that heterogeneity. In any case, as Haraway points out in her ‘A Cyborg Manifesto’, ‘[w]e cannot go back ideologically or materially’.31 Too much has been changed by these technological developments, including ourselves. From this point of view, Haraway’s researcher becomes not pure and objective, but ‘suspicious, implicated, knowing, ignorant, worried and hopeful’.32 These terms capture well my own relationship to the fraught terrain of cosmetic surgery. That is, cosmetic surgery cannot be deﬁned as either a separate or inert ‘object of study’. Implicated in the technological, political and historical culture which has made cosmetic surgery possible, my object is far from separate to me; it is part of my own experience, including my own experience of gender, though I have never gone ‘under the knife’. It is this implicatedness most of all that prompted the formulation of my project along the lines of discourse analysis. To turn to Haraway again, she notes that the ‘imaginary and the real ﬁgure each other in concrete fact’. Thus it is worth taking ‘the actual and the ﬁgural seriously as constitutive of lived material-semiotic worlds’.33 Indeed, the imaginary or discursive has a reach here that the ‘actual’ does not. While many women and some men undergo cosmetic surgery each year, the vast majority do not. Clearly, however, the effects of cosmetic surgery are not limited to the experiences of those who undergo it, but are articulated in different ways with the women and men who read about it, know friends and relatives who have undergone it, or, along other lines, are concerned about the effects of silicone or the availability of silicone breast implants for reconstructive surgery.

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Introduction 9

By no means a discrete and autonomous entity, cosmetic surgery, like many other phenomena, might usefully be seen as what Deleuze and Guattari call a rhizome,34 with all a rhizome’s ability to send out roots in different directions from different points on its totality, or from small fragments produced when the rhizome is dug up, smashed or moved. Chapter 1 will elaborate upon this notion further. Important here is the recognition that cosmetic surgery is articulated in a range of ways with a range of individuals and phenomena, not least through its discursive presence(s). These articulations ﬁnd expression in, and are in turn rearranged through, material practices and objects such as the doctor/patient relationship and the types of prostheses (such as implants) available. The analysis of four (heuristically separated) discourses on cosmetic surgery is at the heart of this book. These discourses, as noted above, are women’s magazines, feminist literature, medical material and regulatory sources on cosmetic surgery. In using the term ‘discourse’ I take up its meaning fairly broadly, by deﬁning it as dialogue produced around and within particular institutions, in this case, the institutions of the media, feminist scholarship, medicine and government regulation. Discourses are produced by or bear the marks of institutions so that ‘any discourse concerns itself with certain objects and puts forward certain concepts at the expense of others’.35 However, as institutions themselves are not without fractures and inconsistencies, it follows that discourse is never completely unitary and non-contradictory. As Foucault notes in his discussion of the tactical polyvalence of discourses, ‘[w]e must conceive discourse as a series of discontinuous segments whose tactical function is neither uniform nor stable’.36 Counter-discourses, generated from the margins around and interstices between institutions, can challenge common assumptions in discourse. Like feminist scholarship, however, counter-discourses themselves can reproduce those assumptions, especially where the marginal sites and interstices that hosted and enabled them undergo movement and themselves come to constitute a type of institution. This tendency will be illustrated particularly clearly in Chapter 4, while the double character of discourse as both unstable and liable to (temporary) solidiﬁcation will become evident throughout the book. The purpose of my analysis is (at least) twofold. First, as I have already stated, it will examine the ways in which gender, and most often femininity, is reﬂected in discourse around cosmetic surgery. This investigation will make no claims about the ways in which cosmetic surgery discourse is ‘received’ by readers, that is, it will not look forward towards the putative discursive effects on these readers. Instead, it will look back towards the conditions of possibility necessary for those discursive utterances to occur. In doing so, it will treat these utterances not as pure insights into the underlying truth or reality of thoughts, opinions and actions, but as available and sanctioned repertoires for the production and maintenance of subject

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10 Cosmetic Surgery, Gender and Culture

positions. Chapter 2 will elaborate on the theoretical issues related to this ‘repertoires’ approach. The aim of this aspect of the book is to produce knowledge about what kind of gender relations exist that make possible the discursive strategies under examination, how these categories may be changing, and what options for self-production are currently available to individuals and institutions in the context of cosmetic surgery. The second aim of the book is related to this in that it seeks to question contemporary orthodoxies within cultural studies which see the media as ‘polysemic’.37 Here, claims to the polysemic character of discourse are tested against the speciﬁc example of cosmetic surgery discourse. Such claims of polysemy are cited as a means of denying the signiﬁcance of media content in the normalisation of subjectivity. Where media messages are seen as varied they cannot be said to impact in any undue way upon the independent production of opinions and self-image of the reader. Certainly, this view incorporates an important recognition that it is untenable to assume media messages are absorbed unadapted by the audience. At the same time, however, this is often asserted in the absence of any comprehensive examination of the material itself, as my discussion in Chapter 2 will make clear. This book insists that polysemy must be demonstrated rather than assumed. Such a demonstration would in part involve the detailed cataloguing of media messages on speciﬁc issues and the comparison of these messages with those generated in other contexts to evaluate the degree to which options exist that readers may choose between. Having undertaken such a project, my conclusion is that, at least in the context of cosmetic surgery discourse, signiﬁcant regularities exist within magazine discourse and between magazine, feminist, medical and regulatory discourses. Beyond certain differences, very important correspondences occur that not only limit reading possibilities but entirely preclude certain options. This will be demonstrated throughout the book, along with a consideration of the cultural implications of the kinds of patterns found. It is important to note that this project does not assume that discourse can function alone in producing cultural and social phenomena. As Maureen Caine points out, in describing Foucault’s notion of discourse: [t]o recognise an organising role for discourse does not imply that other relations, between people or institutions, are impotent (Foucault indicates that the occurrence of some of the objects which appear in discourse is made possible by extra-discursive relations). Nor does such a recognition give the discourse ontological primacy; it does not imply that discourse calls other relations into being or that they exist only through discourse.38 Along similar lines Haraway’s point indicates that there is a relay or exchange between discourse and materiality (that is, as far as the two can

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Introduction 11

be seen to be separate). Only in relation to people, machines, animals, environments and so forth can discourse be seen to have effects.39 It is not the claim of this project that where particular discursive patterns exist, these are enough to shape the world to a speciﬁc form. Discourse is but part of the process, though it is an important part. For this reason, and not because it should be credited with any type of determinist power, it warrants examination. Indeed, Haraway goes on to assert that: [t]extual analysis must be articulated with many kinds of sustained scholarly interaction among living people in living situations, historical and contemporary, documentary and in vivo. These different studies need each other, and they are all theory-building projects. No one person does all the kinds of work.40 While I choose to examine discourse as a means of taking into account the reach of cosmetic surgery beyond the experiences of those who undergo it, others have undertaken, and will continue to take on cosmetic surgery as an object of study in ways that prioritise clearly material issues such as health. In Chapter 4, a detailed account of a range of feminist approaches to cosmetic surgery is provided, indicating some of this variety. However, as I will assert repeatedly, the distinction between representation and ‘reality’ (materiality) is by no means clear. Indeed, the media tend to be evaluated only in terms of their audience reception; whether they can be said to have ‘real’ effects depends on how the audience receives them. Clearly, effects can be produced through avenues other than direct or uncritical consumption by an intended audience. Part of the purpose of this project, then, is to demonstrate the links between media discourse and medical, legal and feminist discourse not only as a means of considering the possibility of preferred readings across these domains, but as a means of showing that through the links between these discourses, media content cannot be said to be isolated from materiality. If medical discourse is understood as signiﬁcant in that it bears on material practices, then the fact that medical discourse draws on media discourse (and vice versa) means that the media must also be seen as generating material effects, though not always directly. The ways in which all four discourses draw on, as well as depart from, each other will be examined in Chapters 3 to 6. My choice of the four discursive arenas of women’s magazines, feminist scholarship, medical material and regulatory debate was guided by the preliminary research I undertook. This research suggested that these four areas are particularly intensely articulated with cosmetic surgery, at the same time that they are broadly inclusive categories. Other discourses, such as psychiatry, medical engineering or insurance, could have been examined, and could equally have been considered separately or been incorporated into the above categories. The material examined here has not been taken up as an

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exhaustive survey, though it does constitute a large corpus. Clearly, particularly in the context of medical material, the amount of literature available is vast and continually growing. Instead, the material examined here is understood as a means of accessing some of the dominant ways of talking about cosmetic surgery and gender. Also central to the choice of discourses examined here was the desire to compare the supposedly objective material of medicine (as science) with material from women’s magazines. While science is associated with the production of pure truths through a transparent and veriﬁable method, I am interested in identifying the cultural assumptions and investments threaded throughout medical discussions of cosmetic surgery, its participants, procedures and aims, and in demonstrating the links between these issues and those found within other discourses. In other words, the intertextual relations between medical and other discourses are identiﬁed and examined throughout this project, with the aim both of drawing out the ways in which medicine fails in its proclaimed goal as producer of independent or transcendental truths and in raising the possibility that gendered notions found within women’s magazines may also arise in medical texts and ﬁnd expression within medical practice. Science has undergone trenchant critique from feminists and others regarding the claims of objectivity and universality commonly associated with it. These critiques follow a number of different concerns.41 While Evelyn Fox Keller and Emily Martin have undertaken now well-known critiques of the language of science as a means of critiquing its assumptions around the possibility of objectivity,42 others have analysed science’s investments in Cartesian binary thinking and the hierarchical conﬁguration of male and female within this.43 Sandra Harding’s use of standpoint theory has also produced a critique of the scientiﬁc assumption that the identity of the scientiﬁc researcher need have no impact on the science performed and the results produced.44 Donna Haraway has contributed to this critique in many ways, in particular through her use of the notion of articulation (rather than representation) to characterise the relationship between the scientist and the object of study, that is ‘nature’.45 The analytic points provided in this body of material apply to many of the texts examined in this book, although it takes up questions of language use and objectivity most consistently. It is important to note here that I do not posit popular culture (here magazines) as the origin for ideas that may be found in other discursive contexts. Although in tracing these connections through Chapters 3 to 6 I begin with women’s magazines, this should not be seen as implying a trajectory of causation from women’s magazines to other discourses. As Deleuze and Guattari note in relation to the rhizome and becoming (which will be discussed in detail in Chapter 1), ‘[i]t has neither beginning nor end, but always a middle (milieu [also meaning medium]) from which it grows and which it overspills’.46 The middle is exactly where this book begins. By looking at

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women’s magazines, neither the origin nor the terminus of cultural notions of gender and cosmetic surgery is sought or considered to be at stake. Nor, by the same token, do magazines occupy any point ‘in between’ two such points. These four discourses are taken to inform, contradict, ﬂow towards and enact radical breaks with each other in ways that do not accommodate straightforward notions of origin. Foucault’s conviction is that discourse must be understood ‘as a series of discontinuous segments whose tactical function is neither uniform nor stable’.47 To suggest a linear trajectory would be to discount other factors which contribute to the appearance of ideas, repertoires and values in discourse. As I noted earlier, the four discourses examined here are separated for heuristic purposes, though the lines between them are often blurred. This is not to say that important distinctions between these discourses do not exist. Perhaps the most obvious way in which the four discourses can be seen to be legitimately distinct is in the involvement of each discourse within the institutions of medicine, feminism, public policy and law, and popular culture. All of these institutions occupy different cultural locations, generate different discursive orthodoxies (though these are often transgressed) and work to limit as well as enable that which can be said. For instance, as will become evident later, while magazine discourse readily produces statements that identify cosmetic surgery as a sign of vanity, regulatory discourse is characterised by statements which continually challenge such a connection. The presence of many injured women at the United States Food and Drug Administration hearings on silicone breast implants and the additional association between implants and the socially valorised process of breast reconstruction after mastectomy placed very real limits upon what could be said about women’s motivations and the validity of their actions. At the same time, Foucault warns that discourse should not be divided into ‘accepted discourse’ and ‘excluded discourse’ or ‘dominant’ and ‘dominated’ discourse, but that it should be seen as ‘a multiplicity of . . . elements that can come into play in various strategies’.48 The regular exchange between magazine, feminist, medical and regulatory discourse that will become evident through my analysis conﬁrms the importance of not reifying discourses and their locations. By the same token, the very real strategic considerations circulating within each of the related institutional realms mean that there is a need to consider each discourse separately. In short, this book addresses itself in Foucauldian terms to those ‘things said and those concealed, the enunciations required and those forbidden . . . the shifts and reutilisations of identical formulas for contrary objectives’,49 in order to trace developments in gender in relation to cosmetic surgery, and to query the unproblematic assumption of polysemy within popular culture. How then might the relations between these four discourses be examined in any systematic way? In order to undertake a study that could identify and compare speciﬁc elements in a detailed way, I have identiﬁed linguistic

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repertoires. As Chapter 2 will explain in detail, these are elements of language such as phrases, clichés or patterns of speech that appear, often frequently, within individual texts and discourses and can tell us something about what kinds of opinions, expressions, assumptions and perspectives are available for use in communication. A linguistic repertoire methodology appealed to me because it is, again, a surface model that considers any concomitant ‘underlying meaning’ of a statement to be both substantially inaccessible and beyond the bounds of its interest. In making this point I disagree with Nikolas Rose’s account of the repertoire approach, which suggests that it reinstates an agent as the producer of statements. He argues that ‘such approaches portray human individuals as agents seeking to bring off their lives with the aid of the sense-making resources made available by language, though often, no doubt, unaware of how they do this and of the conventions and repertoires that constrain them’.50 Rose’s emphasis on constraint is key here. Rather than posing repertoires as the means through which the subject is produced, the notion of constraint itself assumes a preexisting subject curbed by language. Taking up Judith Butler’s approach to the subject as performative, I see the repertoires approach as highly compatible with a post-humanist perspective which understands the subject or agent as a temporary and unstable phenomenon produced through or rendered viable by language. Repertoire use does not reﬂect an agent, rather it posits one, and this unstable, fragile agent must continually be reposited. In undertaking some preliminary research on the representation of cosmetic surgery within women’s magazines, three repertoires appeared repeatedly throughout the material, both in literal and metaphorical forms: nature, agency and vanity. These three repertoires will be critically examined in Chapter 3 as a means of leading into an analysis of the ways in which they are taken up, ﬁrst in women’s magazines, then, in later chapters, elsewhere.

The development of cosmetic surgery Social and cultural histories of cosmetic surgery in the West have so far focused on the United States. Elizabeth Haiken’s Venus Envy51 is essentially a twentieth-century history, and Sander Gilman’s Making the Body Beautiful52 traces cosmetic surgery further into the past, and to Europe. As I noted earlier, Gilman offers a history of the phenomenon based largely on race, while Haiken makes an argument for its development as the product of consumer pressure in the context of the development of medicine as a whole. The two authors take up different terms and deﬁnitions for surgery aimed at changing the appearance: Gilman uses ‘aesthetic surgery’ while Haiken opts for ‘cosmetic surgery’. Both acknowledge that their terms are bound up with the designation ‘plastic surgery’, which refers also to reconstructive

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surgery and was developed by surgeons keen to improve the status and respectability of their work.53 The differences between Haiken and Gilman’s terminology impact on the histories they construct. Gilman traces ‘beauty surgery’ to the Renaissance, when treatment of noses damaged by syphilis was its main purpose.54 However, he argues that it was the Enlightenment that provided the ethos of self-perfectability necessary to the conceptualisation and broader acceptance of surgery for changing the appearance.55 For Gilman, ‘modern aesthetic surgery’ came into being in the 1880s and 1890s, when advances in anaesthesia and infection control made surgery less painful and dangerous, and ﬁnally allowed the pursuit of perfection to develop in relative comfort and safety. Haiken’s account does not accept that the notions of perfectability available in the US in the nineteenth and early twentieth centuries contributed to the rise of cosmetic surgery. She argues that such notions referred to spiritual rather than physical change.56 According to Haiken, the practice of changing the appearance through surgery was poorly regarded in the US at the turn of the century. She asks how, after such a weak start, surgery came to be so widely accepted by the end of the century.57 Despite their differences, both Gilman and Haiken identify the First World War as the major crucible for the development of cosmetic surgery, in that it prompted the perfection of old techniques and the invention of new techniques in treating the injuries inﬂicted during the war. Little scholarship is available on the history of cosmetic surgery in the United Kingdom or Australia, but it is clear that the roles played by surgeons and others from both countries in the development of reconstructive techniques during the First World War were central to the direction cosmetic surgery took after 1919. Australia’s participation in the war saw Australian surgeons trained in plastic surgery in the United Kingdom, and it was a New Zealander, Harold Delf Gillies, who set up the respected plastic surgery hospital at Sidcup, Kent in 1917. Australians trained in plastic surgery in Britain both during and after the two world wars. In this way, Australia’s early introduction to techniques that would provide the foundations for cosmetic surgical ones came about through its political and military ties with Britain. In fact, it was between the wars (1928) that plastic surgery was ﬁrst discussed at the Australian Royal College of Surgeons. Australian plastic surgeons, many working for the armed forces, continued to train mainly in Britain well into the 1950s and 1960s.58 These medical ties with Britain may help to explain why cosmetic surgery does not seem to have developed to any signiﬁcant degree in Australia until after the wars. Australian women’s relationship to issues of beauty and femininity also owed a great deal to ties with Britain during this period. The League of Health and Beauty, for example, was a women’s organisation which began in Britain in 1930 and focused on ﬁtness and ‘racial health’. It had branches

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in Australia as well as Canada and Hong Kong, and maintained a membership in 1935 of 170,000 women.59 These links reﬂect a tendency within Australian culture, particularly in the ﬁrst half of the twentieth century, toward maintaining ties with British cultural values and practices.60 It is, perhaps, due to this tendency that cosmetic surgery in Australia did not follow the United States in developing in the early decades of the twentieth century. In addition, Gilman argues for a strong racial background to the development of cosmetic surgery in the United States, and it is likely that the particular racial issues Gilman identiﬁes were not reproduced in Australia at the time. In the US, the ﬁrst credentialing board for cosmetic surgery was established in 1937 (the American Board of Plastic Surgery). It was followed in 1942 by the American Association of Plastic Surgery, which arose out of the American Association of Oral Surgeons (founded in 1921). In Australia, it was not until 1955 that plastic surgery was made a separate group within the Australasian College of Surgeons, and not until 1956 that the ﬁrst meeting of the Society of Plastic Surgeons was held in Melbourne. It is possible, however, that cosmetic procedures such as nose jobs or facelifts, still frowned upon by some plastic surgeons in the 1950s, had in fact been undertaken by other medical practitioners in Australia during the ﬁrst half of the century.61 One of the most popular areas of cosmetic surgery in the latter half of the twentieth century was that designed to increase breast size. Augmentation procedures had existed since the 1890s (when parafﬁn injections were pioneered), but the development and reﬁnement of the silicone implant in the US during the 1960s made aesthetically pleasing results easier to achieve. The ﬁrst silicone breast implant was exhibited at the Third International Congress of Plastic Surgery in Washington DC in 1963,62 and was used in American and Australian63 women’s breasts in the same year. Despite the controversy that later developed around silicone breast implants, the number of women in Australia, the UK and US whose breasts were augmented with these implants is still unknown. Internationally, cosmetic surgery had begun to expand very rapidly by the middle of the 1970s. Kathy Davis notes, for example, that medical articles on cosmetic surgery increased by 200 per cent during 1975.64 In 1976, a register of plastic surgery trainees was set up in Australia, reﬂecting the increase in interest in plastic surgery as well as the relatively new tendency to seek training in countries other than Britain, such as the US. Related to this increasing bureaucratisation and regulation of plastic surgery as a ﬁeld, inspections of Australian teaching hospitals commenced in 1979. By 1980, cosmetic surgery was emerging in Australia as a major market and could no longer be dismissed as the whim of a few. A newspaper article reports that one Sydney surgeon working two days per week, mostly on cosmetic procedures, grossed about $8,000 per week.65 This level of popularity

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parallels (if not matches) that experienced in the US, where, as Gilman notes, aesthetic procedures increased from 296,000 in 1981 to 477,700 in 1984. By 1995, procedures on the face alone accounted for 825,000 operations.66 The late 1980s and early 1990s, however, saw growing disquiet about the safety of a popular cosmetic device: silicone breast implants.67 US FDA hearings examining the safety of silicone implants were held in 1991 and 1992, and resulted in strict regulation of their use. In July 1992, the Australian government (advised by the Therapeutic Goods Administration) followed the United States’ lead and placed a moratorium on silicone implants. The UK, however, took a different tack. In 1991 it followed the US lead by conducting a review of the evidence through the Medical Devices Directorate (MDD) of the UK Department of Health. However, it found that evidence was inadequate to support a change of practice or policy on the use of silicone implants. No regulatory conditions were placed on their use, but a breast implant registry was set up as a means of collecting data for future analysis.68 In the US, a massive class action suit against seven implant manufacturers was initiated in January 1992, and this was followed in 1993 in Australia by a similar but far smaller suit, ﬁled by 5,000 women who were not covered by the US litigation. Notwithstanding the controversy around silicone implants, cosmetic surgery experienced constant growth during the late 1980s and 1990s. It became the fastest growing speciality in the US at the turn of the decade, and technological changes also occurred at a rapid pace.69 This is particularly evident in the area of skin treatment, where chemical peels ﬁgured in the early 1990s as an alternative to facelifts but have since been joined by ‘dermabrasion’ or the sandpapering of the skin’s surface with small spinning abrasive discs, and laser surgery, which seeks to alter the appearance of the skin through a controlled burning of the top layers. Increasingly, as cosmetic surgery is advertised more and more widely, even through dedicated publications, other kinds of procedures such as eyebrow tattooing and collagen injection are included within its ambit – evidence of the increasing interdisciplinarity of cosmetic surgery, and the ﬂuidity of its boundaries as it develops in the twenty-ﬁrst century.

Aims and structure of the book The book is divided into two parts. Part I contains two chapters, each of which provides theoretical and methodological tools for the pursuit of my two main areas of inquiry. Chapter 1, ‘Toolkit for a Modest Witness’, takes up a variety of theoretical tools provided by Deleuze and Guattari, Moira Gatens and Teresa de Lauretis to investigate how cosmetic surgery functions in culture to produce and reproduce gender. By utilising Deleuze and Guattari’s notion of ‘becoming’, the basically unstable and changeable

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character of both cosmetic surgery and gender is recognised, and the means through which culture undergoes change is theorised. Gatens’ notion of the sexual imaginary or of imaginary bodies is also examined as a means of conceptualising gender as a cultural and individual phenomenon. Gatens takes up the body as the effect of power rather than of biological explanations such as genetics, and sees the state of the sexual imaginary, of understandings about sexed bodies, as crucial to the present and future shape of material bodies. How cosmetic surgery interacts with the sexual imaginary, how it draws on and alters or reproduces imaginary bodies, is central to my investigation. A third theoretical tool for this chapter is de Lauretis’ notion of technologies of gender. Using this notion, I posit cosmetic surgery as a technology of gender (or set of technologies), reinforcing through this Gatens’ understanding of the body as the product of power. Rejecting a simplistic view of gender as imposed upon a neutral body, de Lauretis’ work provides a means of understanding cosmetic surgery as a set of material as well as discursive elements and forces interacting with gender. The second chapter in Part I, ‘Pressures of the Text: Intertextuality and Preferred Readings’, provides several theoretical tools for my second main line of investigation, that is, the evaluation of cosmetic surgery discourse as polysemic through an examination of four discourses and three repertoires. Theories of intertextuality are employed as a means of establishing the interconnectedness of texts and discourses and their mutual dependence upon fundamental concepts such as ‘the natural’. Where intertexts are repeatedly identiﬁed, preferred readings begin to be established. Stuart Hall’s notion of preferred readings features here as a means of articulating the process by which particular ideas are privileged within texts, limiting ways in which those texts may be read.70 My argument rests on the view that preferred readings are not necessarily constituted out of simplistic messages such as ‘cosmetic surgery is good’, but can be found in the use of central deﬁning concepts such as nature, agency and vanity, concepts which have a signiﬁcant inﬂuence upon the ways in which cosmetic surgery issues are understood, discussed and acted upon. Jonathan Potter and Margaret Wetherell’s interpretive repertoires approach is discussed in detail in the last section of this chapter.71 This discussion outlines what might constitute a repertoire, how repertoires may be understood within a poststructuralist, surface model framework, and how repertoires can be identiﬁed and analysed as indicators of available options for self-production within culture. Utilising three repertoires, I take up Hall’s assertion of the existence of preferred readings in texts and compare it to more recent assumptions of polysemy. In producing an argument in favour of a preferred readings approach, theories of intertextuality are drawn upon, linking individual texts with other texts, texts with larger discourses and discourses with each other. Part II contains four chapters, each focusing on one discourse. Chapter 3 looks at women’s magazines, Chapter 4 discusses feminist scholarship,

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Chapter 5 examines medical material and Chapter 6 analyses regulatory debate. In Chapter 3, nature, agency and vanity are explored theoretically and established as central repertoires in the discussion of cosmetic surgery in women’s magazines. Examined are the ways in which these repertoires function, so that a comparison with other discourses can be made in later chapters. Comparing the four discourses and their use of these repertoires will provide a clear picture of the ways preferred readings are built in discourse, through repetition of concepts and through the exclusion of alternative perspectives. Women’s magazines are an interesting place to start as they provide, in some respects, the most varied treatment of the three repertoires. It is important to note, however, that this variety is often the product of a willingness to give voice to ‘taboo’ perspectives that other discourses reject. Chapter 4 investigates the occurrence of the repertoires of nature, agency and vanity within feminist scholarship on cosmetic surgery. It ﬁnds strong similarities with women’s magazines on a number of uses, providing a starting point for my argument about the production of preferred readings. This chapter also argues that despite feminist concern over cosmetic surgery, the particular ways in which repertoires of nature, agency and vanity are taken up in feminist material results in a female subject and body eminently suited to surgical intervention. Chapter 5, which examines medical texts on cosmetic surgery, provides evidence for the consolidation of my argument around the production of preferred readings through repetition and the exclusion of alternative readings. Many of the sub-repertoires found in women’s magazines and feminist material appear in medical discourse, supporting contemporary science studies and feminist critiques of scientiﬁc notions of objective truth produced in isolation from cultural inﬂuences. In this chapter, the ways in which nature, agency and vanity are mobilised again serve to posit a female body well suited to cosmetic surgery, at the same time that they reinforce medical authority, in spite of claims that cosmetic surgery can be ‘about’ women’s autonomy and self-deﬁnition. Here traditional gender relations are found to be reafﬁrmed, rather than overturned. Chapter 6 analyses regulatory discourse on cosmetic surgery, focusing on the 1999 New South Wales HCCC Inquiry into cosmetic surgery, and the United States FDA hearings on breast implants, held in 1991 and 1992. The production and reproduction of gender are traced throughout these debates, showing, again, that although some promising support for female autonomy and agency is evident, many conventional understandings of femininity are reproduced. The three repertoires of nature, agency and vanity are found to echo formulations established in previous chapters and, in fact, to circulate freely throughout all four discourses.

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Part I Tools

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1 Toolkit for a Modest Witness

In examining such a slippery and excessive articulation as cosmetic surgery, gender and culture, it is necessary to assemble a toolkit of theoretical and methodological aids. This chapter is the ﬁrst of two which will introduce these tools. In it I examine three areas: Deleuze and Guattari’s work on becoming; Moira Gatens’ use of the term ‘imaginary bodies’; and Teresa de Lauretis’ development of the notion of technologies of gender. These three theoretical tools will be employed in order to pursue one of the (two) central issues of this book: the ways in which cosmetic surgery is participating in the production of gender. I will discuss these three areas separately, though I will also draw them together to create a ‘toolkit’ with which to try to understand cosmetic surgery in culture. Put simply, I will be arguing that the notion of becoming helps me to identify the ongoing construction of gender and the body in a constantly changing culture. I see this process of becoming as necessarily played out within the sexual imaginary that is at the heart of conventional Western understandings of difference between the sexes. In this sense, I investigate and then temper Deleuze’s construction of identity as inﬁnite, by posing the sexual imaginary as a resource. It is partly through this resource that identity is constructed within society. At the same time, this resource also functions as a limit. Central to my use of this notion of becoming is the view that cosmetic surgery is one of many technologies of gender and that, as such, it needs to be analysed in relation to its use as a means of producing the self in gendered terms. Becoming is the process by which speciﬁc technologies of gender (along with other technologies of identity) such as cosmetic surgery shape subjectivity, at the same time that these technologies are shaped by individuals and the wider culture of which they are a product. The ﬁrst section of this chapter will look at the value of making use of ‘becoming’ as a primary theoretical assumption in my research. 23

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Becoming To date, most feminist discussions of cosmetic surgery have centred on questions of agency, and on evaluations of cosmetic surgery in terms of its status as ‘feminist’ or otherwise.1 My interest in this area is not directed towards this now longstanding debate, but, more broadly, towards the ways that cosmetic surgery practices produce and are the product of change. Deleuze and Guattari’s concept of ‘becoming’ is taken up here to explore cosmetic surgery in terms of change. I look at the way a perspective based on becoming as opposed to being destabilises every category I may wish to use in discussing cosmetic surgery. This process of destabilisation is desirable in that it prompts me to question accepted framings of what are taken to be ‘the issues’ and indeed to question the very limits of these issues. Certainly, central to my overall argument is the idea that the effects of cosmetic surgery are not limited to those individuals who undergo it. Instead, cosmetic surgery redraws and/or stabilises certain aspects of culture and thus the production of our own subjectivities and materiality in signiﬁcant ways. Hence, my focus is not on cosmetic surgery participants themselves, but on cosmetic surgery as the circulation of gender. As a result of this process of destabilisation, I am aware that in my own use of categories such as ‘women’, ‘cosmetic surgery’ or ‘gender,’ I must recognise their contingent and temporary nature.2 In making use of becoming, I follow the advice of Deleuze himself regarding the inadequacy of simply applying theory.3 In ‘Intellectuals and Power’, Deleuze states that ‘[n]o theory can develop without eventually encountering a wall’,4 an inevitability that arises from the status of theory as a diagram, as ‘anexact’.5 Brian Massumi’s book on Deleuze and Guattari asserts that ‘You will ﬁnd that you cannot use the concepts without changing them or the way they interrelate’.6 This view is based on an understanding of all situations as speciﬁc, thus precluding the reiﬁcation of these concepts into a single, concrete methodology. My own appropriation of ‘becoming’ will certainly involve their adaptation to suit the needs of my topic. The work of Deleuze and Guattari is important for this book in its obvious shift away from the primacy of the subject through the development of such notions as machinic assemblages and multiplicities. Regarding machinic assemblages, Deleuze and Guattari argue that ‘[t]here are no individual statements, only statement-producing machinic assemblages’. Machinic assemblages can be understood as collective agents of enunciation, that is, ‘not people or societies but multiplicities’.7 They are temporary conjunctions of elements that interact with each other to produce certain effects. Because this concept emphasises the interaction of a wide range of elements, as well as the impermanence of such conjunctions, it decentres the traditional subject or agent. This decentring of the subject appeals to me because of my desire to avoid entering into the popular debate over cosmetic surgery which

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Toolkit for a Modest Witness 25

sees it as necessarily ‘about’ either victimhood or agency – two sides of sovereign subjectivity. The decentring of the traditional subject reﬂects a rejection of a centre per se in Deleuze and Guattari’s work. They put forward the model of the rhizome to replace the conventional tree model in describing and understanding structures and cultural formations. The rhizome has no relationship to origins or to destinies, it renders the question of progress redundant. The rhizome is multi-directional, asymmetrical and able to regenerate itself from shattered remnants and new sites.8 It has no centre, but rather lines and intensities. As a model for both large and small cultural phenomena, such as the cosmetic surgery industry, it is highly suggestive. For instance, it requires a view of cosmetic surgery as a complex network of relationships and issues, rather than as a simple linear causality running from, for example, patriarchy to woman-as-victim. It also reminds me to cast widely in my understanding of the features contributing to the phenomenon of cosmetic surgery. Hence, while my project utilises published written discourse on cosmetic surgery to pursue its central questions, it does not claim that these sources constitute cosmetic surgery entirely themselves. Analyses which examine only the recipients of surgery, as some feminist works such as Kathy Davis’s Reshaping the Female Body tend to do, leave the full reach and functions of this phenomenon unexplored. Any examination of a particular element of cosmetic surgery (or any ﬁeld of inquiry) must be located within the complex network of discourses, individuals, organisations, machines and locations that make it possible. Hence, the examination of selected discourses around cosmetic surgery undertaken in this book must be seen not as aimed at establishing discourse as the deﬁning force of cosmetic surgery, but as necessarily drawing upon and shaping many other elements such as technological developments, economic factors and broad social relations. The rhizome is composed of various lines of segmentarity, as well as lines of deterritorialisation, where segmentarity might crudely be seen as the contingent and temporary conﬁguring of power and deterritorialisation as the leakage and rupture of those conﬁgurations. Even the latter, which might also be called ‘lines of ﬂight’, are part of the rhizome; that is, both deterritorialisation and reterritorialisation are part of the process of the production and sustainability of any phenomenon.9 Deleuze and Guattari argue that all lines are ultimately connected in some way, so that distinctions between the intrinsically molar or entrenched (in orthodox or conventional relations) and the intrinsically molecular or tending towards escape (from these relations) are impossible: [y]ou make a rupture, draw a line of ﬂight, yet there is still a danger that you will reencounter organisations that restratify everything, formations that will restore power to a signiﬁer, attributions that reconstitute a

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subject – anything you like, from Oedipal resurgences to fascist concretions.10 This view is perhaps at the heart of why my research has avoided longstanding debates about cosmetic surgery practices as either ‘good’ or ‘bad’. Like any cultural phenomenon, the cosmetic surgery industry exists on any number of ‘plateaus’ which may be regarded almost like cross-sections of culture. The different positions cosmetic surgery occupies on different crosssections precludes any single, deﬁnitive pronouncement on its character. This is true in terms of differing locations within any one temporal context, or of similar locations across time, and is clearly evident in some of the repertoires marshalled around cosmetic surgery that I will be looking at presently. Discourse on cosmetic surgery can be seen as a rhizome of interconnections without a recognisable centre, at the same time as this rhizome is part of a larger rhizome incorporating other aspects of cosmetic surgery. What emerges is that good and bad may be evaluated only temporarily and in relation to context,11 though this should not preclude a willingness to recognise patterns and tendencies towards concretion where they are evident through investigation, such as are found in this book. My intention is to examine and map some of these contexts in order to discuss the ways in which cosmetic surgery is impacting on gender. These concepts – the rhizome, deterritorialisation and reterritorialisation, lines and plateaus – all relate to the primary concept considered here; that is, becoming. Aside from the simple view of cosmetic surgery as a form of physical becoming for the recipient, this concept can be used to open up a number of different aspects of the area to analysis. Deleuze’s brief but valuable paper ‘What is Becoming?’ argues that existence is not static; it is constantly in ﬂux, and further, that this existence is multiple: ‘it is at the same moment that one becomes larger than one was and smaller than one becomes.’12 Here, one exists in relation to both the past and the future, and as a result, one can be both more and less simultaneously. Identity as ﬁxed and uniﬁed is challenged here, in that it can function in relation to more than one point of reference and occupy more than one category. In that identity cannot be pinpointed as stable in this model, it is considered to be ‘inﬁnite’; always open to change and always occupying at least two locations. Becoming occurs through a system of machinic assemblages which intricately connect people with technology, modes of enunciation, culture, the environment and desire. Machinic assemblages are rhizomes in their own right as well as parts of larger rhizomes. They are not discrete, but can be heuristically separated from a broader context for analysis; for example, in the way I identify and separate (or construct) the cosmetic surgery ﬁeld for study. Through assemblages, becoming occurs when ‘one “thing” transmutes into another, becomes something else through its connections with

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something or someone outside’.13 All becoming involves the rearrangement of machinic assemblages through the addition and loss of certain connections. It is a concrete process, speciﬁc, not general, and always temporary.14 Furthermore, becoming is not imitation or identiﬁcation, it is the drawing into connection of two distinct things through an assemblage, such as the connection made between the wasp and the orchid.15 As a machinic assemblage, cosmetic surgery combines discourses, people (both as recipients and as professionals, such as doctors, lawyers, psychologists, advertising agents and scientists), equipment and locations (hospitals, clinics, courtrooms, etc.). My study incorporates discourse produced in a variety of locations and by a variety of persons, and recognises that discourse constitutes only part of this assemblage. When I examine gender through this assemblage, I examine a relationship comparable to that struck between the wasp and the orchid, where one does not become the other; rather, both (cosmetic surgery and gender) are transformed in the process of connection in speciﬁc moments. In this vein, Paul Patton discusses the becoming of concepts. Concepts are made up of components which have a history insofar as they arise out of differing contexts and other concepts. It is the virtual (here potential or contingent) relations that concepts possess with other concepts that constitute their becoming. This becoming occurs through the pressure for concepts to render consistent their components, a pressure that is only satisﬁed by ‘communication’ between the components.16 Concepts may be seen as constituting rhizomes in their own right, but at the same time, existing within the larger rhizome of thought in a particular culture. Gender may be seen in this light as a group of concepts necessarily adapting in relation to such phenomena as cosmetic surgery in the attempt to render their components consistent. Later, I will argue that the introduction of the notion of agency to conventional femininity through feminist discourse constitutes one aspect of this process. In relation to rhizomes and becoming, Deleuze and Guattari state that ‘[i]t is neither beginning nor end, but always a middle (milieu) from which it grows and which it overspills’.17 Again, notions of origins and destinies are rejected here, along with any sense of progress which can trace an undeviating trajectory from beginning to end. This positioning of becoming in the middle, along with Deleuze’s emphasis on becoming (through his use of Alice)18 as inﬁnite identity, suggests the multiple and varied nature of becomings.19 Where becoming emerges from the middle, it does not take any linear path and in fact can branch out, reverse and spiral in a variety of ways. Deleuze and Guattari warn us, however, that looking at things in the middle is difﬁcult; that avoiding a view from above or below, from left to right, or vice versa, is a challenge. Indeed, even the middle is an entirely arbitrary point. Nevertheless, they argue that if we try it, we will ﬁnd that ‘everything changes’.20

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Here I would like to take up this challenge in order to see what changes occur when cosmetic surgery is viewed in terms of becoming, rather than of being. So far I have made several main points about becoming: 1. existence is not static but is in constant ﬂux; 2. identity is inﬁnite (it is always moving in at least two directions at once); 3. becoming is neither positive nor negative; it can be deterritorialised and reterritorialised; 4. becoming occurs through machinic assemblages, including the becoming of concepts; 5. the rhizome model positions becoming in the middle. The ﬁrst result of thinking in terms of becoming is that it draws into question all of the given categories and concepts I rely upon in my research. Thus, I cannot use terms such as ‘cosmetic surgery’, ‘gender’, ‘recipient’, ‘the media’, ‘women’, even ‘myself’ without being aware that these categories are constantly changing. They change in terms of both the phenomenon I am discussing and of countless other phenomena which sometimes subtly, sometimes plainly, bear on cosmetic surgery as an assemblage (or become part of that assemblage). Here I will discuss four of the categories in order to illustrate the value of adopting an approach based on becoming for this ﬁeld of research. Because I continually use the term ‘cosmetic surgery’ to delineate my area of research, it is perhaps this category that most pressingly requires analysis. Much of the feminist (and other) work conducted in this area treats this category as self-evident, failing to question its contents in terms of inclusion and exclusion, and the validity of treating it as a homogeneous entity, the implications of which may be applied across the board in all cases. From the perspective of becoming, it emerges that cosmetic surgery needs to be recognised as a category that is constantly undergoing a redrawing of borders. Due to the amount of medical research and experimentation carried out around the broad category of cosmetic surgery, new and revised procedures appear regularly. This is particularly true of skin procedures, especially those designed to reduce signs of ageing. Dermabrasion, chemical peeling and laser resurfacing21 are relatively new additions to the range of facial procedures, and although they do not involve surgery per se, they have been absorbed into the cosmetic surgery category within a range of discourses, including women’s magazines and regulatory discourse. It is interesting from this point of view that such procedures, some of which perhaps bear more relation to services such as body hair waxing, should be positioned within this category. This is possibly a result of the relatively high status accorded to ‘medical’ procedures over ‘beauty’ procedures, and the concomitant beneﬁts in terms of reputation and fee levels this entails, though it is also clear that these treatments carry a considerable degree of risk related to burning, trauma and dis-

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ﬁgurement that may be absent from ‘beauty parlour’ treatments. However, the cosmetic surgery category contains a wide variety of procedures which vary in terms of cost, objectives, complexity and risk. Given that the reasons that procedures are located within that category vary, and given that the types of procedures also vary continually, the possibility of making useful generalisations based on an assumption of similarity is quite small. It may be that the study of cosmetic surgery treatments needs to address different procedures separately, and to map the connections between them consciously, rather than to assume their connection. However, my deﬁnition of cosmetic surgery is guided by the speciﬁc project I am undertaking, and as a discourse analysis, this suggests those procedures that are categorised as such by the discourses I am examining. I see the process of border redrawal as culturally signiﬁcant, and this renders the notion of drawing my own borders in some ways irrelevant. So, in addition to highlighting that my deﬁnition of cosmetic surgery is always contingent, the concept of becoming has prompted me to identify an important aspect of my research, that is, the process of becoming this term is undergoing in culture. A second category that is problematised from the perspective of becoming is that of women in general, that is, those women who do not undergo cosmetic surgery procedures. As Brian Massumi argues: Becoming bears on a population, even when it is initiated by a single body: even one body alone is collective in its conditions of emergence as well as in its future tendency.22 Here, Massumi is referring to the impact of becoming on large groups of people and also to an understanding of the individual as itself a population; a multiple identity. From this point of view, the becoming of a cosmetic surgery recipient is a matter not only of the changes undergone on the individual level, but of the changes that take place amongst the wider population of people who are implicated in the phenomenon of cosmetic surgery as witnesses. It is also true that those linked to cosmetic surgery indirectly may act not only as witnesses but as promoters or critics of it. This realisation that, through representation, cosmetic surgery is relevant to those who do not undergo it as well as to those who do contributed to shaping my desire to conduct this project on the level of representation. Along with those who actually undergo surgical procedures, these subjects also undergo becoming in relation to cosmetic surgery. In complicating the status of the category of those who do not participate in such surgeries, I am prompted to ask questions that focus on the becoming of that category, such as the degree to which the existence of cosmetic surgery techniques constitutes an encouragement or pressure to undergo surgery, the ways that the results of cosmetic surgery serve to alter (or

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entrench) popular views about femininity, masculinity, beauty and the body; in short, how those who are only indirectly linked to the phenomenon are repositioned in culture through it. In this case, the function of becoming as enacted through machinic assemblages is particularly evident. Here, a machinic assemblage may be constituted from various speciﬁc elements such as a woman who has not undergone surgery, the media, family, medical technology, and cultural concepts such as beauty, gender and success, to produce a becoming from potentially colliding and contradictory elements. As I suggested earlier, concepts such as beauty and gender undergo becoming. I also elaborated Patton’s view that the rendering consistent of the components of a concept is its means of becoming. Concepts of masculinity and femininity may be seen to function through this process, with cosmetic surgery as one of many contributors to them. In 1987, de Lauretis argued that ‘[t]he construction of gender goes on as busily today as it did in earlier times’23 and that among the many sites for this construction is the academy, and, in particular, feminism. What this suggests is that the variety of discourses arising out of the phenomenon of cosmetic surgery themselves contribute to cultural understandings of gender. These discourses include medical articles, legal documents, magazine articles and feminist work. Through cosmetic surgery, gender becomes vulnerable to a pressure, theorised by Deleuze and Guattari, to render its constituent elements consistent. This should not be seen as emerging from any kind of agency, but as merely the product of processes where contradictory ideas necessarily clash and alter each other. An example of this process might be the way femininity is reﬁgured within feminism to take account of the determination many women exhibit in pursuing and undergoing cosmetic surgery procedures. For some feminists, such as Davis, cosmetic surgery as a struggle and a trial meshes with femininity more convincingly if femininity is re-posed in terms of agency, rather than victimhood. This process will be investigated in more detail in Chapter 6. For men (this time within aspects of advertising), a reafﬁrmation of masculinity as ambitious and strongly work-oriented creates space for an alliance between masculinity and cosmetic surgery. The emphasis on the importance of youth for success is perhaps a sign of the becoming of masculinity away from an emphasis on seniority to the privileging of ‘youthful vigour’. The ways in which a phenomenon such as cosmetic surgery can affect powerful cultural concepts like gender emerge as a subject for study only when gender is perceived to be in ﬂux, or becoming. Of course, cosmetic surgery is itself developing within certain cultural conditions and, in turn, is structured through paradigms of gender. Again, the becoming of cosmetic surgery itself must be recognised as ongoing and subject to other cultural pressures. Changes in the production and availability of silicone breast implants over the course of the 1990s (discussed in Chapter 6), for example, are the result of a number of cultural factors such

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as women’s changing relationship to medicine in general, an evident scepticism towards the claims of science, and the increasingly litigious US context. In conducting research on an area which bears indirectly on my own life, it is valuable also to be aware of the ways in which this research constitutes my own becoming. This becoming is important if only because it reciprocally bears on my research. As Deleuze and Guattari argue: [i]f the writer is a sorcerer, it is because writing is a becoming, writing is traversed by strange becomings that are not becomings-writer, but becomings-rat, becomings-insect, becomings-wolf, etc.24 It is not so much that in conducting my research I become-writer; more perhaps that I become-participant (in cosmetic surgery), or that I becomewoman in some revised way. By this I mean that through the process of researching cosmetic surgery I familiarise myself with the material and emotional aspects of different procedures and of some recipients’ responses to these and that this effects a change in my own relationship to those procedures. As an example, I now experience curiosity on meeting people who might be considered ‘prime candidates’ for surgery. I ﬁnd myself wondering why they have chosen not to undergo the particular procedure designed for their speciﬁc characteristic (such as ear-pinning). Moreover, I ﬁnd myself assuming that they have considered the option of surgery. Here, a familiarity with cosmetic surgery procedures has resulted in a shift in focus on my part so that some decisions not to undergo surgery require explanation, rather than those decisions in favour of surgery. I see this shift as a (perhaps rather speciﬁc) example of how cosmetic surgery affects those who have never undergone it. This becoming has inevitably altered the methods and intellectual treatment of my ﬁeld of research. The absence of any desire to arbitrate on cosmetic surgery as basically good or bad; as indicating victimhood or agency, is in part an effect of this, though it has certainly prompted in me an interest in the mobilisation of notions of victimhood and agency in the work of others on this subject. In this sense, becoming immersed in discourse on cosmetic surgery has not simply allowed me to answer questions posed in my project, but to structure and restructure that project itself and hence the very questions I seek to answer. In all these ways, becoming can be used to provide a lens through which to identify change. In his book, Brian Massumi emphasises the difference between becoming-other and becoming-the-same. This distinction is made between those changes that ultimately draw a person, category or process closer to an existing norm or ideal (becoming-the-same), and those changes which ultimately bypass or scramble these norms and ideals altogether. To draw an illustration from quite a different context, an example might be the use of the notion of ‘family’ by gay activists to describe the gay male com-

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munity. I see this as a form of strategic molarisation where gay male culture is redeﬁned in order to draw on existing notions of family as a means of promoting public understanding and internal support. It is a ‘becoming-thesame’. An alternative ‘becoming-other’ might involve a refusal to ﬁgure gay male relationships in terms of existing heterosexual familial organisation and to emphasise instead an absence of identity. At the same time, a gay ‘invasion’ of the apparently stable category of the family will ultimately affect change therein. Along these lines, questions of becoming-other and becoming-the-same might be posed in relation to cosmetic surgery. Where change is identiﬁed, is it change towards molarity or molecularity; entrenchment or escape? As suggested by the above example, I doubt a clear binary split can be identiﬁed between becoming-the-same and becoming-other. Context is crucial in considering the nature of any becoming, and the complexity and becoming of that context itself seems to render simple diagnoses dubious. The practice of invading molar categories such as the family and effecting critical change there cannot be dismissed as simply becoming-thesame. As Gatens argues, ‘[i]f bodies and their powers and capacities are invested in multiple ways, then accordingly their struggles will be multiple’.25 In any case, I have already argued that cosmetic surgery is no more than a quite arbitrary (though not meaningless) collection of procedures, and as such, I ﬁnd it untenable to generalise about the effects of each of these procedures.

Imaginary bodies In purely theoretical terms Deleuze and Guattari’s discussion of becoming seems to emphasise a familiar postmodern interest in multiplicity, change and inﬁnite possibilities. Here I place that work alongside Gatens’ use of the notion of the sexual imaginary (or imaginary body) as a means of complicating my awareness of the continually shifting nature of cultural phenomena with an understanding of the resources culture provides for informing the directions those shifts may take. Earlier I referred to Deleuze’s discussion of Alice and the conclusion drawn from this discussion that identity is inﬁnite. This observation is invaluable in theoretical terms as a means of overcoming the tendency to see identity as static and somehow predictable. At the same time, it is clear that culture provides a range of options through which identity can be established and maintained, options that can also carry the weight of norms. In looking at the concept of imaginary bodies, I want to point towards a primary source and means of becoming, not only in terms of individual subjectivity but also in terms of culture. As Margaret Whitford has noted in relation to Irigaray’s sexed imaginary: ‘The point is . . . that an anatomical difference is perceived in the light of the conceptual frameworks already available.’26 From this point of view, our

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individual and cultural becomings are sexed in ways that draw on existing understandings. In her book Imaginary Bodies, Gatens uses the term ‘imaginary’ to refer to ‘those images, symbols, metaphors and representations which help construct various forms of subjectivity’.27 The term ‘imaginary’ has been used in a range of ways by Freud, Lacan, Merleau-Ponty and Bachelard amongst others, though Gatens’ use cannot be said to follow any of these approaches. In discussing the history of the term Margaret Whitford deﬁnes it as the equivalent of unconscious phantasy, though she goes on to say that such a narrow deﬁnition denies the term ‘all its associative richness’.28 A major departure from this basic deﬁnition has been Irigaray’s and Castoriadis’ view of the imaginary as social. According to Whitford, Castoriadis uses this notion of the social imaginary to examine and understand persistent social formations and to investigate how they may be changed.29 However, Castoriadis’ theory fails to specify the sexed nature of the imaginary and it is Irigaray who sees it as necessarily both a social and a sexed phenomenon. Along similar lines, Gatens’ deﬁnition refers to ‘those ready-made images and symbols through which we make sense of social bodies and which determine, in part, their value, their status and what will be deemed their appropriate treatment’.30 Her deﬁnition of the sexual imaginary departs quite distinctly from the earlier psychoanalytic version. In order to identify some of these ready-made images and symbols, and to try to understand why cosmetic surgical procedures are deemed appropriate treatment for the (primarily) female body, this book will undertake an investigation of discursive constructions of cosmetic surgery. Such an investigation, I hope, will shed some light on the ways in which the female body is conceptualised and taken up in culture, and the way gender feeds into and is reformulated by this. In this sense, it is an investigation of the becoming of the lived body and the sexual imaginary, through an analysis of cosmetic surgery as a cultural phenomenon. Certainly, this lived body and this sexual imaginary are historically and culturally speciﬁc. The 1999 Health Care Complaints Commission Inquiry into Cosmetic Surgery, discussed in Chapter 6, will highlight this speciﬁcity, and map aspects of gender construction (and its implication in the lived experience of femininity) in regulatory discourse around cosmetic surgery. In her paper ‘Power, Bodies and Difference’, Gatens uses the work of Foucault to clarify her concept of the imaginary body. As the product, not of genetics, but of power, the body can be understood as an effect of ‘socially and historically speciﬁc practices’.31 From this point of view, the body should not be mistaken for a pre-social body which is then ‘shaped’ by culture, but is a body that can only be recognised as such through these practices. In other words, there is no purely anatomical body, no ‘factual’ body that has not already been constructed through culture. How cosmetic surgery contributes to this process of construction, this becoming of the always cultural body,

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and also to the becoming of gender, is one of the major concerns of this book. As Gatens argues, ‘[t]he present and future enhancement of the powers and capacities of women must take account of the ways in which their bodies are presently constituted’.32 Along these lines, Gatens suggests that we need to investigate speciﬁcally the character of present male and female body morphologies in order to understand how such morphologies make possible and render ‘natural’ particular practices. Gatens gives the example of rape here,33 but I ﬁnd it equally suggestive to investigate cosmetic surgery in this light. In relation to this, it is important to note that Gatens looks at imaginary bodies in the plural. Part of my task is to avoid a tendency to simplify cultural constructions and interpretations of the body to a single paradigm, which would not only be culturally biased, given that society is made up of a variety of cultural groups and nationalities, but would tend to obscure the complex workings of the sexual imaginary, and of power relations along lines of sex. At the same time, it would tend to erase differences across time and run the risk of homogenising the sexual imaginary. Gatens herself posits ‘multiple and historically speciﬁc social imaginaries’ rather than any single pervasive formulation,34 though not all social imaginaries occupy equal status. As she later argues regarding the ‘imaginings’ each sex entertains about the other, ‘such imaginings have asymmetrical implications given the historical predominance of men as producers of public culture and theory’.35 Similarly, differing or contradictory sexual imaginaries are also conﬁgured in relation to each other in terms of access to the production of public culture. While my examination of the sexual imaginary (which is both a resource and a limit for the becoming of gender through the technology of cosmetic surgery) is speciﬁc, it cannot assume that the contents of that imaginary are cohesive and non-contradictory. The discussion of the natural body which runs through Chapters 2–6 illustrates clearly the existence of contradictory imaginary bodies. In her essay ‘Power, Ethics and Sexual Imaginaries’, Gatens uses the work of Baruch Spinoza to argue that knowledge is not a possession but the basis for a mode of existence. She quotes Yovel, who explains that for Spinoza, knowledge is more a mode of being than of having, not something we possess, but something we are or become. As Monique Schneider notes, in attaining knowledge we do not gain an acquisition, as if something new were added to the inventory of our possessions, rather we exist differently.36 Gatens uses this to explain why ideas cannot simply be discarded at will, given that they are part of what constructs our mode of existence. This desire to discard ideas sometimes arises out of contact with new ideas, which by this argument, must themselves cause us to ‘exist differently’. Perhaps, then, the difference in our existence due to the acceptance of new knowledge does not automatically lead to a clear-cut change in our views, and thus to an entirely different mode of existence, but may mean that our mode of exis-

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tence becomes instead characterised by conﬂict, confusion or struggle over the ideas and concepts we entertain and use. To extend a point made earlier, it may be that the becoming of a concept through the rendering consistent of its components also constitutes our becoming as much as its own. From this point of view, we are or become in relation to the sexual imaginary in an ongoing, complex and often fraught way, as we are implicated in attempts to reconcile its constituent elements. Often this struggle takes place on the level of discourse, involving the discourses I will be examining in forthcoming chapters. Certainly, multiple, contradictory and sometimes troubled accounts appear there. As I noted earlier, becoming bears on a population, through the contact that population has with phenomena such as cosmetic surgery. If knowledge constitutes an important element in our state of existence or becoming, and is not just a possession, then the knowledge individuals gather about cosmetic surgery, whether this gathering is intentional or not and whether it leads to the undertaking of surgical procedures or not, irreversibly impacts on or (partially) constructs the mode of existence of those individuals. As knowledge, it cannot simply be discarded. It has become part of our (sometimes fraught) becoming. At the same time, this knowledge indicates the becoming of the object of knowledge as well. The wasp and the orchid, the subject and the assemblage (of cosmetic surgery) each undergo becoming through mutual contact.

The wet silk dress I intend to investigate this process of becoming in quite concrete terms using the case of cosmetic surgery. De Lauretis’ notion of technologies of gender, which I mentioned brieﬂy earlier, will be used to help theorise the means by which the becoming of gender, in connection with the sexual imaginary, is manifested or enacted. Based on Foucault’s work on the technologies of the self and of sex, de Lauretis coined the term ‘technology of gender’ as a means of working beyond the longstanding binary choice within feminist theory between viewing gender as the reﬂection or manifestation of biological facts and dismissing it as an entirely superﬁcial imposition of cultural norms upon otherwise quite neutral subjects. De Lauretis quotes Foucault on sexuality, but superimposes the term ‘gender’ to argue that gender is the ‘set of effects produced in bodies, behaviours and social relations’ by the deployment of ‘a complex political technology’.37 Her project in this chapter is not only to recognise the existence of technologies of gender such as cinema and to understand in some way their function, but also, then, to theorise the implications for questions of agency and the production of subjectivity that this recognition might entail. Here, technologies38 of gender are material and representational institutions and processes that produce gendered subjects, while the sexual imaginary is a realm of

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concepts and ideas upon which such technologies draw in taking shape and constructing gendered projects. De Lauretis poses four propositions at the beginning of the chapter, each of which is later revised to take into account the sense in which technologies of gender are not only imposed, but also taken up in the production of gendered subjectivity. Her ﬁrst proposition, that gender is a representation, is revised to read, ‘the construction of gender is both the product and process of its representation’.39 This is an initial attempt to introduce the idea that gender is continually under construction, both as a result of and during its representation. Her second proposition – that the representation of gender is its construction, that gendered representations constitute the becoming of gender – is later revised to argue that this becoming is the result not only of representation but also of self-representation. Here, individuals not only observe gender represented elsewhere, but themselves represent their gender in everyday behaviour. This move is necessary in order to create room for the notion of technologies of gender, where these technologies are seen as not only externally imposed, but also employed by individuals. It is this element of agency to which self-representation refers. I have already quoted her next proposition, that ‘the construction of gender goes on as busily today as it did in earlier times’ through conventional institutions and discourses but also through avant-garde art, the academy and, in particular, feminism. This proposition and its successor are perhaps of most interest to me here. Its terms are later revised by de Lauretis to incorporate the possibility that non-hegemonic constructions are possible within the margins, and from the outside, of hegemonic discourses, through resistance and self-representation. Again, the common understanding of power as operating from the top down is challenged at this point, allowing for the possibility of agency. Finally, de Lauretis proposes that, ‘Paradoxically, therefore, the construction of gender is also effected by its deconstruction’40 (such as that conducted by feminism). De Lauretis is referring here to her thesis throughout the chapter that feminists stand in a doubled relationship to femininity: both inside and outside of its bounds; both drawn into and critically distanced from gender. This proposition is ultimately augmented to express the necessity to question the political interests that this ‘de-reconstruction’ of gender might serve. Here she is referring to the political implications of male theorists arguing for the ‘feminine reader’, but I think it can equally be posed in relation to the kind of becoming gender undergoes, and the political effects this might have, when feminists discuss women and cosmetic surgery. This issue will be examined closely in Chapter 4, where feminist discourse on cosmetic surgery is discussed. It is the recognition of the becoming of gender, and of the ways in which deconstructive processes can also produce gender, that most appeal to me

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in this piece of work. One of my central premises is that cosmetic surgery, as both a range of medical procedures and a range of discourses, is a technology of gender that is taken up by individuals in the construction and reiteration of their gendered subjectivity, and by institutional and oppositional forces. However, the point at which I part company with de Lauretis involves her conception of the subject as potentially, if only partially, outside of gender, as in the case of the feminist.41 De Lauretis uses an inside/outside opposition consistently throughout her chapter, to describe not only the movement of feminists, but also the geography of culture in general. This is an inside and outside based upon what she refers to as the ‘space-off’, after ﬁlm theory. As such it departs from a traditional formulation of ideological inside and outside by leaning more towards a surface, as opposed to a depth, model. In this formulation, there are both margins in which opposition can occur, and also a clear outside from which change can be envisaged, such as the outside of the heterosexual contract. I suspect it is this formulation of cultural geography that makes possible de Lauretis’ metaphor regarding the ticking of the F box on an application form. She argues that the process of identifying oneself as male or female by this means results in the selected gender, here femininity, ‘[sticking] to us like a wet silk dress’.42 However, I am led to ask, if it is true that there is an ‘us’ or ‘me’, at any rate a subject, to which a wet silk dress might stick, what gender is that subject before ‘she’ ticks the box? In other words, through this metaphor, de Lauretis treats the acquisition of gender as though it is a late addition to an already constructed subject, a subject that is somehow ‘outside’ gender and therefore discourse, until she has ticked that box, and found that gender has a tendency to cling. What made that subject tick the F box in the ﬁrst place? In a sense, de Lauretis seems to appeal to one of the two notions of gender that she rejects at the start of her chapter, that is, the alternative that sees gender as laid upon an otherwise neutral subject. Certainly, de Lauretis does not accept her metaphor as entirely adequate, but the questions she poses in response to it – namely, how the representation of gender is constructed and ‘how it is then accepted and absorbed’43 (my emphasis) – do not get at or seek to remedy the assumption I am identifying here. My question remains: into what is gender absorbed? Deleuze and Guattari’s philosophy does not easily mesh with the inside/outside model deployed here, though there is some shared ground in terms of a preference for surfaces (along the lines of the ‘space-off’)44 as opposed to depth. However, because I want to use some of de Lauretis’ insights, I also need to adapt them in order to ensure a degree of compatibility between my different theoretical tools. An alternative notion to the wet dress model might be, following Butler’s work on performativity,45 that the subject is (re)constructed precisely through the process of ticking the box,

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and that rather than being something that then adheres (and, one feels, encumbers), gender is something that makes the subject possible. In other words, if, indeed, there is a wet silk dress, that dress must be our own skin, where the skin is part of, not the outside of the body. From this point of view, technologies of gender such as the cosmetic surgery industry can be seen as one of the means through which gendered subjectivity is formed, enacted and continually re-established. Technologies of gender are resources for becoming that themselves draw on the historical cultural resource of the sexual imaginary for their form, and thus exert certain normative pressures. Cosmetic surgery can be seen in this light, where notions of appropriate and necessary forms of surgery draw in part from existing sexual imaginaries and are taken up both in discourse (for example, in advertising or ﬁction)46 and in individual practice to become technologies of gender. Similarly, as I have argued earlier, the sexual imaginary, itself a cultural product as well as resource, can also undergo becoming. De Lauretis offers a feminist subject that is ‘at the same time inside and outside the ideology of gender, and conscious of being so’47 and argues that for this reason, feminism cannot be seen as entirely outside ideology. At the same time, it may be this maintenance of the split between inside and outside that allows de Lauretis to use the wet dress metaphor; for the outside subject to be ‘drawn in’ by the process of ticking a box. Butler’s model does not make use of a prior subject or prior, non-gendered state; of an outside, but only of elements of the inside: ways of maintaining viability as a subject. In fact, her approach like that of Deleuze and Guattari consciously eschews the agency that de Lauretis wishes to reinstate. Equally, de Lauretis’ metaphor may spring from a tendency evident within much of the material I examine towards the (intentional and unintentional) positing of a natural pre-cultural body. This natural body ﬁgures consistently throughout magazine, medical, regulatory and even feminist material in a way that (as I will later argue) repositions the body as the logical object of scientiﬁc intervention. Does de Lauretis’ wet silk dress of gender stick to a somehow ungendered, unacculturated natural body? The implications of this natural body will be drawn out throughout this book. The argument Gatens builds from the work of Spinoza also seems at odds with the silk dress metaphor. Spinoza’s view is that knowledge constitutes being rather than existing merely as a possession. As such, Gatens’ employment of this insight to explain why knowledges cannot simply be donned and discarded at will tends to run contrary to the image of a dress that might indeed be put on and taken off, though admittedly, a dress that is wet is more difﬁcult to manoeuvre. In any case, my desire to use the model of technologies of gender is not to look at the ways already constituted human subjects acquire gender, but rather, how ‘always already’ gendered subjects enact, perform and re-establish gender. As I argued earlier, my interest lies not in questions of agency on an individual level as regards cosmetic surgery

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participants, but in the kinds of gendered subjectivity available for a wide range of individuals. I want to map the becoming of that range as an indicator of what Gatens refers to as the ways our bodies are currently constituted and thus what might inform our future possibilities. Women’s enactment of a range of femininities within regulatory discourse on silicone breast implants, found in Chapter 6, is a case in point here. One area of concern I have not yet made explicit are the ways in which imaginary bodies, material bodies, their becoming, and the means of their becoming are not only gendered. In other words, I am aware that bodies are also the site of technologies of age, class and race, amongst many other political locators. These technologies are also of interest in my examination of cosmetic surgery where they can be seen to be in mutually constructive articulations48 with gender. However, this book examines discursive constructions of cosmetic surgery. Race, age and class are only occasionally treated explicitly in the material I analyse. The discourses often imply a ‘generic’ surgical participant, drawing on and constructing an imaginary body that is female, white, relatively youthful (perhaps under the age of forty, though this varies according to the procedure under consideration)49 and classless in that cost, while sometimes cited as a consideration, is rarely presented as a bar to participating in surgical procedures.50 Of course, as postcolonial feminist research has made clear, gender is always produced in relation to other social categories such as race,51 where gender and race can be seen to be in a process of mutual becoming, and cosmetic surgery discourse is implicated in this process. In this way, cosmetic surgery discourse, in particular that generated in the popular media, represents femininity in familiar terms as white, youthful and substantially beyond economic restrictions. This representation of white femininity does, however, vary when procedures speciﬁcally related to conditions understood to be racial markers are discussed, such as eyelid surgery, although such procedures are rarely represented in mainstream women’s magazines. In a sense, this book examines what happens to gender in relation to cosmetic surgery beyond these founding deﬁnitions of femininity as white, middle-class and usually – certainly preferably – youthful. In this chapter I have attempted to outline some of the theoretical tools I make use of in examining the discursive ﬁeld(s) around cosmetic surgery. I see Deleuze and Guattari’s account of becoming as shaping many of the decisions I have made regarding the broadest of my theoretical assumptions, and so the general form of my argument, whereas I have found Gatens’ and de Lauretis’ work to offer theoretical concepts with which to more explicitly make sense of the ways gender circulates. As I have noted above, these theories have been adapted and articulated in ways that may not always reﬂect the intentions of the authors (they too have undergone a becoming), though I hope I have done this in good faith and with respect for their primary concerns and commitments. My commitment in this section has

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been to develop a set of tools suited to a speciﬁc project – an examination of the (quickly proliferating) technologies of gender grouped under the term cosmetic surgery, and of the processes of becoming that gender is experiencing in relation to them.

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2 The Pressures of the Text: Intertextuality and Preferred Readings

This chapter introduces the theoretical and methodological tools I intend to use in the second of my two major lines of inquiry for this book – the production of preferred readings through mutual constitution in discourses on cosmetic surgery. These tools, intertextuality and interpretive repertoires, will be used to analyse the discourses around cosmetic surgery I mentioned earlier, in order to shed light upon the way cosmetic surgery acts as a technology of gender through its construction of preferred readings. In the ﬁrst section of this chapter I investigate the value of notions of intertextuality to my analysis and at the same time confront the use of the concept of polysemy that characterises much cultural criticism at present. While the term ‘polysemy’ refers to the presence of more than one possibility for the interpretation of a text, more than one semiotic function, it is frequently used to argue for a limitless range of possible interpretations. It is the latter appropriation of the term that I tackle in this chapter. My use of theories of intertextuality is contingent upon adapting them so that neither an entirely closed and controlled process of reading, nor an entirely open or free one is implied. In the second section I explore the concept of interpretive repertoires1 as developed by Potter and Wetherell in their book, Discourse and Social Psychology: Beyond Attitudes and Behaviour. I look at its place within a poststructuralist discourse analysis, and detail the ways in which it can be combined with an intertextual approach to investigate and map shared values and assumptions across discourses around cosmetic surgery. The areas of theory I discuss here expand upon the theory I outlined in Chapter 1. In looking at intertextuality I provide a model for precisely how the sexual imaginary is communicated through reading. From this point of view, the sexual imaginary will be treated as a collection of intertexts. Deleuze and Guattari’s model of the rhizome will ﬁnd echoes in this section. This book does not examine in any detail the reception of texts. Instead, it looks at how speciﬁc readings – and here I mean the apprehension and employment of speciﬁc intertexts – can be found in a range of texts when they are compared. The readers I am therefore investigating are the readers 41

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who are also writers – for instance, doctors who reproduce repertoires found in women’s magazines, lawyers who make use of feminist repertoires – readers whose readings I may access through the texts they produce.

Intertextuality and preferred readings In Television Audiences and Cultural Studies, David Morley identiﬁes a tendency within the ﬁeld of cultural studies towards what he calls ‘a facile insistence on the polysemy of media products and . . . an undocumented assumption that forms of interpretive resistance are more widespread than subordination or the reproduction of dominant meanings’.2 In this section I look at two important contributions to feminist cultural studies which I think adopt this particular polysemic perspective on reading, Joke Hermes’ Reading Women’s Magazines and Catharine Lumby’s Bad Girls, to illustrate some of the limitations of this approach. Both books are especially pertinent to my project in that they share my interest in the functions of popular culture. Both are concerned with constructions of gender and both concentrate on questions of reading. For these reasons, the two books constitute part of the theoretical and political milieu into which I want to insert this book. My broader interest is in ﬁnding ways of employing the fertile theories of intertextuality3 while circumventing the ways in which some aspects of intertextuality lend themselves to the kind of problematic polysemic spirit I have just mentioned. As Worton and Still warn, where intertextuality ‘denies the reality of power relations it can seem dangerously neutral’.4 To this end, I will investigate Stuart Hall’s concepts of articulation and preferred readings, drawing connections between these concepts and theories of intertextuality. I argue that polysemy is limited by the preferred readings constructed by and in any given text, and that one of the major aspects of this process of construction is the intertextual nature of every text. The intertexts identiﬁable in this process must be seen not as static, but as themselves becoming, that is, undergoing change in relation to other intertexts, just as the becoming of concepts was outlined in Chapter 1. These concepts are constituted in part from the imaginary bodies also discussed in the last chapter. In Chapter 3 I will examine women’s magazines and the kinds of repertoires they use to represent cosmetic surgery. How these repertoires are gendered will be looked at in order to begin to construct an understanding of how femininity and cosmetic surgery are linked within popular culture, and to provide a basis for investigating the intertextual connections between popular culture repertoires and those evident in feminist, medical and regulatory discourses. By tracing these connections I hope to demonstrate that while no single monopoly on meaning exists or is indeed possible, strong currents between different ﬁelds mean that shared ideas (as well as shared silences) on cosmetic surgery and gender can be identiﬁed across dis-

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courses, and that these work to construct and support each other in a system that is neither completely determined nor thoroughly polysemous. This approach echoes the surface model I invoked in Chapter 1, where Deleuze and Guattari’s insights into the nature of becoming as enacted through processes of connection were elaborated. From this point of view, preferred readings are constructed through processes of connection (between texts), though these connections are never entirely stable, that is, they too undergo becoming. Chapters 3–6 illustrate this by examining intertextual relationships in the form of discursive repertoires, within and between speciﬁc discourses on cosmetic surgery. These relationships, it will be argued, form the basis of preferred readings. Just as the polysemic approach has in some ways been a response to accounts that emphasise a repressive model of power and a simplistic view of individuals as powerless, the position I present here is a response to a subsequent overemphasis on resistance and the romanticisation of the everyday, elements of which can be found in the two books examined here. Before looking at Hermes’ and Lumby’s books, I want to make a few remarks about the concept of preferred readings, because, as I later argue, both books gesture towards it, without incorporating it fully into their analyses. Hall’s notion of preferred readings ﬁrst appeared in his work over twenty years ago and has since remained relatively undeveloped within cultural studies. In spite of this, the concept appears in the work of both Hermes and Lumby, initially qualifying the polysemic positions both construct, but then becoming a limit against which the texts seem to struggle. Because I want to take account of structural issues in relation to the production of meaning (at the same time that poststructuralist insights are employed), and because a general sense of ‘preferred readings’ emerges in this recent material around my area of interest, I have chosen to take up Hall’s term, though not without some adaptation. Preferred readings are deﬁned by Hall as ways of reading a text that simultaneously have ‘the institutional/political/ ideological order imprinted in them and have themselves become institutionalised’.5 These are readings that are structured within the text to lead the reader to conclusions which usually correspond with dominant cultural values (though this should not imply a view of these values as unchanging or unchallenged). Hall makes clear that this reading is not determined by the text, rather it is ‘structured in dominance’ and is neither closed nor uncontested. Simon During deﬁnes this structuring in dominance as a process whereby the text, in his case a television programme, ‘skews and restricts its audience’s possibilities for interpreting the material it claims to present without bias. Though viewers need not accept the preferred code, they must respond to it in some way’.6 Hall’s purpose is to recognise both the possibility for readings that do not correspond with dominant values, and the structures which more often than not, can lead to what he terms ‘hegemonic’ readings. For Hall, codes are a prerequisite of intelligible discourse

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and as such, constantly operate within it.7 In my view, preferred readings may be said to be structured in part through these codes, which include intertextual devices. Connected with this concept of preferred readings is the notion of articulation. I see articulation as a broad space within which to locate an understanding of intertextuality that takes account of dominant processes of structuration. Jennifer Daryl Stack notes that articulation has functioned mainly as a strategy for avoiding reductionist analyses, and as such, ‘isn’t exactly anything’.8 Articulation may be seen as the connection of two or more different elements such as concepts, individuals, institutions, products or technologies under speciﬁc, non-necessary conditions. Here, cultural formations are composed of varied discourses and material objects and practices articulated together which produce and are produced by certain power relations, but which are in no way inevitable or guaranteed. The articulation of elements such as women’s magazines, silicone breast implants, television programmes, US Food and Drug Administration hearings and doctors helps to make up cosmetic surgery as a complex, becoming and sometimes contradictory formation. Preferred readings can be seen as formations in the text (produced through these articulations with other texts, objects and practices) which reﬂect and constitute dominant power relations, but are never guaranteed. These preferred readings may not necessarily take the form of simple notions such as ‘cosmetic surgery is good’, but may serve to constitute concepts central to the issues of cosmetic surgery such as ‘nature’ (as I will demonstrate later) or render other concepts and questions invisible or illegitimate. According to Hall, this notion of articulation needs to take into account the contribution of the intertextual relations I seek to trace in this book.9 Morley’s concern about polysemy applies equally to the work of Lumby and Hermes, to their shared but differently motivated need to relieve the media of responsibility for media products. In Hermes’ case this is to credit women with agency and in Lumby’s case to argue against censorship. In order to make an argument against polysemic analyses which recognise no limit to reading possibilities and in favour of a view that acknowledges some structural impact on reading, I want to examine Hermes’ and Lumby’s books and draw out the problems that adopting a polysemic analysis can produce. This awareness of structural pressures, and the consequent attempt here to establish a theoretical basis for such pressures, is at the heart of my project. My aim is in part to map the paths that certain constructions of gender, certain imaginary bodies and gendered practices, trace through a range of discourses on cosmetic surgery. Hermes’ book is an innovative discussion of the ways in which women (and men) read women’s magazines. She utilises the notion of interpretive repertoires in looking at the interviews she gathers, in order to examine the ways in which magazine usage is described and to identify shared under-

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standings of magazines, their uses and the ways readers approach them. Early on, Hermes argues that ‘texts acquire meaning only in the interaction between readers and texts and that analysis of the text on its own is never enough to reconstruct these meanings’.10 She rejects what she identiﬁes as the traditional feminist approach to women’s magazines, which sees them as a potential source of harm for women, and sets up a binary relationship between the two approaches to readers of women’s magazines that she identiﬁes within feminist scholarship, that is, respect and concern. According to Hermes, concern arises amongst feminists where there is a perception of women as unable to negotiate popular culture in an informed way, while respect is an approach based not on approval of media discourse, but on the ability of women to effectively interpret and manage the media’s messages and effects. As I will argue in later chapters, this binary approach arises at least in part from the conceptualisation of agency as inhering in the individual. Hermes rejects concern in favour of respect, arguing that concern is patronising as well as outdatedly modernist. For Hermes, the researcher needs to respect the agency of women as able to appraise the material they encounter in popular culture critically. At the same time, Hermes does recognise the existence of preferred readings. She states, ‘Texts may be said to have “preferred readings” that invite a reader to read them in line with dominant meaning systems. However, this invitation need not be taken up.’11 This is the only occasion on which this concept is referred to in Hermes’ book. As a result, it functions simply as a kind of gesture, perhaps towards the obvious limits of the media, or else towards the value of providing a ‘balanced account’. Ultimately, accommodation of this concept within her polysemous approach proves somewhat problematic. Hermes rightly points out that no conclusions can be drawn about the way texts are actually read by concrete individuals without direct research into those individuals. Of course, this observation works both ways: if we cannot assume all readings are uncritical and conventional, we cannot assume they are all enlightened and resistant. The recognition that there is no necessary correspondence between encoding and decoding is not the same as the claim that there is necessarily no correspondence between the two. However, Hermes also maintains a commitment to the ability of readers to read critically. Interestingly, in her own research, she discovers that magazine readers have very little to say about their reading processes and about the content of what they have read. This is where some of her difﬁculties begin, because although Hermes argues that concern for readers of women’s magazines is patronising and misplaced, and that actually these readers are always in the process of negotiating the meanings of texts, she also ﬁnds that many read as if on ‘autopilot’, and that ‘readers are not in the habit of reﬂecting on everyday routines or of preserving memories of what made reading pleasurable’.12 In fact, her evidence, gathered in 86 interviews, leads her to comment that while people may leave their television

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sets on and leaf through magazines, ‘that is hardly an indication that they are “read” consciously, seriously or with animation’.13 From this point of view it is difﬁcult to understand on what grounds Hermes argues so strongly for a model that positions readers as ‘active’ (which she contrasts with the ‘dupe’ or passive consumer of meaning).14 This is particularly important in that she uses this argument as the basis for her rejection of any sense of concern about the impact of women’s magazines. This question is further highlighted by her discussion of one of the major conversational repertoires used by interviewees to explain their use of magazines. Here, many readers state that they use such magazines as sources of practical knowledge both about various concrete matters such as medical problems and home repairs, and about emotional issues. Implied here is a kind of reading that credits the magazines with a high degree of accuracy or even ‘truthfulness’. Importantly, if some readers do treat magazine content as accurate and truthful information, the character of that content (its veracity and reliability) is rather more important than Hermes’ accompanying view of reading as fragmentary and distracted might grant. Here, Hermes’ strong commitment to a polysemous model of meaning-making appears to run somewhat at odds with her interpretation of her empirical material, which suggests that readers frequently decode the material as intended; as transparently descriptive and accurate. Her failure to incorporate the implications of preferred readings leads her to argue for a more open and more permissive approach to the media than her evidence seems to suggest. Of course, repertoire use does not necessarily reﬂect actual behaviour, so that claims about the usefulness of information in magazines may not actually indicate such use. While this evidence can be treated as ambiguous, however, no evidence to the contrary is found in the material. Magazines are certainly discussed in some ways that suggest they are not taken entirely seriously by readers, but at the same time, there is an absence of repertoires that assert critical reading, and in fact the opposite is true. What is missing, in the end, is adequate evidence supporting her claims about the critical reader. Catharine Lumby similarly argues that images from advertising offer no ‘true’ reading, that we must be aware of ‘the plurality of meanings which any image or phrase can carry, and of the tendency people have to reinvent and appropriate meaning for their own ends’.15 At the same time, Lumby admits that ‘not all points of view are given equal weight in a given society’.16 Initially a surprising move, this observation is used to argue that feminism has become a dominant viewpoint in the media in Australia.17 However, having made this gesture towards the existence of something that sounds like preferred readings, Lumby then seems to ignore the concept, which does not emerge explicitly at any point in the remainder of her text, and is often contradicted. Like Hermes, Lumby runs into difﬁculties as a result.

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Broadly, Lumby argues that any recognition by feminism of the power of the media is illegitimate because it sets up feminists as more ‘aware’ than the ‘average reader’.18 This criticism is similar to Hermes’ respect and concern duality. Lumby frequently champions the ‘average reader’, and one of her main complaints is directed against what she sees as feminism’s patronising attitude. Like Hermes, her commitment both to an ‘active reader’ model and to a polysemous approach (that is implied to follow from this model) leads her to refuse to take seriously criticism of media representations. At the same time, however, she argues for the production of more varied media images of women. Thus, she states, ‘feminism ought to be encouraging a broad range of images of and for women, in the media and in everyday life’.19 The latter is an odd point to make given that Lumby sees meaning as inhering not in the text but in the reader. It is not clear from this point of view why more varied images of women are necessary. Ultimately, Lumby is forced to abandon her active reader model, if only when it comes to feminism. In order to make her point, Lumby deviates from her view that women are always able to negotiate the media critically. In relation to feminist criticism of a jewellery billboard advertisement, Lumby asks of feminists, ‘Why teach women to read images in a way that makes them feel bad about themselves?’20 The model of female readers underlying this question bears a close resemblance to that used by the feminists Lumby criticises, in that she inadvertently appeals to an understanding of readers as potentially vulnerable, and of messages as containing preferred readings. This is perhaps because her case against feminists would be undermined if readers could negotiate and appropriate meaning in an unlimited way. Feminists would more properly be positioned alongside other cultural producers such as the media, and Lumby would be led merely to defend their right to an opinion on the basis of the ability of the reader to critically evaluate this opinion. In contrast to Lumby’s approach, I want to develop an account of meaning that acknowledges both the pressures exerted by texts and discourses more broadly, as well as the ways in which readers bring complex histories and selves to those texts. Earlier, I brieﬂy discussed what may be meant by the term ‘preferred readings’. Here I would like to offer a formulation of ‘preferred readings’ that looks explicitly at the way intertextuality is implicated in their production. In this context intertextuality refers to the speciﬁc ideological norms, conventions, connotations, idioms, clichés, and so on that necessarily make up the substance and context of a text.21 This approach neither assumes that all texts are ﬁxed within a closed and inﬂexible frame nor that they are the products of countless diverse, varied and fragmentary elements. Social and historical textual resources form the materials from which texts are produced, and can in turn be transformed by these texts. Accordingly, John Frow states that texts are ‘shaped by the repetition and the transformation of other textual structures’,22 or as Riffaterre puts it, ‘[t]he

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text refers not to objects outside of itself, but to an intertext. The words of the text signify not by referring to things, but by presupposing other texts’.23 Within this model is the assumption that no text exists that does not make use of pre-existing texts, and that, according to Kristeva, every text exists under the jurisdiction of other discourses.24 Here, the meanings texts offer are in a constant process of becoming according to a range of factors such as the speciﬁc imaginary bodies prevalent within culture, reﬂected in other texts and elsewhere. Thus, becoming can be a sometimes unpredictable process, as well as being subject to powerful political articulations, such as those around gender. Equally importantly, texts refer to each other in much the same way as do repertoires. Later chapters show how texts build authority through reference to other texts rather than through reference to ‘truth’ or ‘facts’. An example of this is the way in which women are repeatedly characterised through repertoires in regulatory discourse as ‘hysterical’ and irrational in their anxiety over the safety of silicone implants. The idea of women’s hysteria is taken up and cited repeatedly to produce an authoritative diagnosis of feminine instability during the US silicone breast implant hearings examined in Chapter 6. As I indicated earlier, my interest in this issue arises from a study of different discourses that partially construct cosmetic surgery, and from a desire to look at cosmetic surgery as a phenomenon that moves across a number of discourses, without losing sight of structural issues around the production of discourses. Catherine Waldby reveals a similar interest in her book AIDS and the Body Politic when she states that biomedical knowledge cannot be ‘quarantined from general ideas operative in the culture’.25 What we share here is perhaps a general concept of articulation; that is, a recognition that discourses, even those apparently subject to strict laws of legitimation, inform each other, and produce a speciﬁc climate in which powerful ideas are produced, circulated and received. My approach differs from Waldby’s in that I have not chosen to study a particular discourse as my object of inquiry as Waldby has done with biomedical discourse on AIDS. I formulate my object of inquiry, that is, cosmetic surgery, as a somewhat arbitrary term which incorporates a whole range of shifting discourses and practices. This seems to me to offer a basic model for taking account of the kinds of currents, material objects and practices that qualify as relevant to cosmetic surgery at any given time. It is an attempt to minimise the effects of preconceptions, and of acknowledging the signiﬁcance of processes of intertextuality. As Grossberg argues, ‘it’s almost impossible to know what constitutes the bounded text which might be interpreted or which is actually consumed’,26 a view I ﬁnd interesting to extend beyond the single text to my ﬁeld of investigation. My interest is not in designating what is of relevance to cosmetic surgery as a cultural phenomenon, but in studying and interpreting what is taken to be relevant in the discursive contexts examined here.

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Of course, this is not to suggest that all discourses and practices associated with cosmetic surgery occupy equivalent positions in terms of their cultural authority or truth status. On the contrary, I consider that the intertextuality I am examining is one of the major elements in the construction of preferred readings. Fairclough states that intertextual analysis ‘draws attention to the dependence of texts upon society and history in the form of the resources made available within the order of discourse’.27 From this point of view, intertextuality may be seen as a necessary precondition and as a constraining element in any text. A primary aspect of intertextuality is the way in which its constitutive intertexts can be referred to obliquely. In his book Text Production, Riffaterre discusses the use of overdetermined words, arguing that such words, which carry more than one layer of meaning, form: a kind of knot with two semantic threads [which] have a meaning called for by the primary code or context, and a signiﬁcance coming from the secondary code. In a way this secondary code is quoted, since it is possible for us to reconstitute it mentally from the overdetermined word. The efﬁcacy of this phantom quotation is, thus, due to the active participation of the reader, to his rewriting of the unstated. This is none other than the practice of intertextuality.28 Two important points are made here. The ﬁrst is that it is possible to invoke a complex chain of concepts indirectly without open reference to those concepts, simply through the use of one, overdetermined word. In the next chapter, I will argue that the word ‘nature’, for example, acts as such a ‘knot’, tying together a number of ideas and attitudes without directly referring to them, with interesting results for the representation and functioning of cosmetic surgery within culture. The second point Riffaterre makes is that this process of invocation relies directly upon the reader to function successfully. Here, Riffaterre constructs a notion of the active reader, but complicates that notion by showing that an active reader may not necessarily produce an oppositional or even a negotiated reading, to use Hall’s terms, but may prove to be entirely complicit with the preferred readings of the text. This notion challenges the somewhat morally loaded nature of the term ‘active reader’, which tends to associate it with a greater degree of independent thought. In some sense, then, the distinction between the active and the passive reader – in fact, the very possibility of a passive reader – is challenged. The tendency in both Hermes’ and Lumby’s work to invoke the active reader as ‘proof’ that readers are in no danger of being unduly inﬂuenced is problematised from this perspective. Of particular interest for me in this model is the recognition that writers (and speakers) are also readers (or listeners), and that as a result, a writer uses other texts in the process of writing. Equally, as I have implied, the

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reader brings to bear any number of other texts on the process of reading; texts that may allow for the identiﬁcation of speciﬁc, intentional intertexts such as quotes, as well as more general, diffuse intertextual elements such as tone or genre. Clearly, a rigid distinction between readers and writers is false. More speciﬁcally, this model suggests that writers of scholarly or scientiﬁc material may also make use of popular texts in their writing, consciously or otherwise. It is through this process of intertextuality that the kinds of equivalences feminists have drawn between philosophical or scientiﬁc notions and ‘common-sense’ or popular ideas, for example, are produced. So, for instance, in Chapter 5 I examine the use doctors, medical writers and scientists make of ideas and phrases commonly found in women’s magazines and feminist texts to illustrate this idea of writers as readers of other discourses. I am not arguing that speciﬁc writers read speciﬁc texts; rather that intertextuality refers to words and ideas diffused through texts into culture, drawn upon in conscious and unconscious ways. Similarly, Waldby argues that biomedicine ‘constantly absorbs, translates and recirculates “non-scientiﬁc” ideas – ideas about sexuality, about social order, about culture – in its technical discourses’.29 This statement implies a recognition of the inﬂuence of certain texts and discourses. These texts and discourses help produce others which make use of their assumptions. This process can be seen as part of what constitutes the kind of ‘structuring in dominance’ Hall describes and, as such, it is what I would identify as one of the major aspects of the production of preferred readings. These articulations are described by Hall as ‘lines of tendential force’.30 What is being argued here is that preferred readings originate not only within the text, but also within the broader culture, and within the communication or articulation between different texts and discourses. From this point of view, an analysis of a single discourse demands an investigation of the textual ties that exist between it and other discourses and texts. Of course, while this is possible in terms of identifying the texts that are referred to both openly and obliquely within the text, it cannot predict the sorts of texts readers will themselves bring to their reading. Thus, this formulation of intertextuality disallows any tendency to assume a necessary correspondence, in Hall’s terms, between encoding and decoding. Preferred readings, and what they suggest about the culture in which they were produced, can be traced here, but few corresponding assumptions may be made about the reception of these preferred readings. Theories of intertextuality assume that texts inform other texts. Through the ideas of articulation and ‘structuring in dominance’, I am arguing that powerful or widely available texts and discourses are intrinsically best placed to inform other texts, both in their writing and in their reading. Later, I will look at how the powerful contemporary discourse around ‘agency’ is woven throughout all four discursive areas under examination here, that is, popular, feminist, medical and regulatory material. This discourse virtually

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saturates the material, present as it is in widely circulated popular texts and in authoritative medical and regulatory texts. It is important to reﬂect on the effects of such a substantial presence. In relation to what is being argued here, it suggests that some justiﬁcation exists for employing a model of concern about the contents of the media, for where a concept occupies such a prominent rhetorical and logical position, strengthened through the mutual legitimation of supposedly distinct discourses, it can easily eclipse alternative accounts. Both Hermes and Lumby attempt to proceed without any notion of the reader’s limits, and both encounter obstacles as a result: Hermes because the evidence on which she bases her study does not sustain adequately her assertion of the conscious, critical reader, and Lumby because she casts speciﬁc strands of feminism into an ideologically determining role her book denies is possible.31 Accordingly, it seems necessary to utilise a theory of audiences that does not polarise concern and respect. Instead, a theory that recognises the material conditions under which individuals read and form opinions needs to be employed. This theory can still acknowledge respect for decisions made always under other than ideal conditions. In addition, it recognises that an active approach is necessary to produce readings that are not only oppositional or negotiated at any given moment, but also hegemonic. In this way, there is no need to imply that a reader who complies with the preferred reading of a text is necessarily passive, or unworthy of respect. Instead, it is possible to make an argument for the need for fair, accurate and comprehensive media, without posing readers as mindless. This discussion of intertextuality has outlined the ways in which it can be linked to Hall’s notion of preferred readings. It is motivated by the view that while intertextuality offers a great deal for discourse analysis, discussions of reading that fail to take into account structural issues in relation to interpretive options tend to run into problems. It has investigated what elements might constitute the means by which preferred readings are produced, and, in particular, how intertextuality can be theorised as part of this process. Each of the chapters that follow demonstrates strong intertextual links both between texts within distinct discourses, and across discursive lines. I do not ask how these texts are read, for that requires direct investigation into readers. Rather, I question the conditions under which these intertextually produced preferred readings are made possible, and what their existence implies for the representation of gender. There is no longer any doubt that the reader must adopt an active relation to any text, and it cannot be assumed that the reader reads in only one way or from one point of view. On the contrary, the reader can entertain a number of discontinuous or inconsistent ideas about a text simultaneously. As Barthes has asked, ‘who endures contradiction without shame? . . . he [sic] is the reader of the text at the moment he takes his pleasure.’32 My argument has been that while these possibilities for reading exist, very real

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pressures are also at work which function to prompt, though not determine or guarantee reading.

Interpretive repertoires One way of systematically identifying intertextual relationships between texts is to analyse one text in terms of the ‘repertoires’ that can be identiﬁed in or reconstructed from it and compare those with the repertoires used by other texts. The concept of interpretive repertoires originates from social psychology, but it represents a departure from traditional social psychology in favour of poststructuralist methods of discourse analysis. As I will explain, Potter and Wetherell’s approach incorporates a thorough critique of the conventional subject employed by social psychology, and a reformulation of the object of study in media or text analysis. It is not a new method, but it is utilised in relatively recent studies, such as Klaus Bruhn Jensen’s The Social Semiotics of Mass Communication33 as well as Hermes’ Reading Women’s Magazines. Margaret Wetherell ﬁrst introduced this concept as ‘linguistic repertoires’ in 1986, when she stated that ‘[w]ithin a cultural system . . . it is possible to identify meta-patterns or broad regularities in an ideology . . . Linguistic repertoires are the substance which constitute these broad meta-themes’.34 This substance takes the form of speciﬁc repeated linguistic features that may share grammatical, stylistic and lexical elements. Metaphors, tropes and ﬁgures of speech are important examples. Elsewhere, Potter and Wetherell describe the repertoire as ‘constituted through a limited range of terms used in particular stylistic and grammatical constructions’.35 In other words, a repertoire is an identiﬁable pattern that can be reconstructed from discourse on a particular subject or found in a speciﬁc context, a pattern that individuals may tap into in order to express themselves in a socially viable or coherent manner. Such a pattern does not necessarily include the repeated use of particular words, but can relate to sentence construction (such as repeated use of the form of the question). The examination of repertoires is a close-grained investigation of the use of language, where apparently trivial differences can prove highly signiﬁcant. As may now be clear, the repertoire is a concept that derives from discourse analysis, so that the explanation of it I will provide here shares much with discourse analysis in general. The repertoire method can be distinguished from traditional social psychology approaches (as well as many earlier feminist, sociological and cultural studies approaches) in at least three ways: 1. It shifts the object of analysis from the ‘true’ interior of the subject to the ideological and political implications of the subject’s use of language. This is partly because:

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2. The subject it presupposes is neither uniﬁed nor non-contradictory. S/he is a product of language. As a result: 3. It eschews any form of cognitive reductionism. In order to explain these points effectively, I will ﬁrst outline relevant aspects of traditional social psychology. In a general textbook of social psychology, Vaughan and Hogg characterise social psychology strongly in terms of the scientiﬁc method. They deﬁne the discipline as ‘the scientiﬁc investigation of how the thoughts, feelings and behaviours of individuals are inﬂuenced by the actual, imagined or implied presence of others’.36 The scientiﬁc method is put forward as the only alternative to ‘dogma or rationalism, where understanding is based on authority’37 and traditional scientiﬁc processes, such as replication, are promoted as necessary in order to overcome the problems of bias in research. Central to the strategies put forward in this account is a dependence upon the scientiﬁc method and a concomitant faith in objectivity, positivism and the transparency of the object of study, here the human subject. Potter and Wetherell note that the self in social psychology is seen to have ‘one true nature or set of characteristics waiting to be discovered and once discovered a correct description of these characteristics will follow’.38 This self is seen to be uniﬁed and coherent; at the centre of experience, a whole, autonomous and self-contained agent. Of course, this sort of approach to the subject has been shared across many other disciplines such as history, anthropology and women’s studies, but has been effectively challenged in more recent years by poststructuralism, postmodern feminism and semiology. Not only is the subject increasingly seen as potentially fragmentary, shifting and contradictory, but also as an effect of language, rather than as its ‘master’. Interpretive repertoires are particularly useful in the investigation of verbal and written texts because, as I noted in point 1 above, they make the text itself the object of study rather than the writer or the reader. In other words, the ‘true nature’ of the writer or the reader is not hypothesised from the text, as the subject is in some ways seen to be beyond the ‘capture’ of such theorising. Instead, the social and cultural implications of the linguistic form of the text are closely examined. So if the text is a recorded conversation between two individuals, the aim of the analysis is not to attempt to reconstruct the ‘interiority’ of those two subjects, but to examine the linguistic patterns adopted, the repertoires utilised to construct rather than reﬂect the self, and to identify the cultural and ideological context that the availability and circulation of these repertoires might suggest. Thus, when women in magazines state that they have undergone cosmetic surgery in order to improve their career prospects, the speakers are seen as adopting a repertoire in the process of rendering themselves viable as subjects in a performative sense, rather than as revealing the ‘true’ reasons for their actions (or the

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‘real’ degree to which they have been ‘fooled’ by advertising messages). The repertoires speakers take up reveal little about the interiority of the speaker, but much about available options for the reproduction of the subject and about directions gender as representation may be taking. This shift away from the interiority of the subject is in part due to the fact that, following point 2, this model theorises the subject as complex, fragmented and always ‘becoming’, and as such, only very inaccurately represented by simple, cohesive or logically consistent accounts. Here, the presence of apparently contradictory repertoires does not present problems for analysis, while the same may not be said for the traditional model. Where repertoires are seen as useful or convenient ways for constructing the self moment by moment, contradiction and variation is unsurprising and readily encompassed. As Wetherell notes, using this model reveals that ‘variability and inconsistency are exactly the principle characteristics of any naturally occurring human justiﬁcation, explanation or self-analysis’.39 However, where the self is seen as a pre-given, uniﬁed entity, contradiction cannot be accounted for, unless as some ‘failure’ of the self. In the following chapters, I will be drawing out the ways repertoires are used to organise gender and cosmetic surgery. The presence of a variety of separate and sometimes colliding repertoires will be evident from the material I present. As a result of this theorisation of the subject as multiple and complex (that is to say, inﬁnite and always becoming) and of this shift in the object of study, the repertoires approach rejects the traditional tendency toward cognitive reductionism (as noted in point 3), or, as Potter and Wetherell explain, ‘any explanation which treats linguistic behaviour as a product of mental entities or processes’.40 This means that language is not seen as a direct avenue of access to the ‘true underlying nature’ of the subject. In fact, Potter and Wetherell reject the existence of an originary subject (the same originary subject I argued against in Chapter 1). Where there is no ‘true’ subject, there can be no clear or coded language that may reveal it. Where language is conceived instead as social and political, its subtle and varied use can fruitfully be viewed as a product or indicator of social and political pressures, options and limits. This approach is particularly useful to my own study as my desire has always been to avoid any discussion of cosmetic surgery in terms of questions about ‘true, underlying motives’; the ‘real’ reasons why people undertake surgical ‘beautiﬁcation’. Instead, as I noted above, this book takes as its object of study the ways in which cosmetic surgery can be talked (and thought) about and what this range of options tells us about our culture, our understandings of gender (that is, our culture’s imaginary bodies), and other options in negotiating contemporary society as gendered subjects. The kinds of subjectivity available to individuals (as partly indicated by the kinds of repertoire in use) are speciﬁc to the forms of organisation our culture takes at any given time, and can be examined to provide insights

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into our culture and society. The production of subjectivity is central to the process of subjection, where subjection refers to the ways in which individuals become subject to certain laws and injunctions, as well as subjects of them. Particular forms of subjectivity allow for particular forms of subjection. This observation can be applied to gender. The subject is continually producing itself as masculine or feminine. This is achieved in part through the use of interpretive repertoires, which are one means by which the always gendered subject continually re-establishes legitimacy. From this point of view, repertoires can be seen as technologies of gender which function on both an individual and social scale. When I argue that repertoires are gendered, I am utilising a now familiar observation within feminism that gender does not consist of two distinct and permanent categories of traits and practices. Rather, gender, like everything, is always in the process of becoming, and can be seen as a relation, or a culturally speciﬁc organisational device that, certainly in a Western context, implies a hierarchy. Wetherell sees repertoires as implicated in this system, arguing that gender develops from contradictory and frequently fragmentary pieces of discourse, repertoires, and accounting systems available to individuals to make sense of their position, and which historically and contingently have come to be marked as feminine or masculine responses.41 In some senses, then, I would argue that repertoires are not only used to ‘make sense’ of issues, but to actively constitute or establish a position. In other words, repertoires can be used pragmatically, strategically or opportunistically as well as ‘genuinely’ or with some sense of their authentic applicability. Some repertoires may be used quite unconsciously, while others may be intentionally tapped into as a means of marshalling power. However, I argued above that language cannot be seen as an access point to the underlying true subject or meaning of a text, and accordingly, I would not attempt to distinguish between repertoires used pragmatically and those used ‘genuinely’. Again, the focus for me is the range of these repertoires and what they reveal about culture. In the previous chapter I used some broad theoretical concepts to begin to understand the relationship between gender, discourse and the subject. The concepts I use in this chapter, however, are more speciﬁc methodological tools. How do the two ﬁt together? As I argued earlier, intertextuality is central to the communication of concepts between discourses. Some of these concepts, such as nature, agency and vanity, take the form of speciﬁc repertoires which appear repeatedly within one discourse and can also be found in other discourses. Where such repertoires refer to or imply gendered qualities and divisions (the sexual imaginary), they are also technologies of gender. Chapter 1 provides tools designed for examining cosmetic surgery

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as a technology of gender, where becoming is used to describe the character of gender in ﬂux, and the notion of imaginary bodies is taken up as a source of this becoming. Parallel to this, the theoretical tools presented here make possible the tracing of speciﬁc intertexts (in the form of linguistic repertoires) and the identiﬁcation of preferred readings through these repertoires. These are two distinct but interconnected issues in that the preferred readings available in the texts I examine are themselves the products of gender as well as part of the becoming of gender. In looking at popular, feminist, medical and legal discourses on cosmetic surgery, it is possible to identify a number of repertoires that act as technologies of gender, in that they (re)construct gender in speciﬁc ways when they are used. I have chosen three repertoires – nature, agency and vanity – which I intend to trace through these discourses as a means of mapping the exchange between apparently objective technical knowledge and ‘lay’ knowledge, an exchange that produces preferred readings. These preferred readings will be shown to take two main forms: those that are produced by intense repetition and those produced by the exclusion of alternative viewpoints. Thus, preferred readings are those readings heavily structured into the text so that refusal to take them up demands considerable additional knowledge and/or continual alertness to the effects of repetition as a form of persuasion. Looking at these discourses in terms of repertoires, I want to add to Potter and Wetherell’s earlier deﬁnitions by saying that repertoires exist at a number of intensities. By this I mean that broad repertoires can be identiﬁed which are also fruitfully analysed as sub-repertoires. In the next chapter, for example, my discussion of the repertoire of the natural will be conducted by distinguishing very speciﬁc repeated patterns of usage of this repertoire. Nature emerges here in differing sub-repertoires such as that which posits the body as ‘raw material’, or femininity as ‘naturally concerned with the appearance’. Each separate ‘sub-repertoire’ has particular implications for the functioning of gender within the broader discourse, and together they also constitute a more general repertoire. Wetherell states, in a manner not dissimilar to Emily Martin’s use of discourse analysis in The Woman in the Body,42 ‘[b]y making the banal and commonsensical strange through analysis, it is possible to see in a new way something of how ideologies operate’.43 This expresses quite well my approach, in that I will be analysing everyday ways of discussing cosmetic surgery, gender and the self in order to reconstruct a sense of what the most accepted, potentially invisible and so particularly powerful ways of talking and thinking about these matters might be. Not only is a repertoire usefully seen as a technology of gender, but it can also be understood as an intertext: a ‘knot’ of meaning, which in its rich associations, says much in few words. This connection between the concepts of intertextuality and repertoires

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relates to the idea of preferred readings that I raised earlier, for this idea pinpoints the political nature of communication. Where unequal relations of power exist, preferred readings must also exist. They are constituted from processes of authorisation through textual and verbal devices such as the use of accepted or popular repertoires, and make reference to inﬂuential or wide-known texts. So, from the point of view of writing, repertoires are sometimes employed to create preferred readings, but from the point of view of reading, preferred readings can be seen in another sense. While they can be constituted from repertoires, they also function themselves as repertoires, that is, repertoires for reading, for making sense of the text and of ourselves. They are both product and resource. This is a mutual process of meaningmaking, where our beliefs and attitudes are constantly reformulated, constantly undergoing becomings, although we may not always be aware of it. Our views may often strike us as merely obvious. ‘Inﬂuential’, ‘widely known’ or ‘accepted’ ideas and ways of talking (for instance, repertoires drawn from Western culture’s sexual imaginary) are the basis for our most automatic or unreﬂective attitudes and responses as much as they can be used consciously or pragmatically. They are the ‘banal’ thoughts and words which yield so much when ‘made strange’ in a project such as this.

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Part II Discourses

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3 Glossing Femininity: Women’s Magazines

A successful television comedy actress features under a banner that reads ‘Tortured lives’. Her ‘shock confession’ includes repeat cosmetic surgery and extreme dieting, but her circumstances and her outlook hardly invite pity: ‘I’ve always dreamt of looking beautiful. And now, with a pocketful of money and an opportunity to wear the most gorgeous designer clothing, I’m not going to blow my chance,’ says Patricia, who earns $11 million a year for her role [in Everybody Loves Raymond].1 Is Patricia a victim or a hero? Are her concerns and her circumstances natural or otherwise? Is she vain, and if so, is that OK? In this chapter I look at the ways three powerful concepts – nature, agency and vanity – function in discussions of cosmetic surgery found in women’s magazines. This investigation is predicated on the arguments made in Chapter 2 that see the contents of popular culture as signiﬁcant to the production of other discourses and material practices. Here, I identify speciﬁc repertoires used when cosmetic surgery and femininity are discussed in women’s magazines. These same repertoires will be shown to recur throughout feminist, legal and medical discussions of cosmetic surgery in later chapters. It will be clear that they overlap, support each other and help to produce preferred readings, although I would not argue that this overlapping constitutes a total, seamless meaning system that is never contradicted or ruptured in any way. The three repertoires of nature, agency and vanity make use of the system of interlocking binarisms which underpins western culture and philosophy, a system that opposes nature to culture, masculine to feminine, mind to body, activity to passivity and public to private, among other dualisms. By looking at these repertoires, I map out how discussion of cosmetic surgery in popular culture takes up and utilises particular culturally signiﬁcant concepts as part of the complex reinscription and reinvention of gender. In this ﬁrst of my empirical chapters, my emphasis is on establishing the three 61

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repertoires and interpreting how they function within the boundaries of women’s magazines. Later chapters elaborate on these functions, making connections with those found in other discourses, to gradually develop a complex view of the ways in which the repertoires and discourses interact and help produce each other. The magazines I have looked at cannot be said to offer a homogeneous approach to cosmetic surgery. These publications are themselves varied in terms of readership, sponsorship and tone. At the same time, the representations they construct comprise distinct sub-genres in which signiﬁcant patterns can be identiﬁed, although these patterns are sometimes disrupted. For instance, while most articles on cosmetic surgery procedures assume that women’s pursuit of beauty is a natural and unquestionable practice, occasional pieces assert that personality, not appearance, is what matters, and that the pursuit of beauty is of secondary importance. Here, the existence of broad assumptions upon which debate about cosmetic surgery is conducted can be identiﬁed, though these assumptions are not universal. For instance, while it is not uncommon to encounter two unrelated pieces on cosmetic surgery within one magazine, and ﬁnd them completely at odds on questions of cosmetic surgery’s legitimacy or desirability, they may share other, more far-reaching perspectives on the meaning of nature, or the location of agency. Most of the more lengthy articles about cosmetic surgery that I analysed for this chapter are primarily about informing the reader about the possibilities of cosmetic surgery, offering an emphasis on best-case results, and engendering a generally positive attitude towards cosmetic surgery for women.2 Several investigations are conducted ‘under cover’ in that the writer or others pose as potential clients to discover what forms of surgery cosmetic surgeons consider appropriate for the author’s physical characteristics, whether the subjects themselves can predict accurately what the surgeon will target, and whether surgeons attempt to sell unrequested surgery to clients. The effect such articles tend to create is one of apparently unbiased reportage where information is provided in a pseudo-neutral setting. Actually, the provision of innumerable photographs, personal testimonies to success and the subtle inference through photographs of naked models alongside such ‘wish lists’ creates a sense in which cosmetic surgery, when carried out by a qualiﬁed and experienced doctor is almost limitless in its potential to transform. A different group of pieces looks at cosmetic surgery in relation to celebrities, offering a variety of perspectives.3 The primary tone in which these are written is one of mild titillation, where the reader is invited to wonder at the strange, sometimes sad and often extravagant cosmetic surgery experiences of famous people. Such pieces can express a range of emotions from curiosity to horror, pity or admiration at once. This sort of article is more often found in less expensive, gossip-style magazines such as Who Weekly or New Weekly, while the previous group of informative pieces tend to appear

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in more expensive glossy magazines such as Cosmopolitan, Cleo and Elle. In many cases the latter category run advertisements for surgeons along with the features, or later in the same issue, a factor which presumably helps to shape the positive tone in which the articles are written. Other kinds of articles also appear regularly, such as entirely negative pieces about breast implant tragedies or (rare) critical feminist pieces which argue for selfacceptance.4 A number of articles documenting the negative effects of silicone breast implants appeared in 1992, at the same time that the availability of silicone implants was being debated in Australia and the United States. More recently, articles have offered cosmetic surgery as a prize in competitions, and a regular column on cosmetic surgery was launched in a major magazine.5 Because of this range, I would not attempt to argue that women’s magazines offer any sort of monolithic view on cosmetic surgery. For instance, I do not think it feasible to suggest that women’s magazines are universally positive on the subject. At the same time, it would be accurate to say that articles opposing cosmetic surgery are found less frequently in magazines published in 1999, compared with those published at the beginning of the decade. During the 1990s, advertising and editorial functions increasingly merged to produce features promoting cosmetic surgery and providing lists of surgeons and clinics. This does not mean that articles criticising cosmetic surgery entirely disappeared, rather that advertising techniques changed as higher advertising budgets were made available, and a much larger presence in women’s magazines resulted. Changes over time, and the continuing presence of articles that promote surgery and those that critique it mean that simple generalisations are not possible. As an analysis of the repertoires of nature, agency and vanity will show, however, signiﬁcant common ground can be identiﬁed in terms of fundamental concepts which help shape notions of gender. In general terms, cosmetic surgery is gendered in women’s magazines by the fact that surgeons are almost exclusively referred to as ‘he’ and recipients as ‘she’. Similarly, most articles on cosmetic surgery deal with surgery designed for women, or use women as their subjects. This tends to reinforce the notion that cosmetic surgery is mainly intended for women, and consequently that women are the most appropriate subjects of this surgery. My discussion of the 1999 Health Care Complaints Commission (HCCC) Inquiry into Cosmetic Surgery in Chapter 6 highlights this gendering by noting the disproportionately male expert panel and body of expert speakers, and the entirely female body of cosmetic surgery ‘victims’ present. A similar distribution of experts to ‘victims’ is evident in the US Food and Drug Administration hearings on silicone breast implants discussed in the same chapter. In other words, the representation of surgeons as male and recipients as female is both the ‘product and process’ of cosmetic surgery as a technology of gender; here gender stereotypes emerge from and help produce asymmetrical patterns in surgical practice.

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It is also quite uncommon to ﬁnd articles that combine surgery for men and women within the same discussion. Usually, discussions are segregated, and surgery for men is frequently separated into briefer pieces which often make a point of expressing some surprise that men, too, undergo such procedures. This pattern may simply be the result of the fact that these magazines are aimed at women, and as such, focus on women’s behaviour. At the same time, however, a sense that cosmetic surgery is primarily a women’s concern is created. After all, similar features and advertisements could be run in magazines aimed at men, if promotion were perceived in nongendered terms. This is still quite rare. An examination of a separate cosmetic surgery guide provided with a women’s magazine in 1994 shows that of 50 pages, two are set aside to discuss ‘men’s surgery’.6 This section deals with penis enlargement, hair transplant and testicle tuck surgery, suggesting that the procedures discussed elsewhere are essentially the domain of women. Similarly a magazine entirely devoted to cosmetic surgery, launched in 1998 and straddling the border between medical information, advertising and magazine journalism (in the substantial contribution of doctors to the material) provides two pages directed at men in a publication 87 pages long.7 In both cases, while procedures discussed elsewhere are not inherently designed for women only (for example, rhinoplasty), the provision of designated ‘men’s’ pages excludes them from the majority of the text by implication.8 Clearly, in spite of suggestions that cosmetic surgery is becoming as appropriate for men as it is for women,9 women are still overwhelmingly the main target of advertising, even within the new genre of publications devoted entirely to cosmetic surgery and other cosmetic procedures. My main project is to discover whether particular repertoires can be traced through to feminist, medical and regulatory discourses around cosmetic surgery. The repertoires I have chosen to investigate, that is, the natural, agency and vanity, are three notes struck consistently, if in varied ways, throughout discussions of cosmetic surgery in a wide range of contexts. They are of particular interest because all three are heavily implicated in the production of sexual imaginaries within Western culture, that is, they all play a role in cosmetic surgery discourse as a technology of gender, and as such, are valuable instruments in gauging shifts in cultural representations and formulations of masculinity and femininity. How and in what ways discussion of cosmetic surgery in popular culture is impacting on and reﬂecting broader social understandings of gender, that is, how gender is in the process of becoming through its mutual constitution with cosmetic surgery, is my main concern in this section.

The natural The ﬁrst repertoire I discuss is situated at the very centre of a system of dichotomies which work to delineate male and female. This is the category

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of the natural. Closely examined by a number of feminist scholars, the distinction between nature and culture has been identiﬁed as a central organising feature of culture, and, according to Haraway, provides the necessary legitimation for science. She argues that just as the ﬁctional construct of the ‘Orient’ makes possible the Orientalist, the ﬁctional construct of ‘nature’ makes possible science.10 Mary Jacobus, Evelyn Fox Keller and Sally Shuttleworth conﬁrm the development of this relationship in the postEnlightenment age. They make the point that nature is concomitantly gendered in the feminine, arguing that: The last two centuries have witnessed an increasing literalization of one of the dominant metaphors which guided the development of early modern science. For Bacon, the pursuit of scientiﬁc knowledge was ﬁgured rhetorically as the domination of the female body of nature, illuminated by the light of masculine science. With the professionalization of science, and the development of ever more sophisticated technologies of control, the metaphorical base of this epistemological quest has become explicit material practice. The full weight of the power and authority enjoyed by science in our culture has been brought to bear on the female body.11 In light of this observation, it is possible to argue that traditional constructions of nature help make possible the scientiﬁc/medical ﬁeld of cosmetic surgery, although nature is ﬁctionalised in more than one way.12 The natural has occupied at least two main roles in post-Enlightenment Western culture, one pre-dating the Enlightenment, the other a product of it. According to Bloch and Bloch, one understanding of nature has been that it constitutes the inert raw materials upon which culture sets to work. This view of nature sees it as something to be overcome, transcended and, in the process, moulded, adapted and controlled. It is a view that privileges culture over nature, and sees human existence as necessarily a struggle against the primitive, impoverishing forces of nature. Of most interest in this model for my discussion of the natural in cosmetic surgery is the understanding of nature as representing a passive material which must necessarily be built upon, overcome or adapted. During the Enlightenment an alternative view of nature gained inﬂuence. This view elevated nature to the status of ideal model for culture, appealing to the natural as a pure and perfect blueprint for society,13 which itself could exhibit both positive and negative characteristics. In this view, nature was no longer to be denigrated; rather, it became an ideal condition not to be tampered with. Both of these models of nature can be said to share at least two assumptions. The ﬁrst is that nature is a self-evident, closed category that exists prior to culture, that demands no explanation and deﬁes historical change. The second model assumes that, as Grosz among others notes,

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women are somehow closer to nature than men.14 Gatens argues that within the modernist body politic, woman ‘becomes nature . . . she is the very ground which makes cultural life possible, yet she is not part of it’.15 Here, femininity is identiﬁed as the category against which culture is deﬁned; that is, particularly from the viewpoint of the body politic, culture is all that woman is not – rational and universal. Much recent feminist and postmodern theory would deny the distinction between nature and culture, and argue instead that nature is a culturally deﬁned category, the contents of which change over time.16 This tendency is demonstrated no more clearly than in the pages of this book, where nature adopts a stunning array of forms. In this chapter, I want to argue that the two traditional views of nature I have described above, nature as force to be overcome and nature as ideal model, dominate in the use of the natural in women’s magazine discussions of cosmetic surgery, and that even though these views differ and in some ways contradict each other, their shared assumptions feed into dominant dualist understandings of gender. Before I go on to examine the uses of nature in women’s magazines, I want to articulate an alternative position on the question of nature from which the limited options available within the material can be critically viewed. In looking at the repertoire of nature in discourse on cosmetic surgery, this book takes up Donna Haraway’s work. As I have noted, nature is commonly taken to be a self-evident category, the source of all origins including the body, and a resource from which humans can draw in order to create and sustain culture. In spite of this connection with culture, nature is understood in this view to occupy one side of a dichotomy, with culture on the other. This will be illustrated repeatedly throughout this chapter. Haraway’s position on nature is in some ways ambiguous and I will also clarify where there appear to be points of departure from her formulation in my approach. Haraway’s initial premise is the rejection of nature as origin and resource: ‘[w]e must ﬁnd another relationship to nature besides reiﬁcation and possession’.17 The reiﬁcation Haraway refers to is that which sees nature as a closed category, the contents of which are self-evident and remain stable over time. Nature is no longer an idea in this process of reiﬁcation but a set of objects, practices and places. In claiming possession of this set of objects, practices and places, human culture allows for the exploitation and even destruction of those elements classiﬁed as nature. This view of nature not only impacts on issues such as the environment but also on humans directly, in that ‘human nature’ is a powerful and politically contested concept. Haraway cites the Human Genome Project as an example of the ‘imperialising essences’ apparent in projects which assume and support notions of human nature.18 Even those environmental projects which enjoy popular support in an atmosphere characterised by fear of environmental destruction are liable to reproduce disabling reiﬁcations of nature. The idea of

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‘saving nature’ comes under criticism from Haraway here for its false boundary-making between culture and nature. Through this boundarymaking, notions of violation and transgression become attractive, reinforcing the related notions of ‘natural’ and ‘unnatural’. Certainly, as nature and culture are made to exist on two sides of a dichotomy, so are the natural and the unnatural. Haraway sees any appeal to the natural and the pure, no matter for what purpose, as unhelpful.19 This is certainly true, I would argue, in the case of cosmetic surgery, where the natural is not only found to be a very ﬂexible concept, applicable both to those who do undergo surgery and those who do not, but is used over and over to obscure what is most at stake in these procedures. Whether cosmetic surgery is ‘unnatural’ or not should matter less than whether it is dangerous, painful, time-consuming or expensive. Indeed, were it to become none of these, its unique status amongst cosmetic practices might be said to disappear. The natural is a concept that not only regulates through its compelling cultural weight, but also through the debates it obscures or precludes. One of Haraway’s central questions throughout Modest_Witness@Second_Millennium.FemaleMan©_Meets_OncoMouse TM reﬂects her awareness of this: ‘[w]hat counts as nature, for whom and at what cost?’20 These issues will emerge again and again throughout this book. In contrast to this view of nature as self-evident resource and possession, Haraway posits her own formulation of the natural, characterised by a ‘relentless artifactualism’.21 This artifactualism emphasises nature as inaccessible except through the lens of culture, and indeed, as shaped by culture itself. Nature is an intellectual commonplace, as well as a trope. As artifact, nature ‘is made, as both ﬁction and fact’.22 It is a discursive construction, produced through interactions between humans, animals and other nonhuman ‘actants’, such as equipment, chemicals, books or buildings (discussed later). Actants exert their own shaping force on the outcome of practices that involve them. This process is illustrated clearly through the range of material examined in this book. The recognition that nature is a culturally produced category, containing elements that shift over time and are themselves shaped, enabled and produced by humans is fundamental to the critique of nature utilised in the following chapters. In particular, the examination of scholarly feminist work on cosmetic surgery in Chapter 4 uses this understanding of nature to identify the ways in which feminists too have drawn upon notions of nature in their accounts and critiques. However, while this understanding of nature has been taken up keenly here, there are points of difference with Haraway’s model. These differences arise over the manner in which Haraway poses and resolves an important question related to the artifactual understanding of nature. Anticipating criticism over a view of nature that sees it as entirely produced by human culture, Haraway asks:

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[i]s the insistence that nature is artifactual not more evidence of the extremity of the violation of a nature outside and other to the arrogant ravages of our technophilic civilization, which, after all, we were taught began with the heliotropisms of enlightenment projects to dominate nature with blinding light focused by optical technology?23 Rightly, Haraway recognises that a claim to the cultural construction of nature could be read as yet another example of Enlightenment hubris. Elsewhere, she calls this the ‘nature of no nature’ and illustrates its risks through a reading of a textbook treatment of genetics, which places genetic engineering in the same category as hybridisation.24 In this example, the claim to the ‘unnaturalness’ of genetic engineering is refuted by comparison with a practice that humans have undertaken for centuries and that also occurs without any human participation. Thus, she argues that ‘the new nature of no nature gives back the limpid image of the world as engineered and engineering, as artifactual, as the domain of design, strategy, choice and intervention’. Doing away with the distinction between nature and culture serves here to further the interests of this controversial and problematic scientiﬁc project, and to further pose nature as passive. This is a problem that could apply equally to cosmetic surgery. In order to overcome the difﬁculties inherent in the double rejection of nature as it is conventionally understood and nature as a direct product of culture, Haraway utilises the notion of the ‘actant’. Actants are non-human objects, animals and phenomena that exert their own force in the production of nature, rather than being passive tools for human manipulation. Hence, regarding nature, Haraway states, ‘[i]n its scientiﬁc embodiments as well as in other forms, nature is made, but not entirely by humans; it is a co-construction among humans and non-humans’.25 Through this formulation, Haraway allows for the existence of a domain of nature, thereby refusing total creative agency and power to humans, at the same time that an artifactual aspect to nature is retained. Later in this book, particularly in Chapter 4, this formulation of nature will be taken up and adapted, for while Haraway retains nature as a category, this book rejects it altogether. Of course, Haraway’s concern – that without some notion of nature, a view of humanity as all-powerful and all-creative results – is an important one. At the same time, there are perhaps more choices than the two options presented in her article, ‘The Promises of Monsters’, from which her discussion is drawn. In deﬁning her own project, she states that ‘this will not be a tale of the rational progress of science, in potential league with progressive politics, patiently unveiling a grounding nature, nor will it be a demonstration of the social construction of science and nature that locates all agency ﬁrmly on the side of humanity’.26 Notwithstanding her commitment to a ‘relentless artifactualism’, Haraway’s argument seems to be that because nature cannot be completely produced, controlled and manipulated

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into any form (that is, because all agency cannot be attributed to humans), it cannot be considered fully artifactual. Implied here is a very strong deﬁnition of the artifact. Certainly, there are many (if not all) artifacts that cannot be produced or manipulated into any form. Cars and aeroplanes, for instance, are surely understood to be fully artifactual, though they cannot be made to run on any substance for fuel, made to cover any distance, to exceed any speeds and so forth. What renders them artifactual is that they are predominantly enabled, shaped and disposed of by humans. Given that it is now possible for humans to destroy all of the Earth’s ecosystems and organisms, to visualise and photograph all the Earth’s surface (as well as beneath it), to cultivate, map, traverse, lay waste to, protect, manage, buy and sell its every corner, it seems untenable to retain nature as a category and therefore somehow distinct from culture, based upon degrees of artifactualism. Where the absence of total ‘human authorship’ disallows the label of artifact, all culture must be categorised as nature. Nothing in culture is fully artifactual by this deﬁnition. Haraway’s views on nature are in some ways ambiguous. At times she seems to reject it altogether, thus, as I indicated earlier, she argues that ‘saving nature is, ﬁnally, a deadly project. It relies on perpetuating the structure of boundary violation and the falsely liberating frisson of transgression’,27 while at others, she retains a redeﬁned concept of nature. It may be that her view differs from mine only in the retention of the word ‘nature’ to describe what might equally be referred to as ‘matter’, for while humans can alter and manipulate matter, we are still essentially unable to create it. This point is made because in this book I reject the value of nature as a category, having traced its ubiquity in discourse on cosmetic surgery, its political ﬂexibility, its authority and its power to obscure and preclude important issues and debates. As later chapters will demonstrate, nature appears over and over as an inﬂuential substitute for other concepts. ‘Natural’ is a word that always replaces a complex of (often) less convincing, powerful or controllable ideas and issues. It is a rhetorical device, where its power to persuade is frequently taken for granted, indeed, relied upon. Even where it is taken up for the purposes of persuasion to a ‘progressive’ or ‘radical’ viewpoint, its limitations, implications and consequences mean it is a blunt (and dangerous) instrument. I am certain that if notions of nature were somehow prohibited from such discussions, their shape and content would perforce become more complex and speciﬁc. Despite this difference of opinion, other aspects of Haraway’s work on nature appeal to me greatly, including her notion of articulation, which bears some resemblance to that of Deleuze and Guattari, and Hall.28 Haraway chooses articulation over representation as the most useful and ethically sound means of ﬁguring political action. To articulate is ‘to signify . . . to put things together’.29 Like Deleuze and Guattari’s articulation, which refers to the connection of nodes upon a surface, Haraway’s version is also about the

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forging of connections rather than about one thing (group, individual) standing in for, or speaking for another. Articulation ‘is always a noninnocent, contestable practice; the partners are never set once and for all. There is no ventriloquism here’.30 It is Haraway’s emphasis on ﬂexibility and contingency that relates most closely to the argument I want to make in this book about the uses of nature in discourse, and indeed about all three of my repertoires. While important consistencies regarding questions of nature, agency and vanity emerge repeatedly throughout this examination, these are often achieved through the most unpredictable and temporary of articulations. Both strong connections and sudden or distinct disjunctures are found. Hence, an ‘articulated world has an undecidable number of modes and sites where connections can be made . . . unlike things can be joined – and like things can be broken apart’.31 This understanding of articulation informs the processes by which connections and fragmentations are recognised in this project. In the following section, I will examine some of the articulations the notion of nature makes with magazine representations of cosmetic surgery. A more natural look As I have suggested, nature functions as an uninterrogated foundational category in popular culture discussions of cosmetic surgery, revealing a ﬂexible yet eminently disciplinary capacity.32 This can be seen in three main ideas that appear repeatedly in women’s magazines. The ﬁrst rests on recurrent discussion of the ‘natural look’. This notion is mobilised in order to distinguish between good and bad cosmetic surgery (in that good cosmetic surgery succeeds in achieving the ‘natural look’) and also in order to criticise cosmetic surgery altogether, by arguing that in contrast to surgically altered appearances, the natural look is better. Many articles refer to procedures as having achieved an ability to produce a more natural-looking result: A skilled surgeon will make sure you retain a natural-looking hairline.33 Face-lifts are now more natural and longer lasting than earlier operations in the seventies.34 They are the best results I’ve looked at so far, the results are extremely natural.35 At the same time, a ‘more natural look’ is often cited as grounds for rejecting cosmetic surgery entirely: I think the natural look is far better.36 If women were meant to look like Barbie, we would have been born that way.37

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The ‘natural look’ is rarely deﬁned within these articles – instead, it is taken to be self-evident. What this notion also assumes is the dual importance of manipulating or altering one’s appearance whilst ensuring that evidence of this process is minimised. Sander Gilman’s history of aesthetic surgery makes an argument for the origins of cosmetic procedures in the treatment of the ‘syphilitic nose’ and as such provides one way of understanding the centrality of a natural result to the considered success of any cosmetic procedure. Where the surgery seeks to redress damage caused by a disease understood to be a marker of immorality and degeneracy in the sufferer, repair without trace of the process of repair holds a high value.38 In a more general sense, this repertoire of the natural deﬁnes nature as that which cannot be detected; it represents an order of existence almost beyond conscious perception as it is positioned as the very condition of our own existence, our own consciousness (that is, we ourselves are the products of nature). Nature is something we have to stop and force ourselves to notice; it is that which does not push itself on our awareness. Because the natural must be that which is beyond conscious reﬂection, it is also one of the most most ideological of categories. From this point of view, that which is nontraditional, that which is novel or which attracts our attention is vulnerable to being cast as ‘unnatural’. As feminists have noted in their criticisms of essentialism, this version of nature can be deployed as a disciplinary strategy against women, providing grounds for the condemnation of nontraditional behaviour, such as the rejection of reproduction. Here, the risks of retaining the category of nature are clear. As I argue later, cosmetic surgery is bound up in contemporary portrayals of individual agency and more crudely, freedom of choice. However, the commitment to this notion of the natural that much discourse around cosmetic surgery exhibits suggests that cosmetic surgery can function to circumscribe choice by subscribing to the validity of the natural – dictating that which is natural and therefore acceptable. Certainly, clear limits are placed upon what kinds of surgery are available and who may undergo them. The artist Orlan, for instance, has been subjected to questions relating to her sanity and to the ‘morality’ of her project as a result of the volume of surgery she has undergone and the ‘unnatural’ results obtained in some of these procedures.39 From this point of view, the status of texts as either for or against cosmetic surgery is often irrelevant to their role in reproducing traditional notions such as the value of the natural. This will become particularly clear when feminist material is examined in Chapter 4. As I demonstrate, material which critiques the practice of cosmetic surgery is as likely as material which supports it, to invoke the natural and its implications.

What your DNA doled out Central to mobilisations of the natural in women’s magazines is the contemporary preoccupation with genetics as the origin of all aspects of bodily

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form and function.40 As Dorothy Nelkin and Susan Lindee note, ‘[n]arratives of genetic essentialism are omnipresent in popular culture, here explaining evil and predicting destiny, there justifying institutional decisions. They reverberate in the public debates about sexuality and race, in court decisions about child custody and criminal responsibility, and in ruminations about the meaning of life.’41 Through the invocation of genetics, cosmetic surgery comes to symbolise culture in opposition to nature, which is represented by genetic determinism. This notion is signiﬁcant in that it assumes an unproblematic duality between what nature (genes) ‘gives’ us and what culture (cosmetic surgery) makes possible. Genetic determinism is set up in opposition to the possibilities of cosmetic surgery and is appealed to as a kind of ethical and physical limit, both by advocates and by critics of cosmetic surgery. On the one hand, an article describing the future of the human body in positive terms predicts that ‘human ingenuity will more than make up for the reduced inﬂuence of natural selection’,42 while another piece, discussing a woman who has undergone multiple operations, comments: ‘[s]he doesn’t accept for a moment that there are millions of ordinary-looking women out there, content with their chromosomal lot, happy to enhance it with cosmetics alone’.43 In an article about men who undergo cosmetic surgery, we are told that for some men, ‘the reason for tampering with what their DNA doled out has to do with sex and performance’,44 and that for many, ‘giving Mother Nature a helping hand’ through surgery is easier than sweating at the gym. Here, the equivalence assumed between nature and genetics is clear. The scientiﬁc role, to investigate and ‘master’ the static, passive ‘encyclopaedia’ of the chromosome, is an example of what Haraway refers to when she argues that the category of the natural provides the justiﬁcation for science. Paul Rabinow describes the Human Genome Project in similar terms: the object to be known – the human genome – will be known in such a way that it can be changed. This dimension is thoroughly modern; one could even say that it instantiates the deﬁnition of modern rationality. Representing and intervening, knowledge and power, understanding and reform, are built in from the start, as simultaneous goals and means.45 In talking about human bodies as the products of nature in the form of genetic determination, women’s magazines participate in the construction of the body as the logical object for scientiﬁc intervention (along the lines of the view of science as deﬁned against nature that I elaborated earlier). Further, this body, now passive, awaiting the touch of the master, in need of control, is unmistakably gendered in the feminine.46 I have already suggested that the feminine and the natural occupy one side of a set of binarisms. This side also includes passivity and the body. How these concepts mesh together and reinforce each other in the case of cosmetic surgery is

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apparent in a variety of articles. When, in one article, a surgeon lightheartedly but apparently not ironically refers to model Elle McPherson’s body as ‘terriﬁc raw material’47 he immediately positions that body in terms of a passive natural resource, to be mined, utilised, developed: its potential unrealised in its current state. When another article states that ‘[y]our cosmetic surgeon will leave his mark on you for the rest of your life’,48 this sense of the body as passive terrain is echoed. Reinforcing this is the clear distinction drawn in terms of agency between the surgeon and the recipient. As I will explain later, men’s participation in cosmetic surgery tends to be represented in terms that play down any imputation of femininity by emphasising agency and decisions made from positions of strength, though again, this is not a universal strategy. The function of cosmetic surgery discourse as a technology of gender is clear here. The use of genetics to characterise the (usually female) body reinscribes that body as passive and somehow outside culture prior to the imprint of cosmetic surgery. It is the surgeon (unfailingly characterised as male) who can ‘defy’ nature by altering the body, and by implication the subject herself. In some cases, women are portrayed as their own ‘creators’ in this process, and a discussion of the notion of agency will follow later in this chapter. What is constant, however, is the presence of the surgeon as benign paternal authority ﬁgured beside the female participant. A broader formulation of the natural body is also invoked repeatedly in discussions about cosmetic surgery. One article asks: ‘Look what Marilyn Monroe started . . . but is it natural?’49 while another, openly feminist, piece contrasts the undesirability of surgery with beauty measures described in an article entitled ‘The Body Beautiful (naturally)’.50 This article cites Madonna as an example of natural beauty, recommending her daily physical training and strict diet as a natural, more moderate approach to modifying the appearance. In this instance, the distinction between the natural and the cultural is revealed to be arbitrary at best. Where surgery differs from extreme ﬁtness and diet regimes in supposedly circumventing genetic makeup is obscure, although one signiﬁcant difference between surgery and exercise is that surgery requires a surgeon, whereas exercise, at least theoretically, requires no agent other than the subject her- or himself. Although the article does not spell this out, it may be that it is the possibility of dispensing with the surgeon and the patriarchal authority ‘he’ represents that renders Madonna’s option preferable. This makes sense, though it is obviously unrelated to the arguments raised about the ‘unnaturalness’ of surgery. Here, as elsewhere, appeals to nature stand in for other (often more tenable) objections. Whether this is merely a function of imprecise argumentation or of conscious decisions about the persuasive power of different arguments is, of course, unclear. What is clear is that feminist approaches which make their way into magazine culture do not necessarily escape the same appeal to the natural that characterises the rest of the material. In Chapter 4 I elaborate

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on this observation by looking at scholarly feminist treatments of cosmetic surgery to argue that a similar appeal to the natural frequently emerges there. Growing old gracefully The notion of ‘growing old gracefully’ is another common nature repertoire present in these discussions of cosmetic surgery. Again, this term is used both to justify and reject the use of surgery. On the one hand, it is argued that procedures such as facelifts, chemical peels and liposuction can assist us in growing old gracefully. On the other, growing old gracefully means refusing to tamper surgically with the evidence of ageing. The latter approach is frequently presented as the more natural option, as if other practices, such as hair dyeing, clothing selection or make-up are somehow more natural than surgery. Statements such as ‘I think you should just grow old gracefully’51 and ‘[s]houldn’t people simply grow old gracefully?’52 pepper less enthusiastic discussions on the value of cosmetic surgery, and are remarkable in their faith in the self-evident quality of the natural alternative. Where the results of surgery are such that it is obvious procedures have been undergone, ‘growing old gracefully’ refers to a conviction that desiring a youthful appearance is undigniﬁed and a sign of immaturity inappropriate to the (still) obvious mature age of the recipient. While Gilman looks to the history of the medical pursuit of ‘rejuvenation’ to support his argument that cosmetic surgery is both originally and in the present substantially ungendered, it is clear that youthfulness remains a primarily feminine area of concern. Throughout this examination of women’s magazines, and that of the medical and regulatory material presented later, women are almost overwhelmingly represented as the appropriate recipients of youth-oriented procedures such as facelifts, eyelid surgery and skin resurfacing. Equally, breast augmentation and reduction can be interpreted along these lines as methods of reproducing a youthful body complete with ﬁrm, high breasts. While some advertising and other material related to the promotion of a youthful appearance is also directed at men (particularly, as I will show later, as a form of career investment) this remains a relatively small proportion of the total material produced. Not only does magazine discourse on cosmetic surgery act as a technology of gender by representing a passive female body, but it designates the ideal body/subject as – at least apparently – youthful. Here, appropriate femininity has two forms; ﬁrst and ideally, youthful, and second, when youth is no longer possible, committed to the pursuit of a youthful appearance as an endorsement of youth as the ideal manifestation of femininity. Built into cosmetic surgery as represented in women’s magazines is a version of femininity that is characterised by obsession with youth and indeed, by preoccupation with inadequacy. In other words, femininity is not only associated with youthfulness, but also with the very state of desiring lost youth. The ﬁrst and most common use

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of the repertoire of ‘growing old gracefully’ relates to this model of femininity by arguing that the role of the feminine is to resist age, however ineffectually. Along these lines, the reverse use of the repertoire of ‘growing old gracefully’, where women are advised to allow ‘nature to take its course’ and to accept the signs of age, is one which expresses a familiar conviction that the older woman is no longer fully feminine and as such, the pursuit of feminine concerns such as beauty (deﬁned here as youth) are no longer appropriate. Clearly, this response is as limiting and disciplinary as the ﬁrst. It seems that where the natural is mobilised as a means of interpreting and directing behaviour, binary arguments based on the natural/unnatural divide tend to arise. The results of these arguments are often unsatisfactory, and indicate that any contemporary feminist critique of cosmetic surgery would do well to avoid simple arguments grounded in appeals to nature. Earlier I suggested that two major approaches to nature can be found within popular culture discourse on cosmetic surgery. The ﬁrst approach sees nature as a primitive phenomenon to be contained, moulded, and improved upon, while the second argues that nature is the ideal to which culture should aspire. As I noted, these approaches can be identiﬁed within both positive and negative discussions of cosmetic surgery, where the latter view is offered as an explanation for why cosmetic surgery is undesirable, and the former is employed to justify its use. I also noted that both understandings of nature cast it as a passive, self-evident category which does not change over time. Because nature and the feminine have been closely associated throughout the history of Western thought (along with the body, as I suggested above) I would argue that this continual invocation of the natural succeeds in feminising cosmetic surgery within these publications, even where the explicit intention is to discourage women from participating in it. Where the natural carries many of the same implications as the feminine, a view of women as the passive objects of scientiﬁc/medical intervention persists, and cohabits easily with important aspects of cosmetic surgery. It is considerations such as these that, despite Haraway’s reservations, lead me to reject the category of nature altogether. This is not to say that men do not participate in cosmetic surgery. As I indicated earlier, men are indeed targeted on occasion. Some statistics suggest an increasing level of participation amongst men. I would argue, however, that women’s magazines tend to treat women’s use of surgery as an extension of their normal wish to be beautiful, while they represent men as moving out of ‘normal’ male behaviour in doing the same. This view is often communicated by the positioning of stories about male surgery as small addenda to ‘general’ articles about cosmetic surgery, and by looking in great depth at a man’s story and at the reasons why he underwent surgery. Almost all the (quite rare) articles on surgery for men I found deal with penis extensions and were written in a style which added to a sense of male recip-

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ients as occupying a novel or bizarre status. No articles on men that I came across dealt with the more prosaic and common procedures such as hair transplant surgery or dental surgery, although some addenda discussed chest and calf implants and liposuction. While surgery is represented as, in some ways, the ‘norm’ for femininity, it tends to be positioned as the exception for masculinity. The role of cosmetic surgery as a technology of gender emerges quite powerfully here. In presenting these articles and advertisements, women’s magazines provide gender representations that position women as preoccupied with their appearance and with youth at the same time that they are suitably subject to the benign authority of the surgeon. This pattern does not mean that contradiction is absent altogether from these texts – it certainly is not, particularly where the validity of surgery itself is debated. There is one pattern, however, for which I found no exceptions: the constant, uncritical use of the repertoire of nature to authorise both favourable and critical positions. Ultimately, its effect is to feminise cosmetic surgery. As femininity and nature are linked within dominant Western sexual imaginaries, it is unsurprising that nature re-emerges within this relatively recent debate. The sexual imaginary, in its traditional alignment of femininity with nature and with passivity has functioned here to provide a resource for discussing cosmetic surgery (as it did for the development of the surgical procedures themselves). As such, this discussion contributes little that may be regarded as ‘new’ in the production of gender, by which I mean that cosmetic surgery discourse which uses the repertoire of nature tends to reiterate very familiar notions of femininity. Only a critical and original look at nature itself would afford innovative constructions of femininity in this context. In any case it is not ‘originality’ that is anticipated here. If anything, the ‘new’ can be deﬁned in terms of new articulations and machinic assemblages, such as those found in the potentially problematic articulations formed between notions of cosmetic surgery, autonomy and femininity in women’s magazines.

Agency In this section I look at the ways women and men are positioned in terms of agency in women’s magazine discourse on cosmetic surgery. While many of what I identify as statements around the theme of agency are made by the recipients themselves, it will be clear from earlier discussions that I do not wish to treat these statements as a ‘real’ insight into cosmetic surgery and its participants. Instead, these comments and the articles they are drawn from are indicators of magazine culture; of magazine production of cosmetic surgery and of people, not of ‘real’ people themselves. My interest is in how women’s magazines represent and construct people, so I am not positioning magazines as a reliable means of accessing how people ‘really’ feel, even

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in general terms. As I established in the introduction, my interest is in surface investigations: on the ways the material utilises repertoires as the means of producing culturally coherent positions, rather than underlying truths or realities. The question of agency is central to this issue. Much feminist research into cosmetic surgery has used the utterances of recipients as a means of access to the ‘real’ reasons why women undergo surgery. From this starting point, debates about the relative agency or victimhood of recipients arise. In treating discussions about motives as to some extent reliant on the range of linguistic repertoires available to individuals, however, comparisons such as this are no longer appropriate. Equally, judgements about the ‘authenticity’ of certain statements or motives are irrelevant, as what becomes interesting is the type and range of repertoires available to the individual, the options or models for producing the self, and what these repertoires indicate about gender and culture. Where language is seen as a means of producing a viable subject rather than expressing an originary one, attempting to excavate any prior subject with prior motives for language use does not make sense. The originary subject eschewed here would more properly operate at the centre of a modernist, humanist project. Feminist53 and postmodernist scholarship have taken up the issue of agency vigorously in recent years. Similarly, sociology has long concerned itself with debates over the relationship between ‘individual and society’54 or ‘structure and social action’.55 Within sociology, Marxist understandings of the individual as an agent acting within structural constraints have been important. At the same time, social action approaches such as those advocated by Weber, which see society as created through human action (and thus downplay the view that social structures constrain the individual) have also been central. Some of feminism’s early ‘second-wave’ platforms tended to reﬂect structuralist concerns by positioning women as the helpless victims of patriarchy. However, debate within feminist circles and an appropriation of Foucault’s work56 have meant that interest has developed around redeﬁning power in terms that focus on its productive function rather than its repressive function. This view sees power as a network which runs through every individual, as produced and reproduced in day-to-day practices, rather than as possessed and guaranteed by any particular individual or group. Here, de Lauretis’ notion of technologies of gender is particularly relevant as it draws on Foucault’s view of power as ubiquitous, and recognises that relations of power are mutually constitutive rather than simply one-way. As I argued in Chapter 1, her recognition of gender as representation and selfrepresentation is a means of accounting for power that both acts on and is enacted in the process of producing the individual. Within feminist discussions of cosmetic surgery, the question of agency is conceptualised through a continuum which places passive victimhood at one end and autonomous individualism on the other. Some feminist work such as Germaine Greer’s The Whole Woman57 offers an account of cosmetic

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surgery that leans heavily toward the former end, while other studies, like Kathy Davis’s important Reshaping the Female Body,58 focus on an individual agency more in keeping with the latter. What all of these works share, and what this book seeks to depart from, is a view of agency as inhering in the individual. Using Nikolas Rose’s Inventing Our Selves, this section will look more closely at this idea, locating our current understandings of the self and agency in relation to modern forms of liberal democratic government. In order to adopt a critical perspective on the use of agency repertoires with women’s magazines and other texts, I explore agency using the alternative model found in Rose’s study of the emergence and development of the ‘psy’ disciplines in the West. Rose regards the psy disciplines as historically interconnected with the injunctions of liberal democracy toward making ‘a project of our own identity’.59 By following this move, this section also draws connections between cosmetic surgery, psychology and liberal democracy. As this book goes on to demonstrate, the psy disciplines – psychology in particular – are central to contemporary portrayals of cosmetic surgery as therapeutic and therefore medically valid. This link between cosmetic surgery, psy and liberal democratic forms of government provides one way in which to understand the spectacular increase in popularity of cosmetic surgery during the twentieth century. The modern Western version of the self has been described by Clifford Geertz in the following terms: [t]he Western conception of the person as a bounded, unique, more or less integrated motivational and cognitive universe, a dynamic center of awareness, emotion, judgement and action, organised into a distinctive whole and set contrastively against other wholes and against a social and natural background is, however incorrigible it may seem to us, a rather peculiar idea within the context of the world’s cultures.60 The view Geertz describes here is no less incorrigible in the work of feminist writers than in any other context. This is partly the case because the attribution of agency and selfhood to women has been central to their acquisition of legal and political rights. Indeed, among some feminist scholars, poststructuralist deconstructions of the uniﬁed, bounded subject have been greeted with suspicion. Why deconstruct the very subject women have only recently laid claim to? There is no doubt that the taking up of what might be seen as a classically masculine subject/citizen by feminists has many uses and should not be eschewed as a matter of principle. It is important, however, to remember that this account of the subject is only one of many; that along with its advantages, it also carries limitations. Both these advantages and limitations will ﬁnd examples in the material examined in later chapters. In general, however, it is possible to argue that the kind of agent constructed since the Enlightenment and recently challenged by theorists

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such as Deleuze and Guattari, and Foucault,61 has made possible, and drawn upon, both the psy disciplines and cosmetic surgery. Rose introduces the idea of the interconnectedness of psy and contemporary governmentality when he states that ‘[t]he history of psy . . . is intrinsically linked to the history of government’.62 Rose links the psy disciplines with an autonomisation of the self, and identiﬁes a similar reﬂex within Western liberal government. Individualism beneﬁts democratic forms of government in that it represents subjectiﬁcation as essentially voluntary and self-deﬁned. Rose argues that ‘[t]he forms of freedom we inhabit today are intrinsically bound to a regime of subjectiﬁcation in which subjects are not merely “free to choose” but obliged to be free, to understand and enact their lives in terms of choice under conditions that systematically limit the capacities of so many to shape their own destinies.’63 In other words, the view of the subject as autonomous and self-contained not only allows for accounts of behaviour that privilege individual decision-making, action and reward, but demand it. In this way, the individual, while able to claim any successes as his or her achievement alone, must likewise claim all failures. In passing on responsibility for success to the individual, governments are also able to pass on responsibility for ﬂaws, disappointments, absences and lacks – for instance, the inability to ﬁnd paid work, to obtain higher education or to maintain a certain standard of living. This formulation of responsibilities is by no means seamlessly expressed within culture, and indeed, Chapter 5 demonstrates that it is possible to produce versions of individual responsibility that allow for the retention of external authority over the individual (the doctor) at the same time that responsibility for failures (surgical) substantially accrue to the individual patient. Still, there is no difﬁculty in recognising the prevalence of these notions of individual responsibility and agency within contemporary culture. As Rose puts it: ‘[t]he healthy self is to be “free to choose”. But in embracing such an ethic of psychological health construed in terms of autonomy we are condemned to make a project out of our own identity and we have become bound to the powers of expertise.’64 Rose identiﬁes the psy disciplines as one of the technologies of the self that construct and distribute the above notions of individual power and agency within the framework of expertise. In describing technologies of the self, Rose refers to technologies in this way; [h]uman technologies produce and enframe humans as certain kinds of being whose existence is simultaneously capacitated and governed by their organization within a technological ﬁeld.65 This deﬁnition of human technologies relates equally well to the psy disciplines and to cosmetic surgery. In Chapter 1, de Lauretis’ work on technologies of gender was examined in detail. This understanding of human

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technologies can be recognised within de Lauretis’ argument, although of course, in de Lauretis’ account, human technologies are displaced in favour of explicitly gendered ones. Rose sees our sense of ourselves, our capacities and our freedoms as produced through these technologies. This is not a process of suppression but of production. Therefore, his project is not one that focuses on ‘lamenting the ways in which our autonomy is suppressed by the state’, but on examining how the subject has been taken up as the target and resource for regulation.66 Rose argues that current forms of regulation are shaped around a notion of the self as ‘enterprising’; as the improvable, transformable object of psy practices of ‘self-help’.67 This enterprising self ﬁnds countless echoes in each discourse on cosmetic surgery examined here and in later chapters, such as in repertoires of risk/beneﬁt analysis and ‘doing it for oneself’. Rose deﬁnes enterprise in the following way: ‘[t]he enterprising self will make an enterprise of its life, seek to maximise its own human capital, project itself a future, and seek to shape itself in order to become that which it wishes to be.’ This account mirrors many feminist, medical, regulatory and magazine accounts of the surgical subject. Not only do such ideas of the enterprising self ﬁnd expression in these discourses, thereby implying links to the psy disciplines, but the role of the psy disciplines in cosmetic surgery is also overtly expressed, particularly within medical and regulatory material. Rose describes psychology as a generous discipline, by which he means that it ‘enters into alliance with . . . agents of social authority, colonizing their ways of calculating and arguing with psychological vocabularies, reformulating their ways of explaining their normality and pathology in psychological terms, giving their techniques a psychological coloration’.68 This deﬁnition is highly relevant to cosmetic surgery. As Sander Gilman argues in both his works on cosmetic surgery, notions of happiness and psychological well-being were, from the late nineteenth century onwards, marshalled as justiﬁcations for cosmetic surgical intervention.69 He lists a number of ways in which cosmetic surgery practice parallels those of the psy disciplines. First, he argues that the logic of cosmetic surgery draws upon, but directly inverts, that of orthodox psychoanalysis on the question of the role of the body. Psychoanalysis sees mental discomfort as expressed in physical symptoms, while the aesthetic surgeon sees mental discomfort as a product of the physical body. Second, in both psychoanalysis and cosmetic surgery, the patient undertakes selfdiagnosis and proposes the form of treatment to the doctor. Third, both psychoanalysis and cosmetic surgery require from the patient what Gilman calls a ‘complete narrative’ of the illness and its solution as a means of indicating basic mental health and thus suitability for treatment. Lastly, in cosmetic surgery, the ‘difﬁcult patient’ places the surgeon in the role of the psychiatrist. These comparisons are by no means unproblematic. For instance, in many cases, self-diagnosis is often augmented by diagnosis on the part of the

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surgeon or clinic employee as to what operations should be undertaken. Indeed, at the NSW HCCC Inquiry into Cosmetic Surgery, some agreement was expressed on the idea that it is the surgeon’s (and even the general practitioner’s) role to identify and make clear to the patient cosmetic features that may be impacting on well-being and therefore require treatment.70 However, the link between cosmetic surgery and the logic and language of the psy disciplines is amply documented in Gilman’s Creating Beauty to Cure the Soul and in the material examined in this book. What this connection makes clear, then, is twofold. While Rose helps us to understand that the language and concepts of twentieth-century psy are profoundly linked to contemporary forms of liberal democratic government, Gilman’s work demonstrates a further link between these psy disciplines and cosmetic surgery. Each of the three arenas of government, psy and cosmetic surgery makes possible its counterparts, although the individualist forms of government produced by Enlightenment liberal politics have probably played the deﬁning role. In this way, cosmetic surgery can be seen as the (partial) product of the kind of agent introduced during the Enlightenment, and as such, its theory and practice contribute to a cultural and political milieu in which those liberal democratic values and logics can thrive. This is most poignantly demonstrated in a message frequently repeated throughout the material examined in this book: collective change is impossible or unnecessary, but individual change to accommodate existing conditions is an adequate alternative and even a badge of pride. Clearly, where understandings of the subject and of agency engender such notions, alternatives need to be considered. As I have noted, the versions of agency described above are not without value. At the same time, it is important to recognise other possibilities, both to denaturalise our current versions and to analyse and potentially dismantle some of their negative effects. In relation to processes of subjectiﬁcation, Rose states that they should be located within ‘a complex of apparatuses, practices, machinations and assemblages within which human being has been fabricated, and which presuppose and enjoin particular relations with ourselves’.71 Where the subject is deﬁned as a cultural product, attributes of the subject such as agency are properly understood as cultural as well. This statement is an initial step towards relocating agency as external to the individual at the same time that it suggests another equally important point: that the subject is, in any case, a fragmentary, nonuniﬁed one. Rose argues that individual subjects ‘live their lives in a constant movement across different practices that subjectify them in different ways. Within these different practices, persons are addressed as different sorts of human being, acted upon as if they were different sorts of human being’.72 The recognition that the subject is not only culturally produced in complex ways but is ﬂeeting and fragmentary, is crucial for a politics that seeks to avoid a reiﬁcation of the subject that can occur even where ‘cultural construction’ is assumed. The cultural subject,

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reconsidered, does not exercise an agency implanted by culture and which she or he now possesses, rather it is produced through those forms of agency available at any given moment. This is particularly apparent in the case of cosmetic surgery where forms of agency vary signiﬁcantly in terms of availability and efﬁcacy across a range of contexts. As later chapters show, types of agency available within feminist discourse differ from those available in regulatory discourse, and so forth. Although the subject can be theorised as fragmentary, one effect of the processes of subjectiﬁcation is a subject that is experienced as stable. Rose argues that the stable subject is an effect of a range of assemblages of all sorts, involving language, practices, technologies and other phenomena: it is more effect than origin, as is individual agency. To illustrate his point, Rose lists ‘ﬁghting subjects in the machines of war, laboring subjects in the machines of work, desiring subjects in the machines of passion, responsible subjects in the diverse machines of morality’.73 A similar observation can be made about the ‘machines’ of women’s magazines, feminist scholarship, medicine and regulatory practice, all of which can be seen to produce cosmetic surgery participants as different kinds of subjects. Within each machine, agency is produced differently, although a central understanding of agency as internal persists. Given that debates over women’s roles in the growth of cosmetic surgery and in the outcomes of individual procedures tend to be constrained by the assumption that only two options exist, agency and victimhood, Rose’s formulation offers an intriguing alternative. His approach is useful, then, in three ways: 1. It rejects Enlightenment views of the subject which are implicit in the production of both the psy disciplines and cosmetic surgery. This allows for an approach in this book which does not analyse cosmetic surgery through the very concepts that enable its existence. 2. It offers an alternative to the oft-debated dilemma of women’s ‘real’ role as victims or agents in relation to undergoing cosmetic surgery. 3. It provides a means of also overcoming the political risks involved in choosing between identities of agent and victim for women, identities that each carry speciﬁc disadvantages in regulatory and other contexts (as will be illustrated later). Agency repertoires74 (like those around nature or vanity) offer a lens through which this book’s two main lines of inquiry can be pursued. First, they can be analysed to provide insights into how notions of gender are changing in relation to cosmetic surgery. Second, they can be mapped in order to build an argument that complicates contemporary assumptions about the polysemic character of popular culture. How varied are the agency repertoires found in cosmetic surgery discourse? To argue convincingly that media texts can be read ‘against the grain’ (against the overt intentions

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expressed in those texts) resources for alternative viewpoints must be shown to exist. Are alternative viewpoints on central questions such as the meaning of nature or the location of agency present in these discourses? I consider this issue below. Perhaps the most frequently encountered approach to agency found in magazine articles is the construction of the agency of women as exempliﬁed through their use of cosmetic surgery. In this view, women’s use of cosmetic surgery to negotiate personal and professional relationships is cited as a form of agency. It is presented as a kind of ‘practice of the self’ through which the individual, along the lines of Foucault’s model, establishes an ethical relationship with her- or himself in the process of self-governance.75 In contrast, cosmetic surgery is also often represented within women’s magazines as suspect, illegitimate and dangerous. In some cases a woman’s willingness to undergo surgery is presented as evidence that she may be psychologically disordered, or, more simply, that she has been fooled into believing that her body is inadequate or unsightly and that her life will be signiﬁcantly improved by surgery. Here, the woman is constructed as lacking precisely that ethical relationship to herself that would allow for a conscious reﬂection upon her desires and conduct. This view is often argued in articles that adopt a feminist tone and, sometimes underpins the terms in which recipients themselves construct their own motives in both feminist and other pieces. A very good investment Often cosmetic surgery is posed as part of every career woman’s repertoire of tools for achieving success, and as such, its use is cast as a sign of empowerment, ambition and freedom. Within this model, no particular surgical procedures are posed as most appropriate to the pursuit of professional success. While facelifts, collagen injections and skin treatments such as dermabrasion are considered to be useful rejuvenating procedures, liposuction, rhinoplasty and breast augmentation are seen as improving a woman’s general appeal, and so her career prospects and even her job performance. This approach to cosmetic surgery assumes that a woman can (and even should) control her professional destiny by controlling or manipulating her appearance. Here, the obligation to make an enterprise of the self is clearly constructed. So for example, we read: For most actresses whose faces are their fortune, remodelling is not just vanity, it is a career move.76 In a world where good looks often equal success, some executives are heading for the cosmetic surgeon in a bid to score the top jobs.77 This time it’s for my career . . . as I am expected to look a certain way.78

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In the time it takes your colleagues to polish off that third beer, you’ll be returning to your desk with the buffed, pore-tightened face of a child.79 But all [recipients] essentially want to improve self-esteem and this enables them to function effectively in their careers. In this sense, cosmetic surgery is a very good investment.80 These statements echo a longstanding stereotype in which it is acceptable that women compete and are judged on the basis of their appearance. Perhaps one innovation these statements effect, however, is the location of competitiveness in the realm of careers, as well as in the traditional realm of romantic relationships. Nevertheless, by promoting this method of competition in the workplace, magazines construct another familiar form of femininity, one open to the imputation that career success has been achieved through illegitimate means.81 Other articles take a rather different approach to this issue, positioning the recipient as a negotiator of circumstances beyond her control. From this point of view, women are conscious of the unjust demands placed upon them in the workplace, but choose to meet these demands in order to accrue beneﬁts. One woman states: It irked me that men are so caught up with what you look like but I had a ﬁnancial interest in ﬁxing my appearance . . . On one level, I abhor the fact that I’m batting my eyelashes to get the sales when it’s my brain I should be using. On the other hand, it worked. I’ve never been better off.82 Elsewhere, a woman argues that ‘I didn’t make the rules – they were already in place when I was growing up . . . I just want to play the game to the best of my ability and come out a winner.’83 In this case, agency inheres in the process of negotiating values that are seen to be immutable and beyond the individual’s power to change or reject. As suggested earlier, the possibility of collective change is rejected here in favour of resignation to individual forms of negotiation and compromise. Working on the self, rendering oneself an enterprise, is emphasised. Interestingly, ﬁnancial gain is often posed in the material as a more legitimate explanation for undergoing surgery than ‘vanity’ alone, and it may be that this indicates a change in the way femininity is constructed in culture, in that beauty has traditionally been presented as a means of acquiring attention from men, and a loving relationship, rather than direct material gain. The representation of interest in money and success instead of love as legitimate suggests that certain feminist values such as ﬁnancial independence are readily used in contemporary popular culture discussions of cosmetic surgery, and that conventional femininity as represented within these pages may in some ways be expanding to include this range of personal goals. In

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the chapter on feminist discourse on cosmetic surgery, I will take up this question.

Doing it for me Another common agency repertoire utilised in magazine articles on cosmetic surgery is the assertion that women have become recipients not for the sake of their partners, but for their own self-respect and happiness. Many of the articles I examined discuss surgery in terms of the individual’s right to make changes that improve her own well-being. As such, these pieces directly challenge assumptions that women undertake surgery as a result of pressure from partners. An extreme example of this approach can be found in an article detailing the breast implant surgery of British television celebrity and ex-wife of rock musician Bob Geldof, the late Paula Yates. The introductory text states that: [i]t was a symbolic act for 36-year-old Paula. During her nineteen years with Bob Geldof, she was tortured by deep-rooted insecurity about her less-than-spectacular bust. She felt unfeminine and longed for a womanly cleavage. But Bob – whom Paula has described as a ‘control freak’ – sneered at cosmetic surgery and put a ban on any such plans.84 Here, the power of the husband to ban certain activities is contrasted with the image of Yates as ‘tortured’ and ‘longing’. Yates is the victim until her marriage dissolves. At this point, cosmetic surgery becomes a means of asserting a new independence and strength of character: ‘[n]o sooner had Paula broken free of the marital shackles than she was on the phone to a plastic surgeon’.85 Indeed, Yates is reported as saying, ‘Bob wouldn’t let me have the operation, but after I left I felt free to do as I pleased.’86 A number of magazine interviews with women cosmetic surgery recipients emphasise this same sense of empowerment in undergoing surgical procedures in spite of resistance from those around them. In some cases, the value of undergoing cosmetic surgery is explicitly linked to the sense that such surgery must be for oneself alone, and not to please others. Thus one woman states: It’s been great for my self-esteem and conﬁdence and I couldn’t recommend it enough for anyone wanting it. It’s got to be done for yourself. Don’t do it for a partner.87 However, in an indication of how contradictory many articles can be, this statement is made within a piece that is based around a football commentator and his evaluations of the breasts of ﬁlm stars. While one aspect of the article suggests that the opinions of others are insigniﬁcant, another

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privileges the views of a man on his preference for a certain kind of female breast. The degree to which women (or men) make autonomous decisions about such a public aspect of the self as appearance is in some ways an incoherent question. The undeniable status of appearance as social belies the possibility of ‘autonomous’ decisions about it. However, this notion of ‘doing it for oneself’ recurs over and over in a number of discourses on cosmetic surgery, reﬂecting a contemporary preoccupation with the self as entirely independent and self-deﬁning, as internally located, rather than as a product of culture. Importantly, this notion tends to reconﬁgure femininity along more independent lines than traditional formations. In this way, cosmetic surgery discourse (as a technology of gender) works to introduce elements of autonomy into a sexual imaginary which has traditionally tended to ﬁgure femininity in terms of connection and dependence. Of course, examination of the material conditions under which women participate in cosmetic surgery may reveal a high degree of dependence upon the surgeon as well as other individuals and institutions, but my point is rather that magazine representations of cosmetic surgery produce notions of femininity on a cultural level, becoming themselves the resources for understandings of gender and for material practices. Investigation into other discourses around cosmetic surgery conducted in later chapters will provide some insight into the durability and reach of this development, as well as some of the material implications of its use.

Weighing the risks against the rewards Central to the discourse of agency that saturates much cosmetic surgery discourse in women’s magazines is the notion that the individual is able to evaluate the relative risks and rewards of undergoing cosmetic surgery, and, it is implied, that the individual has adequate access to information in order to make an informed decision. One woman, familiar with stories of cosmetic surgery failure through her work in the media, states that she ‘weighed up the validity of the stories and decided to accept the risks’ in the decision to undergo breast augmentation.88 Another woman, exhibiting an awareness of the dangers of breast augmentation, observes that, ‘apparently, they are still unsure of the long-term effects of the saline implants, but that’s the risk you take’.89 In this case, it is not made clear on what grounds the participant decided to take the ‘risk’ of breast augmentation. The discourse of justiﬁed risk appears to be regarded as adequate explanation in itself. This emphasis on ‘risk’ reﬂects the ascendancy of risk analysis as an industry in the latter three decades of this century. Originally used to refer to potential outcomes both good and bad,90 risk has since become synonymous with the negative. Mary Douglas argues that the employment of this term relies on a spurious claim to the possibility of ‘a scientiﬁcally objective deci-

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sion about exposure to danger’ and allows doctors to ‘let the patient choose for herself’, a state of affairs desirable to surgeons in the context of high rates of malpractice litigation.91Similarly, Deborah Lupton notes that risk discourse is directly related to contemporary individualism. Echoing Rose’s identiﬁcation of the ‘enterprising self’, she sees it as ‘an extension of one’s life as an enterprise and the belief that individuals should plan for the future and take judicious steps to ensure protection against misfortune, retaining responsibility for their affairs’.92 The regulatory or forensic implications of this risk discourse are examined in greater detail in Chapter 6, in which it emerges as an extremely common repertoire. At this point it is interesting to consider how the discourse of risk contributes to the image of women not only as rational decision-makers weighing up risks and beneﬁts, (along the lines of the claim to scientiﬁc choices noted above) but also as somewhat heroic in their willingness to take risks. Certainly, while critical analysis of the notion of risk tends to concentrate on the contemporary injunction to manage one’s life effectively through minimising risk, cosmetic surgery as well as other activities such as investment depart from this model in promoting the calculated and purportedly edifying practice of risktaking.93 Chapter 5 examines the construction of female cosmetic surgery participants as more active and capable than other women. In contrast to the magazine accounts of women as determined, fearless and aware consumers of cosmetic surgery, a portrayal of cosmetic surgery recipients as hapless victims of social pressure and advertising also emerges. In many magazine discussions of cosmetic surgery, agency is posed directly against victimhood. Either the recipient is an entirely free individual with completely self-generated desires and values, or else she is a mindless pawn, easily swayed by what she encounters in popular culture and by the wishes of sexist partners. Here, victim and agent become ontological categories, so that the degree or type of agency the participant exhibits is seen to emanate from within. Located in the individual, agency or the lack of it becomes an individual quality or failing. The latter view of women as pawns characterises some of the anticosmetic surgery material I encountered in undertaking this study – and is not entirely unexpected given the nature of some pro-surgery material. In one article entitled ‘I Did it All for Antonio’, ﬁlm star Melanie Grifﬁths is interviewed about her marriage, her work and her appearance. Having recently undergone cosmetic surgery, Grifﬁths states, ‘[b]eing married to Antonio Banderas was enough of a motivation for me to get it together . . . I’ve got to look pretty damn good, you know.’94 It may be that Grifﬁths’ remark is meant humorously: it is in some respects ambiguous. However, the remainder of the article strikes a serious tone, and suggests that Grifﬁths is serious here too. This approach is distinctly at odds with the tendency I discussed earlier to construct cosmetic surgery as entirely about career opportunities, material gain or other self-focused motives. Pleasing her

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husband appears to be Grifﬁths’ primary and unabashed motive, and if other motives do exist, they do not get an airing in this article. As I noted above, this construction of the relationship between women and cosmetic surgery renders conclusions about women as victims less surprising than they might otherwise appear. As one article explains: Many are able to look beyond the shifting trends in body shape, the risks of the operation and fears about the safety of silicone, to the world of opportunity it seemingly offers. It’s easy to convince yourself that a nip, a tuck and a suck will make you more taut, more sexy, more beautiful.95 On a different tack, but equally invested in the notion of the victim, another article asks, ‘Could there be hundreds of women out there who have been suffering in silence and on their own for years and years’ over their breast implants?96 Several articles argue that while women have been succumbing to the pressure to be beautiful through surgery for years, men are just beginning to follow suit. One piece on penile extension surgery, entitled ‘Men Who Have Cosmetic Surgery: Would You Respect Him in the Morning?’, treats men who undergo it as the victims of media pressure in a manner reminiscent of discussions of women and cosmetic surgery. A surgeon is reported as saying, ‘I suspect a lot of insecure people are being brought out of the woodwork by these ads [for penis extensions]’.97 The article positions susceptibility to pressure and to feelings of insecurity as most properly a feminine domain and, as its title suggests, implies that cosmetic surgery and the associated vulnerability is for women only. Magazine discourse on cosmetic surgery tends to feminise male participants through such chains of associations. As de Lauretis argues, ‘the representation of gender is its construction’.98 Here, the representation of cosmetic surgery as feminine not only constructs femininity, but also masculinity (and the gender binary itself) by problematising in speciﬁc ways those men who do participate in surgical alteration. Like the associations drawn between the natural, the body and femininity, the passivity and victim-status often accorded to cosmetic surgery recipients help feminise cosmetic surgery. The connections these concepts share raises the question of whether any reference to victimhood in the conventional sense serves to reinscribe women as open to (physical and psychological) manipulation, and cosmetic surgery as an inevitable extension of this. These issues will be considered in more detail in Chapter 6’s examination of regulatory material, in which strategic use of victim/agent arguments is found to be common. While victimhood offers a range of ‘risks and beneﬁts’ in terms of gender representation and self-representation, agency is equally ﬂexible and equally risky. As I have shown, agency is a common repertoire in women’s maga-

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zines, reconﬁguring femininity along some unfamiliar lines, but frequently invoking established ideas based on feminine agency through appearance. While the pitfalls of invoking the victim are many, an exclusive emphasis on agency has its disadvantages as well. For example, it tends to undermine the need for legislative and other safeguards around the cosmetic surgery industry. This debate is ﬁxed in a binary mode which conceptualises agency as inhering within the individual and which offers only two choices for the reader – victim or agent. As a result, femininity is reproduced within the sexual imaginary as either traditionally passive, as in the case of the victim, or as a more modern (but largely unchanged) agent intent on ‘protecting her assets’ and obtaining success through her appearance if necessary.

Vanity The last repertoire I look at in relation to women’s magazines and cosmetic surgery is vanity, and how it is put to use in discussions of surgical procedures and surgery recipients. Unlike nature and agency, vanity appears to have been overlooked by contemporary critics, and there is very little commentary on its cultural signiﬁcance. While a great deal of discussion around the related concept narcissism can be found in psychoanalytic discourse, little in the way of cultural perspectives is offered there. This is also the case, perhaps most surprisingly, in relation to feminist commentary, where analysis and critique of notions of vanity would appear to be highly pertinent. Works such as Susan Bordo’s Unbearable Weight99 and Naomi Wolf’s The Beauty Myth100 or Simone de Beauvoir’s classic The Second Sex101 (where issues of immanence and transcendence might relate closely to vanity) contain little or no acknowledgement of the concept. In short, vanity remains an extremely under-researched cultural concept, particularly given the extent to which it features in popular culture. Later chapters demonstrate that vanity has become something of an unspoken accusation in relation to cosmetic surgery – indeed, almost a taboo concept. This is not the case in the women’s magazines I examined, where explanations in terms of individual vanity, both positive and negative, are quite common. In this regard, these magazines occupy a somewhat surprising location in presenting the widest range of accounts on motivation for cosmetic surgery amongst the four discourses examined. This observation prompts a question: What is behind the greater diversity of perspectives on vanity found in magazines? Is it the case that magazines are articulating a concept that is too ‘controversial’ for feminist scholarship, medical writing or regulatory debate? In response it must be noted that those additional perspectives given voice in the magazines analysed here, that is, perspectives carrying accusations of vanity, are perhaps the least tolerant of those available. As such, they may not represent the enactment of any higher principle of openness.

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The notion of vanity appears to contain a number of related and contradictory meanings. Traditionally associated with the feminine, vanity has occupied a powerful position in that it is both derided as trivial by masculinist culture, and regarded as a natural or primary aspect of the female character. Martin Danahay argues that ‘[w]hile it is conventionally viewed as permissible, and even “natural” for women to look at their own reﬂections with a narcissistic fascination, it is impermissible . . . for men to be too preoccupied with their own looks. Such self-involved desire must be expressed through a swerve into the feminine.’102 Indeed, the feminisation of cosmetic surgery and of its male participants is a question that arises regularly in this book. Danahay makes an interesting argument about the Victorian male artist and his desire to paint images of narcissistic women. He argues that through such work, male artists project their own narcissism onto women, thereby maintaining the boundaries of their masculine egos.103 This is particularly suggestive in relation to cosmetic surgery, where the surgeon, usually male, is often ﬁgured as an artist. Danahay remarks: ‘Goethe was not mistaken in ascribing narcissism to men, but he should have said that man is a true Pygmalion rather than a Narcissus.’104 Here, cosmetic surgery can be read as a process whereby the narcissism of male surgeons ﬁnds expression in the Pygmalionesque ‘transformation’ of female patients. Danahay neglects to mention, however, that while vanity may be seen as natural in women, this does not mean that its acceptance as feminine carries with it no disadvantages for women. In fact, vanity is a characteristic understood to reﬂect women’s triviality. As such, those women who do undergo surgery remain vulnerable to the accusation of vanity and by implication, of triviality. Moreover, while a lack of interest in personal appearance has been, and often still is, regarded as a possible symptom of mental illness,105 too great an interest in preserving or altering the appearance has also been associated with this.106 For these reasons, vanity is ‘a word whose meaning wavers between good and bad’.107 It is associated with both negative traits, such as arrogance,108 hypocrisy and inauthenticity,109 and the positive attribute of self-conﬁdence.110 In addition, vanity and related attributes are clearly gendered. In their article on arrogance, Tiberius and Walker, possibly unwittingly, reﬂect this gendering process. Consider the following passage: Vanity is a concept that appears to be closely related to arrogance, inasmuch as the two words are frequently used in the same breath, to refer to the same person. Vanity, however, seems to consist almost entirely in a person’s having an excessively high self-estimation; it differs from selfconﬁdence because the self-conﬁdent person esteems herself appropriately though highly. Arrogance differs from both of these insofar as the arrogant person derives further beliefs from his high self-estimation, beliefs about the normative structure of his relations with others, and is disposed

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to put these beliefs into action by structuring his relationships in hierarchical, non-reciprocal ways.111 Here, self-conﬁdence is offered as an alternative to vanity using the feminine personal pronoun, suggesting that vanity is a feminine trait, needing to be converted into (female) self-conﬁdence, while arrogance is clearly gendered male through the use of the masculine personal pronoun. Implied in this construction is an understanding of vanity as feminine and arrogance as masculine, with self-conﬁdence the ideal for both. This close relationship between vanity and femininity is linked to the feminisation masculinity can undergo when it too becomes linked with vanity through cosmetic surgery. This will be explored later, with an emphasis on how vanity ﬁgures differently in relation to men. In negotiating the complex cultural net of pitfalls and rewards associated with vanity, women must learn to judge appropriate levels of interest in beauty and appearance. Like the concepts of nature and agency, though to a lesser extent, vanity acts as an important (if changing) theme in magazine constructions of cosmetic surgery. Where simple accusations of vanity were frequent in the past, veiled references are now more common.112 Thus, although Gilman identiﬁes accusations of vanity in relation to cosmetic procedures as early as 1906,113 in contemporary material this repertoire is more often used obliquely. The notion of vanity orders behaviour, gender difference and social expectations in a variety of discourses aside from magazines, sometimes openly, but often in subtle ways. This will be examined in later chapters. Most notable for this book, however, is the way in which vanity lends itself to other discourses and concepts. Thus, vanity can be natural or unnatural, a sign of agency or a sign of victimhood. From this point of view, vanity emerges as a discursive resource, highly ﬂexible as both a positive and negative trait, but especially powerful through its ability to censure. Not just vanity One of the most striking aspects of the contemporary use of vanity for ordering discussion of cosmetic surgery in women’s magazines is its continual juxtaposition against other supposedly more legitimate motivations for undergoing surgery. This process inevitably constructs vanity as an undesirable trait. As I suggested in the last section, the notion of agency has been employed with signiﬁcant effects in the production of viable repertoires for explaining the use of cosmetic surgery by women. Connections can be drawn between this range of repertoires based on agency and the advent of ‘second-wave’ feminism with its rejection of conventional norms of femininity and various strictures of vanity such as the importance of physical attractiveness and of elaborate grooming practices.114 An example I used earlier in looking at the repertoire of agency is particularly illustrative here. New Idea’s piece on cosmetic surgery in Hollywood states that ‘for most

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actresses whose faces are their fortune, remodelling is not just vanity, it is a career move’.115 This suggests that, while vanity, or a more traditional feminine concern with the appearance, is no longer considered adequate justiﬁcation for undergoing expensive and dangerous treatments, fame, ﬁnancial gain and success certainly are. Another article, this time in the pages of the more upmarket and in some respects more feminist glossy magazine, New Woman, complains that ‘[k]eeping powerbrokers happy and salaries rolling in is one reason to consider cosmetic surgery and tyrannical ﬁtness regimes, but there is a new group of women who seem content to go after physical perfection simply because it is there’.116 This is a particularly interesting statement, ﬁrst, because it suggests that the category of women who pursue beauty as an end in itself is in some way new and without cultural precedent. Second, it positions acquiescence to the demands of male-dominated professions for young, physically attractive as well as competent female employees as self-evidently more justiﬁed. In fact, at the centre of the takenfor-granted hierarchy of values that makes possible this conﬁguration is a familiar public/private split that privileges the public, and its demands on the individual, over the private. Traditionally, the public domain was the exclusive realm of men, while women, at least within the middle and upper classes, were consigned to the private sphere. Lower-class women always worked, but faced clear limits on the range and status of work available to them. Increasingly during the latter half of the twentieth century, women of all classes have participated in the public sphere, albeit in consistently relatively junior roles. ‘Second-wave’ feminism contributed to women’s move into the public domain, a move that has come to symbolise the liberation of women from economic and emotional dependence upon men.117 At the same time, and as the magazine material indicates, a relative devaluation of work within the home has taken place, resulting in a reafﬁrmation of the importance of the traditionally male-dominated arena of public life over the traditionally (and still primarily) female-dominated realm of the domestic sphere. In other words, the arena in which men still dominate, and in relation to which women perceive a need to conform to more taxing and speciﬁc stereotypes of behaviour and performance than men, is the arena that still tends to be most privileged. While in analytic terms the public/private distinction can be shown to be a ﬁction which denies the interconnection of the two realms, it is a ﬁction that performs a variety of tasks within popular culture, one of which is to designate more and less prestigious and valuable forms of work, leisure and personal improvement. Thus while physical self-improvement through cosmetic surgery is an understandable extension of the accepted desire to succeed in business and the professions, it is laughable, pitiable or trivial when undertaken in the belief that it will bring success in the private realm of friendships, romance and long-term relationships. In relation to cosmetic

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surgery, the personal appearance and the physical body in general has become, for both sexes, an extension of the public domain. A body that reveals details about the subject and his or her history; that transgresses the boundaries between public and private by reﬂecting personal characteristics such as age, status as a smoker or as someone who has borne children, undertaken extensive physical labour or outdoor work, is an unruly and unprofessional body. The public body is instead a body that speaks a language of repertoires around youth, vigour and discipline, a body that is almost ‘immaterial’ in that it is irrelevant to the powers of the intellect within (the real professional in the mind/body dualism) and it denies its own substance or corporeality through its erasure of the effects of life processes. The pursuit of this public body is positioned within magazine discourse on cosmetic surgery almost as the opposite of conventional forms of vanity, which as I noted above, are by implication identiﬁed with the traditionally feminine private sphere. It may be that women’s magazines that position cosmetic surgery as not ‘merely’ about vanity but about the apparently more legitimate concerns of career advancement and ﬁnancial reward are responding to a perceived change in women’s priorities, brought about by a century of economic and social change in part precipitated by feminist movements. Later chapters will demonstrate an even more pronounced rejection of traditional vanity in women’s stated motivations for surgery. In this chapter and elsewhere, these denials suggest that participants expect the accusation of vanity to be levelled at them from a number of quarters. It is interesting to note that in articles that discuss male use of cosmetic surgery, vanity also features as a potential accusation or reproach, but does not appear to pose the serious threat that it does for women. Boys like bigger toys In most cases the issue of vanity is brushed off casually by male recipients, either with unapologetic assertions of the individual’s right to idiosyncrasies such as the following: I’m a very complex person and nobody has to deal with those complexities but me.118 I didn’t feel I was being vain. I felt I deserved it.119 Or with a lighthearted attitude that plays with the idea of vanity and does not ﬁnd it threatening: If it gets you two more looks or a smile, then it’s worth it.120 So why do men go through [penis enlargement surgery]? ‘Boys and toys you know’ laughs Craig. ‘Boys like bigger toys.’121

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It may be that the male body occupies an a priori public status that is not readily threatened by minor transgressions along the lines of vanity. This is not to say that the women’s magazines I examined use this accepting, lighthearted repertoire alone in dealing with masculinity and the possibility of vanity through cosmetic surgery. At some points it is clear that, just as women’s behaviour can be judged and disciplined through the pages of these publications, so too can men’s. The journalist’s response to Craig’s lighthearted attitude noted above is in fact quite critical: My last question to Craig Hallett, after he has spent nearly $30,000 and had ﬁve operations in 18 months is: ‘Are you ﬁnally content?’ He says no, he’s considering having his nose restructured. More money, more surgery.122 Unlike material critical of women’s participation in cosmetic surgery, however, Craig and his ilk tend to be treated more as reckless risk-takers or as ﬁnancially extravagant than as pitiable victims. These characteristics mesh more readily with conventional understandings of masculinity. While magazines frequently play with gender categories in the process of producing an interesting story, they can exert strong normative pressure upon those categories at the same time. The discrepancy between the ways in which femininity and masculinity are conﬁgured in relation to vanity is an example of this. As a technology of gender, magazine discourse on cosmetic surgery provides a direct comparison between acceptable masculine and feminine subjectivity and behaviour. Advertising strategies for attracting men to cosmetic surgery differ from the repertoires used above, often reﬂecting more traditional concepts of masculinity such as those that adhere closely to the repertoire of career success. Within this more conservative gender format, it appears to be unacceptable for men to admit to motives based on vanity. As I mentioned, however, this approach is generally conﬁned to advertisements. Most of the other magazine material I examined suggests that some degree of reversal has occurred around the acceptance of vanity within traditional masculinity and femininity. Many texts construct male recipients as open to the suggestion of vanity, while female recipients are portrayed as preferring to utilise professional repertoires in accounting for their choices. Does this reversal represent some degree of progress around gender representation? This is, I think, an open question. Certainly, the readiness with which these changes can be analysed ﬁrmly within traditional binary frames would suggest that any such progress remains vulnerable to reversal or sidetracking. Where apparently new cultural constructs are enmeshed within classical dichotomies, they are readily put to use in sustaining those dichotomies, and as such, can function to undermine their own novel impact. Of course, no version of femininity or masculinity is entirely static,

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and the processes through which gender and individual subjectivity experience becoming are complex and continuous. From this point of view, change cannot be evaluated simply on the grounds of an ideal of permanence. A view that emphasises becoming renders such an evaluation meaningless. At the same time, cultural understandings of gender do demonstrate some stability, and there is a legitimate need to examine these patterns.

Women’s magazines and their imaginary bodies In this chapter I have outlined some of the general and speciﬁc trends visible in the representation of cosmetic surgery within women’s magazines. I am tempted here to ask the question: ‘What kind of imaginary body is constructed for femininity through these representations?’ Of course, no monolithic, or entirely consistent, body emerges, although as I have shown, speciﬁc philosophical investments are identiﬁable. In relation to the body, however, some important observations can be made. The bodies represented in the material are overwhelmingly Caucasian, and the procedures, some of which are utilised to modify racial markers such as noses and eyes, are consistently represented as simply about ‘beauty’. Evidently, while it is culturally acceptable in women’s magazines to experience dissatisfaction with oneself in terms of beauty, and to act on this dissatisfaction to alter aspects of the body and so the self, it is almost taboo to present race in a similar way. Here, ideal femininity in the form of beauty is presented as a legitimate goal, though ideal race is not, despite the fact that we know that procedures intended to modify racial characteristics such as ‘single’ eyelids and ‘saddle’ noses in people with Asian features are quite common.123 Although such procedures are undergone, they ﬁgure little, if at all, in the imaginary body constructed by women’s magazines. In addition, as racial differences in terms of procedure choice and issues such as scarring on dark skin are also ignored, the ‘universal’ white body is reintroduced here through implication. Certainly, all photographs I came across represented Caucasian recipients. From this point of view, cosmetic surgery is also very much a technology of race. Broadly, then, the bodies imagined by writers on cosmetic surgery in women’s magazines are primarily female and white, and essentially open to invasion, manipulation and improvement. They are professional bodies, bodies that ostensibly exist only in the public sphere. They show little evidence of their passage through the private sphere, that is, through life experiences such as childbirth, ageing, and so on. In this sense they are closed bodies, unwilling to allow passage to the effects of age, or to tolerate apparent imperfections. These bodies are as reassuringly familiar as they are alien and new. Where intense career-related ambition is the stated motive for undergoing surgery, for instance, a departure from traditional understandings of femininity as preoccupied with the private sphere can be identiﬁed. By the same token, ideas of growing old gracefully, either through the

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decision to abandon all claims to attractiveness or through the refusal to ‘show one’s age’, are undoubtedly familiar and continue to provide an unappealing binary choice. These are bodies undergoing novel becomings at the same time that they reinscribe the most stable and mundane dualisms that seem to deny the possibility of change. Clearly, their becoming is multidirectional, open both to deterritorialisation and reterritorialisation. The body is female, but what of the gender? In some ways, magazine discourse on cosmetic surgery indicates and/or produces a certain feminisation of the masculine, and a masculinisation of the feminine, through the repertoires of vanity and agency respectively. But it is worthy of note that many of the procedures undertaken serve to exaggerate existing primary and secondary sexual characteristics. Just how valid is it to argue for the disruption of gender norms through the representation and undertaking of procedures that increase the size of women’s breasts, or the size of men’s penises?124 But perhaps this is a question not about the cultural impact of discourses on cosmetic surgery, but the impact of cosmetic surgery procedures themselves. While I would not argue for a simple opposition between the ‘real’ and the representation, I would not collapse the two either. In any case, not all procedures are so unambiguous. The comparability of rhinoplasty (nose job) with breast augmentation, for example, or with chest implants in men becomes tenuous. These procedures all impact on the appearance, but in utterly different ways. In this sense, the category of cosmetic surgery is revealed to be a necessarily artiﬁcial one, though this does not impair its ability to perform cultural work.125 It is a technology of gender reproducing the sexual imaginary in both traditional and novel ways, partly through the repertoires examined in this chapter.

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Of course, magazines are not the only context in which the powerful concepts of nature, agency and vanity are played out. In this chapter, I review scholarly feminist discussion of cosmetic surgery. A brief account of the various approaches to cosmetic surgery and beauty found in the texts is provided, then the three analytic repertoires of nature, agency and vanity are examined in detail, in order to identify intertextual connections between feminist writers and women’s magazines in their treatment of cosmetic surgery. Part of this process involves identifying the ways in which the repertoires draw on and contribute to the sexual imaginary. As I noted in Chapter 2, Gatens conceptualises the sexual imaginary as plural. This plurality was evident in the last chapter and emerges again in what follows, revealing various contradictions, most clearly in the section on nature. In the ﬁrst section I deal with some of the texts which share a notion of the natural as identiﬁed in Chapter 3; that is, where some appeal to nature plays a part in the account of cosmetic surgery. Often this takes the form of an implicit reliance upon the natural body through the construction of the body as the pre-existing object of cultural pressures. I argue that although there are points at which the natural is brieﬂy problematised in this work, it is never thoroughly critiqued. Instead, the natural (or precultural) body remains a founding concept for many of the arguments put forward. In the second section, I concentrate on the repertoire of agency, which emerges as a central concern of many of the authors. Some of these writers tend to engage with each other in an antagonistic manner, interpreting their differences as qualitative. However, having examined their debate over agency and cosmetic surgery, I am more inclined to view these differences in terms of degree. By this I mean that they tend to argue on the same terrain, making the same assertions and observations, their conclusions based mainly on variations in emphasis. The relative importance of institutionalised domination versus individual agency is constantly weighed up. This debate erases any consideration of agency (or victimhood) as emanating from anywhere other than the individual. Lastly, I look at the repertoire of vanity, which is 97

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the least utilised of the three, only appearing in any signiﬁcant way in the work of Iris Young. Ultimately, I argue that the speciﬁc conﬁguration of ideas around nature, agency and vanity present in feminist discourse on cosmetic surgery tends to construct a logical and positive relationship between women and the surgical pursuit of ‘beauty’ or ‘normality’. This is in spite of an almost unanimous sense of disquiet about cosmetic surgery as medicine and commodity. In Chapter 1, I introduced Teresa de Lauretis’ notion of ‘technologies of gender’, and argued that cosmetic surgery, as both a range of practices and a grouping of discourses, can be seen as a technology of gender, or collection of technologies of gender. I understand technologies of gender to be discourses, practices and institutions that produce the gendered subject and the sexual imaginary, that is, the ‘ready-made symbols and images’1 available for the conceptualisation of the possibilities and limits of gender. Along these lines, de Lauretis positions feminism as a primary site and tool for the construction of gender through the process of its deconstruction, and in this chapter I want to look in detail at the ways feminists construct femininity through their assumptions about nature, agency and vanity, when talking about cosmetic surgery. From this point of view, both feminism and cosmetic surgery are each technologies of gender in their own right in that each contributes to general understandings of what might constitute masculinity and femininity, male and female, and indeed gender itself. Each utilises gendered concepts in the formulation of its areas of interest and responsibility, and each impacts on broadly held ideas about gender as well as the material expression of gender though the body and its presentation. This chapter argues that feminism as a technology of gender produces femininity and cosmetic surgery as fundamentally compatible through the evocation of a natural body, the embracing of contemporary understandings of agency and the eschewing of notions of vanity in favour of those of pleasure. Detailed discussion of race and class issues as they relate to cosmetic surgery speciﬁcally are substantially absent from this body of scholarship, with notable exceptions,2 so that although the female subject produced in this material is rarely if ever pronounced white or middle class, it is easy to assume this. Because black skin generally produces more noticeable scarring than white skin, procedures that require large incisions such as abdominoplasty or ‘breast lifts’ carry different risks and enjoy different degrees of popularity, depending upon race. In addition, some procedures such as the building up of the bridge of the nose and the formation of a ‘double eyelid’, as noted in Chapter 3, are forms of surgery developed expressly with racial features in mind. Clearly, differences of race or class can impact signiﬁcantly upon material aspects of cosmetic surgery, although they remain relatively unexplored within feminist accounts. My main focus in this chapter is on analysing the forms that femininity and the female body are made to take in the process of scholarly feminist

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discussion of cosmetic surgery. Do these forms correspond in any way with those utilised by women’s magazines?3 If so, women’s magazines and feminist research, in spite of apparent conﬂicts of interest, might be said to participate together through mutual discursive authorisation in speciﬁc becomings of the sexual imaginary and of material bodies. Here, longstanding doubts about the material effects of the media might be reconsidered. If these two discourses can be seen to function in a mutually informative way, and if, indeed, this reciprocity can also be identiﬁed between the media (women’s magazines in this case) and other technical discourses such as medicine and regulatory material, such doubts which dismiss the media as producing a set of basically harmless ﬁctions (not least due, as I noted in Chapter 2, to the supposedly polysemic nature of these ﬁctions), are thrown into question. It may be that although the concepts magazines produce and use have no direct material application, they are tightly interwoven with other discourses – are informed by and also inform these discourses. As such, their material effects may emerge through practices commonly associated with other discourses. For instance, notions of femininity found in feminist scholarship and in regulatory hearings around breast implants affect governmental decisions on the availability and regulation of silicone implants. Here are the two main objects of inquiry in this book: the impact of cosmetic surgery as discourse on gender; and the interconnection of technical and lay discourses in the production of cultural orthodoxies via the construction of preferred readings.

Nature In Chapter 2, my discussion of Gatens’ imaginary bodies noted the absence of any factual or purely anatomical body in her work. Instead, her view is that the body can be recognised only through culture. Utilising Judith Butler’s conceptualisation of the subject, which sees subjectivity as made possible by culture rather than shaped by it after its presumptive foundation, I want to argue that the body, too, can be seen in this way. Here, the body is not a biological given or base upon which culture works or which we need culture to understand; rather, it is made possible by speciﬁc cultural conditions. Butler argues that ‘bodies only appear, only endure, only live within the productive constraints of certain highly gendered regulatory schemas’.4 Thus, under different cultural conditions, some bodies will readily appear and be enabled whilst the occurrence of others will be minimised. For example, cultures which value male children may discourage the occurrence and endurance of females through practices such as selective abortion, infanticide and, potentially, genetic engineering.5 Similarly, an intolerance of disability or mixed race will discourage the endurance and occurrence of disabled or mixed race bodies.6 The point is that bodies are not pregiven entities, which are then worked upon by culture. Their very possibility and

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viability rely in the ﬁrst instance on culture, its resources and its preferences. This formulation allows for a view of the body that does not collapse it with ‘nature’ – a collapse that is central to the body’s establishment as the traditional object of scientiﬁc intervention within conventional deﬁnitions of nature. In spite of this link between nature and scientiﬁc intervention, not to mention the link between nature and essentialising normative understandings of gender,7 the non-naturalised or fully artifactual body is absent from existing feminist discussions of cosmetic surgery, which share with women’s magazines a tendency to appeal to a foundational and uninterrogated nature, although unlike women’s magazines, they often simultaneously indicate a suspicion of the validity of this category. Here, I discuss those texts that use this repertoire of the natural. Kathryn Pauly Morgan’s article ‘Women and the Knife’, published in 1991, takes as one of its central concerns an understanding of the choices of women who undergo surgery. She is also interested in cosmetic surgery because she sees it as part of a broader technologising of the female body in Western culture, and notes that the medical model treats the body as a machine, allowing it to be divided into parts, judged functional or defective. She identiﬁes cosmetic surgery as a primarily self-imposed surveillance of the body under patriarchal power and describes this process as a form of colonisation of women’s bodies. Morgan cites Foucault’s notion of docile bodies in her interpretation of women’s participation in cosmetic surgery, utilising his idea of disciplinary power to identify a body that is regarded as open to intervention, improvement and transformation. At the same time, she recognises that women’s actual experience of cosmetic surgery can be one of ‘self-creation, selffulﬁlment, self-transcendence, and being cared for’.8 Morgan ﬁnds she cannot afﬁrm the choice of cosmetic surgery unequivocally and so offers two ‘utopian’ strategies for feminists dealing with beauty and surgery. The ﬁrst is refusal; the refusal by all women, ideally, to participate in this industry. This strategy is advocated along with a sympathetic interpretation of women who do choose cosmetic surgery, arguing that for them, refusal may be seen as tantamount to ‘social death’. This notion of ‘social death’ resembles Butler’s argument about viability. Where the subject must continually enact his or her gender in order to remain culturally ‘viable’, refusal to enact ‘beauty’ may for some women represent the loss of viability – or a kind of ‘death’. Morgan’s second (and rather far-fetched) proposal for strategic action is the revalorisation of the ‘ugly’. This strategy would reappropriate the technological expertise of cosmetic surgeons to create ‘ugly’ bodies, in order to destabilise beauty. Any number of gender performatives such as this could be envisaged, such as the intentional and publicised alteration of the body to reproduce supposedly ‘ugly’ attributes such as cellulite.9 Morgan initially exhibits an awareness of the natural as a cultural category when she points out that ‘what is viewed as “the natural” functions

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primarily as a frontier rather than as a barrier’.10 In this instance her use of the phrase ‘viewed as’ points to nature as by no means self-evident. Later, however, Morgan discusses the coercive power of technology and argues that ‘[n]atural destiny is being supplanted by technologically grounded coercion, and the coercion is camouﬂaged by the language of choice, fulﬁlment, and liberation’.11 What Morgan means by ‘natural destiny’ is somewhat unclear, although what is clear is that the phrase is used to suggest a process of physical maturation and decline that is somehow beyond the ambit of culture, and which Morgan valorises over the implied ‘artiﬁce’ of cosmetic surgery. This idea is preﬁgured earlier in the article when Morgan states: [c]osmetic surgery entails the ultimate envelopment of the lived temporal reality of the human subject by the technologically created appearances that are then regarded as ‘the real’. Youthful appearance triumphs over aged reality.12 In this passage reality appears both unquestioned and surrounded by inverted commas, suggesting a degree of scepticism about its legitimacy. This ambivalence is not elaborated upon, and ultimately a hierarchy of terms identiﬁes the ‘real’ as what is sacriﬁced when cosmetic surgery is embraced, the ‘real’ remaining as unexamined and assumed as the natural. Morgan vacillates between an awareness of the natural as problematic, and a desire to use the notion herself as a repertoire for establishing the value of the non-surgical body. Later, she says, ‘I suspect that the naturally “given”, so to speak, will increasingly come to be seen as the technologically “primitive” ’.13 Clearly, there are moments in which Morgan is disinclined to use the natural with any assumption of the transparency of the term. However, elsewhere she describes bodies as ‘dialectically created artifacts’14 (where a dialectical relationship exists between nature and culture) and biotechnology as ‘invading even the most private and formerly sequestered domains of human life, including women’s wombs’15 (a fascinating, if inadvertent, reference to the traditional feminine imaginary body which sees it as a ‘dark continent’ of impenetrable mystery). Both these formulations of the body imply at the very least a separate domain for the natural body, even if that body is at some point affected by culture. This is particularly interesting in that Morgan also acknowledges herself that ‘[t]he domain of technology is often set up in oppositional relation to a domain that is designated “the natural” ’.16 Of course, the notion of repertoires that I presented in Chapter 2 acknowledges the possibility of contradiction within and between repertoires, and certainly there is nothing unusual in the use of a repertoire in a way that runs contrary to other aspects of a text. Equally, it is not the task of an analysis of repertoires to identify the speaker or author’s ‘real’ or primary meaning. The value of such an analysis lies rather in drawing conclusions

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about the conditions of possibility for those repertoires. Here, the apparently inadvertent appeal to the natural that occurs in Morgan’s work points to both the ubiquity and the political familiarity and strength of this repertoire. Hers is by no means the only approach that uses this appeal. It may be that in some contexts it is difﬁcult to argue against cosmetic surgery in the absence of a ‘pure’ natural body that can, if somewhat nostalgically, be posed against the danger and uncertain beneﬁts of cosmetic surgery. In this context, nature corresponds to one of the two deﬁnitions described in Chapter 3: the ideal state upon which culture should be modelled. This questioning of the natural which occurs at the same moment that the repertoire is employed constitutes part of that term’s becoming within feminist and philosophical discourse. As Deleuze and Guattari argue in relation to becoming in general, this process is not easily deﬁned as either positive nor negative. In this case, the body constructed can no longer simply be regarded as the given ground for action, although debate over whether any component of nature should remain continues.17 This debate makes up a signiﬁcant element of feminism’s role as a technology of gender, as it connects with other ideas about the nature of sex and sexuality, as well as with assumptions about natural gender behaviour and practices such as child care, which is popularly seen as the domain of natural female expertise. The persistence of such notions, and of the category of the natural itself, points to heavy cultural and political investment in nature (certainly, the discourses I examine in this book are saturated with it) as well as the difﬁculty with which such ideas are transformed. Spinoza’s view of knowledge as being that I outlined in Chapter 1 is particularly relevant here, in that it is clear that the knowledge of nature as foundational category for the production of the self and others cannot be readily discarded. As we shall see, feminist attempts to challenge these assumptions within discussions of cosmetic surgery achieve only partial success at best. The woman-made body Published in 1991, Naomi Wolf’s extremely inﬂuential book The Beauty Myth18 discusses cosmetic surgery in detail, also offering what some would call utopian strategies for dealing with the phenomenon. The book is not strictly a scholarly work, but it warrants analysis here due to the substantial treatment of cosmetic surgery it provides in a relatively small ﬁeld, as well as the strong presence it maintains in public debate about feminist issues. Wolf attributes the existence of the beauty ideal for Western women to economic motives, stating that ‘[t]he current Surgical Age is, like the Victorian medical system, impelled by easy proﬁts’.19 It is a market created utterly from nothing; a mandate for medical intervention where no illness exists, produced through a corruption of women’s self-image. For Wolf, cosmetic surgeons not only service a demand, they construct it.

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Wolf acknowledges the inappropriateness of telling women what to do with their bodies, and of blaming women for their choices. She provides a reading of cosmetic surgery that rejects it in principle, but acknowledges localised conditions leading women to participate in it.20 Her emphasis, however, is very much on institutionalised forms of power working in concert to force women into extreme beauty practices. Wolf discusses in detail the issue of medical ethics in relation to unnecessary operations. As so little is known about the long-term effects of many cosmetic surgical procedures, and as, at the time of her writing, silicone implants were unregulated, the issue becomes for her what doctors ought to be allowed to offer, not what women ought to be allowed to choose.21 She compares this surgery to genital mutilation and footbinding, both widely condemned, noting that social pressures render women willing to submit to these practices too, creating the illusion of choice. According to Wolf, continual exposure to cosmetic surgery and beauty propaganda desensitises women to the horriﬁc nature of the interventions in the body that these procedures involve. Put simply, women become ‘used to’ the prospect of these serious and bloody practices. As women are constructed in culture as ‘naturally’ invested in their own beauty, the pain and difﬁculties associated with surgery are deemed natural for women to undergo. Wolf argues that such levels of risk and suffering would be seen as excessive were men the main candidates for surgery. She argues strongly that such surgery can be considered a matter of choice only if women have nothing to lose by refusing.22 Like Morgan, Wolf both questions the category of the natural and uses it as a repertoire for strengthening her argument. In her introduction she argues that through the beauty myth, women ‘must unnaturally compete for resources that men have appropriated for themselves’.23 Here, Wolf uses a different repertoire of the natural to Morgan, posing women as ‘unnatural enemies’ and later as ‘natural allies’. In this case, it is women’s relationships that are naturalised rather than their bodies. In both cases, however, nature functions to authorise preferred states or practices. It can refer to the ‘real’ body or to ‘real’ mental and social conditions. The lure of the nature repertoire as a means of supporting the assertion of particular traits or qualities in order to construct an argument is clear here. Women are only ‘natural allies’ when their shared battle is also natural. This use of the natural helps construct gender relations by feeding into a notion of men and women as possessing opposing ‘natural interests’24 – a common essentialist argument implying the immutability of relations of conﬂict between the sexes. Wolf wants to challenge the contemporary Western sexual imaginary which sees the female body as necessarily positioned along an index of beauty, but her own argument rests on the notion that all women are already beautiful. She provides an account of the physical and cosmetic changes undergone by

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older women in an attempt to rewrite female maturity as beautiful. This argument is valuable as far as it goes, but fails to confront the issue of the necessity for women to be beautiful at all. In mobilising the notion of beauty in this way, Wolf appeals to or employs the existing sexual imaginary, which itself makes the issue of beauty central to the ‘real’ female body. As a technology of gender, Wolf’s discourse undermines the association of femininity with youth, but reinforces its association with beauty. The book’s main discussion of cosmetic surgery appears in the chapter entitled ‘Violence’. The argument Wolf pursues exhibits an awareness of the ﬁctional character of nature, at the same time that it relies on references to nature. Wolf has difﬁculty deﬁning the non-surgical body, arguing early in this chapter that ‘[a]round 1990, technology introduced the end of the woman-made female body’.25 Like Morgan’s ‘natural destiny’, Wolf’s ‘woman-made female body’ is somewhat unclear.26 If by this she means a body that has been entirely created by the individual women themselves (or by the mother’s body?), she would seem to be naturalising women, placing them outside culture, in contrast to an invasive culture represented by cosmetic surgery. This tendency to speak of the body, particularly the female body, as outside culture is also evident within Morgan’s text, as well as in the women’s magazines I examined in Chapter 3. Elsewhere, Wolf quotes a model who describes the female bodily ideal as ‘a muscular body with big breasts’ adding that ‘[n]ature doesn’t make women like that’. This point is pursued when she argues that ‘women no longer see versions of the Iron Maiden that represent the natural female body’.27 Later, Wolf elaborates on her concept of the beauty myth by stating that ‘[w]omen’s natural attractions were never the aim of the beauty myth and technology has ﬁnally cut the cord’.28 This is a very distinct example of the way in which Wolf amongst others adheres to the nature/culture divide in criticising cosmetic surgery. At other times, nature is bracketed as a problematic concept, for instance in the statement: ‘Whatever the future threatens, we can be fairly sure of this: women in our “raw” or natural state will continue to be shifted from the category “woman” to the category “ugly” and shamed into an assembly-line physical identity.’29 Here, the nature repertoire is used with ambivalence. It seems that Wolf wishes to criticise contemporary beauty demands and chooses to do so by using this repertoire despite a sense, indicated by the use of inverted commas, of the fragility of her terms. No elaboration on her ambivalence about nature is provided. Again, the purpose of this analysis is not to attempt to discover Wolf’s underlying feelings about cosmetic surgery or about the natural. Rather, it is a process of mapping of repertoires, in the belief that the resulting map may say something about the becoming of gender in Western culture. It may be that the (female) imaginary body is so interdependent with the natural that discussion of the body always runs the risk of implying nature. Certainly, towards the end of the chapter Wolf describes women as ‘tenants

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of our bodies and this planet’,30 echoing a familiar conﬁguration between women, the body and nature (here the environment). In particular, her use of the word ‘tenants’ conﬁgures the mind as separate from the body, a formulation closely tied to the nature/culture dualism. Wolf is aware that her formulation recalls traditional associations between women and land or territory and that within this formulation, both exist as inert, passive objects awaiting the shaping, controlling male hand. Such is Wolf’s commitment to the repertoire of the natural, however, that she proves willing to risk this association by arguing that ‘we serve both ourselves and our hopes for the planet by insisting on a new female reality on which to base a new metaphor for the earth’.31 This use of nature repertoires to argue against particular beauty practices corresponds with discussions of cosmetic surgery in women’s magazines as well as in Morgan’s article. Particularly in the use of words such as ‘raw’ and ‘unprocessed’, Wolf’s text reveals an intertextual exchange with women’s magazine articles which often describe women’s bodies as ‘raw material’. Interestingly, while Wolf uses this repertoire to argue against cosmetic surgery, elsewhere (see Chapter 3) it has been used to argue in favour of surgery. Ultimately, both uses emphasise the female body as a natural resource and, through this ‘knot’ of meaning that is nature, participate in the construction of the feminine imaginary body as a kind of terrain. Further, if the use of this repertoire of the natural (which implies a view of the female body that allows for the intervention of science) is common in a range of texts on cosmetic surgery, then a ‘built-in’ meaning for the body and for cosmetic surgery will exist in these texts. This meaning is constructed through the authority the texts hold, constituted through mutual validation. It is this built-in meaning that can be called a preferred reading. The body inscribed Like the other writers I have discussed here, Susan Bordo’s work on cosmetic surgery in her book Unbearable Weight recognises that women can beneﬁt from surgery in an individual way, at the same time that she sees these practices as highly problematic. Bordo’s interest is in applying discourse analysis to the complex ﬁelds of knowledge produced by society about women’s bodies and appearance. Much of her work in this area looks at advertisements and their meanings. She refers to Baudrillard’s notion of the ‘hyperreal’ to explain why even as we are aware that the photographs we see in magazines have been doctored and that the stars in the photographs are the products of surgery, we experience those images as ‘ontologically convincing’. The knowledge that what we are seeing in these cases is pure fantasy and fabrication ‘simply does not compute’,32 in other words, it makes no sense and is not intellectually assimilated. Bordo interprets liposuction as a cultural reﬂection of our anxiety about the eruption of internal processes. The ideal body is totally controlled, con-

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tained and possessed of distinct, rigid borders. This body resembles the professional body I outlined in the last chapter in that its main characteristics are control, limits and closure. Bordo argues that although popular culture tells us that we now have freedom to ‘choose’ this ideal body, this is no choice at all. Expectations around the form and apparent age of a female body render the concept of choice highly problematic. Not only does the rhetoric hide economic inequalities, but it denies the ‘desperation’ many women experience.33 In spite of the relatively brief treatment Bordo gives cosmetic surgery in her book (where most relevant discussion occurs around a response to Kathy Davis’s article, ‘Remaking the She-Devil’), the use of the repertoire of the natural can be readily identiﬁed. The sub-repertoire used here differs from that used by Morgan and Wolf in that Bordo does not directly refer to nature, rather, it emerges in the ways she constructs her arguments. Utilising Foucault’s Discipline and Punish and his focus on the disciplined or ‘docile’ body in her chapter ‘The Body and the Reproduction of Femininity’, Bordo argues that ‘[n]ot chieﬂy through ideology, but through the organisation and regulation of time, space and movements of our daily lives, our bodies are trained, shaped, impressed with the stamp of prevailing historical forms of selfhood, desire, masculinity and femininity’.34 I would argue that this formulation of the body as imprinted with culture, a formulation that follows Foucault’s view of the body as a surface to be inscribed, still leaves unquestioned the pre-cultural, given body which is then inscribed, disciplined or trained.35 Is this none other than the natural body, perhaps the biological or material body, in any case, the body that must be touched by culture after the fact of its existence? In the absence of any direct refusal of conventional nature/culture relations, her formulation seems to appeal to this dichotomy.36 This notion of the pre-cultural body is reiterated later in the chapter ‘Reading the Slender Body’ where Bordo states that ‘whether externally bound or internally managed, no body can escape either the imprint of culture or its gendered meanings’.37 Again, an imprinted body, here a bound or managed body, is described. Although Bordo makes it clear that no body can exist that is not touched by culture, the repertoire she uses constructs a body that at least for some initial moment, exists beyond culture; before the imprint. A view that recognises the centrality of power to the possibility of the body’s existence, to its very appearance and endurance, requires a formulation of nature and culture which avoids reducing the relationship to one acting on the other. This model suggests a relationship where power is always one step behind the body, rather than fundamentally productive of it. A similar observation can be made about Bordo’s remark (mentioned above) that ‘the knowledge that Cher’s physical appearance is fabricated is an empty abstraction; it simply does not compute’.38 Here, the use of the term ‘fabricated’ preﬁgures this kind of body. Interestingly, in common

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usage, the word carries (at least) two meanings – to construct or manufacture, and to forge (as in a document) or lie. One must ask, what kind of body is not ‘fabricated’? In the absence of any further clariﬁcation within the text, the answer seems to be the natural body, the body that has not been manufactured, and is no forgery. Marked with meaning Annette Corrigan and Denise Meredyth offer a similarly ambivalent treatment of nature in their paper ‘The Body Politic’. They see cosmetic surgery as more than an expression of women’s oppression and argue that feminists need to move beyond the equation of resistance with consciousness39 in order to formulate a position that avoids a politics of the vanguard within feminism. The paper argues that no authentic self exists under the trappings of beauty practice, and reasons that because no body is a natural body, condemning practices like cosmetic surgery as unnatural is incoherent, due to the implied appeal to a natural body prior to surgery.40 The problematising of nature begins early in the paper when Corrigan and Meredyth argue that ‘[w]hen we begin to analyse these problems [such as beauty practices] we ﬁnd the need to challenge some common ideas about the body, particularly the notion of a natural body’. They go on to reposition the body as a ‘cultural product’, as a means of analysing cosmetic surgery in a new way. Later, this view is reinforced through the assertion that ‘[r]ather than trying to restore women to their “natural bodies”, it is more important to interrogate the meanings and signiﬁcances attached to the body and to distinctions between the natural and the “social” ’.41 This approach is similar to my own aims in analysing cosmetic surgery discourse. However, despite the authors’ concerns about nature, the text exhibits frequent ‘relapses’ into uninterrogated references to it, and attaches particular meanings to the body as a result. An example of this can be drawn from their discussion of the range and variety of human bodies and bodily practices, which they contrast with the bodies and behaviour of animals, arguing that ‘[u]nlike animals, humans possess the capacity for creating culture – that is, for constructing complex systems of social organisation and meaning’.42 Here, despite an awareness of the artifactual character of nature as a category, Corrigan and Meredyth distinguish between the human, cultural body, and the now homogenised animal body, which is not cultural but natural. They go on to use words such as ‘sculpture’, ‘decoration’, ‘deformation’, ‘intervention’ and ‘management’ in relation to human bodily practices, words which reinstate the ‘natural substratum’ they have otherwise rejected. Asking the question, ‘[i]sn’t there a basic raw material, akin to the artist’s canvas or the sculptor’s clay which these social and cultural transformations work upon?’,43 they acknowledge that the body has anatomical, biological and physiological properties, but note that the forms and meanings these contain are never fully guaranteed (that is, predictable and ﬁxed).

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They conclude that this ‘anatomical’ body can be deeply ‘inﬁltrated’ with culture. Again, the use of the word ‘inﬁltrated’ cannot help but to set the body up as a pre-cultural entity, as the nature upon which ‘culture’ works. Similarly, the terms ‘raw material’ and ‘artists’ clay’ reﬂect the constructions of the body as passive and in need of reﬁnement found in women’s magazines. There are many moments in which the authors reject the view of the body as the object of culture, but just as many moments when the descriptive repertoires they use recall it. Phrases such as ‘culture pervades the body’; ‘cultural inﬂuence’ and ‘marked with meaning’ reveal the limitations of the available repertoires for discussion of the body. This is a critical aspect of this study of the natural. The difﬁculties feminist scholars of cosmetic surgery encounter in discussing the body without producing it as a natural phenomenon have signiﬁcant implications for the future of feminist analysis of the body and for female embodied subjectivities.

A sign of culture Anne Balsamo’s discussion of cosmetic surgery in her Technologies of the Gendered Body proves just as wary of the category of the natural as the writers described above, and just as implicated within it. Balsamo looks at cosmetic surgery in relation to new body imaging technologies to argue that this combination allows for new modes of body discipline and self-surveillance. Despite her sceptical treatment of nature, Balsamo, too, uses a nature repertoire in constructing her text. For example, her introduction problematises nature by placing it in inverted commas,44 but her chapter on cosmetic surgery intermittently takes the natural body, or at least a pre-cultural, purely material body (that is, a natural body within contemporary dichotomies) as given. This is particularly evident in her statement that ‘cosmetic surgery literally transforms the material body into a sign of culture’,45 as if somehow, prior to this moment, the material body was not a sign of culture. In the absence of any indication that her use of the terms ‘nature’ and ‘culture’ reference anything other than the conventionally understood binary conﬁguration between the two, Balsamo’s use of the pre-cultural body cannot help but reposit nature. The repertoire of the natural can only fully be avoided, as I have argued is desirable in the context of conventional understandings of the body as the proper object of science, if the body is recognised as always a cultural signiﬁer, that is, always a cultural product. As I suggested in relation to the appearance and endurance of certain bodies such as the disabled or mixed race body, the body is not something that ‘would have happened anyway’, in spite of culture. Particularly in the context of genetic testing, it is something that can be vetoed prior to conception and certainly prior to birth. At the very least, it is not something

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that we can know ‘before’ it has become a cultural signiﬁer. The task of the critic is to examine speciﬁcally the advantages and disadvantages of cosmetic surgery, rather than naturalising (and valorising) the pre-surgical body. Balsamo goes on to discuss the production of common signs of ageing as ‘deformities’, and in doing so, she uses the phrase, ‘ “natural” characteristics of the aging body’.46 Here, much like Corrigan and Meredyth, she problematises the natural by placing it in inverted commas. Later, however, when detailing cosmetic surgery techniques designed to disguise evidence of age, she identiﬁes these procedures as attempting to combat ‘natural body deterioration’, this time without inverted commas and quite without the scepticism for the natural displayed earlier. In the section entitled ‘Morphing and the Techno-Body’, this use of the nature repertoire appears again, when Balsamo describes cosmetic surgery as ‘rendering whatever features nature created obsolete and irrecoverable’.47 This is a speciﬁc use of the natural in that it poses nature as an active, productive force, where at other moments it is posed as a passive, inert ground or substance to be moulded. These two distinct uses of nature have also appeared in previous texts, and represent one of the most interesting aspects of the politics of the natural. On one hand, if nature is deﬁned as an inert ground or substance, as I argued in Chapter 3 and again in relation to Wolf, the need for ‘processing’, ‘reﬁnement’ or intervention is readily incorporated into its meaning. On the other hand, if it is a powerful force often producing undesirable effects, it just as easily lends itself to a deﬁnition that requires its control or mastery. Of course, these deﬁnitions mirror conventional deﬁnitions of the feminine in a context where women far outnumber men as the targets of cosmetic surgery advertising and as participants in such surgeries. From this point of view, cosmetic surgery can be seen as ideally placed to draw upon the logics of the natural for its legitimacy. Balsamo’s nature as raw material and nature as productive both contribute to the construction of the female body, which then runs the risk of becoming the natural (meaning both ‘suitable’ and ‘arising from human nature’ – which itself is traditionally masculine) object of study and manipulation. An analysis of feminist texts on cosmetic surgery reveals a substantial debt to the natural body, in spite of the determined efforts of many of the writers. The difﬁculty feminists presently face in discussing the body without invoking the natural has signiﬁcant implications for feminist research in that it makes clear the real need for developing other ways of discussing the body. At the very least, a redeﬁnition of nature needs to take place to lift the term out of its frame of associations with science, though this is no easy task. In many instances nature is utilised to stand in for speciﬁc arguments about the body and cosmetic surgery. As I argued above, it is preferable to be explicit about the disadvantages of cosmetic surgery, such as medical risk, time consumption, pain, expense, potential futility as psychological inter-

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vention, and so forth, rather than to use the (admittedly authoritative) shorthand of nature. Steven Vogel argues that ‘[t]he naturalistic fallacy is a constant political danger, whether it takes the form (say) of critiques of homosexuality or of nuclear power. To call either of these against nature is to abdicate moral responsibility, pretending that fundamental questions about how to live can be answered by appeal to something other than the social realm that is in fact the only source of normative justiﬁcation.’48 Similarly, objections to cosmetic surgery are sometimes couched in terms of the transgression of natural laws, with the effect of stigmatising (usually female) participants in some contexts. Vogel’s point is not only that the ‘naturalistic fallacy’ invokes essentialist arguments (which is also a danger in feminist mobilisations of nature), but that its use directly precludes considered debate based on the recognition of the social as the locus for ethics. In any case, as I have noted in relation to the question of the feminised body as the object of science, this reliance on repertoires that invoke nature runs the added risk of undermining arguments intended to disarticulate women from the range of material/semiotic technological practices that are experienced by some as almost compulsory. The difﬁculty in rejecting the natural demonstrates the centrality of notions of nature to the imaginary body that both feminists and women’s magazines often share, and indicates the need to challenge these notions at the most fundamental level as they are currently formulated both within feminist research and other areas.

Agency In this next section I argue that the complicity of feminist accounts in the discourse of the natural body is even more problematic when examined in relation to the deployment of the repertoire of agency in discussions of cosmetic surgery. The debate over agency that has occurred within feminist writing over the last decade corresponds with a separate but connected debate related to the rise of postmodernism, on the relationship between ‘ideology’ and ‘discourse’. The classical Marxist notion of ideology that some feminists utilised during the ﬁrst decade of ‘second-wave’ feminism also owed much to Louis Althusser’s reformulation of the concept in his essay ‘Ideology and Ideological State Apparatuses’.49 In it he grapples with a central concern of Marxism: how to understand the relationship between material and social production. Althusser attempts to move away from Marx’s notion of ‘false consciousness’ in formulating a view of ideology as maps of meaning – as representations of the individual’s imaginary relationship to the ‘real conditions of existence’. For Althusser, this does not entail a view that the individual experiences ‘false’ relations to real conditions, rather, that those imaginary relations construct the meaning of the individual’s relationship to the real conditions of existence; that they make sense of them.

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In addition to this, Althusser makes the crucial point that ideology is material; it does not exist in opposition to material conditions. In this way, ideology can be seen as a product of material conditions and thus as ‘real’, not ‘false’. He uses the term ‘ideological state apparatuses’ (ISAs) to describe the numerous sites from which ideology ﬂows, such as the school or the Church. This ideology may be diverse, due to the different nature of each apparatus, but he argues that their function is ‘always in fact uniﬁed . . . beneath the ruling ideology, which is the ideology of the ruling class’.50 These apparatuses are separate from, but connected with, ‘repressive state apparatuses’ (RSAs) such as the police and the army. It is the ISAs that secure the state for the most part, with the RSAs called upon to maintain order only ‘in the last instance’. Although Althusser argues in part that the ISAs are amenable to class struggle through their diversity, his main emphasis seems to be on the power of ideology to crush dissent; and to construct individuals so that dissent does not even occur to us. His conviction that the state maintains its power mainly through the functioning of the ISAs (with the RSAs utilised only in the last instance) conﬁrms this. It is this formulation of ideology, primarily as a one-way mechanism whereby individuals are ‘interpellated’51 as subjects to identify with their designated place within ideology, that some recent feminist writers argue characterises the earlier feminist work on beauty in culture and of cosmetic surgery speciﬁcally.52 As this section will demonstrate, feminists writing on cosmetic surgery have tended to move away from this approach, using discourse theory and some of the ideas of Michel Foucault to offer perspectives on cosmetic surgery that allow for greater recognition of individual agency. Foucault’s approach to discourse recognises the existence of discourses that support the status quo, and those ‘counter-discourses’ which challenge, obstruct or rupture it. He refers to these counter-responses as ‘skirmishes, active and occasionally preventive defenses’53 and characterises power as ubiquitous, as taking both overt and covert forms. He and Althusser share some similarities here in that both argue that there is no place outside of discourse, that is, that nothing is untouched by it. However, unlike Foucault, Althusser makes one exception to this model for science, which he sees as able to use its objectivity to venture beyond the ambit of discourse. In recognising a broad ﬁeld in which power operates, and a broader notion of the character of power, Foucault is able to argue that ‘the relationship between desire, power, and interest are more complex than we ordinarily think’.54 Foucault also recognises that power operates through both prohibition and permission, and that this latter function has been largely ignored by existing formulations of power. In The History of Sexuality, he argues that power provides us with options and choices, and that these choices obscure the repressive functions of power.55 This proliferation of options is enabled

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through the variety of discourses available at any time. Foucault’s approach to power, applied to cosmetic surgery, has led some of the writers I discuss below to focus on the pleasurable, self-afﬁrming aspects of these beauty practices. Earlier writing on cosmetic surgery (which spans little more than a decade in entirety) tends to focus mainly on the oppressive, punitive aspects of cosmetic surgery, sometimes by utilising Foucault’s notions of docile bodies and the panopticon.56 In response to the work of Foucault and to a broader shift within feminist politics away from the notion of collective politics and towards individual freedom, more recent feminist work tends to focus on women’s agency in participating in the cosmetic surgery industry. In this section I argue that a noticeable shift has occurred toward the view of women as agents rather than victims, and that this shift, in the context of similar shifts in women’s magazines, constitutes some elements of a preferred reading that will be investigated further in later chapters. More pointedly, however, I will also be arguing that the most common element in this debate over agency is the formulation of agency as inhering in the individual subject. It is this assumption which leaves debate about women’s motivations for cosmetic surgery trapped in an agent/dupe binary; labelling women as one or the other or at best as somewhere in between. In turn, it neglects any examination of how the concept of agency itself is constructed in culture.57 A radical and courageous act The contemporary emphasis on agency as opposed to victimhood can be recognised in the early example offered within Kathy Davis’s 1991 article on cosmetic surgery, ‘Remaking the She-Devil’. This paper precedes her book on the subject by several years and anticipates the main thrust of its argument closely. Davis argues that feminist accounts of beauty are unable for the most part to explain women’s participation without undermining them and treating them as ‘cultural dopes’.58 For this reason, feminist theory has moved away from an oppression model to one that focuses on discourse, both reformulating women in terms of agency, and avoiding pitfalls that the old approach experienced such as the assumption of an authentic, natural self beneath the rituals and pressures of beauty. Davis argues that conventional feminist interpretations of cosmetic surgery radically split the mind and the body in that they ignore the lived relationship women have to their bodies; how they experience themselves prior to and after surgery. Davis’s use of Fay Weldon’s Life and Loves of a She-Devil is indicative of her approach to beauty and to social change in general in this article. She cites the actions of the main character, Ruth, who spends many years (as well as a great deal of money) transforming herself in order to ‘win back’ her husband, who has left her for another woman. When she ﬁnally

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succeeds in doing so, her husband is a broken man, completely under her thumb. Davis argues that Ruth wins by undergoing the torture of achieving conventional beauty. However, Weldon’s text is in some ways ironic, and it is made clear in it that Ruth’s husband, Bobbo, is ultimately no great prize. Aside from using this example of how women exercise power through the beauty system, Davis asserts that greater attention must be paid to the pleasure women attain from beauty practices. For her, feminism must embrace this dilemma if it is to understand women’s participation in cosmetic surgery. She notes that surgery is ‘an irrevocably dilemmatic situation: problem and solution, oppression and liberation, all in one’,59 but her primary repertoire in explaining women’s participation is one based on the idea of surgery as something women do for themselves, a manner of taking control in life. Along these lines, Davis argues that cosmetic surgery ‘may be, ﬁrst and foremost about being ordinary, taking one’s life in one’s own hands, and determining how much suffering is fair’.60 She goes on to critique other feminist work on cosmetic surgery, saying that ‘women’s active and lived relationship to their bodies seems to disappear in feminist accounts of beauty’.61 The use of the word ‘active’ is central to Davis’s repertoire of agency, as is her phrase ‘taking one’s life in one’s own hands’. Later, she argues that ‘structures of hierarchy are continually being produced, but also undermined and transformed by the everyday social practices of individuals’.62 Other phrases Davis uses in this vein include ‘a radical and courageous act’; ‘getting one’s life in hand’ and ‘actively negotiate’. These produce what she sees as a new feminine subject within feminist discussion of beauty practices. Of course, this subject resembles closely the feminine subject put forward in the women’s magazines I discussed in Chapter 3, where repertoires such as ‘doing it for myself’ and ‘taking control of my life’ appeared frequently. Here is another intertextual exchange between feminist writing and women’s magazines. By this I do not mean that Davis has read the texts I discussed in Chapter 3 and reproduced the meanings in them, or that they have necessarily been informed by Davis. Rather, I mean that ‘agency’ is evidently a recognised way of discussing the feminine subject’s relationship to beauty practices, and as such functions as a resource (and limit) in debates over cosmetic surgery. Reshaping the Female Body was published four years later than this article, but its approach is very similar.63 Early on, Davis argues that the pursuit of an appropriate body through grooming and other beauty practices is a primary way people construct a sense of identity and selfhood in modern society. This observation shapes her later arguments, which hinge on the positive effects of participation in beauty. Davis continues to use the repertoire of agency to explain women’s experience of cosmetic surgery, focusing perhaps even more on these practices as a question of choice. Her intro-

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duction makes room for this by expressing a profound scepticism for ideals of freedom: freedom under conditions of modernity is, at best, a risky business . . . and, at worse, only a ‘pseudoliberation’ with the old chains of patriarchal authority replaced by the new ones of consumer culture and neuroticism.64 This account of modernity cannot be called optimistic, and although this view may at ﬁrst seem to contradict her emphasis on agency, it goes some way towards explaining why her book focuses on the negotiation of existing cultural conditions rather than on resistance. Certainly the portrait does not readily allow for the possibility of more radical change, tending instead to recuperate what cultural change has occurred into accounts that emphasise the continuity of existing power relations. Davis’s aim is to argue against what she sees as a patronising approach to women who are treated as though they cannot make an informed decision about cosmetic surgery. For her, to take this decision out of a woman’s hands is a ‘violation of her personhood’.65 Instead, she wants to ‘explore the decision to have cosmetic surgery as a way for women to take action – paradoxically perhaps, to become female agents’.66 Later, Davis argues that through cosmetic surgery, a woman may ‘move from a passive acceptance of herself as nothing but a body to the position of a subject who acts upon the world in and through her body’.67 This construction runs somewhat contrary to her earlier statement about the character of power in contemporary society, a statement that would suggest that rather than acting on the world through her body, she is acting on her body in and through the world. In either case, the repertoire of agency is apparent. In this instance and in many others in the book, this repertoire is expressed through the equation of agency with action, whatever that action might be. This equation of agency with activity pure and simple is problematic in that Davis in turn links agency with heroism. She argues that ‘[h]eroism is also part of the process of obtaining surgery’68 and uses the words ‘suffering’, ‘ordeal’ and ‘hope’ to invoke the image of a hero. According to Davis, the choice these women participants face is between ‘passively accepting the status quo and continuing to suffer or taking action under the motto, “at least I will have tried to do something about it” ’.69 It is signiﬁcant that all options appear to be exhausted by this choice. It is also interesting to consider the question of which ‘status quo’ Davis is referring to. It is possible to reverse the terms and pose the pursuit of beauty in the form of cosmetic surgery as the status quo and refusal to participate as the action. Here an equally heroic but quite different form of agency emerges. The portrait of agency Davis uses has signiﬁcant political implications in that it tends to pose negotiation of cultural constraints as some sort of resistance, and in so

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doing, obscures the possibility for agency focusing on broad social change. As Riffaterre argues in relation to reading (see Chapter 2), activity by no means guarantees resistance. Even the most hegemonic behaviour implies agency when deﬁned as activity.70 This replacement of resistance with negotiation in discussion of the possibilities for feminist social change may be related to wider cultural developments such as the rise of postmodernism and the changing relationship between feminism and young women, where ‘militant’ or ‘revolutionary’ feminist identities are no longer common. As I noted earlier, more recent work on cosmetic surgery tends to reﬂect this generational shift.71 Of course, Davis’s approach to agency does not exhaust the range of feminist analyses of cosmetic surgery, but it is linked with much recent feminist work (as will be demonstrated below),72 as well as with approaches taken by women’s magazines. As I demonstrated in Chapter 3, cosmetic surgery constitutes a frame through which agency is deﬁned in women’s magazines very much along the lines of negotiation and compromise. This intertextual exchange should not be underestimated in terms of its possible effect on the direction of feminism amongst young women. It is an exchange that produces a deﬁnition of contemporary feminism based on individual satisfaction within apparently immovable limits. This issue will emerge even more strongly in Chapter 5, where medical material demonstrates a focus on the surgical treatment of dissatisfaction. Here, cosmetic surgery is repeatedly promoted as a solution to discrimination based on age and other physical attributes.

Agency as pleasure As I noted earlier in the chapter, Corrigan and Meredyth also express a sense of ambivalence about cosmetic surgery, but favour an emphasis on agency, arguing that feminists should not assume an equation between resistance and consciousness. Certainly, there are many who disrupt the social order with no conscious intention of creating social change. In Corrigan and Meredyth’s analysis, the repertoire of agency is used in relation to the experience of pleasure. They argue that ‘[i]t has become increasingly important to study and conceptualise the ways in which women mediate and negotiate social forces and actively take pleasure in rituals of femininity’.73 Here, the taking of pleasure is a signiﬁcant part of the deﬁnition of agency (and indeed, ascribing agency to those who apparently seek pain has been a major difﬁculty for feminists).74 However, this formulation of agency not only implies that the repertoire of agency is more ﬁtting to pleasure than to pain, it also implies that while pain can befall any subject, either active or passive, pleasure must actively be sought. In relation to this, Foucault’s view that power is productive and functions as much if not more by permission as by prohibition might suggest otherwise.75 This view would

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indicate that women’s experience of some forms of pleasure, particularly through participation in consumer culture, is in fact entirely ‘built into’ contemporary society; is permissible where other alternatives are prohibited. I do not want to argue that agency must be attached only to certain practices or that pleasure is not a feminist goal. However, I do want to suggest that the experience of pleasure is in itself no particular evidence of agency (deﬁned as resistance, conscious or otherwise) and to consider the political implications of the use of this particular repertoire which associates pleasure with agency. Clearly, one implication is that women’s pursuit of pleasure is in itself a form of agency, and that (particularly within popular discourse) agency means we are ‘free’. This ‘free’ pursuit of pleasure is then taken to be a form of feminism in itself, such as may be observed in contemporary popular culture concepts such as ‘girl power’. When Corrigan and Meredyth go on to ask, ‘[h]ow can analysis of power relations incorporate elements of resistance, of activity, desire and pleasure?’76 they repeat this conﬁguration of pleasure and agency. Like Davis’s portrayal of a feminist agency based on individual satisfaction, this formulation suggests a feminist agency deﬁned by pleasure. In both instances, feminism is deﬁned away from collective action aimed at collective beneﬁts and broad social change in favour of individual action aimed at individual beneﬁt within largely undisturbed social constraints. For our own ends Balsamo’s chapter on cosmetic surgery utilises Foucault’s work on sexuality, particularly his terms ‘inscription’, ‘surveillance’ and ‘confession’ to produce a reading that in general omits an analysis based on agency. At the end of the chapter, however, Balsamo does utilise an agency repertoire, noting that ‘[f]or some women, and for some feminist scholars, cosmetic surgery illustrates a technological colonisation of women’s bodies; others see it as a technology that women can use for their own ends’.77 She goes on to argue that regardless of whether cosmetic surgery is ‘a form of oppression or a resource of empowerment’, it is a practice whereby ‘women consciously act to make their bodies mean something to themselves and to others’.78 This is expanded to argue that not all forms of surgery result in a conformist body, that in fact, some uses may disrupt expectations of the feminine body in signiﬁcant ways. This is Balsamo’s preferred vision for cosmetic surgery, although interestingly, it bears a strong resemblance to the ‘utopian’ option that appears in the work of Morgan, where the current repertoire of ‘agency’ is not used. The late appearance of this line of argument in her chapter feels a little like an afterthought: it suggests that the use of this repertoire in discussing women and beauty in Western society has become obligatory in the production of a supposedly balanced account. In Balsamo’s case, its appearance adds little to her analysis; in fact, it represents a considerable inconsistency with her main thesis. However, as I have noted, repertoire use

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is not necessarily consistent. Repertoires should not be considered an indication of interior convictions, rather, an indication of contemporary political, cultural and aesthetic options. In a different sense, I ﬁnd myself wondering whether this now quite common inclusion of the repertoire of agency within feminist discussions of cosmetic surgery is a product of the need for the contemporary feminist embodied subject to be reconciled with the advent and growth of modern cosmetic surgery. As I argued in Chapter 2, concepts, as well as individuals and institutions, are always in the process of becoming, are often characterised by conﬂict, and are always undergoing the (unpredictable) process of reconciling their disparate and changing elements. Could it be that the increasing involvement of women (many of them self-avowed feminists or, at least, part of a feminist generation) in cosmetic surgical practices is contributing to the need to formulate this new feminine subject? Davis herself makes clear that the decision of her avowedly feminist friend to undergo surgery caused her to think twice about the issue.79 Are repertoires of agency and the pursuit of pleasure now being used to explain, coherently or otherwise, what earlier ‘second-wave’ feminism could not; that is, the participation of relatively economically secure and educated women in painful, dangerous operations solely designed to alter the body’s surface. For this subject, it would seem that agency is deﬁned as activity per se then valorised as proof of some kind of resistance. In the context of feminist research on sexuality, where the work of Lynne Segal and Carol Smart incorporates the possibility of sexual pleasure-as-agency-as-resistance, this subject makes a lot of sense.80 After all, the right to take pleasure in sex has been an important issue for feminists. However, in relation to cosmetic surgery where activity (in the form of consumption) comes to stand in for resistance, a familiar story within feminist analyses and advertising emerges. It is one that in turn reproduces the cultural conditions suited to women’s participation in body-altering technologies. While feminists may be striving to keep up with women’s desires, and formulating subjectivities to reﬂect and enable the satisfaction of those desires, they may also be helping to create the conditions in which those desires are produced.81 The functioning of feminism as a technology of gender can be readily identiﬁed here. As in the last section, it may be that feminist interventions reproduce gender (in this case, femininity) in ways that reinstate rather than deconstruct conventional formulations. As a striking television advertisement for hair dye argues, ‘You can’t change the world, but you can change your hair colour’. This starkly expressed sentiment prompts a question: how different is this from some of the feminist formulations of agency I have examined here? Combined with the naturalised body I identiﬁed earlier, this formulation of agency means that cosmetic surgery within feminist discourse begins to accrue a sense of legitimacy and inevitability. This is hardly surprising given that feminists present only two options; victim status or

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agent status. It may be that only a notion of agency that does not locate it within the individual will extricate women from the bind of laying claim either to victimhood on the one hand or agency on the other. As will be clear by now, both terms carry the weight of identity and are in themselves highly problematic. As feminist scholarship on cosmetic surgery tends to reproduce this dichotomy, it also tends to reproduce femininity in familiar forms – either passive and victimised, or more recently, active and determined about succeeding through the conventionally sanctioned avenue of the appearance.82

Vanity Within the context of this increasingly aligned relationship between feminism and cosmetic surgery, it is to be expected that vanity is the least utilised of the three repertoires in feminist discourse. One reason for this might simply be that this repertoire is emotionally and politically loaded, carrying with it suggestions of censure, and that this approach does not ﬁt with current tendencies to afﬁrm women’s behaviour. Another explanation might be based on the argument I made earlier about the connection between pleasure and agency. This view might conclude that vanity is no longer regarded in the same negative light, and in fact, is becoming a little used repertoire in feminist writing, replaced by a valorised notion of pleasure. Both notions incorporate a sense of indulgence, which is generally condemned when linked with the idea of vanity, although Chapter 5 will demonstrate that the traditional understanding of vanity as ‘bad’ is itself undergoing change. In the case of pleasure, it occupies a more ambiguous location. Perhaps it is this ambiguity that has created space for feminist intervention over issues such as cosmetic surgery. In any case, Iris Young’s article ‘Breasted Experience’ is the only text I looked at which utilises the vanity repertoire, although it is an interesting case given the argument she makes. This article does not deal with the issue of cosmetic surgery in great detail and as such, I do not want to make too much of its signiﬁcance as a whole. However, it is the ﬁrst substantial feminist reference to cosmetic surgery, in a ﬁeld of feminist scholarship that is still relatively small. Because of this, its use of a repertoire of vanity is necessarily of some interest. Diamonds and furs Young’s article, which deals only in part with cosmetic surgery (in particular, breast augmentation and reconstruction), is probably the earliest scholarly feminist discussion on this topic. It is a phenomenological paper which looks at the lived body and argues that the presence of breasts means that women’s experience of the self differs greatly from that of men. Young notes that the heart is in the centre of the chest, just beneath the breasts, and that when one indicates oneself, one points directly to the heart. She uses

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Irigaray’s metaphysics of ﬂuids to develop a woman-centred view of the breast, one that emphasises sensation over appearance, and argues that nipples in particular are a ‘scandal’ to patriarchal society in that they represent both sexuality and motherhood. Given that a phenomenological approach to the body emphasises the importance of the body to the production of subjectivity and lived experience, it is, then, rather odd that Young chooses to describe cosmetic surgery in these terms: ‘[g]iven the frequency of breast-augmentation surgery, I believe that much of it must be frivolous and unnecessary, like diamonds or furs’.83 Here, cosmetic surgery is posed as a form of vanity, and as such, trivialised. This view seems to run rather at odds with her phenomenological approach, which stresses the absolute centrality of the body to the sense of self, and consequently, the signiﬁcance of alterations to the body. In her own terms, this is particularly so in the case of the breasts. Again, this repertoire does not necessarily mesh with others that are used in the same text. Instead, it indicates existing associations between femininity, vanity and triviality and the ease with which these associations emerge in surprising places. It conﬁrms that the feminine sexual imaginary incorporates vanity within its sometimes quite contradictory terms, and that feminist writing itself can act as a technology of gender in reiterating and reproducing this aspect of the sexual imaginary. De Lauretis’ point that the construction of gender is effected by its deconstruction is highly pertinent here. Gender is not only constructed in critical or new ways in this process; it may also be reconstituted in its most conventional forms. Hence, in the process of deconstructing traditionally formulated gender, Young reconstructs aspects of traditional femininity which link it with trivial reﬂexes. Obviously, the role of feminism as a technology of gender is by no means always a radical one. Young’s appraisal of breast implantation, written in the late 1980s, now ‘shows its age’ in that the accusation of vanity is no longer commonly used as an explanation for women’s behaviour within the scholarly feminist work I examined. Indeed, it is difﬁcult to imagine a similar statement being made today, although this may change in the future. By the same token, it is possible that vanity will remain out of favour within feminist writing in the future, given the rise of the repertoire of ‘pleasure’, which functions primarily to validate desires that once might have been open to accusations of extravagance and selﬁshness. Of the three repertoires discussed in this chapter, vanity is the one exhibiting the least crossover with women’s magazines, where it is still quite widely used. This marks an important boundary between the two discourses, where conscious political agendas drive feminist scholarship in ways that do not apply to popular women’s material. Interestingly, women’s magazines can be seen to present a wider range of opinion on this question than feminist (and as will be apparent later, medical or regulatory) material. A similar circumstance will be described in Chapter 5, in which medical material aimed at the public is found to offer less information than women’s magazines in

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terms of representation of failed surgery. It may be that the pursuit of a ‘good’ story means women’s magazines are less likely to exhibit restraint in terms of ‘taste’ where accusations of vanity, or graphic photographs of mutilated bodies may act as circulation boosters. An interesting picture emerges from these three repertoires when they are examined together. Here I am considering the role of feminism as a technology of gender. In relation to those instances of the ‘deconstruction’ of gender identiﬁed by de Lauretis (such as that performed by feminism), she foregrounds the following question: If the deconstruction of gender inevitably effects its (re)construction, the question is, in which terms and in whose interest is the de-reconstruction being effected?84 This has been a central question for this chapter. At the same time that the feminist imaginary body is still in some ways a natural body, it is now often encouraged to take its pleasure. Indeed, within this imaginary the body is almost ‘free’ to do so, and at the same time is now rarely if ever open to the censure of vanity. As such, the imaginary body and the female subject produced within feminist discourse is positioned between the appropriateness or inevitability of technological intervention (into the body as nature), the possibility of actively taking ‘pleasure’ from this intervention and the probability of approval, even valorisation in place of censure in so doing. Here, femininity is undergoing becomings through articulations with a range of concepts and issues, and in so doing, rendering any simple notion of progress untenable. Nominally feminist versions of femininity are proliferating from as diverse sites as the ‘woman-made body’ and ‘beauty’. Following Deleuze, it can be said that change is emanating not unidirectionally (from some kind of past wasteland to free feminist future) but from the ‘middle’, from different parts of the rhizome of feminist femininity. As I argued earlier, feminism’s role as a technology of gender is not always one that produces oppositional versions of femininity. Further, as my introduction suggested, where concepts that helped produce cosmetic surgery in the post-Enlightenment era (such as nature and agency) are taken up to critique it, the result is curiously circular. Ultimately, in spite of a shared sense of caution bordering on disapproval for cosmetic surgery, feminist writing on the subject combines to reiterate femininity in a manner that subtly situates contemporary women as a ﬁt and proper object of surgical bodily production. In this examination of feminist analyses of cosmetic surgery I have attempted to demonstrate the ways in which certain repertoires common within women’s magazines appear in the scholarly work of feminists. I have tentatively put forward the possibility that this frequency represents a degree of intertextual exchange between the two discourses, and I will clarify and

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extend this proposal in my discussions of medical and regulatory material in later chapters to see whether these apparently separate discourses also share similar assumptions and ways of talking about gender. Such shared assumptions are what constitute the authorisation of discourses and the construction of preferred readings. Additionally, I have reﬂected on some of the implications of the repertoires of nature, agency and vanity for the function of feminism as a technology of gender, and for the future shape of feminist theory and practice itself.

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5 The ‘Art’ of Cosmetic Surgery: Medicine, Metaphor and Meaning

Medical, scientiﬁc and ‘popular medical’ literature on cosmetic surgery is overwhelming in volume. This chapter incorporates material drawn from books, medical journal papers, articles found in cosmetic surgery advertising and material intended to inform the public. The resulting corpus represents technical work in the area as well as material written by experts but intended for the public. I use this collection to identify and map the analytic repertoires traced in previous chapters; that is, nature, agency and vanity. This chapter seeks to address a set of questions also posed for the project as a whole: can shared terms and assumptions be identiﬁed across discourses which deal with cosmetic surgery? If so, what do those shared terms and assumptions mean for gender? The becomings of the biomedical imaginary body will be investigated through this material, as will any intertextual processes at work between medical, feminist and magazine discourse. I ask, how much do these quite different, sometimes conﬂicting discursive arenas share, and how does this relate to contemporary notions of gender? In analysing medical discourse on cosmetic surgery, it is necessary to begin by deﬁning what might constitute ‘medical discourse’. Certainly, this discourse is far broader and more varied than the discourse of women’s magazines that constituted my third chapter, although diversity was also evident there. Chapter 4, on scholarly feminist work on cosmetic surgery, is different in another way, in that it is based on a relatively small body of material. However, as I noted above, medical writing in this ﬁeld constitutes a huge body of material. In selecting material for this chapter, I began with Australian sources, but quickly realised that expansion was necessary as the ﬁeld is largely international. Consequently I have included materials from the US and the UK. In doing this, it is important to acknowledge that certain differences do exist between national contexts, for instance, different racial issues can be identiﬁed.1 No Australian research is available on the scope and volume of surgical procedures designed to alter perceived racial characteristics, although some of the material does indicate the existence of such procedures.2 Race is rarely considered a signiﬁcant variable in the material 122

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I examine here, as was the case with the feminist texts analysed in the last chapter. Most photographs accompanying the medical texts display white women and rarely are issues such as scarring discussed with skin colour in mind. Again, as I have argued in the previous chapters, femininity tends to be constructed as implicitly white here. For this chapter I researched a range of publications, so that the examples I use draw on brochures as well as prestigious international journals, on books written to inform the public about breast implants, as well as textbooks on plastic surgery. Women’s magazines carry such varied material on cosmetic surgery that it is useful to think of medical material as existing on a continuum with them. This continuum ranges from purely sensationalist ‘freak show’ magazine articles of dubious accuracy, through to more serious ‘informative’ pieces which incorporate advertising within women’s magazines, into the ‘popular medical’ material emerging from clinics and professional societies and promoted as medically accurate. At the far end of this side of the spectrum is the material that appears in technical and professional journals, constituting a discussion ‘within’ medicine. As I have argued thus far, apparently discrete discourses share ideas and repertoires. Medical discourse demonstrates this crossover particularly clearly in that its contributors – doctors, research scientists and surgeons – also contribute to popular and, as will be apparent in Chapter 6, regulatory discourse as well. It is highly signiﬁcant that the boundaries around medical publishing are both so broad and so ﬂuid. For the lay reader, distinguishing between sound medical advice and sales material can prove difﬁcult. In addition, this indeterminacy around technical and promotional material reﬂects the enmeshment of these technologies in the pragmatic world of business. Like other forms of science, medical research presents itself as value-free. However, the status of cosmetic surgery as a commercial enterprise impacts heavily on its claim to impartiality. Of course, the issue of scientiﬁc impartiality and objectivity is central to this book. In examining the language and metaphor found in magazines and feminist material on cosmetic surgery through the notion of linguistic repertoires, a strong sense has emerged of the sexual imaginary these two discourses share (though differences were also apparent). In this chapter, medicine will be examined in order to establish whether elements of this sexual imaginary can be identiﬁed within its borders. Medical understandings of sex and gender underpin the development and sale of cosmetic procedures and as such, constitute a central organising feature of the development of cosmetic surgery as a medical specialty itself. As this chapter will indicate, these understandings may also impact on the way medical crises, such as the silicone breast implant controversy, are viewed and negotiated. Given that the medical material I examine here covers work aimed at a lay audience as well as work aimed at a professional medical audience, consideration of the differences between these two areas is necessary. It will be

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clear from the following discussion that some of the most explicit mobilisations of the three repertoires occur in texts which speak to the public. These texts combine alluring photography and verbal description with a claim to accuracy and concern for safety. Written by practising surgeons or by medical journalists under the direct auspices of qualiﬁed surgeons, they almost always emerge in favour of cosmetic surgery, though they may express doubts over speciﬁc procedures. They engage the reader in persuasive and tactful ways, producing a sense of the importance of cosmetic surgery for the appearance whilst minimising the potential for causing offence, as is possible where surgery to ‘correct’ certain characteristics is advocated. The use of the three repertoires, however, is not conﬁned only to the ‘popular medical’ material. Apparent in articles designed to inform the general practitioner, in work that discusses the psychological aspects of surgery for the beneﬁt of surgeons and their nursing staff, and in textbooks and specialist plastic surgery journals, the repertoires of nature, agency and vanity also inform the sexual imaginaries internal to medicine. In reviewing this material I again follow the method described in the discussion of analytic repertoires found in Chapter 2. An analysis based on repertoires eschews any claim to accessing ‘true’, ‘underlying’ meanings and intentions, focusing instead on basically overt uses of linguistic options and meditating on what these uses tell us about culture and options for individual subjectiﬁcation. This is a poststructuralist approach utilising a ‘surface’ model rather than the conventional ‘depth’ model which posits the existence of an underlying core to be uncovered – a core that too readily becomes the ‘real’ in contrast to a ‘false’ surface. For this reason, although many of the texts I examine carry implied notions of nature, agency and vanity, I have not pursued these interpretations. To my mind, the overt references themselves, while more common in ‘popular medical’ material than elsewhere, are none the less clearly traceable throughout the entire corpus of material, and provide a valuable insight into the exchange of repertoires between popular, feminist and medical material, as well as some speciﬁc insights into the character of the sexual imaginaries within medicine. Equally, I have not separated the ‘popular medical’ from the ‘internal medical’ material, as such a move would imply a categorical distinction between the two, where the basis of my argument suggests the opposite. It is true that these two areas fulﬁl some different functions and address the three repertoires to different degrees; however, they emerge from the same commercially driven milieu. To produce a functional separation between them in this chapter would again risk distinguishing between the ‘real’ medical material (found in serious journals and textbooks), and the ‘fake’ or ‘superﬁcial’ discourse of popular medicine. My point is that despite these distinct functions, the two aspects of medical discourse share the same notions and in turn produce shared effects. At the same time, differences in terms of intended audience, for instance members of the public or

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colleagues, do inﬂuence modes of address and tone and this too will be taken into account. This chapter will establish that strong connections exist between the ways popular culture, feminist and medical material use the three main analytic repertoires taken up in this book. These connections point to an often unrecognised intertextual exchange between these ﬁelds and to some interesting and unlikely alliances. One context in which medical discussions of cosmetic surgery do directly acknowledge an intertextual relationship with other discourses is in the frequently given advice to prospective patients that photographs of models in magazines be examined by the patient in order to clarify the speciﬁc look desired. These photographs should then be supplied to the surgeon as a ‘blueprint’ for the operation.3 Here, medical texts actively encourage potential participants to look to women’s magazines and to fashion models and celebrities for their aesthetic ideal. Similarly, medical material sometimes credits magazines with prompting older women to have surgery to remedy longstanding ‘problems’. According to Julian Reich, a widely published Australian surgeon, women often report that they ‘delayed’ having cosmetic surgery because of a lack of available information. Exposure to information in women’s magazines is thus cited as a reason why women eventually do undertake surgery.4 This observation was made in the 1970s, but its gist is equally relevant now: women’s magazines are represented as working in tandem with surgeons to promote cosmetic surgery. Earlier I noted that women’s magazines gender cosmetic surgery in obvious ways, through the consistent representation of surgeons as male and participants as female. This phenomenon is equally evident within the medical material I examined, particularly in texts designed to inform the public about the possibilities and limitations of cosmetic surgery. While these publications occasionally refer to participants as ‘he’ within the text, their photographs and drawings often entirely ignore men and depict women only. In cases where men are included, they are positioned within separate, minor addenda in a very similar way to their treatment in women’s magazines. It is interesting to consider the relative impact of photographs and text in this context. Two categories of photographs can be identiﬁed in this material. The ﬁrst category contains before and after pictures of surgery participants, with an unerring emphasis on success. The second category contains photographs of young models used to create a general sense of the possibilities available to women through surgery. Unlike women’s magazines, it is very rare in medical material aimed at a public audience to ﬁnd photographs of failed surgery. In this sense, women’s magazines could be said to provide a wider range of representations of cosmetic surgery than medical discourse aimed at the public. One book, written as an exposé of silicone breast implants, offers a highly critical account of breast augmentation with silicone and describes many possible serious failures and side-effects, but

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contains no pictures.5 Again, the relative power of persuasion wielded by text or photograph is crucial to consider. It is common to ﬁnd models used in photographs alongside text which insists that ‘suitable’ patients should not expect too much and that the desire for perfection is a strong contraindication for surgery. For example, in a publication produced in conjunction with the television programme ‘Good Medicine’, a full-page photograph of a young model stands opposite the words: Dr Olbourne also has to deal with the mental attitude of his patients, as well as their often unrealistic expectations. [He says] ‘that’s when they need Merlin the magician, not Olbourne the surgeon!’6 Contradictory messages are often present in these texts. In fact, it is tempting to interpret the combination of persuasive photographs with warnings as an attempt to minimise the impact of these warnings. Certainly, there is much within the medical material that indicates a strong desire on the part of surgeons to provide only the minimum of information on risks so as not to ‘frighten’ women. In that these publications are also intended to encourage participation in undergoing cosmetic surgery, the minimisation of potential risks and failures in this way has serious implications for the notion of ‘informed consent’ that is frequently used as a defence for the (often risky) surgical procedures.7 Indeed, the silicone breast implants controversy both revealed and produced a heavy ethical reliance within some medical circles on this very notion. As Dr Olbourne’s statement above suggests, cosmetic surgeons often position themselves as psychological therapists as well.8 In the journal Plastic Surgery Nursing, Pruzinsky argues a very common case when he states: ‘[t]he primary goal of cosmetic plastic surgery is to change patients’ perceptions of themselves’ and further, that this change can ‘facilitate improvement in the patient’s psychological functioning.’9 The deﬁnition of cosmetic surgery as ‘psychology with a scalpel’ appears frequently within the literature, which contains many examples of work on the psychological motives for and impact of cosmetic surgery in general. Often, the author indicates no formal qualiﬁcations in psychology or psychiatry. Within this context, the importance of patient selection is repeatedly emphasised. Although a potential participant should believe that in itself, cosmetic surgery can improve selfesteem, expectations should not be too high. Unrealistic expectations lead to disappointment, further psychological damage and even litigation. In fact, in some cases, litigation is posed as an indicator of mental illness in itself. Where the surgeon deems the operation a success, the patient’s failure to agree is pathologised. For example, in one textbook, it is asserted that dissatisfaction ‘may lead to the appearance of attention-seeking devices, accident-proneness in relation to the site of the operation, the search

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for further aesthetic surgery elsewhere, or embarkation on a process of litigation’.10 Due to the subjective quality of judgements about aesthetic appeal, surgeons are in a somewhat unique position to argue that the results of their surgery are successful even when the participant does not agree. In fact, participants’ disagreement on this point is sometimes posed as an indicator of mental instability in itself, and the undertaking of litigation is often taken to conﬁrm this. In the MJA, Reich states that ‘[r]eactions of complete satisfaction and a quiet acceptance of the inevitable period of resolution can be expected of those with a normal personality and a realistic attitude to an objective deformity’.11 Reich is speaking in general terms, but the article makes clear that his patients are overwhelmingly female. The gendered nature of these comments is evident: a ‘normal’ personality is one that is completely satisﬁed and quietly accepting. Presumably, dissatisﬁed and vocal patients are not normal. This article dates from 1972, and certainly the necessity of an ‘objective deformity’ no longer widely obtains in securing access to surgery. However, this idea that dissatisfaction and concern about the results of surgery represents a sign of feminine instability reemerges in contemporary discussions of silicone breast implants. This re-emergence is indicated in two ways. First, contributors to the MJA and elsewhere frequently describe the concern around silicone breast implants in ways that characterise it as irrational and illogical. Accusations of ‘hysteria with regard to silicone breast implants’,12 ‘irrational theories’13 and the ‘spite and envy of the Feminist Sisterhood’14 gender the debate within medical circles in unmistakable ways, leaving those women concerned about their implants positioned as hysterical, illogical and motivated by jealousy. Of course, these claims do little to confront those concerns directly. Instead, they work to undermine the validity of women’s experiences of illness and pain and to contain a potentially damaging situation. Second, common within the internal literature is a conviction that cosmetic surgery participants, particularly breast augmentation patients, are best provided with only a limited amount of information on the risks involved. This is a debate that, for obvious reasons, has not been conducted in the public arena, and as a result, reservations about full disclosure are not manifest in material aimed at the public.15 Detailed accounts are called ‘well-meaning but unnecessarily comprehensive’,16 and women are portrayed as being ‘frightened unnecessarily’ by these.17 Elsewhere, the investigations into silicone breast implants are characterised as creating ‘quite unnecessary anxiety’.18 The repeated use of the word ‘unnecessary’ here is important in that it points to a subjective evaluation of women’s need to know information about their health. In a clearly paternalistic mode, surgeons position women as in need of information only up to the point that they feel reassured about a procedure’s safety. This suggests that a decision about safety

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has been made prior to women’s involvement and that participants are actually informed only about the outcome of that decision, which is that the procedure is safe. Informed consent, posed by many as the appropriate response to risky operations, means little in this context. In these ways, a view is produced that women (as cosmetic surgery participants) are unable to evaluate risks logically or fairly, and hence, that they should be allowed access only to limited accounts of such risks.19 This supposed mental incapacity or instability in dealing with information about cosmetic surgery reﬂects longstanding reservations about women’s ability to reason.20 Following de Lauretis’ notion of technologies of gender, this reﬂection of the medical sexual imaginary can also be seen as enacting its construction in that it reproduces ideas about femininity. As I have noted earlier, de Lauretis observes that ‘the representation of gender is its construction’.21 Where traditional femininity, in the form of assumptions about women’s mental capacities, guides practice, that practice in turn reproduces traditional notions of femininity. Central to this argument is the recognition that representations of femininity do not represent women, rather they represent particular understandings of sex difference. Later in the chapter I argue that the concurrent mobilisation of the repertoire of agency directly contradicts this construction of women as helpless and irrational, but that both versions share important assumptions and are strategically deployed together in the interests of the cosmetic surgery profession.

Nature The use of nature in medical discussions of cosmetic surgery shares much with the women’s magazines I discussed in Chapter 3. Several main subrepertoires can be recognised, some of which correspond closely with repertoires I identiﬁed in Chapter 3, and which suggest that an intertextual exchange exists between the two discourses. This is very clearly evident in publications written by doctors, nurses, or medical reporters with endorsements by surgeons, intended for a lay audience. In some cases, the magazine genre itself is imitated. It also occurs, however, in material intended for readers within the specialised ﬁelds of medicine, psychiatry and psychology. The main sub-repertoires of the ‘natural’ I examine here are the ‘natural look’, the natural body in opposition to the technologised body, ‘Mother Nature’, or nature as a productive, quasi-conscious force, and nature as expressed through the discourse of genetics. Each of these sub-repertoires appear in the women’s magazines I looked at, and some also appear in feminist writing on cosmetic surgery. Natural/normal The ‘natural look’ is an extremely common way of talking about cosmetic surgery through this repertoire. The sub-repertoire spans the entire range

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of operations, from breast augmentation to liposuction, dermabrasion to rhinoplasty. As I argued in Chapter 3, the repertoire reveals a strong cultural imperative toward obscuring the processes behind the production of appearance. This imperative demands a seamless public appearance that not only erases indicators of diet, age, child-bearing or class status, but most importantly, which minimises the evidence that these factors have been erased at all. So, in a book written for the public by surgeon and professor Donald Marshall, he argues: ‘Good plastic surgery should provide a result which appears normal; it should not be apparent that anything has been done.’22 Here, the aim is to create aesthetic ‘normality’. This ‘normality’ also implies that cosmetic surgery itself is abnormal in that surgeons insist that evidence of surgery must be avoided. Certainly, cosmetic surgery in general is not yet considered entirely ‘normal’ although different procedures carry different cultural meanings.23 Participants can achieve a look that is normal, but their participation in surgery itself marks them still as somewhat abnormal. Consequently, normality can only be imitated through these means, never achieved. Along these lines, and somewhat startlingly, another surgeon comments that ‘[p]atients are trying, as much as possible, to simulate a normal person’ (my emphasis).24 Not only does this statement suggest an awareness that normality cannot be achieved, only simulated, it also reveals a common slippage or parallel in the material, this time between appearance and subjectivity, or external and internal. I have already noted that cosmetic surgery casts itself as a form of psychological intervention, and perhaps it is this that allows for an assumption that a person’s appearance is interchangeable with their subjectivity. Cosmetic surgery relies heavily on a view that sees appearance as primary to personality development. While this assumption may be accurate in a sense, it is one that cuts two ways: ﬁrst, by recognising that cultural beliefs around appearance (for example, a person’s size or skin colour), contribute to the individual’s development as a subject through social pressures resulting from these beliefs; and second, by a reverse logic which assumes that the appearance is then necessarily revealing of the personality of an individual in predictable ways (for example, that fat people are to be pitied as they are unhappy, or regarded with contempt as they are selfindulgent). This latter assumption, that much can be inferred from a person’s appearance, is of course, a fundamental basis for the popularity of cosmetic surgery. Clearly, if the distinction between mind and body, nature and culture is to be adequately challenged, as I have argued thus far is necessary to a feminist critique of science, this two-sided logic must be negotiated. If appearance is deﬁned as a facet of the lived body, it may usefully be acknowledged as part of an individual’s subjectivity, at the same time that the meaning of that appearance to the individual cannot be taken for granted. In other words, while appearance does mean something, is signiﬁcant, precisely what

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this signiﬁer refers to is by no means self-evident. The slippage between appearance and subjectivity that occurs in this repertoire of the natural, as well as in the repertoire of agency which I will examine later, is the product (as well as the producer) of familiar cultural alignments between appearance, value and authenticity: surface and depth. As natural as possible In this material, both the look and the feel of a body part can be more or less natural according to criteria never clearly deﬁned. The use of the phrase ‘natural look’ is one of several clear intertexts apparent between women’s magazines and ‘popular medical’ discourse, although it can also be found in formal medical material as well. Thus, we read: [The saline implant] doesn’t feel quite as natural as silicone.25 The aims for all cosmetic surgery are to reduce scarring and the trauma of incisions and make the results look as natural as possible.26 The look is entirely natural.27 Done properly, the results are very effective and natural.28 The ‘look’ is a concept commonly employed in women’s magazines to refer to the total effect of the appearance, where the appearance (often through clothes or makeup) has been consciously controlled and coordinated. Where all elements of the cultivated appearance are related by some dominant characteristic such as a shared manufacturer, ethnic reference or activity, this is often called a ‘total look’. In a sense, the natural is the necessary ‘total look’ for cosmetic surgery. This is not always true of makeup or other grooming practices, and it is interesting to consider whether, with increasing commodiﬁcation, cosmetic surgery will prove to be as susceptible to variations in fashion. Certainly, the readiness with which some procedures trade particular bodily changes for scarring that cannot be seen as natural, or some women opt for extremely large breast implants suggests that the ‘natural look’ is also vulnerable to other priorities. A second signiﬁcant mode in which the repertoire of the natural appears in medical discourse on cosmetic surgery can be identiﬁed in discussions of procedures and body parts that divide the natural from the non-natural. While this discourse does not generally present cosmetic surgery itself as natural, it does at times position some aspects of surgery, and some parts of the body involved in surgery as nonetheless natural. Thus, the common problem of capsular contracture (the formation of a tough capsule of scar tissue around the breast implant, causing a hard, ‘tennis ball’ effect) is described as ‘[t]he ﬁbrous tissue “capsule” that naturally forms around the implant’.29 The terms under which a speciﬁc type of scar tissue formation, prompted by a breast implant and frequently comprising tissue saturated

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with silicone molecules due to implant leakage or rupture, can be identiﬁed as natural are at best unclear. Nature here seems to represent those bodily events for which no direct human agent can be identiﬁed, even if the body which exhibits the phenomenon is human. Here, the body, as opposed to the mind, is again clearly positioned in the realm of nature. In Guthrie’s book aimed at women considering breast augmentation or implant replacement, the beneﬁts of lumpectomy for cancer are explained in a similar way: The attraction of lumpectomy, of course, is that although as much as a quarter of the breast may be removed and the breast left smaller, at least it is a woman’s own natural breast.30 Here, the breast, thoroughly examined, altered and constructed through surgery is yet a natural breast. This repertoire is repeated in a number of contexts: The skin is then frozen and sent to the US where it is specially treated to extract natural collagen.31 The veins [treated with a laser] then collapse and are removed naturally by the body.32 [W]omen with very large breasts might wish to inquire about matching the new breast with a smaller natural one through breast reduction surgery.33 Frozen, transported and extracted collagen; laser-treated spider veins; surgically reduced breasts; each of these ﬁgures as natural in contrast to other procedures and other substances. The reasoning behind these distinctions is unclear, although degrees of invasiveness and levels of artifactuality are sometimes relevant. There is no consistent measure, however, and this points to the arbitrary character of the category of the natural, a category which is nevertheless used effectively for commercial and thus political purposes. Here, the natural stands in for notions such as ‘acceptable’, ‘safe’ and ‘normal’. Most of these examples are taken from material aimed at the public, and as such, can be seen to be utilising the natural as a term intended to inspire conﬁdence in the reader that the cosmetic surgical body is not entirely unnatural or somehow ‘wrong’. Evidently, invocation of the natural is perceived to be ‘reassuring’ to the public, and this may well be the case. Television advertising constantly represents natural products as inherently safer than ‘man-made’ ones, and the public component of medical discourse on cosmetic surgery functions as advertising in many respects. Of course, too great an emphasis on the natural would undermine cosmetic surgery altogether. As I argue later, the use of agency repertoires goes some way

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towards managing this risk by representing cosmetic surgery as an active and appropriate way of overcoming nature’s less desirable effects. As I have noted, it is common practice to refer to products as natural in order to command market share. In the case of cosmetic surgery, the association between natural bodily processes or reactions and surgical procedures helps to subtly position surgery itself as somehow in the realm of the natural. By linking certain procedures to nature through the claim that they are ‘more natural’ than other (often by now superseded) procedures, an impression of naturalness, interpreted as safety and normality, is achieved. In this process, the arbitrary, shifting character of the natural is obvious. Often statements about nature diverge and contradict where procedures, materials and equipment are deﬁned and redeﬁned inside and outside the category of the natural. Clearly, nature is a distinctly malleable category, capable, as I have argued in previous chapters, of performing a range of political work. As such, it is a powerful and attractive repertoire. Certainly, it is taken up vigorously in magazines and feminist texts as well as in medical literature in grappling with the issues of cosmetic surgery. Nature as intentional Also common in each of these discourses on cosmetic surgery is the representation of the natural in the form of ‘Mother Nature’. This reference is sometimes made directly, and sometimes through references to a form of nature that incorporates a degree of consciousness or intentionality. This somewhat anthropomorphised version of nature is usually employed in instances where the intentionality of the surgeon and the participant is fruitfully contrasted with an intentional body or universe. One text, published in JAMA, describes women’s use of breast implants for cosmetic rather than reconstructive purposes as ‘a seemingly easy means of gaining the buxomness Mother Nature may have denied their own two healthy breasts’.34 The article’s overall aim is to present women who have undergone breast augmentation and later sued over the question of the safety of silicone, as caught in the bind of their own vanity. This will be discussed in greater detail later in the chapter. Here, the invocation of Mother Nature serves to censure women in that they are seen to have ignored the laws of nature for superﬁcial reasons. Nature is deployed as a distinctly normative category in that deviation from or resistance to its laws is seen to legitimately attract criticism. Nature is invested with a type of consciousness that suggests the possibility of retribution if its laws are not followed, and the justice of such retribution. This understanding and mobilisation of nature has been used extensively in the past, such as in debates around women’s rights and capabilities, as well as more recently, perhaps most notably in the case of homosexuality and AIDS.35 References like those noted above are common both in academic and clinical material as much as in popular medical texts: ‘circumvent[ing]

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nature’, ‘what nature had offered’36 and ‘patients can accept that from Mother Nature’37 are a few examples. Here nature is undeniably feminine; this time in the shape of the formidable and unpredictable mother. Signiﬁcantly, it is only masculine science, in the form of cosmetic surgery, that can challenge the intentions of Mother Nature as revealed in our natural bodies. Here the sub-repertoire proves to be obviously and intensely gendered. Not all of these references are used to censure participants, but they do consistently serve to suggest that beyond human agency lies a larger plan, one that we disrupt at our own risk. Again, the combination of a vague and malleable category of the natural with the anthropomorphisation of nature as intentional and potentially disciplinary is a politically powerful one. This combination allows for instances in culture where certain practices are deemed unnatural and represented as likely to attract the just retribution of nature. Those who undertake these practices are positioned outside legitimate society. In the next chapter, the effects of this conceptualisation and deployment of nature will be measured in the context of breast implant litigation, where regulatory discourse as a technology of gender struggles over deﬁnitions of women as natural victims and/or narcissists. As a technology of gender, the deployment of Mother Nature in this form serves to reconstruct nature as feminine, and the feminine as natural. Genetics: at war with fantasy A fourth way the natural is invoked in medical discussions of cosmetic surgery is through the highly consistent use of genetics to ﬁgure nature in contrast to the ‘man-made’ possibilities of surgery. Like the women’s magazines I examined, the pre-surgical body is understood as shaped by its genetic make-up. Other physiological factors, such as the role of diet or hormones, are largely ignored. As I argued in Chapter 3, genetics has become the privileged scientiﬁc version of nature, carrying with it strong metaphorical connotations of immutability, save for the slow changes wrought by ﬁerce Darwinian competition. However, at the same time that the discourse of genetics constructs the body as nigh-on immutable, its mobilisation of the image of the ‘genetic blueprint’ allows for the body (and nature in general) to be ﬁgured as ultimately readable and controllable. Along these lines, genes are positioned as a kind of limit, beyond which it is known to be impossible to step without the complex knowledge and extreme measures made available through science. Nature exists here not only as the ‘proper’ object of traditional science, but also as a boundary impenetrable to all but science.38 Thus, in one textbook, Reich argues that appearance ‘depends basically on a genetically determined proportionate relation of its various features’, which can to some extent be ‘modiﬁed by environment’.39 In this case, factors aside from genetics are taken into account, but a clear hierarchy is established, in which the effects of environment are secondary to the effects of genetics. This hierarchy is highly

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ideological, in that it tends to transfer responsibility for the physical wellbeing of people from environmental factors, to the seemingly non-political, amoral, self-evident realm of the natural. In other words, in this view, our illnesses and inﬁrmities are the result of genetic diseases and predispositions, which are merely triggered by environmental factors. Signiﬁcantly, the ﬂaw resides within us. An alternative position might see these inﬁrmities as being a product of the environment (for instance, pollution, diet, social pressure to be thin, and so on), which are to some extent curtailed or enabled by genetics. As was the case in Chapter 3, references to genetics appear extremely frequently within the material. Thus, one text notes (in a relatively uncommon reference to male participants): ‘You may want to look like Arnold Schwarzenegger, but your genetic type may be more suited to the Richard Gere model.’40 Here, a publication aimed at informing the lay reader explains why attempts to alter the body through exercise to meet an ideal can be unsuccessful. Similarly, in a paper on the psychology of female cosmetic surgery participants, Goodman states that ‘in all but a few cases, genetics was at war with fantasy’.41 In this case, women’s desires about their appearance encounter the powerful limit of genetics. Of course, cosmetic surgery is posed as a way of overcoming the deﬁning genetic code. This focus on genetics incorporates a recognition that the individual cannot be blamed for his or her genes (for his or her ‘ugliness’) and this is no doubt appealing. However, in some instances in the literature, a new kind of blame is constructed, one based on failure to ameliorate the effects of these genes through cosmetic surgery. As another medical publication aimed at the lay reader states: ‘In the future, there will be no excuse for looking a day over the age of 35.’42 Surgeon as artist Other ways in which the repertoire of the natural is taken up within medical discourse on cosmetic surgery include nature as unpredictable and the natural body as raw material or ‘clay’, which the ‘artist surgeon’ can mould. One textbook argues that ‘[l]ike the sculptor, the surgeon must be fully aware of the strengths and weaknesses of the material on which he works’.43 This example is drawn from a publication nearly twenty years old, but parallels constructions of the body as raw material in women’s magazines today. A 1998 popular medical publication also picks up this notion in its title; The Art of Cosmetic Surgery. This repertoire will be familiar from my earlier discussion of women’s magazines, in which a ‘raw material’ repertoire is also common, representing the female body as a substance yet to reach aesthetic fulﬁlment. The function of this sub-repertoire differs in the medical context in that it now serves as an injunction to the prospective surgeon to incorporate aesthetic and artistic values into his or her practice, positioning cosmetic surgery as located on the borderline between art and science, requiring

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skill in both ﬁelds. In this sense, successful cosmetic surgery becomes a matter of talent, requiring an indeﬁnable ‘touch’ like that of the master artist. Here, authority is gleaned from two different sources, positioning the surgeon as doubly in control. The reiteration of this artistic element in the popular medical material presents the surgeon to the prospective participant as an elite practitioner, and may also function to limit the number of cosmetic surgery practitioners by positing the necessity of an added, indeﬁnable talent for success. Of course, the association between art and the pursuit of beauty is longstanding. Its appearance in popular medical material serves to reﬁgure surgery in more familiar and acceptable terms. The focus on art ennobles cosmetic surgery through the historically legitimate aspiration to beauty in its purest ‘artistic’ form. It works to replace images of operating theatres and surgical instruments with rather more romantic images of art, in which the female body is the artwork in a very traditional sense. Here, mere vanity is not the woman’s motive, nor avarice the surgeon’s, rather it is the elevation of our culture, through a central symbol of civilisation, ‘Great Art’. As Gilman argues: ‘The body as art and art as the basis for understanding the body echo the commonplace about art being the locus of truth and beauty.’44 Art itself is a powerful technology of gender, but in this context, it is the cluster of associations around art that contribute to the reiteration of femininity through the metaphor of surgeon as artist and body as artwork. Although Gilman’s history to some extent denies the centrality of gender to cosmetic surgery, I think the passage cited above draws that link effectively. The ‘art’ that cosmetic surgeons allude to and attempt to associate themselves with is the very art that Mulvey and others have persuasively argued utilises and solidiﬁes the objectifying male gaze and the passive female object.45 Where surgical bodies (overwhelmingly female) are artworks, Parker and Pollock’s observation, on viewing the works of the ‘Old Masters’ is informative: ‘[a]ll present woman as an object to a male viewer/possessor outside the painting.’46 The metaphor of the artist shaping the unreﬁned clay of the surgical body not only convincingly links cosmetic surgery with femininity on a profound level through the relationship between art object and femininity within the sexual imaginary, but it also reproduces traditional elements of passivity, and acceptance of the mastering gaze and touch.47 In this metaphor, the feminine is nothing more than a product of the necessarily male artist. As Parker and Pollock tellingly note, while the ‘Old Masters’ enjoy uneclipsed admiration, there is no such thing as an ‘Old Mistress’. The role of the feminine in cosmetic surgery is clearly laid out here. Nature as a self-evident category is widely used within medical discourse on cosmetic surgery. Some uses of the repertoire position the pre-surgical body as natural, while others utilise inconsistent deﬁnitions of the natural to present some body parts and some surgical procedures as ‘more natural’

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than others. The range of sub-repertoires available is fascinating in its breadth, and certainly equals the frequency with which the natural is employed within feminist discourse and women’s magazines. Some subrepertoires have a long history, such as the raw material repertoire, while others are relatively new, as in the case of genetics. At the same time, the ways ‘nature’ is taken up in ‘popular’ versus ‘internal’ medical material can vary. Some strong continuities are clear, while the emphasis on one subrepertoire or another may change depending upon the nature of the work the concept is mobilised to do. In many ways, the natural is continually developing as a cultural artifact.48 It is undergoing speciﬁc becomings related to historical, social and political factors, here through its circulation within discourse on cosmetic surgery. Its intertextual character is demonstrated through the many crossovers I have identiﬁed thus far between women’s magazines, feminist material and medical literature. This co-construction of medical discourse and other disourses suggests that claims to the objective nature of medicine, and in another vein, to the polysemic character of popular culture, may be less than accurate. To consider this last question of preferred readings, I want to argue here that the medical use of nature repertoires helps to construct a preferred reading within women’s magazines. In other words, the sub-repertoires of nature as limit, as genetics, or as passive and malleable appear in both medical and popular literature, and as such, function to legitimise each other, in clear intertextual terms. In a context where medical, popular and to some extent feminist literature all employ the natural as a fundamental, self-evident category, the possibility of reading women’s magazines against the grain, of responding with the question ‘Well, what is natural anyway?’ is meaningfully curtailed, if not pre-empted. Equally, the use of a magazine format and magazine terms such as the ‘natural look’, reciprocally construct a preferred reading of medical material which aims both to inform women and convince them that cosmetic surgery is safe and desirable, at the same time that it invests these surgeries with the glamour associated with women’s magazines. Here, women’s magazines and medicine are articulated together in ways that involve the becoming of both elements: medicine accrues a degree of glamour, while magazines inspire greater conﬁdence through associations with medical authority. Cosmetic surgery itself undergoes a becoming too, in that both glamour and scientiﬁc practice now meet harmoniously within its parameters. As I have already argued, repertoires of the natural are multiple and contradictory. It is as easy to read nature as sacred and not to be interfered with, at least within women’s magazines, as it is to see it as the basis for the inevitable intervention of humans – although the latter interpretation differs from the former in that it is implicated in the authority of science. These repertoires are often inconsistent, and certainly always in the process of becoming. However, this is not to say all perspectives on nature ﬁnd

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expression in these materials. Within the three discourses I have examined so far (magazines, feminist scholarship and medicine) the most consistent factor has been the absence of any thorough critique of the natural itself. As I demonstrated earlier, although some feminist literature on cosmetic surgery gestures toward a scepticism for the category, its use is extremely common. In this sense, although nature is used in a variety of ways and is at times questioned, the female imaginary body remains powerfully naturalised. In that the category of the natural serves to legitimate technoscientiﬁc/cultural practices such as cosmetic surgery, the three discourses that produce this naturalisation can be seen to serve a particular function. By failing to debunk the natural, and by reifying it through a multitude of references, they create preferred readings in favour of the logic of technoscience. Moreover, this process also functions as a technology of gender. The alignment of the feminine with nature, and the masculine with culture (or science: nature’s only legitimate master), means that such a reiﬁcation also serves to reconstitute gender relations along traditional lines.

Agency Medical discourse on cosmetic surgery relies heavily on the repertoire of agency in several ways. The need to establish the validity of cosmetic surgery and to carefully select patients for success is at the centre of this. The most obvious sub-repertoire apparent in the material is the familiar characterisation of cosmetic surgery as a positive career move, and the participant as an active, motivated and intelligent person. Connected with this speciﬁc subrepertoire is the presentation of cosmetic surgery as a phenomenon which properly requires the weighing up of risks and beneﬁts by the patient. As in the case of ﬁnancial investment, the ‘professional’ is required to take calculated risks and to carry any unforseen losses. These sub-repertoires appear frequently in popular medical material, and also, particularly in the case of the weighing up of risks and beneﬁts, in the internal material. Also common, this time more often within internal medical discussions, is the sub-repertoire that links cosmetic surgery with psychological treatment and casts participation as the conscious attempt to intervene in and improve one’s own mental health. Within this model, the participant must undertake cosmetic surgery to please no one but her/himself. The strong individualist tone that runs through these repertoires is perhaps most clearly reﬂected in the frequent use of another repertoire, this time based on courage and heroism. Many of these repertoires will be familiar from previous chapters and indeed, like the use of nature, a strong intertextual relationship exists between medical, popular and feminist discourses in the use of agency. At the same time, the implications of the medical mobilisation of agency differ from those generated by feminist or popular culture uses.

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A competitive and youthful edge The representation of cosmetic surgery as a legitimate and valuable means of improving employment prospects and of ‘maintaining an edge’ amongst younger colleagues is almost as common in medical material as it is in women’s magazines.49 In some ways, it is an ingenious approach as it can be used equally for both men and women. The suggestion that any improvements will translate into career success goes some way towards ‘masculinising’ cosmetic surgery. Equally, while Western women are perhaps more sensitive to the accusation of vanity now than ever before during the last century, the desire to advance in career terms has become an acceptable one. Moreover, the career itself can provide the funds for such treatment. Because the idea of women’s need to rely on their appearance for success is a longstanding one, the use of cosmetic surgery to advance career interests is both a ‘modern’ yet familiar expression of femininity. Accordingly, surgeon Darryl Hodgkinson addresses general practitioners, explaining that people (his article’s photographs emphasise the female patient) ‘seek to maintain a competitive and youthful edge’ in undertaking facial surgery.50 In a similar vein, Reich states that an ‘emphasis on youthfulness, as synonymous with capability and commerce’ is behind the desire for surgery.51 These two articles were written more than twenty years apart, yet the ‘career’ subrepertoire is common to both. A textbook ﬁrst published in 1979 conﬁrms the consistent popularity of this approach, although it may be that over time the use of this repertoire has changed in some ways, becoming more widely used by women: [A] businessman or a professional man can be very much affected by what he sees when he is shaving. If the reﬂection is a pleasing one to him, he stands a much better chance of success in his work.52 Here, the subject is clearly male. Interestingly, the passage is careful to circumvent any suspicions about the vanity of the subject by providing him with the ‘alibi’ of shaving to explain his gazing into the mirror. Later, career prospects are cited in instances where the targeted sex is not clear, as well as in cases where women are obviously addressed. The kind of subject constructed through this discourse is a highly motivated individualist, certain that particular changes will provide the edge in an environment that is seen more as competitive than cooperative. It may be that this particular way of talking about cosmetic surgery, ﬁrst intended as a means of selling procedures to men, has been successfully redirected at women. An interesting spin-off from this is the way this discourse on cosmetic surgery, emerging both from the relatively powerful medical milieu as well as from magazines, not only identiﬁes women’s career interests, but also legitimates them. Of all the ways in which cosmetic surgery interacts with the sexual imaginary, it is probably this conﬁguration of femininity with unabashed ambition that

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is the most readily identiﬁable as a departure from traditional middle-class femininity. Let the buyer beware Another agency sub-repertoire evident in the medical material I examined is one based on a ‘caveat emptor’ approach which emphasises the ability of the individual to become informed about the risks and beneﬁts of surgery, and weigh them up independently and dispassionately. This repertoire will be familiar from Chapter 3, in which I noted its common use in magazines. The individual constructed here owes much to the motivated and rational careerist described above. The textbook, Cosmetic Surgery, states the case this way: Unlike other forms of surgery, where the advisability of an operation is based on the surgeon’s assessment of medical necessity backed up by laboratory ﬁndings, the need for cosmetic surgery is grounded on the patient’s own diagnosis. It is therefore up to the patient to shop carefully for his or her surgeon – and ﬁnding the right cosmetic surgeon is not without its dangers.53 As Donald Marshall conﬁrms much more recently: ‘Caveat emptor or “let the buyer beware” certainly applies in the ﬁeld of cosmetic surgery.’54 The repertoire is frequently used in both popular and internal material, although it is vigorously opposed by David Kessler, one time head of the FDA, and the man responsible for the moratorium on silicone breast implants in the United States.55 The apparent opposite of this repertoire, however, is equally disquieting. It can be identiﬁed in the tendency I described at the beginning of this chapter towards limiting the amount of information offered to women on the safety of silicone breast implants and other procedures. On the one hand, participants are treated as incapable of understanding and coping with complex information on safety and side effects, on the other, they are characterised as independent and dispassionate assessors almost wholly responsible for the success of their operations.56 Between them, these two positions justify an arrangement more favourable to surgeons than to patients. Clearly contrary, these two repertoires are nevertheless well placed to work together in excusing inadequate advice and inadequate results. Like the participants described in the chapter on women’s magazines, these ‘skilled consumers’ are characterised as participating in a kind of ‘investment surgery’ where assets are maintained and upgraded for future proﬁtability. The use of this sub-repertoire suggests that within medical material almost as much as within women’s magazines, explanations based on individual agency are valuable in establishing the legitimacy of cosmetic

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surgery. In addition, it indicates the presence of space within medical discourse on cosmetic surgery to credit women with independence and agency when this approach offers beneﬁts for practitioners. The opposing repertoire, based on the criticism of ‘unnecessarily detailed and frightening warnings’ indicates that cosmetic surgery discourse also maintains an view of women as irrational and in need of protection within its sexual imaginary. Later, I examine the signiﬁcance of these two repertoires when examined side by side in the medical context. Internal motivations Connected with these repertoires based on professionalism and free consumerism is another agency sub-repertoire also commonly found in women’s magazines and some feminist texts. This particular version of agency relies on the notion of ‘pleasing oneself’, and is one of the most decidedly individualist versions of agency identiﬁable in the material. Frequently cited, it sits strangely in a context where women are advised to look for their ideals in women’s magazines, and where the surgeon has the ﬁnal say on the shape of the nose, the size of the breast implants or whether the operation is appropriate at all. In fact, the mark of an ethical surgeon seems in some ways to be deﬁned as the readiness to refuse surgery where the request is aesthetically ill-advised or offends ‘good taste’. Patients should exhibit appropriately high levels of self-determination, but they should also be ready to follow the surgeon’s lead. Wengle poses the ﬁrst part of this paradox very simply in his article on the psychology of cosmetic surgery when he says ‘motivation should be internal’.57 Other writers make similar remarks: The best candidates for surgery are patients seeking the operation for themselves, not because of the demands from another person.58 ’She isn’t doing this for you’ [the nurse] would reply matter-of-factly. ‘She’s doing it for herself.’59 It’s important for the patient to realise they are doing the operation for themselves, not anyone else.60 It should never be done to please someone else. It should be done only for yourself.61 Certainly, this sub-repertoire of agency is extremely common in the material, particularly, though not exclusively, in the ‘popular medical’ literature. The obvious problems associated with applying a notion of purely selfdriven motivation to socially deﬁned issues such as beauty are ignored here. The popularity of the repertoire points to the currency of ideas about selfdetermination and independence in relation to women’s choices that are no

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doubt partly the result of contemporary feminist thinking. Indeed, one writer reports a surgeon as saying: When I talk to some of the leaders of the [feminist] movement, they say feminism teaches us that we can self-realise and if they feel that’s the way to realise themselves then they do it.62 The possibility that motives can be generated solely from internal processes is pushed strongly here, again reﬂecting the value placed on the individual, and the need to sidestep accusations of conformity. The quote adds another spin to this repertoire by clearly identifying feminism as a source for the individualist approach. As my earlier discussion of feminist constructions of agency suggested, analyses that emphasise individual agency and individual mechanisms for negotiating culture are increasingly common within feminist writing. The repertoire of ‘doing it for oneself’ also has other applications. In a review of breast augmentation surgery published in Plastic and Reconstructive Surgery, one surgeon argues that: [c]areful review of those who did not respond positively revealed that the surgery was carried out to please someone else, and the operation failed to satisfy the other party.63 In this case the emphasis on ‘doing it for oneself’ offers a means of explaining away instances of dissatisfaction, with the claim that all cases where patient satisfaction is low can be traced to the failure of the patient to be participating for the right reasons: purely of her own volition. Again, any problems relate to the patient rather than to the surgeon or to the process. ‘Doing it for oneself’ becomes an effective means in popular material of encouraging participation in surgery, and a valuable defence against peer criticism during internal debate. As I argued in Chapter 4, feminist use of the sub-repertoire of selfmotivation serves to account for women’s apparent participation in processes of normalisation in a way that suggests independence and individual power. This account is readily picked up in medical material on the subject, both in technical discourse as well as in promotional material and advice to the prospective patient. In this way, the feminist desire to examine women’s participation in cosmetic surgery in a respectful way can be seen to contribute to that participation through the production of a repertoire that enables participation by providing positive ways of discussing it. This state of affairs is taken one step further when Goodman argues that: [A] comparison of locus of control between surgery and non-surgery groups showed a trend . . . suggesting women who had undergone surgery were more internally driven.64

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In this case, the act of undergoing cosmetic surgery both reveals and constructs a subject with strong internal drive. The valorisation of this quality in Western culture means that cosmetic surgery takes on a distinctly positive cast here. Participation becomes desirable not merely because it improves the appearance but because it is said to indicate the presence of a strong, internally motivated character. Also evident is an assumption that runs through much of the material I have discussed in all three discourses examined so far: that cosmetic surgery can be examined as a single phenomenon with a single set of effects. Goodman’s study does not attempt to distinguish between different procedures and their different effects. This monolithic treatment of cosmetic surgery is evident in the way the repertoires I have identiﬁed are found across all different types of surgery, both in medical and lay material, as well as in feminist and magazine discourse.65 As with the emphasis on career motivation, this ‘internal drive’ repertoire functions on one level to rewrite the sexual imaginary to include notions of agency within femininity. From this point of view, cosmetic surgery as a technology of gender could be argued to be producing gender in unfamiliar ways. It must be borne in mind, however, that beauty is perhaps the one area in which women have long been accorded a degree of agency, in fact, traditional notions of vanity (for instance, in fairy tales) represent women as able to exhibit formidable levels of (sometimes malign) agency in the pursuit of beauty and the eradication of ‘competition’.

Acting to redeem the body Another sub-repertoire of agency commonly found in the medical material is one linked to the insistence that cosmetic surgery acts as a kind of emotional or psychological therapy. This sub-repertoire is characterised by claims that participation in surgery represents a highly desirable attempt to solve one’s own mental health problems. In some cases, this method is even posed as more desirable than conventional means. In 1974, Reich wrote: In deciding to undergo surgery she is actively trying to solve a psychological problem – an attitude of mind inﬁnitely preferable to that which relies on the help of others, whether based on verbal persuasion or the prescription of drugs.66 This is clearly a rather strong claim and one that once again relies on the value of the autonomous agent, acting without the help of others, in spite of the obvious need for the help of the surgeon. It may be that such strong claims about the curative powers of cosmetic surgery have been made in the past due to the need to promote cosmetic surgery as legitimate. However,

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similar comments appear in more contemporary texts. In a textbook reprinted in 1991, Reich states his case again, arguing that: The signiﬁcant point of difference between the aesthetic surgery patient and the psychiatric patient is that with the former we are concerned with an individual who is actively trying to deal with his problem.67 Goodman picks up this sub-repertoire, suggesting that facelifts can enable an easier resolution of anxieties about ageing because ‘recipients had acted to redeem their body’s integrity’ (emphasis in the original).68 Here, the by now familiar implication is that cosmetic surgery represents action while less visible forms of coping do not. Also interesting is the characterisation of ageing as an inevitable loss of bodily integrity. Wengle, too, uses the sub-repertoire, arguing that: [i]nstead of considering the wish to have a cosmetic operation as a possible pathological sign, we can interpret this wish as a creative act of adaptation in response to a psychological stress-situation.69 This reference differs from those above in that it does not obviously set up a hierarchy in which cosmetic surgery is deemed a more valuable or active means of negotiating mental distress than other options, such as counselling or drug therapy. Nevertheless, this sub-repertoire is often used to promote cosmetic surgery as the premier treatment for bodily dissatisfaction and distress. Again, cosmetic surgery becomes more than an option through this. It becomes the best or most effective means of attaining satisfaction, chosen by the most active, self-reliant subject. Clearly, a sub-repertoire that links cosmetic surgery with treating mental illness would not be very successful if used within popular medical material, and unsurprisingly, it does not occur there. This is a repertoire that appears almost exclusively within internal debates, aiming to legitimate cosmetic surgery in the eyes of professional colleagues. The repertoire not only promotes the surgery patient as coping in an ideal fashion, but it allows for a view of those who do not undergo surgery for obvious ‘ﬂaws’ or signs of ageing (factors that surely ‘must’ cause dissatisfaction in any woman) to be considered less competent in solving their own problems – less mentally healthy. Perhaps one day the failure to undergo facelifts at the onset of wrinkles will prompt the classic criticism that one is ‘letting oneself go’ and a suspicion that one is in some way mentally ill. Pride in battle The active, self-reliant subject at the centre of this particular cosmetic surgery discourse is sometimes framed in terms of another sub-repertoire found in some feminist texts. The courage or heroism repertoire evident in Kathy Davis’s work also appears in the medical literature in a number of

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places. Participants are characterised as possessing ‘considerable courage’,70 or as ‘having the resolve and the ‘chutzpah’ to circumvent nature’.71 One female participant is paraphrased along these lines; ‘she did not have to win the battle; pride in knowing she had fought well was enough’72 and prospective participants are warned elsewhere that ‘[y]ou might have to battle the preconceptions of those close to you’.73 This emphasis on battle, courage and heroism can be found to varying degrees in women’s magazines, feminist texts and both public and internal medical material, and represents another intertext deployed in the process of constructing the meaning of cosmetic surgery. It ties in closely with other sub-repertoires which emphasise women’s activity and strength of will in relation to undertaking surgery. At the same time, it further presents women who might not choose to have surgery as surrendering; as lacking the necessary moral ﬁbre to obtain or maintain appearances. It is possible to interpret this constellation of discursive repertoires around agency as evidence that medical discourse on cosmetic surgery is reconstructing femininity in a more active, self-determining way. In some senses, particularly when looked at in relation to the trends in feminist thought discussed earlier, this may be fair. At the same time, it is clear that this discourse of self-determination functions within the context of normative beauty pressures, and that considerable ﬁnancial sacriﬁce and risk to health are involved. Can the repertoire of agency work to redeﬁne femininity in a nontraditional direction while the practices it promotes are enmeshed in the most conventional forms of femininity? Moreover, how does this repertoire of self-determination relate to competing repertoires which patronise women by insisting they should be protected from all the facts about surgery? It is possible to analyse these repertoires as merely occupying adjacent positions, ready to be taken up when required. However, they also exist within networks of power created by other discourses and by processes of intertextuality and the construction of preferred readings. Signiﬁcantly, the suggestion that women be protected from unnecessary anxiety through the withholding of facts that may frighten them does not appear anywhere within feminist or women’s magazine discourse, and as such, is not legitimated by any intertextual crossover. At the same time, it taps into longstanding notions of femininity. In this respect cosmetic surgery acts as a technology of gender by producing a number of competing elements which are drawn together at certain moments and abandoned at others. At times, agency repertoires present femininity in active modes, but given the overall context, one in which this agency is conﬁned to acting on one’s appearance, the value of these comparatively new modes is limited. Moreover, in devolving responsibility for surgical success to the participant and implying that those who do not undergo surgery are passive, the agency repertoires used in the medical material carry with them as many problems as they do advantages.

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The range of sub-repertoires on agency I have examined here utilise and produce a version of femininity that combines determination and strength of will with a willingness to be directed by the surgeon and a vulnerability that justiﬁes the selective reporting of risk. Participants must combine a desire to conform to particular standards of attractiveness with a sense of undertaking surgery only for themselves, and a sense that should problems arise, responsibility for evaluating the risks lies primarily with them. The feminine sexual imaginary constructed here (for the material overwhelmingly deals with women) is a contradictory one which simultaneously promotes independence and conformity. It is also an understanding of agency that again locates it internally, within the individual. As with magazine and feminist material there is a failure to articulate alternative formulations here. In what ways is femininity becoming, then, in medical discourse on cosmetic surgery? While the natural body identiﬁed in the previous section (and in magazine and feminist discourse) poses the female body as ultimately passive and open to the directing hand of the doctor, the repertoire of agency seeks to give back responsibility, in the form of agency and power to the individual woman. Here, the notion of agency as emanating from within is signiﬁcant. Where agency is internal, so is responsibility. In this way, medicine constructs both a body and a mind appropriate to surgical intervention; that is, a malleable body, and a mind that, while accepting direction from the surgeon and taking its cues from culture, sees itself as in control and independent. This does not mean, of course, that discourses of women’s agency or even of the natural body always so readily serve the interests of cosmetic medicine. Following Deleuze and Guattari’s model of the rhizome, which recognises lines of ﬂight as well as lines of segmentarity, it is important to avoid blanket judgements about complex phenomena undergoing complex becomings. However, current articulations between medicine, women’s magazines and trends in feminism are such that the elements of femininity identiﬁed above are readily harnessed by the cosmetic surgery industry. The strong crossover in style and content between women’s magazines and medical material here suggests that magazines conﬁrm and strengthen, or produce preferred readings, in relation to constructions of femininity favoured also by medicine. As I have argued, women’s magazines reﬂect and inﬂuence other more materially grounded discourses such as medicine. From this point of view, the contents of the media can be located in a net of materially productive discourses, rather than seen, as is sometimes the case within contemporary cultural studies, as a kind of pure representation where the possibility of material effects is minimised or denied. As Deleuze and Guattari note, becoming is a process of articulation between two or more elements in which both elements undergo change. This is the drawing together of two things into an assemblage, rather than the imitation by or

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identiﬁcation of one thing with another. As much as women’s magazines may take their form and content in part from medicine, medicine (in this case cosmetic surgery) must too be altered through its articulations with women’s magazines.

Vanity In keeping with the feminist material and women’s magazines examined earlier, the repertoire of vanity is utilised less frequently within medical discourse than are repertoires of nature and agency. In fact, vanity is often mentioned only in the process of denying it or rationalising an anticipated criticism. In Chapter 6 on regulatory discourse, where this phenomenon is very pronounced, I will argue that vanity ‘haunts’ cosmetic surgery as an unspoken accusation.74 There are, however, instances where some form of the vanity repertoire is used in good faith in the material, that is, where vanity is used as an explanation for participation in cosmetic surgery, although this does not always carry a negative connotation. In certain instances, concern with the appearance or ‘body image’ is portrayed as a normal aspect of the psyche, a kind of drive that requires legitimate attention. Elsewhere, vanity becomes ‘narcissism’, a treatable psychological trait, which falls into the range of understandable human characteristics. However, this tolerant view can break down where litigation initiated by recipients is discussed. Here, the charge of vanity returns with full force. Material exhibiting the most permissive attitudes toward vanity often falls into the category of medical advertising or promotional material. These texts tend to deny the legitimacy of the label of vanity altogether, insisting that a preoccupation with the appearance is healthy – somehow not about vanity. Paradoxically, however, this genre might be considered the most intolerant amongst those that I have included in this chapter, in that vanity as it is traditionally deﬁned appears to be something that cannot in the least be acknowledged. For example, in texts which are aimed at the public and clearly designed to promote cosmetic surgery, statements such as the following appear: A successful nose reconstruction is not about vanity – more an adjustment of self-image.75 [A]s this surgical revolution gains momentum, so too does the general public’s acceptance of what used to be considered the exclusive domain of the super-rich and super-vain.76 In the old days, if you couldn’t come to terms with the reality of a large nose or small breasts, you were neurotic or at least vain. Now it’s gener-

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ally accepted that the way you look and feel about your looks can affect the way people treat you from infancy to adulthood.77 Statements such as these are made both by surgeons and medical journalists. They seek to inﬂuence public perceptions of cosmetic surgery in at least two ways. First, they redeﬁne a strong concern with the appearance as legitimate, rejecting the term vanity altogether. Second, they suggest that this shift in culture away from the censure of vanity is one that has somehow already happened, rather than being something that publications such as these seek to facilitate. In doing this, the persuasive role of the statement is obscured behind its apparent function as a report on social trends. At other points in this material, vanity appears in a rather different form, this time taken up entirely unapologetically. The passages cited above demonstrate a rejection of the label of vanity, and as such, cannot be classiﬁed as utilisations of the repertoire. However, the following examples, which effect a shift in the deﬁnition of vanity, are not so easily categorised. Here vanity is not denied: instead, it is embraced and pronounced normal.78 This does not correspond with conventional notions of vanity as shameful. In that vanity is deployed in the material in a way that afﬁrms its explanatory relevance (and bearing in mind that concepts such as vanity are constantly undergoing becomings) I would consider the use to which vanity is put here legitimate repertoire use, in spite of the change in deﬁnition the term undergoes in the process.79 Thus a hair replacement pamphlet reassures men that ‘[v]anity, or concern with one’s appearance, is very important to the well-being of the human psyche’.80 It may be that advertisers see the male target audience as in need of greater reassurance against the charge of vanity than are women. A slightly different sub-repertoire appears in an article aimed at female readers. In a ‘personal account’ of breast augmentation surgery, a woman states that: I thought, ‘Am I being vain?’ but, after the operation the minute I put a shirt on and it looked beautiful, I thought, ‘I have done the right thing.’81 In this case, the charge of vanity is dealt with not through denial or debate; rather, it is justiﬁed simply by the successful result of the operation. Satisfaction renders any concern about vanity a non-issue, reﬂecting an attitude which acknowledges vanity as a motive, then says ‘so what?’ when the outcome is perceived as good. In both these cases, vanity becomes admissible, lacking any power of censure. However, in the ﬁrst case, it is linked directly with the highly respectable aim of maintaining mental health. Other accounts are not quite as positive about vanity as these. In some instances, vanity is appears in the form of ‘narcissism’, deﬁned by Dunofsky as:

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a grandiose sense of self-importance . . . requir[ing] constant admiration . . . [along with the] experience [of] deep self-doubt, as well as feelings of emptiness and worthlessness.82 Utilising standardised psychological tests, Dunofsky’s survey of cosmetic surgery recipients samples only women and makes no distinction between the types of surgery undertaken. Instead, it tests for certain characteristics including levels of ‘narcissism’ among women who undertake cosmetic surgery compared to women who, by their own description, are interested in their appearance but have not had surgery. Are cosmetic surgery participants more narcissistic than other women? His answer is yes. Dunofsky’s survey is interesting in several ways. First, as it tests only women, it implies that cosmetic surgery is the exclusive domain of women. Second, as a consequence of this ﬁrst assumption, it tests only women for narcissism, implying that this too, is exclusively a women’s domain. Dunofsky’s survey translates vanity into a potentially pathological psychological trait, and then looks for it only in women. As a technology of gender, the survey reinforces the links between women, vanity and mental pathology often found in the most traditional representations of femininity. Interestingly, Reich’s 1969 survey on psychological factors in cosmetic surgery attributes only 4.6 per cent of cases to this kind of motive. Regarding these cases, he argues that: [s]uperﬁciality and the emphasis on superﬁcial things is all that some people are capable of . . . this may be due to an actual absence of deeper qualities or a lack of conﬁdence in anything except external appearance.83 He acknowledges that ‘a need to be admired or to regain admiration enjoyed before’ would be seen by some as mere vanity, but emphasises that such a motive is by no means frivolous. His view of these patients places vanity at the very centre of their psyches. Nevertheless, over 95 per cent of his survey sample avoid the taint of vanity. By contrast, because Dunofsky’s 1997 paper is set up to measure relative amounts of narcissism, it takes the presence of narcissism as given, in both his control group and his cosmetic surgery participants. A corollary of this fairly common association between cosmetic surgery and vanity is the potential for the accusation of vanity to be invoked in a disciplinary fashion. I have already argued that much of the medical discussion of cosmetic surgery fails to censure participants on the grounds of vanity. However, in some instances, both recent and otherwise, vanity proves itself to be a highly unstable concept and open to redeployment. In 1965, Van Duyn argued that:

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The psychologic effects of a physical defect may be far-reaching. On the other hand the plastic surgeon must resist a patient’s passing whim to attain the ‘perfect’ appearance.84 The whim to pursue perfection that Van Duyn describes falls clearly within the terms of the vanity repertoire. The paternal tone and the assumption that a distinction between genuine defect and illegitimate whim can be clearly delineated combine to render the repertoire of vanity a tool of control and censure. The desire for surgery is sanctioned only within limits: beyond these, the surgeon has ultimate control. Medical discourse acts as a technology of gender here by drawing on common understandings of vanity in order to maintain a traditional paternalistic relationship between doctor and patient. Gold’s statement, discussed earlier in the chapter in the section on nature, is also important in this context. In response to increasing breast implant litigation, Gold argues that: [a] surgical procedure introduced 30 years ago with the promise of restoring wholeness to the relatively few women who lost a breast to therapeutic mastectomy, or correcting deformity, was co-opted by hundreds of thousands of their sisters as a seemingly easy means of gaining the buxomness Mother Nature may have denied their own two healthy breasts. The censorious tone is unmistakable here. Not only have healthy women contravened unspoken laws of nature, they have ‘co-opted’ a therapeutic tool aimed at the genuinely needy in the process of looking for an ‘easy’ option, and are now seeking compensation through litigation for their selfinﬂicted ills. Vanity is not explicitly cited in this passage, but its presence is unmistakeable. It is no coincidence that vanity re-emerges as a negative trait in the context of litigation. When cosmetic surgeons want to sell procedures, vanity is ignored or even valorised. When women seek redress for malpractice or faulty devices, the accusation of vanity becomes an easy weapon to pose women’s suffering as a result of their own folly. Like nature and agency, the repertoire of vanity is fascinating in its ﬂexibility. Sometimes it operates to provide support for individual practices, always it threatens to render individuals and their practices illegitimate. This is particularly true for women, who have long been closely aligned with vanity. The notion of vanity (in its negative sense) relates closely to the notion of risk discussed above. As Lupton argues, ‘risk discourse provides a powerful rationale, cloaked in the “neutral” language and practice of public health and health promotion, to cast blame upon stigmatized minority groups for their state of health’.85 Lupton is referring to AIDS and the gay community here, but it is interesting to consider how closely this statement ﬁts with the traditionally trivialised category of vain women. Like gay men or injecting

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drug users, ‘vain women’ are seen to place themselves at risk, endangering both their own and the common good. In this section, I have demonstrated that vanity repertoires do ﬁgure in medical discourse on cosmetic surgery, but that this depends heavily on the context. The struggle over vanity that is played out in this discourse functions as a technology of gender, (re)constructing femininity in a range of ways. Vanity features in a number of forms, as natural characteristic, as fault and as something to be wholly denied. As in the discourses examined in previous chapters, femininity and vanity are linked in both censorious and accepting modes. Under some circumstances, the link is altogether denied. What remains constant is the power relationship suggested in this material, one which strives to regulate decisions on the question of vanity through medical discourse. Ultimately, surgeons have the ﬁnal say on whether surgery is warranted or desirable. In this sense, although women are free to redeﬁne their own feelings about vanity in deciding to undertake surgery, they remain vulnerable to medical deﬁnitions of vanity, deﬁnitions which provide the context in which decisions about their suitability for surgery are made. Partly because surgeons understand cosmetic surgery as a kind of psychological therapy, degrees of narcissism and questions of ‘realistic expectations’ are considered relevant to patient ‘selection’. This ‘psychological’ approach to cosmetic surgery also means that complaints made by patients are liable to be viewed and acted upon within a psychological framework that includes judgements of vanity. What are the implications of these observations? Although some change is apparent in the way femininity is constructed in relation to particular understandings of vanity, these changes appear to be the product of the interests of the cosmetic surgery industry, rather than of women per se. As such, they are vulnerable to other changes, most notably, changes in the interests of the industry or of the surgeons who participate in it. As Deleuze and Guattari note (quoted in Chapter 1): [y]ou make a rupture, draw a line of ﬂight, yet there is still a danger that you will reencounter organisations that restratify everything, formations that will restore power to a signiﬁer, attributions that reconstitute a subject – anything you like, from Oedipal resurgences to fascist concretions. Following Deleuze and Guattari, feminist ‘agency’ can be ﬁgured as a line of ﬂight, potentially restratiﬁed by its articulation with cosmetic surgery in the process of reconstituting a female subject overseen by the paternal authority of the surgeon. The medical discourse on cosmetic surgery I have examined in this chapter reproduces femininity (that is, acts as a technology of gender) in a variety of ways. From the mobilisation of ‘the natural’ as an aesthetic stan-

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dard to the invocation of ‘Mother Nature’, the repertoire of nature functions to emphasise the importance of beauty as uncalculated and effortless, and of the body as properly positioned within the realm of nature. As I have noted, the fundamental object of science is nature. Where the female body represents nature, it too becomes the object of science. The repertoire of agency presents women with a dilemma in terms of self-determination and reliance upon medical expertise. In some ways this is a reﬂection of traditional dilemmas women face around ‘being oneself’ as the best means of gaining masculine approval. Here, in a thoroughly paternal medical context, agency is encouraged only so far. Desirable when it disregards the opinions of friends, family or lovers and when it funnels ambition and professional commitment into appearance, it must never be allowed to hamper the inﬂuence of surgeons over their patients, or to render redundant paternalistic limits placed on the provision of information on risk. Vanity ﬁgures in equally contradictory forms. It is harnessed both as an encouragement and as a criticism. In all these repertoires, femininity is produced in tension between remarkably malleable concepts. As such, it remains inherently unstable and always risky. Each repertoire functions to include women: by positioning the body as natural resource as well as subject to the laws of a sometimes vengeful nature; by constructing the feminine subject as both independent and open to direction from ‘appropriate’ authorities, and by positioning women as acceptably vain under some conditions, improperly vain under others. These formulations of femininity are characterised strongly by contradiction. Of course, formulations of femininity as contradictory are by no means new. Importantly, however, contradiction becomes not the perceived obstacle to ‘proper’ participation in culture (that is, cosmetic surgery) here, but the necessary means by which women may negotiate this aspect of culture. In other words, in its role not merely as interpreter but as gatekeeper of cosmetic surgery,86 medical discourse on cosmetic surgery requires and thus forcefully produces femininity as contradiction. While women’s magazines and feminist material also offer contradictory accounts of femininity, both function primarily as commentators on the process of undertaking cosmetic surgery. Medical discourse differs here because it is directly through medicine and what it requires of femininity that surgery can take place at all.87 As Moira Gatens has argued, paraphrasing Foucault, ‘the legal and medical regulation of human behaviour tends to produce subjects who “recognise” themselves in these regulative discourses.’88 Nikolas Rose argues much the same in his work on twentiethcentury psy disciplines.89 The centrality of ‘authoritative’ discourses such as medicine and the law to the production of sexual imaginaries through cosmetic surgery underlines the need for investigation into these discursive productions. In a sense, medical discourse emerges as the most conservative (that is, the most protective of existing power relations) of the three discourses presented so far, if only because in spite of its range of discussion

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on agency, nature and vanity, its own authority remains positioned as paramount. Many of the sub-repertoires described in this chapter tie in closely with those used in feminist discourse and women’s magazines. This weight of conﬁrmation from one discourse to another is what constructs preferred readings. Often, it is not merely the presence of shared repertoires that produce preferred readings, but the concomitant absence of alternatives, as is the case with repertoires of nature and agency. Although various formulations of nature and agency are apparent in the material, central aspects of both are left uninterrogated. This issue will be taken up in the next chapter.

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6 The Regulation of Gender: Cosmetic Surgery, Regulatory Processes and Femininity

The last decade has seen regulatory discourse on cosmetic surgery explode. Much of the focus ﬁrst rested on the now well-publicised issue of silicone breast implants, which were the subject of major hearings held by the US Food and Drug Administration (FDA) in 1991 and 1992. Debate in Australia was initiated in 1991 by the Therapeutic Device Evaluation Committee (TDEC) on behalf of the Therapeutic Goods Administration (TGA). This debate began as a result of the investigations pursued by the FDA,1 and its recommendations were in large part determined by parallel recommendations in the United States.2 In this chapter I examine a range of sources dealing with the regulatory discussion of cosmetic surgery, including the FDA hearings on silicone breast implants, as well as the 1999 New South Wales Health Care Complaints Commission (HCCC)3 Inquiry into cosmetic surgery. The material examined in this chapter is drawn from a geographically diverse range of sources, but this does not mean the regulatory processes undertaken are separate. For example, US deliberations are central to those undertaken in Australia because class action damages cases brought by Australian silicone implant recipients have been heard in US courts and are subject to US rulings.4 The record of the FDA hearings provides insights into the processes through which one form of cosmetic surgery has been drawn into the realm of government responsibility.5 It differs in many ways from the more recent discussions that took place through the HCCC, not least because the latter were not limited to one area of surgery, but covered the entire range of what is currently considered cosmetic surgery. Also, the status of silicone breast implants as an aid to augmentation and reconstruction after mastectomy means that debate over therapeutic value has carried very speciﬁc meanings and suggested very speciﬁc legislative and ethical requirements in the FDA context. The HCCC Inquiry and the FDA hearings comprise the two primary governmental arenas in which cosmetic surgery is examined in this chapter, although a range of other texts relating to the central issue of government control and legislation has also been included. 153

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Of the four discourses this book examines, the regulatory discourse is perhaps the most overtly interdisciplinary. By this I mean that the process of debating, evaluating and legislating on cosmetic surgery brings together participants from the media, feminism and medicine as well as elsewhere. Not surprisingly, policy and legislation on cosmetic surgery is the meeting point for all these discourses, as it is in this realm that binding decisions are made about the availability of cosmetic surgery to the public. The cosmetic surgery industry’s meanings, responsibilities and freedoms have been, and continue to be, shaped here in ways that directly affect its viability.6 A central argument put forward in this book is that discourses are not discrete entities; rather, they are deeply intertextual. While individuals and groups of individuals produce texts, these individuals are not located in one discourse alone, such as medicine. Their roles and responsibilities extend over a range of institutional settings. Institutions impose rules, requirements, interests and agendas on their discursive productions. This observation is fundamental to the rejection of the possibility of ‘truth’ within discourse. Given that speaking positions are authorised (made possible) by discourse, there can be no place outside discourse from which to speak. What is said is the product of discursive rules, requirements, interests and agendas, not of pure truth. Therefore, it is important to recognise that the surgeons and scientists whose work appears in Chapter 5 also occupy positions as committee panellists and professional society members, as well as consumers of the media. In other words, the individual producers of texts and the participants in the governmental regulatory processes I examine in this chapter can never ‘belong’ solely within this discursive context, nor any other. As regulatory discourse tends to draw on ‘expertise’ from other arenas, it is an especially overt example of the interconnections between the production of apparently discrete discourses. Where there are interconnections, there is the possibility for the production of preferred readings, as I have illustrated in previous chapters. This chapter also demonstrates the ways in which preferred readings are produced as continuous strands linking different discourses and shaping how each discourse and each text within may be read. Notwithstanding this, it is necessary to recognise the effects of differing institutional settings on the occurrence of certain repertoires. In the regulatory context, for instance, the question of consumer protection arises far more frequently and is dealt with in far more detail than in magazine discourse. Some repertoires saturate certain discourses but appear infrequently in others. Certain repertoires arise again and again in almost every discursive arena, but their effects and implications differ due to contextual variations. My aim is to analyse the continuities and discontinuities recognisable between discourses by examining repertoire use. It is then possible to identify particular readings that are promoted or disallowed as a result of these patterns.

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By mapping the three repertoires of nature, agency and vanity, I will analyse regulatory discourse on cosmetic surgery as a technology of gender. At the same time, as I have just pointed out, I will make an argument for the production of preferred readings through intertextual connections between this discursive arena and that of women’s magazines, feminist scholarship and medicine. Of course, nature, agency and vanity are not the only themes around which commonly used repertoires circulate, nor are they the only tools with which gender is refashioned in this context. In this ﬁrst section I will look brieﬂy at two other major (and in some ways related) themes that emerged in the material during my research, that is, questions of real science versus ‘junk’ science, and the formulation of implant recipients as an anonymous mass of ‘hysterical’, ‘panic-stricken’ women. Both these issues featured in previous chapters, and the latter cannot be entirely separated from the issue of agency that runs through almost all the material. However, they are not simply extensions of my other analytic concerns and as such require separate examination. ‘Science on the one hand and compassion on the other’7 The question of ‘junk science’ has characterised debate around silicone breast implants in almost every forum.8 The ﬁrst case against a manufacturer of silicone breast implants was won in the United States as early as 1977, but this case was based purely on implant rupture and the plaintiff’s need for subsequent repeat operations, causing pain and suffering.9 It was not until the mid-1980s that cases began to appear claiming that implants cause serious diseases.10 Over the next ten years, however, debate around the scientiﬁc merit of claims about the dangerous character of silicone would be intense. This has subsided somewhat since the late 1990s as further research has been conducted.11 The debate itself, however, is worthy of note mainly because of the intriguing questions it raises about the authority of science in the 1980s and 1990s and of many scientists’ view of science as utterly and unproblematically distinguishable from personal, social or political questions (as the heading for this section suggests). US court cases frequently favoured plaintiffs in spite of expert testimony denying any links between implants and disease. Publicity surrounding these cases and around media events such as Connie Cheung’s television broadcast in 1990 concerning breast implants mean that the question of real science versus ‘junk’ science is continually raised in the transcripts of both three-day sittings of the FDA hearings in 1991 and 1992. Here the phrase ‘junk science’ almost invariably refers to anecdotal evidence. Indeed, although individual implant recipients were expressly invited to tell their stories at the hearings, the panel repeatedly questioned the value of this anecdotal evidence. Many nonscientiﬁc participants appeared uncertain as to the meaning of the term ‘anecdotal evidence’, offering themselves as ‘proof’ of claims about the dangers of implants.12 This issue arose again

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more recently at the HCCC Inquiry where implant recipients spoke, and again uncertainty as to the requirements of ‘proper’ scientiﬁc proof was apparent. Interestingly, anecdotal evidence becomes subtly gendered in both instances; tolerated as the inevitable expression of a necessarily feminine emotion (breast implants are a women’s device) but given little formal credence by experts who, unlike the recipients, are credited with understanding the requirements for ‘real’ evidence. In some ways, the most interesting aspect of this issue of ‘junk science’ is that, as any reading of the transcripts of the FDA hearings will reveal, the ‘real’ scientiﬁc evidence presented was itself ambiguous – satisfying some panellists and not others, apparently complete in some estimations, fundamentally lacking in others. Even speciﬁc studies produced diametrically opposed readings in terms of their ﬁndings. This state of affairs was read by some as consistent with one aspect of the public perception of science; its embodiment of progress through a continual revision of ideas. Thus an FDA panelist states: ‘[t]his is the nature of science that we learn and we progress, and certainly we’ll have more facts at our disposal to make more informed decisions as this science evolves.’13 However, this contingent view of science clashes with other primary deﬁnitions (apparent during the hearings) which see it as able to produce unarguable ‘facts’, and to provide a solid, incontrovertible foundation for decisions. Of course, none of even the most widely accepted scientiﬁc ‘truths’ is invulnerable to revision or overturning through further scientiﬁc investigation as well as other means, and it may be that jurors in US cosmetic surgery court cases were aware of this when they made decisions in favour of plaintiffs and against the advice of experts. At the same time that signiﬁcant doubts about the infallibility of science are manifested within the FDA transcripts and elsewhere, appeals are frequently made to focus on the ‘facts’ and, as one participant, a member of congress, puts it, to ‘Let science look at the real science. Don’t look at the pseudo-science. Get the real information.’14 Based on distinctions between ‘real’ and ‘false’ science, this repertoire has strong ideological implications. None of the scientiﬁc evidence presented at either hearing, favourable towards implants or otherwise, could be called conclusive. When the panel, that is, ‘science’, looks at ‘the real science’ rather than the ‘pseudo-science’, which science should it look at? The speaker who makes this appeal identiﬁes herself as in favour of maintaining the availability of breast implants, and sceptical of claims against their safety. She mobilises this repertoire as a means of categorising evidence questioning the safety of implants as false, and evidence supporting its safety as ‘real’. This strategy would be more coherent if the pro-implants ‘side’ of the debate were characterised by clearly better designed studies and more conclusive results than the other. As it is, real and pseudo-science emerge in the congresswoman’s testimony as little more than arbitrary categories employed as a means of discrediting opponents. Later, a panellist, this time a scientist, makes a similar argument by

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referring to ‘pathologic science’, deﬁned as ‘errors in science created by a loss of objectivity, the science of the unreal and bias’.15 Again, anti-silicone opinions are targeted here as biased and based on ﬂawed science, and again, objectivity is claimed as the domain of pro-silicone science. There is no doubt that a signiﬁcant part of the struggle over silicone breast implants has been conducted on the terrain of scientiﬁc objectivity and skill. The FDA panel’s continual references to the need for scientiﬁc facts about the safety and efﬁcacy of implants, as opposed to emotional responses such as ‘compassion’ for women who have either suffered as a result of implants or desperately want them to remain on the market, point to a strong belief in the ability of science to be value-neutral, and indeed in the desirability of this. The ability of an overwhelmingly science-trained panel to arbitrate on the availability of silicone breast implants, a question that is deeply intertwined with social issues beyond the matter of the physical safety of a chemical, is never questioned in the material.16 One result of the overwhelmingly science-oriented panel is the limited way in which ethical questions and strategies around issues such as informed consent, patient autonomy and risk are articulated.17 Deliberations primarily revolve around the assumption of an autonomous individual able dispassionately to decide upon breast implants through a rational process of weighing up risks and beneﬁts. This risk/beneﬁt repertoire has featured in previous chapters and will be examined in detail later in this chapter, but I should say here that I am not arguing that it has no value in itself, although it does consistently fail to articulate the individual as social and cultural. Through this distinctly objective, rational subject, and despite science’s avowed neutrality, scientists bring to bear their own methods and standards in characterising and prescribing women’s proper mode of negotiation with silicone implantation.18 What is more, an examination of the evidence provided at the hearing itself further undermines this claim to neutrality. An obvious case in point is the paucity of evidence proving not the safety but the efﬁcacy of breast implants. Perception of the success of implants as a treatment is a complex issue tied in with claims I elaborated in the last chapter. These claims rest on the idea that cosmetic surgery is psychological intervention, or ‘psychology with a scalpel’. On this argument, the validity of cosmetic surgery is established through the claim that surgery can alter body image and improve self esteem and happiness more quickly and effectively than therapy.19 This is a strong claim, but it is left entirely unsupported (and primarily unquestioned) throughout the hearings. In other words, what is striking about the detailed and exhaustive debates around whether to allow implants to remain on the market is that although efﬁcacy is presumably a central requirement for device approval, proof of efﬁcacy is distinctly lacking in this case. In spite of occasional protests to this effect, this issue is persistently sidelined. When the decision to allow implants to remain available under strict conditions is eventually made, the need to actually prove the

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ability of implants to solve women’s psychological discomfort (the main claim of breast implant advocates) is essentially ignored. Clearly, assumptions about women and their relationship to their bodies are at work in this logic, naturalising the connection between ‘beauty’ (larger breasts) and happiness; requiring little or no proof of this connection. This assumption points to cultural constructions of feminine identity as strongly linked with appearance. Put crudely, the assumption rests on the claim that looking good makes women happy, that large breasts are part of looking good because (supposedly) men like them, and therefore that breast implants, which make women’s breasts bigger, will inevitably make them happier. Signiﬁcantly, no long-term studies into the effects of breast implants on women’s self-esteem and general satisfaction are presented at the hearings, let alone any that actually prove a connection. The failure of the panel to recognise the importance of the lack of research in this area is an indication of the lack of objectivity brought to bear on the issue of breast implants. Any ‘objective’ consideration should have placed a high value on the ability of a device, particularly one requiring surgical placement and under the shadow of health claims, to prove its efﬁcacy. Perhaps if more scientists were able to take on board criticisms made by feminists and others20 as to the objectivity of science, their desire to present themselves as only interested in the facts, and to range themselves against obviously desirable concepts like ‘compassion’, would diminish. What would a compassionate science look like? This is a question of some magnitude, and one taken up in part in Donna Haraway’s book Modest Witness. I suspect that such a science would not register as masculine in the sense that science does at present. For within the debates around science that emerge out of the FDA hearings and related discourse, irrationality, compassion and ‘anecdote’ are subtly and not so subtly gendered in the feminine along with the female recipients of implants, while objectivity, ‘real’ science and the power to rule on implant availability rests with masculine rationality, not least represented by a predominantly male scientiﬁc panel and pool of ‘experts’. Here, debate around science and breast implants can be seen to function as a technology of gender, reafﬁrming women’s connection with emotion, appearance and lack of objectivity, and reinscribing masculinity as rational, unemotional and powerful. This is ironic given the FDA panel’s expectation, as evidenced in their discussion of risk/beneﬁt analysis, that women become dispassionate, objective decision-makers when considering silicone breast implants.

Hysterical masses Reinforcing this gendering process within the FDA hearings and in other texts is another widely used notion; one that constructs an anonymous, panic-stricken, hysterical mass of ‘implanted women’ numbering in the mil-

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lions and ready to act out their fears in unpredictable and self-destructive ways.21 This way of characterising concerned women is alluded to in Chapter 5, where it is shown to be employed frequently in the medical context, particularly where the alleged dangers of silicone are denied. The role the repertoire plays in the regulatory context is quite different, however. Mobilised far more frequently here, particularly in the US material, the repertoire provides a mandate for action on breast implants, clearing a space for notions of vulnerability and protection that I will examine in a later section on agency. In general, claims are made through this repertoire for the need to protect women from the inﬂuence of the media, so that one participant states, ‘The information currently available to us . . . does not seem to warrant the current hysteria that has been generated by the media.’22 Elsewhere, a speaker begs the panel ‘to quail [sic] the undue alarm created by the media’.23 Yet another participant wants a solution to ‘take back to these people to encourage them that maybe after all science would prevail and not hysteria’.24 Through a veritable multitude of references, an unstable, illdeﬁned and threatening mass of hysterical women is produced. A plastic surgeon states that ‘[t]hese women are terriﬁed, and it’s very, very difﬁcult for them to make good decisions sometimes’,25 and goes on to describe the implant recipient considering explantation as ‘frightened out of her mind’.26 This characterisation refers to women who have heard the claims made against silicone implants and are carrying those implants themselves. In focusing on irrational fear, it makes possible a separate argument in favour of approving implants, based on the restoration and protection of ‘the mental and physical health of millions of women’27 through an afﬁrmation of the safety of silicone. At this point, the mental health of millions of women is under question, translating into the need for a managerial strategy toward them. As a member of the FDA taskforce states: ‘one of the ﬁrst things we have to do is not have the American woman panic. It’s too late for that.’28 Women are homogenised here in clearly unfavourable terms, and what is striking is the apparent ease with which the charge of ‘hysteria’ is applied during these hearings. Nowhere is any protest at this extremely common characterisation apparent. Discourse around breast implants here clearly functions as a technology of gender, drawing on and contributing to a familiar construction of women as emotional, unstable and in need of management. Given that the source of much of this ‘panic’ is seen to be unnecessarily alarming media reports, this formulation of breast implant recipients brings home quite clearly the strategic nature of arguments about the power of the media over individuals. Certainly within the implants debate the inﬂuential role the media play in the life of women is rarely questioned. When criticisms are aired, as illustrated above, they indicate a critical stance toward the activities of the media based on a belief that women are readily inﬂuenced by the media’s pronouncements. Because breast implants are used

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almost entirely by women, a line of reasoning has developed which links women, fear, vulnerability and management. What if this controversy over safety centred on a device used by men? Would the lines of reasoning develop differently? Comparisons are not easily drawn here. Breast implants occupy a distinct cultural location because they are a form of elective surgery and are in many ways positioned as unnecessary. Certainly, in 1992 men were not using any comparable device on the same scale. In any case, the relationship so commonly drawn in this material between media representations and women’s panic and hysteria is simplistic and assumes a high degree of credulity on the part of women. Of course, the media cannot be dismissed as a source of medical information for the public, and its responsibilities should be formulated accordingly.29 However, as I argued in Chapter 2, the range of ways in which media texts are read need to be mapped carefully rather than simply assumed. While this book argues for a view of the media that sees it as enmeshed in a constellation of discourses which can produce preferred readings on particular issues, claims about the modes of reading used in speciﬁc contexts need to be based on research, not on assumptions arising out of gender (or other) stereotypes. Moreover, the representation of women as highly vulnerable to questionable messages from the media can impact on women materially. An example of this can be found in current legal strategies used to counter claims by women that they were not adequately informed of the risks of breast implantation (and other cosmetic surgery) by their surgeons. Here, women argue that had they known about the risks, they would not have undergone the surgery. In response to this claim, a legal argument strikingly similar to arguments originally developed by feminist scholars has been taken up.30 This argument emphasises the ubiquity of idealised images of women in the media and argues that because of the pressure these images exert, many prospective cosmetic surgery participants are unlikely to be discouraged by even the most unguarded and comprehensive accounts of risk. Accordingly, University of Melbourne law academic Loan Skene advocates that ‘cosmetic surgeons should defend failure to inform cases on the basis of immateriality of risk and lack of causation instead of on whether adequate information was given’.31 In a fascinating illustration of Foucault’s observation that discourse involves ‘reutilisations of identical formulas for contrary objectives’,32 a now quite familiar argument made in order to protest the limited representations of femininity in the media, and motivated by a broadly feminist agenda, is being redirected in a way that clearly does not serve the interests of many women. What links this instance to the situation described earlier, where women implant recipients are portrayed as ‘hysterical’ and panic-stricken in response to media reports on silicone, is the assumption that these women readers lack any critical relationship to media messages. This idea will be familiar from the discussion presented in Chapter 4 on feminist accounts of

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cosmetic surgery. Susan Bordo’s argument that ‘the knowledge that Cher’s physical appearance . . . simply does not compute’33 is a good example. My point here is not to argue that what is needed instead is a model of subjectivity where women are seen as entirely ‘free’ to interpret the media and act autonomously. The section on repertoires of agency that appears later in this chapter will demonstrate the comparable risks involved in this formulation. What I do wish to highlight is the need for a ﬂexible relationship between feminist theorising and political intervention; one which recognises the contingent character of any argument. Theoretical purity has no place where theory of all kinds can be co-opted in ways that impede women’s access to justice or compensation. My aim in the section on agency is also to consider an alternative understanding of agency, one which does not formulate it in terms of identity. This position is articulated as an attempt to undermine the common victim/agent dichotomy which can be identiﬁed in the debate outlined above. However, in keeping with previous chapters, an investigation of the uses of nature repertoires in the regulatory context will be undertaken ﬁrst in order to trace links with other discourses around cosmetic surgery and to provide some indication of the complexity and diversity of this discourse.

Nature As a concept and ﬁgure of speech, nature appears frequently throughout regulatory discourse on cosmetic surgery. As such it is a very densely overdetermined intertextual ‘knot’. There are two main ways in which nature is drawn upon, ﬁrst as a measure against which onset of disease, adverse response to surgery or ageing and ‘unsatisfactory’ bodies can be evaluated as acceptable or otherwise. Second, as a ﬁgure of speech used to describe the ‘essence’, the authentic, unchangeable or deﬁning character of an object or process. These uses, particularly the ﬁrst, are similar to those found in feminist, medical and magazine material. However, the regulatory context differs greatly from feminist or popular discussions of cosmetic surgery mainly because nature does not occupy so central a place here in terms of logic. While references to nature are common, regulatory material differs in a fundamental way from medical, magazine and feminist material in which broad issues about the validity and ethics of cosmetic surgery are debated openly and often at length. Within regulatory material, debate is increasingly conﬁned to ways of performing cosmetic surgery that are safe and effective, with general questions about legitimacy severely curtailed. Nature often functions as a cultural resource to justify or criticise controversial practices, as is the case in feminist and magazine texts. Where regulatory debate seeks not to halt or consider halting cosmetic surgery but to oversee, organise and control it, persuasive strategies based on nature occupy a more minor role.

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This is not to say that issues of validity are completely absent from the regulatory material examined here, but they are certainly muted. The effects of the use of nature repertoires on these issues are implied rather than spelt out, although instances in which nature is directly mobilised for this debate do occur and will be discussed below. In this section I want to argue that while references to nature are not in the main made as a means of directly engaging with the question of the legitimacy of cosmetic surgery, they certainly link to similar references in other discourses, reinforcing the effect I identiﬁed earlier where nature is reiﬁed and becomes a self-referential category. By this I mean that ‘nature’ as a concept is consistently deployed under the assumption that its meaning is self-evident, thereby establishing the term as an authority against which the ‘naturalness’ of other practices or ideas may be judged. As I found elsewhere, there is no point within this regulatory discussion that the category of nature itself held up to scrutiny. The question ‘what is natural anyway?’ is precluded as effectively in this context as in each of the others examined in earlier chapters. In the process, the validity and authority of nature is conﬁrmed as a preferred reading in all this material. An examination of the becoming of nature, that is, the ways in which nature is deployed as a repertoire here, will clarify the argument I am making. Chemistry is destiny As I noted above, nature appears in two main modes. Commonly, particularly in the FDA material which includes lengthy explanatory sequences examining the processes which the body and silicone undergo in relation to augmentation, it functions to characterise the essence of an object or event. Thus, phrases such as ‘the nature of the gel’ or ‘the nature of the material’34 are extremely common. Other uses include: The nature of the patients with auto-immune diseases is to make a multiplicity of antibody responses.35 By looking at the nature of the distributions . . .36 [D]evice failure of a mechanical nature.37 In these examples, nature is the deﬁning and essential feature of a process or object. This section’s heading, ‘Chemistry is destiny’, reﬂects the kind of inevitability and immutability produced by these uses. Nature is that which cannot be overridden or sidestepped. This use of nature will be familiar from previous chapters and is certainly a commonplace in any number of discursive contexts. Following Margaret Wetherell’s approach outlined in Chapter 2, however, it is precisely this kind of commonplace that may usefully be ‘made strange’ in my project. This deployment of nature as the central, essential and deﬁning element helps establish it as a source of

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authority in the regulatory debate. In other words, nature is positioned here as ‘about’ what is most central, signiﬁcant and unavoidable. This authority contributes to quite a different set of uses of nature repertoires. As is the case in the medical material, discussion in the regulatory arena of the aesthetic and physiological effects of breast implants is frequently couched in terms of nature, aligning the natural with positive outcomes. This similarity is to be expected, as the technical debates around the chemical and physical properties of implants in the body are medical or scientiﬁc in themselves. Indeed, some panellists and speakers at the hearings are the authors of articles and books examined in the last chapter. This is a very straightforward example of the intertextuality of different discourses. Not only do contributors to the regulatory debate read medical material and bring some of its ideas, blindspots and repertoires to this forum, they contribute to the medical context themselves. Here readers are also ‘writers’ or producers of texts. Some also contribute to magazine discourse by appearing in or writing articles about cosmetic surgery and ‘advertorials’. In spite of the different demands placed upon textual productions in different discursive arenas, some strong similarities are found across these discourses. The appearance of these ideas in several discourses is part of the production of preferred meanings. Thus, when the safety and efﬁcacy of breast implants are discussed in the regulatory context, many uses of the natural will be familiar from elsewhere in this study. The use of nature to characterise bodily responses to implantation is a good example here: That ﬁbrous capsule that occurs naturally may itself encase the gel in some women.38 This is the natural way the body . . . tries to roll this foreign body off and hopefully to get rid of it.39 Nature tries to wall off the implant, so there is a ﬁbrous capsule around every implant.40 They also want to know what happens to silicone in the body. Is it naturally released by the body, or does it remain?41 As with medical discussions, this utilisation of the nature repertoire works primarily to insert implantation into the realm of natural physical processes.42 By suggesting that the body possesses ‘natural’ or pre-existing ways of dealing with implants, the repertoire naturalises the relationship between the human body and implantation itself. Most frequently the repertoire is used where the formation of a scar tissue capsule around the breast implant is represented as basically benign. This formation is considered to be universal, varying only in the degree of thickness and tightness of the capsule: formation of the capsule is an inevitable product of implantation,

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resulting from the body’s reaction to the chemical, silicone. Even where extremely hard or painful capsules develop, this repertoire allows for the representation of the problem as natural and as a sign of the proper workings of the body (through the obvious vigour of the immune system). As in other instances, the precise meaning of nature here is, at best, confused. Why is nature equipped to provide a response to an entirely artifactual phenomenon? Because that phenomenon is itself natural? At this point, distinctions between nature and culture become difﬁcult to map. The effect, as I have argued, is to couch implantation in terms that render it within the bounds of acceptable practice through its alignment with natural bodily processes. This is of no small signiﬁcance where limits on women’s access to breast implantation on the grounds of safety are being debated. The ‘natural history’ of implants Another nature repertoire found frequently in this material is one based on the notion of the ‘natural history’ of disease. A recent epidemiology textbook lists one of epidemiology’s aims as the study of ‘the natural history and prognosis of disease’ and elaborates on this aim in the following way: Clearly, certain diseases are more severe than others; some may be more rapidly lethal, and others may have longer or shorter durations of survival. We want to deﬁne the baseline natural history of a disease in quantitative terms so that as we develop new modes of intervention . . . we can compare the results of using such new modalities to the baseline data to see whether our new approaches have truly been effective.43 The repertoire that draws on this epidemiological model appears only within the FDA material where the focus on speciﬁc disease aetiologies and developments is discussed in detail. An intriguing aspect of this usage is the reference to the ‘natural history’ of silicone implants themselves. How can an artifact have a natural history?44 This idea emerges in a number of instances: In at least one of the cases that you described, you followed a patient serially and found that herniation went on to a rupture. Is that always the natural history of that condition?45 When you talk about the natural history of a hernia through the ﬁbrous capsule eventually becoming a rupture . . . you may not be looking at the natural degradation of the prosthesis at all because the one loose cannon that you haven’t even talked about is the degree and severity of manipulation that is applied by the surgeon.46 [Whether ruptured implants should always be removed] will only be determined as we look further at the natural history of the leaks.47

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In this instance, nature most clearly refers to that which is predictable. The ‘natural history’ of an implant, then, is the established process that implants normally undergo in their lifetime, presumably knowable through testing. Implants begin by being surrounded by a scar tissue capsule which can be more or less pliable and comfortable. Over time, implants will eventually rupture due to forces exerted upon them through the course of daily life. This rupture may be preceded by a herniation visible on X-rays or may remain entirely undetected due to the absence of symptoms such as bulging or deﬂation. Any forces strong enough to rupture an implant suddenly are classed as ‘unnatural’ forces, even those that have at different times been recommended to surgeons as a means of managing implants, such as closed capsulotomy (the crushing of the breast with the hand to break up scar tissue around an implant). The natural history of an implant is the range of predictable responses an implant demonstrates to anticipated events and processes. In this context ‘natural history’ becomes a normalising concept, judging normal responses to normal events. Anything that occurs beyond the foresight of the design speciﬁcations of an implant (such as extremely strong force) is unnatural. The natural is that which has been and must be predicted, accommodated or curtailed. Control is central here. This is a signiﬁcant use of the natural, emphasising as it does the centrality of perceptions of intended use; of remaining within understood boundaries. That which is unnatural is that which transgresses understood limits in the scope or mandate of an object. This repertoire, as noted in Chapter 5, will be familiar from popular debates around a number of issues, such as homosexuality where ‘what nature intended’ becomes a coercive form of logic. What makes this position particularly ambiguous, however, is that the natural degradation of an implant is judged not by the intentions of nature but by the intentions of human individuals; those who envisaged and produced the implant. Clearly, the ‘natural’ and ‘unnatural’ can be applied according to human authority, and as such prove amenable to arbitrary application as disciplinary labels. This use of the natural as a disciplinary tool was identiﬁed in earlier chapters, particularly within feminist and magazine material, although in each context, that which is seen to require discipline varies considerably. Naturally occurring disease Posed against the question of whether silicone breast implants may be said to cause disease in women through events such as rupture, or even in their intact state, is the notion of naturally occurring disease. Although the causes of diseases such as scleroderma and lupus are by no means presented as clearly established in this material, there remains a strong distinction between those instances of disease which are natural and those which are not. Examples of this distinction include:

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These patients both looked very much like natural scleroderma. In fact, there was no way clinically to be absolutely certain that they did not have the natural disease.48 The scleroderma patients, on the other hand, seem to be fairly uniform and very similar to what we’ve seen in naturally occurring disease.49 How does [the disease exhibited by women with implants] relate to these naturally occurring or spontaneous types of autoimmune disease?50 The use of the word ‘spontaneous’ in the last quote provides a clue to the forces driving the use of this particular nature repertoire. In this instance, nature is that which emerges in the absence of human agency or awareness. In so far as diseases caused by implants can be understood to be caused by humans, other developments of disease not directly attributable to humans are thus classiﬁed as natural. This includes causes that, on examination, might emerge as linked to cultural artifacts, but which are at present unknown, and therefore outside the range of human awareness. Human agency and nature are directly juxtaposed here in a familiar formation. Unsurprisingly, the human body remains aligned with nature as the source and object of ‘naturally occurring disease’ as well as the object upon which human culture works. Hence, ‘augmentation mammoplasty is performed on a breast in its natural state’.51 This conﬁguration reinstates the nature/ culture, body/mind dualist pattern where the mind (or human intention) opposes everything else; the human body; diseases not caused by cultural artifacts and even diseases potentially caused by cultural artifacts, the origins of which humans are yet to understand. At this point, only the iatrogenic diseases currently under debate fail to qualify as ‘naturally occurring’. Naturally soft Part of this idea can be linked to the notion of ‘originality’ where the ‘original’ (or ﬁrst identiﬁed) causes of disease are classiﬁed as natural and subsequent causes are seen as cultural. Equally, the body, in its supposedly ‘original’ condition (for instance, prior to cosmetic surgery), is classiﬁed as natural. This ‘original body’ comes to be used as the measure against which claims about the natural aesthetic effects produced by cosmetic surgery are made, both within FDA material and elsewhere, although of course the original body invoked is always an idealised one: A year later I had the smooth implant replaced with the infamous meme, which resulted in a naturally feeling breast I continue to enjoy today.52 Grade 1 [of the Baker classiﬁcation system of capsule formation] represents an outstanding result, where the breast is naturally soft and the implant is not detectable.53

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In part in reaction to reports of implants becoming hard and unnatural, researchers undertook the development of an ‘improved’ product.54 This repertoire reﬂects very closely those used in magazine and medical material to evaluate the success of a cosmetic surgical procedure. Values inherent in this repertoire include the need to produce an aesthetic effect that obscures its origins as surgical. Equally, the ‘natural softness’ mentioned above is the softness of the ideal youthful breast, not the statistically most common breast. Nature here equals ideal.55 As a technology of gender this regulative aspect of the category ‘nature’ renders forms of femininity or the female body that do not conform to current ideals open to the accusation of unnaturalness. These repertoires are thoroughly entrenched within the discourses examined throughout this work. They function always without qualiﬁcation or explanation, revealing not only their ubiquity but the conﬁdence with which they are used as self-evident. This self-evidence is central to the overall claim I am making about a particular preferred reading which organises discussion around cosmetic surgery; that is, the status of nature as given and beyond qualiﬁcation, disallowing any doubt about the legitimacy of the (potentially disciplinary) category of the natural. Unlike scholarly feminist material on cosmetic surgery, in which certain gestures are made towards such doubts, feminist analyses brought to bear within regulatory discourse do not venture beyond natural/unnatural dualisms. Feminist critiques of cosmetic surgery emerge only infrequently within this material and their arguments often make use of the natural in familiar ways: Cosmetic surgery is promoted as an anti-ageing device which pathologises the process of natural bodily change.56 [There is] evidence for the mediated growth in the denial of the natural, physiological ageing process.57 Nature is used in this case to radically undermine the legitimacy of cosmetic surgery in favour of an otherwise natural body. The deployment of this strategy is perhaps unsurprising given the sheer ubiquity of this repertoire, present as it is in every discursive context examined in this book. Elsewhere it is used for the same purpose; to argue that the natural body should not be tampered with and that cosmetic surgery represents a unique and extreme form of such tampering. As I argued earlier, however, this alignment of the body with nature simply serves to reposition it as the logical object of scientiﬁc intervention, control and improvement, through science’s role as ‘master’ of nature. These feminist arguments are presented as very general remarks suited to the HCCC context where cosmetic surgery is investigated in the most broad terms. As such they remain unchallenged

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by those who would defend cosmetic surgery, in spite of the hearing’s often intensely combative atmosphere. It is possible that the critiques attracted so little attention simply because the existence of the ﬁeld of cosmetic surgery was never under threat from the outcome of the inquiry. Indeed, its perceived inevitable growth was an accepted and motivating factor in establishing the inquiry.58 In spite of the very diverse, contradictory and at times confusing array of nature repertoires mobilised in the regulatory material on cosmetic surgery, silence around the question ‘what is nature anyway’ is total. Nature as a selfevident, legitimate and unquestionable category is the central preferred reading produced by the nature repertoires. Also reproduced in this reading is the familiar view of the (female) body as open to manipulation, and the view that the mind is separate from the body (as nature is to culture). It is difﬁcult to draw all these uses of the natural together in a single diagnosis. Nature is a concept undergoing becomings in a number of directions here. Again, the model of the rhizome is helpful. Points of regeneration do not radiate from a centre, but shoot from disparate nodes and even from disconnected fragments (such as the contractor’s silicone gun mentioned below). Some emergences of the repertoire are so puzzling as to defy categorisation, for example, in response to questions about the safety of silicone in the body, an FDA Taskforce doctor remarks: Silicones are ubiquitous to nature. Have you ever watched a contractor take a silicone gun, run the gun down on a window, take his ﬁnger, smooth it out and go on and on? He’s ingesting silicones.59 Here, both a builder at work and his tube of silicone sealant are articulated with the concept of nature to produce a surprising deﬁnition of the natural. Silicone and nature undergo surprising becomings in this passage through their mutual articulation. This is perhaps an extreme example of a similar state of affairs found also in medical, magazine and feminist material, where nature emerges as an inﬂuential or authoritative word or idea attachable to any practice, object or event for persuasive purposes. It is through this constant incantation of nature, however, that the legitimacy and concreteness of the concept is re-established. This too is the becoming of nature as it functions in a speciﬁc discursive context. The inﬁnite identity of the concept (in Deleuzian terms) is illustrated in its seemingly limitless ﬂexibility, although this ﬂexibility can become temporarily or contingently articulated to other concepts for speciﬁc political purposes. Also re-established here, as I noted earlier, are connections between the female body and nature; the female body and openness to technological intervention. Where the female body is linked with nature it is also linked, through contemporary imaginary bodies, to the dual notions of passivity and threat that circulate around notions of nature. These two ideas serve to characterise femininity as well

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as the female body. In this way, repertoires around the theme of nature within regulatory discourse act as a technology of gender, feeding into characterisations produced in other discursive contexts of femininity at once both passive and thus open to moulding; and threatening and potentially unpredictable. The female body is thus aligned with the values of scientiﬁc intervention, while the female subject is positioned in a hierarchical relation to the scientist (or here, surgeon). The implications of this will be drawn out in the next section.

Agency Regulatory discourse on cosmetic surgery is also extremely rich in repertoires circulating around the notion of agency. This is perhaps to be expected given that debate in regulatory contexts directly affects freedoms. As I noted earlier, some of these repertoires cross over between the two main sources used here, that is, the FDA hearings and the HCCC Inquiry. Others circulate mainly within only one or other of the two sources. The FDA hearings occupy a particular location in that their focus on breast implants brings into relief questions around distinguishing augmentation surgery and reconstruction after mastectomy.60 This issue is played out in intriguing ways through the question of vanity, which will be elaborated in the last section. It also impacts on the central agency repertoires of risk/beneﬁt calculation and the ‘right to choose’. The fact that the HCCC Inquiry explicitly excludes the question of ‘the link between implantation of silicone breast implants and connective tissue disease’61 probably minimises discussion on the issue of silicone breast implants. This means that the inquiry’s area of interest differs signiﬁcantly from that of the FDA hearings, as does the frequency with which particular repertoires are used in the material. Nevertheless, strong connections are visible between the various sources examined here, as well as between the regulatory, medical, feminist and magazine material. A close examination of the sources reveals that every agency repertoire outlined in the last chapter on medical discourse is reproduced in the regulatory material. Many of these also appeared in the magazine and feminist sources. Demonstrating this ﬁnding runs the risk of making monotonous reading, but is, after all, my point. In any case as I have argued before, while these repertoires arise again and again, they function in different ways in each context due to the institutional or discursive demands placed upon them. I will begin this section by discussing the three most frequently used agency repertoires. These are ‘risk/beneﬁt evaluation’, ‘informed consent’ and ‘freedom of choice’. All three are logically interdependent. A woman’s right I have already suggested that the sources for this chapter rely heavily on rights discourse. A woman’s right to her own body is a notion appealed to

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repeatedly in the material, although, in a departure from other mobilisations of this discourse (such as in the context of rape or abortion) and in a parallel with Chapter 5 as will be illustrated shortly, women’s right to their own bodies is understood (by women’s advocates as well as others) to be most appropriately limited by medical opinion. In the context of abortion, a woman’s right to control over her own (reproductive) body is often argued to exist irrespective of the opinions of doctors. While the procedure must be performed by a doctor, the doctor is not understood by advocates to have a legitimate right to decide who is suitable for the procedure and who is not. However, in the case of cosmetic surgery it is medical expertise, continually reinstalled by surgery recipients, consumer advocates, feminists, elected government ofﬁcials and others, who enable women to ‘freely and beneﬁcially choose’.62 In this extract, found in an HCCC presentation by a lawyer critical of cosmetic surgery, ‘freedom’ is clearly tempered with beneﬁt, while beneﬁt remains an undeﬁned entity. Here women’s ‘freedom of choice’ is framed as appropriately exercised under the guiding hand of the surgeon who can ensure that a decision is made that provides appropriate beneﬁt to the patient. What constitutes beneﬁt is thereby deﬁned by the surgeon. Accordingly, the presentation argues for the adoption of a ﬁduciary role by cosmetic surgeons, that is, a role that places the patient’s interests ﬁrst and does not attempt to beneﬁt the surgeon by actively promoting the use of surgery. Where the surgeon arbitrates on the beneﬁt to be gained by surgery for a particular patient, and thus the availability of surgery to that patient, freedom to choose is clearly curtailed. In spite of the widespread promotion of this decision-making hierarchy, the repertoire of ‘freedom of choice’ appears again and again in the material: We need to protect a woman’s right to choose and to keep all treatment options available.63 I have given up my privacy which is very important to me, in hopes that I may help the women of this country to keep the rights to free choice.64 Why are we here today? One of the answers is simply freedom of choice.65 If [women] choose not to proceed when more fully understanding the risk, that is their right and they are entitled to make that choice.66 The facts on the table Unlike in the FDA hearings, explicit reference to freedom of choice is absent from the HCCC Inquiry material. This is probably because the FDA hearings directly threaten the availability of a product and hence the opportunity for women to exercise choice about that product, while the HCCC Inquiry functions purely as an information-gathering process. The preoccupation

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with ‘freedom’ is undoubtedly a characteristically North American one, but I doubt that under similar circumstances, the freedom repertoire would remain absent in an Australian context. In any case, related repertoires arguing for women’s ability to weigh risks against beneﬁts in a process of informed decision-making and consent transcend the boundaries of these two texts and appear frequently throughout all the material, for example: We feel that if you can ensure that you have an educated and informed consumer, they’re going to be more able to make an informed decision.67 Adequate information should be available so the consumer is able to make an informed decision.68 An unbiased evaluation of the risks and beneﬁts . . . of cosmetic surgery is not easily or widely available to the general community, thus limiting consumers’ ability to make truly informed decisions.69 I support informed consent, patient’s choice based on this consent made in conjunction with their surgeon.70 Congresswoman Oakar and I have introduced legislation requiring informed consent, but this very personal decision should be made for a woman with her doctor, with the facts on the table.71 The right to choose and freedom of choice are at the very core of this issue. Our right as citizens should be protected and promoted. The decision needs to be left with the individual and her doctors.72 This repertoire is represented in the material in dozens of references. While there is no agreement on whether adequate information and measures exist to allow for informed consent to take place, there is a very widespread articulation of women’s rights and responsibilities in terms of their ability to make an informed decision under the appropriate circumstances. Apparent here too is the frequency with which the patient is referred to as a health care ‘consumer’. Rosemary Gillespie comments on this development, arguing that cosmetic surgery ‘can also be seen to constitute a “brand extension” or expansion of the boundaries of medicine into consumer services, whereby physicians have a vested economic interest in the medicalisation of appearance and shape’.73 The discourse of consumerism in medicine is by no means limited to cosmetic surgery, but, classed as elective, it is clear that cosmetic surgery occupies a central position within this tendency. Beneﬁt and risk analysis The repertoire of weighing risks against beneﬁts relies upon women’s ability and willingness to participate in cosmetic surgery in a rational way: to

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actively carry out research into success rates of particular surgeries, to seek out the best doctors through comparison and evaluation, and to question other people who have undergone the procedures. This repertoire will be familiar from previous chapters,74 but, as Mary Douglas argues, it is primarily its usefulness as a forensic resource that renders it so central to contemporary culture.75 In that the ‘consumer’ ideally becomes equipped with all the necessary information to make a good decision, this repertoire both supports and contradicts aspects of the earlier ‘freedom of choice’ repertoire. The emphasis on the responsibility of individuals in educating themselves supports the idea that individuals should have the freedom to decide what is done to their bodies. However, these highly informed consumers, willing to take conscious risks, would not seem to need the guiding hand of the benevolent surgeon. In some instances the surgeon is positioned as central to the decision-making process, in others, the surgeon is left out of the equation: There has been a tremendous emphasis on informing patients about the risks and beneﬁts of the operation, and the FDA has had a very important role.76 [A lack of information means that] women have been hindered in their efforts to make informed decisions about the risks and beneﬁts of this procedure.77 I think these decisions are ones which clearly should be based upon informed consent issues, based on beneﬁt and risk analysis. That based on good science and good doctor-patient trust.78 As an informed consumer I ask that I be allowed, in partnership with the board-certiﬁed medical professional I have chosen, to weigh the beneﬁts and risks.79 Patients must have the opportunity to make their own decisions after being informed of the real and suspected potential risks. Only they can know if the risks outweigh the beneﬁts to be gained.80 These repertoires construct a very particular subject for the purposes of regulatory practice. This subject is rational, able to make dispassionate decisions about her own well-being based upon the facts available to her. According to the repertoire of ‘freedom of choice’, this is also her right. I have illustrated throughout this book the ubiquity of these kinds of repertoires in contemporary cosmetic surgery debate. In both a regulatory and medical context, they function more or less explicitly to render the individual responsible in relation to practices that are controversial in terms of safety.81 At the same time, they often insert the authority of the surgeon or other medical practitioner into the process of decision-making while leaving

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ultimate accountability with the consumer.82 Of course, these repertoires around a rational, informed subject with a right to choose do not stand entirely unquestioned. Occasionally, their use is questioned in terms of the scope of the particular notion of choice deployed, and through references to social pressures. Still, this intervention is extremely rare and reﬂects the imbalance of emphasis within the regulatory context in favour of scientiﬁc responses to issues that are in many respects social. In this sense, the authority of science as producer of knowledge and problem solver remains almost entirely unchallenged. The gender make-up of participants in this forum is also signiﬁcant, reﬂecting patterns found within medical discourse, where primarily male scientiﬁc experts interact with female lay participants. Where female experts do participate they are clustered around the social sciences, although in what was perhaps a conscious move reﬂecting breast implants as a women’s issue, the appointed chair of the FDA hearings was a woman. How does this group of repertoires, which so strongly focuses on individual agency and the rational weighing up of evidence, mesh with the ‘hysterical panic-stricken masses’ also constructed within the material? The agency repertoires do not stand alone here, of course, but exist alongside important though ultimately less prominent repertoires based on the vulnerability and victim status of women. A similar pattern can be found in medical and magazine material, while feminist literature indicates a move away from victim repertoires to those which emphasise agency (although signiﬁcant cross-over is evident there too). ‘Protection’, ‘exploitation’ and ‘vulnerability’ all feature strongly, as does the repertoire of the victim itself. I will look at these repertoires more closely before going on to consider the ways in which both victim and agent repertoires are deployed and interact. ‘Victims who have a problem with their appearance’83 The repertoire of the ‘victim’ is one that has enjoyed wide circulation in the past, but is increasingly unpopular within regulatory, social welfare and therapeutic contexts. Incest and sexual abuse ‘survivors’84 among others reject the implications of the label of ‘victim’ and as a result of this, repertoires mobilising the term ‘victim’ are not common in some contexts. While explicit references to victims are not as common in the cosmetic surgery material as are some other repertoires, they do appear regularly, suggesting the continued viability of the repertoire. Frequent users of this repertoire are women who themselves have undertaken breast implantation with poor results, though others who champion the cause of these women also use the term, for instance: My wife is a victim of breast implants.85 I have suffered this mental and physical abuse . . .86

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For those of us who are victims, the implants have been our worst nightmare.87 Many of us victims are also of the understanding that these implants would last a lifetime . . .88 [Cosmetic surgery magazines] feed off victims. Victims who have a problem with their appearance.89 This repertoire does not match the dynamic, rational agents constructed elsewhere in this material. It is mobilised under very speciﬁc circumstances, that is, where women seek acknowledgement and redress for a medical procedure that has harmed them. Although the repertoire of the victim appears in women’s magazines, it is almost never used as a self-description, except where failed breast implant cases are detailed. It is nearly entirely absent from medical material, in which the legitimacy of cosmetic surgery is assumed and promoted. In the case of breast implant recipients, selfrepresentation as victim can function strategically to position women as worthy of compensation. The concept of victimhood is gendered in the feminine here, and it may be that the identity of ‘victim’ is particularly effective in relation to female complainants. It may also function to repose the issue of breast augmentation and cosmetic surgery in general away from notions of vanity, for the purposes of convincing a judge or jury. At least within the FDA documents, there is a strong sense in which women’s role as victim, particularly in the context of panic, works to engender deep concern in the panel at the same time that vanity is effectively challenged as a motivation. Vulnerable and open to exploitation Other elements in this victim repertoire are the notions of exploitation and vulnerability. These work hand in hand and appear very frequently in all the material. The HCCC Inquiry tends to link this repertoire most commonly to the issue of advertising, constructing women readers as readily manipulated. An interesting debate around understandings of the function of advertising appears as a corollary of this concern. While some panellists, particularly those representing consumer bodies, as well as some speakers, cast women as vulnerable to advertising (particularly those advertisements which use professional models for procedures those models have never undergone themselves), several doctors asked to comment see advertising as merely the ﬁrst contact an individual has with the idea of surgical alteration. After a consultation is sought, they argue, the prospective patient is quickly brought down to earth by the surgeon who outlines the real possibilities of surgery. It is at this point that the client makes the decision to proceed or not. Interestingly, both versions pose women as initially taken in by advertisements. If the surgeons’ own accounts are to be believed, the advertisements function as a lure where goods not actually available (the appearance

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of the models in the advertisements) are offered for sale in order to draw in consumers and convince them to purchase something else (small changes to their appearance). How often, if at all, these strategies work (as they are understood to do by the devisers) is difﬁcult to ascertain due to a lack of research in this area. This general concern over advertising results in many utilisations of the vulnerability repertoire: [Low self-esteem] can make them vulnerable and open to exploitation.90 The Commission is particularly concerned about the effect of advertising, particularly on vulnerable people.91 It would concern the Inquiry that people, vulnerable groups or groups open to exploitation are seeking cosmetic surgery purely to be in the employment market.92 I think there is an element of seduction; I think there is a group of patients who are exploited . . . A lot of the problems we see come from very poor patient selection.93 Now that problems are beginning to surface, listen to the guinea pigs who paid up front to choose when we were the most vulnerable.94 ‘Can and should sociologists use their skills to try and help bring about what they regard as a more balanced and positive view of cosmetic ageing for those who are vulnerable enough to fear it?’95 At the same time that a very strong set of repertoires is utilised to assert the independence of women and their right to choose cosmetic surgery, another group draws on women’s vulnerability and what emerges as an a priori victim status whereby cosmetic surgery ﬁnds and exploits victims rather than produces them. Although the two repertoires seem to contradict each other, they operate in a similar way by locating agency within the subject, and classifying women as either essentially free (to choose) or essentially victims. This issue emerged in my discussion of feminist treatments of cosmetic surgery, in which the question of whether women can be seen as victims or agents when they undertake surgery has been central. At least two issues arise out of this tendency to locate agency within the individual: ﬁrst, the diagnosis of victim or free agent tends to solidify into an identity that can then impact on other unrelated social, legal and regulatory issues. The utilisation of these two categories within discourses of cosmetic surgery is, after all, itself a reﬂection of existing solidiﬁcations of identity played out in other political realms such as in debate over rape.96 Cosmetic surgery discourse did not introduce these categories, although it uses them in speciﬁc ways. Second, this solidiﬁcation of identity around

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judgements of victimhood or agency creates an understandable reluctance on the part of individuals to take up related repertoires for fear that they will be permanently or exclusively identiﬁed by them. These repertoires are used highly strategically as a result, risked only under very speciﬁc conditions. This certainly limits the means by which individuals may express or produce their experiences of cosmetic surgery and the ways in which it is possible to conceptualise interaction between individuals and social, cultural and political events. For example, where women are hesitant to attract the label of victim, they may be unwilling to report instances of medical malpractice in relation to cosmetic surgery. In the existing model, individuals bring to events an a priori status instead of developing a status in and through speciﬁc events (which themselves are shaped by individuals). The latter view, which owes much to Judith Butler’s notion of performativity as outlined in Chapter 1, allows for an understanding of agency that is more contingent and thus ﬂexible. It recognises the becoming of individuals and events, their ﬂuidity as much as their moments of concretion. Equally, where agency categories are not perceived as identity categories, their enmeshment in gendered (and racialised) representations is weakened. Woman as victim and victim as woman become untenable where woman has no prior identity. This simultaneously undermines the corresponding associations, woman as free agent and free agent as woman, which are equally persistent and pernicious categories, as the material examined in this chapter demonstrates. While the categories of agent and victim do differ, their role in locating the ‘issue’ (here of access to cosmetic surgery procedures) in the individual is potentially disciplinary in that the individual is held up to evaluation and deﬁnition as a means of securing rights or beneﬁts. Hence, women’s status as ‘rational decision-makers’ may provide them with certain rights of access to surgery, but deprive them of beneﬁts such as legal protection in the case of surgical failure (as the practice of signing consent forms suggests). A number of other agency-based repertoires can be found throughout this material. They will be familiar from previous chapters, and include the notion of ‘doing it for myself’, also represented in this context by a preference for internal rather than external motivations for undergoing cosmetic surgery. As in the medical material, this discussion of internal and external motivations sets up appropriate and inappropriate reasons for seeking cosmetic surgery and makes good use of this distinction to tie dissatisfaction with outcome to wrong (external) motivations. The assertion that surgery is undertaken purely for one’s own satisfaction and not at the behest of another party is central to constructions of agency as they currently stand, for example: The vast majority of women in McGhan’s study identiﬁed self-image and appearance as the principal motivations for undertaking augmentation

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mammoplasty. Very few women identiﬁed reasons such as job, husband or boyfriend or any other external factor as the primary determinant.97 [When interviewed for research purposes] many people talked about selfesteem and doing it for themselves.98 What is striking about all of these women is their emphasis on the pursuit of surgery for themselves, often in the face of neutral or at times even opposed family response.99 Many more examples of this repertoire could be given, but these few instances begin to illustrate the ambiguous and confused character of this repertoire. What is appearance if not, at least, an external factor? Although statements around this issue are couched in terms that emphasise self-image, appearance is fundamentally a social perception based as it is in cultural understandings of beauty and the availability of cultural measures against which one’s self-image is formed. Again, as in previous chapters, a simplistic notion of self-motivation or autonomy is mobilised through this repertoire. In a regulatory context, this assertion of ‘internal’ motivations functions to instate women’s ‘right to choose’ as autonomous individuals. Manufacturers and surgeons take up this repertoire as readily as patients themselves as a means of validating cosmetic surgery. As I have argued before, an examination of repertoires does not seek to discover what speakers or actors ‘really’ think ‘underneath’ it all. It is certainly tempting to ask whether those utilising this repertoire ‘really’ believe it. What is a more interesting question for this book, a question related to the impact of cosmetic surgery as technology of gender, is how and why this repertoire emerges as so useful. Not only is ‘doing it for myself’ a repertoire of agency, it is a very direct means of undercutting possible accusations of vanity. This will be examined later in the chapter. Femininity emerges from this regulatory context as a technology of gender more clearly divided over the issue of agency than in any other. As I have argued, this is a result of particular strategic demands. Femininity presents a somewhat multiple form here, including straightforward rearticulations of existing feminine stereotypes. Women’s emotional and potentially hysterical nature is clearly reinscribed in this material, in fact, women’s fear becomes a central driving logic within the FDA texts. Equally, there are clear differences in the way this issue develops between my two main sources, that is, the FDA hearings and the HCCC Inquiry. This is unsurprising given that the FDA’s role is both to prevent harm caused by breast implantation and respond to harm already caused, while the HCCC Inquiry focuses primarily on prevention. However, I have demonstrated that there are also very strong intersections within the regulatory context and between this and the other discursive arenas examined in this book. At the same time that femininity emerges as persistently open to articulation with ideas of instability

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and irrationality, it can be reconstructed (or transcended) in response to a requirement for an autonomous, ‘internally motivated’ rational individual; in short, the liberal citizen. Here, femininity can be rewritten as classical masculinity for the purposes of commerce and regulation. Interestingly for understandings of the sexual imaginary, femininity is never both at once in this material, that is, both hysteric and citizen. Mobilised as they are on either side of an apparently dualist debate about protection and freedom, these two versions of femininity are drawn upon as if they are the only choices and are mutually exclusive. Of course, both alternatives share a tendency, that is to locate agency (or the lack of it) within the individual, and to understand regulatory issues through this assumption. It is this apparent split in the possibilities of femininity itself that characterises social and political debate for feminists and others, producing the kinds of difﬁculties I outlined in Chapter 2 when examining the work of Catharine Lumby and Joke Hermes. As I argued, both authors operationalise the victim/agent dichotomy by mobilising repertoires of agency over victimhood, producing useful but limited analyses as a result.

Vanity Related to this split in notions of femininity is the way the theme of vanity is played out in the regulatory context. As with every other discourse I have examined, overt characterisations of cosmetic surgery as the preserve of vanity are rare; in fact, I found only one direct use of this form. Here it is used as a positive self-identiﬁcation and as such does not correspond with classic uses of vanity as a negative trait: ‘I am one of those vain women who chose to have bilateral augmentation and I am proud of it.’100 This emerging repertoire of vanity as positive was identiﬁed earlier in this book. However, it is possible to interpret a strong note of defensiveness in these comments that I think is borne out by an examination of the ways in which vanity is continually and often openly denied as an aspect of cosmetic surgery in regulatory material. What I will suggest in this section is that in spite of a clear absence of negative uses of vanity repertoires here, a strong sense remains that vanity is a central criticism to which women who undergo cosmetic surgery expect to be subjected. This is signiﬁcant from a regulatory (as well as medical and feminist) perspective in that it may indicate that an environment exists in which punitive accusations of vanity are predicted and that failed surgery and other negative outcomes may remain underreported due to fear or embarrassment.101 Vanity and the unworthy The FDA hearings deal with both reconstruction and augmentation procedures. Women affected by silicone breast implants are those who have under-

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gone mastectomy surgery for cancer and those who chose breast implants to improve the appearance of breasts which were otherwise untouched by surgery. This dual role is central to the development of this repertoire of denial of vanity, as it has given rise in the material to frequently posed questions about the differences in motivation and ‘need’ between augmentation and reconstruction patients. As I suggested above, however, panellists and presenters do not claim that augmentation patients are less needy or worthy of implantation than those wanting reconstruction. At most, participants occasionally raise questions about whether augmentation and reconstruction should occupy equivalent status in determining access to implants under the proposed moratorium. Equally often, however, warnings such as this are issued: To the panel, your decisions must not be prejudiced by personal value judgments on whether or not a woman needs an implant or whether implants are more justiﬁed for women that seek augmentation or reconstruction. It’s absolutely not within the purview of this panel or the FDA to determine the political correctness of why women seek implants.102 This statement assumes that questions about the relative value, justiﬁability and need of augmentation versus reconstruction are uppermost in the minds of panellists. There are a number of other similar statements to be found here, for instance: The opinion [exists] that women who have a medical reason to use breast implants are worthy, whereas those of us who choose them for other reasons, psychological and emotional, are somehow unworthy. I ﬁnd both judgmental and irrelevant.103 If you make that distinction [between augmentation and reconstruction] you are denigrating, in what I consider a very offensive manner, the motives of a very large number of people who are seeking this operation for cosmetic purposes.104 I assure you that aesthetic surgery at all levels is devalued in our society.105 There is no doubt that statements such as these are made far more frequently than those which question (however covertly or tentatively) the relative value of augmentation to reconstruction or of cosmetic surgery in general. They suggest an awareness that breast augmentation is widely dismissed as trivial and vain. Other more directly worded statements make the same point: Insurance companies are denying claims for explantation [the removal of implants] and women are being blamed for their own problems because they were vain enough to want implants in the ﬁrst place.106

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Still others see reconstruction itself as open to accusations of vanity: A woman who has a mastectomy and has no cup [size] at all . . . that is not just vanity.107 They are not motivated by vanity but in many cases a desire to feel whole again.108 Two fears emerge in the regulatory material examined here; ﬁrst, that augmentation surgery may be judged as vain in comparison to reconstruction surgery, and second, that reconstruction surgery may also be judged by some to indicate vanity. Elsewhere, similar anxieties are expressed about cosmetic surgery in general: Those of us who are not considering cosmetic beautiﬁcation may see [cosmetic surgery] as a matter of personal vanity [when participation is actually caused by media pressure placed upon vulnerable people].109 A lot of problems are not just being dismissed out of hand as being vanity [as they have been until recently].110 This repertoire of the refusal or refutation of diagnoses of vanity in cosmetic surgery reveals nothing more clearly than the way in which vanity ‘haunts’ this material. It may be that debates around whether augmentation candidates should have equal access to implants with reconstruction patients are on some level motivated by assumptions about the triviality and vanity of augmentation. It may be that distinctions drawn between augmentation and reconstruction view reconstruction as the legitimate restoration of the natural body while augmentation compromises this natural body. Similarly, debates around exactly how safe implants need to be before their use can be justiﬁed may also suggest a scepticism about the merits of or genuine need for augmentation surgery. At the same time, little or no direct reference is made in the material to vanity as a part of cosmetic surgery. In terms of repertoire theory then, no vanity repertoire exists in this material. Instead, vanity is both absent and present in regulatory struggles over cosmetic surgery as an accusation sometimes imagined, perhaps sometimes actually spoken, though always in an obscure form. In this sense, the denial of vanity itself constitutes a commonly used repertoire (that is, a separate repertoire from one which would openly or straightforwardly use vanity as a description or accusation). Other discourses I have examined demonstrate that in spite of its relatively minor role in contemporary discussion of cosmetic surgery, the accusation of vanity is still a functioning and in some contexts acceptable repertoire. This is particularly so of magazine material. From this point of view, those who deny the validity of accusations of vanity here do have

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reason to assume those accusations may occur, or at least that they are implied within debate. It may be that the repertoire has become ‘unspeakable’ due to the vigour with which alternative interpretations are argued. Certainly, the dominance of repertoires of agency (both here and in feminist material) seem to preclude the possibility of characterisations of women as driven by trivial or ‘superﬁcial’ motivations. As Chapter 4 demonstrated, feminist discourse currently exhibits a strong focus on pleasure as agency, rendering vanity obsolete (or unspeakable) as an explanatory concept. Equally, commercial interests have rendered the diagnosis of vanity understandably absent from medical discussions of cosmetic surgery. Cosmetic surgeons have a signiﬁcant stake in ﬁnding ways of talking about cosmetic surgery that satisfy participants’ self-image. The use of repertoires of agency and of denied vanity seem to have worked to render vanity repertoires not ethically or intellectually viable at present. While it is possible for contradictory repertoires to ﬂourish side by side, this does not mean they will never form articulations; impact upon or supplant one another, as appears to have occurred to some extent in the case of agency and vanity. In any case, it is clear that cosmetic surgery is still seen here as opening the individual up to the risk of accusations of vanity, even in the absence of evidence to demonstrate this. To what extent this openness to the accusation of vanity impacts on levels of reportage of failed surgery or other negative outcomes is unknown. Certainly, it is an issue worthy of further research. Thus it can be said that vanity haunts regulatory material, a haunting that is linked to the binary split in notions of feminine agency discussed earlier. Repertoires around women’s victim status, their vulnerability and need for protection leave open space for a sense that they are impressionable and driven by trivial or emotionally immature motivations such as vanity. At the same time, versions of femininity produced through agency repertoires focus on autonomy and rationality and are constructed against these very accusations of impressionability and vulnerability. Vanity is continually denied and refuted here in the process of constructing and maintaining the feminine agent. In other words, vanity functions as a concept through which regulatory debate takes up femininity in terms of victim and agent, protection and autonomy. This debate cannot overcome the apparently contradictory elements of victim and agent because, as I argued in the previous section, these traits are seen to exist within and to emerge from the individual. They are concrete and total identities and cannot accommodate one another. It may be that as long as femininity is split along these lines of victim and agent, vanity will be taken up and denied as a means of supporting one category or the other. Indeed, this continual raising of the spectre of vanity, even through the process of denial serves to link femininity to vanity once again. As a technology of gender, this struggle over vanity communicates quite powerfully the continuing presence of

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the ‘threat’ of accusations of vanity, reinforcing the idea that femininity may really be about being vain (if not in this instance, then in many others). In this chapter I have looked at the ways the three themes of nature, agency and vanity are manifested in regulatory material on cosmetic surgery. While the circumstances of its production impose speciﬁc demands upon this discourse, strong lines of consistency can be mapped between medical, magazine and feminist work and this material. Uses of nature here emerge as perhaps the most complex in any context, reﬂecting the extremely diverse range of contributors to the regulatory debate. At the same time, the central repertoires used are articulated directly with those discussed in previous chapters. The female body and femininity are woven into a net of nature references in a way that aligns them again with the natural and with notions of control and improvement, in a familiar form of the sexual imaginary. As with previous chapters, regulatory discourse focuses almost entirely on female consumers of cosmetic surgery and in the process genders cosmetic surgery in the feminine. Whether or not men undergo cosmetic surgery procedures, they are only extremely rarely acknowledged within this discourse. The effect of this is to link debates about cosmetic surgery’s legitimacy, underlying causes and motivations with women, a process that both reﬂects and constructs gender conventions. This is true of the nature repertoires and is even more apparent within agency repertoires where questions of autonomy and rationality are applied over and over to women alone, while points of difference among women, such as those of race or class remain entirely unacknowledged. Many repertoire connections will be evident between this material and previous chapters, with perhaps the most signiﬁcant notion being the location of agency within the individual, here the woman. This notion has been central to the form taken by the most elusive of my three themes, vanity, which exists primarily though denial in this material. This denial indicates both the unspeakability of vanity in contemporary regulatory discourse involving women and the ways in which repertoires act to shape other repertoires through their absence, thus shaping public discourse on women in general. Here, regulatory discourse on cosmetic surgery acts as a technology of gender in that femininity, both through representation and self-representation, is reformulated with an emphasis on the value of the natural, the internal location of agency (both as victim and as rational subject) and on the suppression of overt judgements about individual vanity. Thus femininity emerges as similar in form to versions found in previous chapters. It is women who are visibly undergoing cosmetic surgery while men almost universally perform it and regulate it. Femininity is divided into two forms; the vulnerable and hysterical and the autonomous and rational, each accounting inadequately for the complexity of the subject. As in medical material, however, the autonomous and rational woman is constituted only in the context of direct professional medical supervision. Her

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autonomy is limited by the ‘legitimate’ authority of responsible surgeons as opposed to ‘snake oil salesmen’111 (irresponsible doctors), husbands, partners and other individuals. Along very familiar lines then, women’s ‘vulnerability’ is invoked as a means of instating legitimate authority at the same time that responsibility for undergoing surgery remains with the woman herself. As a technology of gender, regulatory discourse recalls and reconstructs quite conventional forms of femininity, although the development of agency repertoires is not by any means complete and may branch out or regenerate in new directions in future. It may be, too, that eventually vanity will cease to ‘haunt’ debate on cosmetic surgery, or become a socially acceptable (ungendered?) personal quality. Cosmetic surgery itself may also become socially acceptable. Certainly, the shift noted in medical discourse where vanity is sometimes characterised as healthy, suggests that such change may be possible. These concepts are quite visibly undergoing complex becomings in their articulations with other concepts, and according to the needs of the speciﬁc discourses within which they are taken up.

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Conclusion

Maybe to describe what gets sucked into the gravity well of a massive unknown universe, we have to risk getting close enough to be permanently warped by the lines of force. Or maybe we already live inside the well, where lines of force have become the sticky threads of our own bodies.1 Cosmetic surgery has indeed become part of us, part of women and men as surgeons, participants, friends, relatives and witnesses (modest and otherwise). Modes of self-production through bodily production ensure that, indeed, our own bodies constitute the materiality of particular lines of force such as gender. What this book has demonstrated is not only the ubiquity of cosmetic surgery discourse, but also the ways in which this discourse is intertwined with many of our most signiﬁcant and central cultural concepts. Ideas of agency, nature and vanity are reproduced over and over in this material, and because all these ideas are intrinsically gendered, we ﬁnd gender reproduced in novel and familiar ways too. This reproduction of gender occurs partly through the production of preferred readings within texts, texts which accrue their meaning in relation to other texts. By two main processes, repetition and the preclusion of alternative viewpoints, texts on cosmetic surgery have been shown to reiterate gender in important ways. As I argued in the Introduction, this examination of texts has not been undertaken as a means of examining the realm of discourse understood to be separate from the realm of ‘reality’ or materiality. On the contrary, this study of texts has been undertaken because, by using the particular theoretical models that it does, it aims to examine more broadly the material implications of cosmetic surgery than research on speciﬁc procedures, participants or events can. In the context of technoscientiﬁc advertising and textbook material, Donna Haraway argues that ‘[w]e inhabit these narratives, and they inhabit us’.2 This is exactly why an examination of discursive production can be so valuable. The narratives constructed and reconstructed in cosmetic surgery discourse (re)produce all of us, not only 185

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directly, through our exposure to articles, documentaries, photographs, and so on, but through the interventions they make into larger cultural and material forms such as gender. As gender is produced and reproduced in culture, we are continually repositioned therein ourselves, sometimes in agreement, sometimes at odds with the various versions of masculinity and femininity articulated, often implicated in ways irrelevant to these conscious struggles. As Nikolas Rose suggests in relation to his essays on contemporary versions of selfhood, ‘in rendering the historical contingency of our contemporary relations to ourselves more visible, they may help open these up for interrogation and transformation’.3 In a similar way, I have attempted to render apparent the ways in which three, supposedly self-evident concepts – the ‘nature of nature’, the location of agency within the individual, and the role of vanity in the undertaking and understanding of cosmetic surgery – are, in fact, historically contingent. None the less, what this project has also made clear are the ways in which such notions are relentlessly reproduced and depended upon in important material/semiotic contexts, such as medicine and government regulation. This process of clariﬁcation has relied upon a range of theoretical tools, all of which are committed to a model favouring surfaces. This commitment has sprung directly from an awareness that utterances around politically and socially loaded subjects such as cosmetic surgery are produced and constrained by their marginal status. By taking up an approach that sees all statements as forms of repertoire use, where repertoires represent common and acceptable ways of articulating ideas, and where the subject is produced through the manipulation and expression of these repertoires, the question of whether discourse around cosmetic surgery ‘reﬂects’ ‘real’ feelings and viewpoints is effectively circumvented. If an examination of repertoire use cannot tell us about the interiority of the subject, however, what can it tell us? Answering such a question requires a second theoretical move. In setting aside the issue of how representative statements of ‘underlying motives and feelings’ might be, and rejecting ‘depth’ models intent on uncovering underlying meaning, this project has also had to abandon any ambition towards assuming that statements found within texts are taken up and read unaltered in the process of reading. While individuals, texts and discourses may repeatedly make use of certain repertoires, this cannot be said to reveal underlying feelings that correspond with those repertoires, or prove that these feelings were engendered through the process of reading. Such assumptions would re-pose the subject as the origin of repertoire uses, rather than their product; thereby reinstating the sovereign subject. By rejecting the pursuit of underlying motives and by eschewing an originary subject, a different perspective on what cosmetic surgery texts and their interrelationship can tell us has been adopted.

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This perspective has two elements. First, it entails a view of repertoire use as reﬂective not of individual feelings or motives, but of the contingent and historically speciﬁc state of culture, which (in its role as condenser and disperser of human and other activity) is the actual origin of repertoires and their use. By this I mean that the range and variety of repertoires available for individual subject production tells us a great deal about the investments, commitments and material circumstances of the culture in which they are available. Here, we must look back to the culture that offers these options for self-constitution, rather than forwards to the character of the subject who makes use of them. Second, in tracing the production of preferred readings through texts and their use of repertoires, this book has not assumed that such preferred readings are inevitably absorbed unquestioned by the reader. The trajectory of my study is not from text to reader (meaning to its acceptance) but from text to text, that is from meanings to meanings, and the ways new meanings are produced in the friction between texts. Where preferred readings have been identiﬁed, no assumptions are made about reader response to these privileged meanings. Readers may or may not take them up – whether they do, and how, is an investigation worthy of another book – but certainly, preferred readings can be said to exist, telling us more about processes of writing and of cultural production in general, than about reading. Indeed, in examining such a broad range of material on cosmetic surgery, a high degree of intertextual exchange, both via repertoire use and the proliﬁc output of individual contributors (often surgeons) across a range of texts becomes startlingly apparent. Demonstrated clearly throughout this book has been the tight exchange between apparently separate or autonomous discursive realms. Where individual surgeons publish in medical journals, produce books aimed at the general public, allow themselves to be quoted in women’s magazines and present evidence at commissions and hearings, their assumptions, values and perspectives link those domains in ways that mutually authorise meaning. Feminist contributors sometimes operate in a similar way. This, then, is an insight into how common understandings around signiﬁcant phenomena like cosmetic surgery are partly produced and what an investigation into the viability of the notion of preferred readings can demonstrate. The book is divided into two parts, the ﬁrst theoretical, outlining the tools used in conducting this research. In the ﬁrst chapter I established the basis upon which a surface model investigation of cosmetic surgery might be undertaken, utilising three main theoretical perspectives. By taking up Deleuze and Guattari’s notion of becoming, I problematised a range of terms central to my project, reﬁning both my object of research, my own location in relation to my object, and the ways in which cosmetic surgery might be understood. In adopting Deleuze and Guattari’s rhizomes, articulations and becomings, I mapped a trajectory away from depth models and towards

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surface models, a trajectory that informed subsequent discussions of the two notions of technologies of gender and imaginary bodies. These two theoretical perspectives were elaborated as a means of providing a framework in which to understand gender and its production, both through the processes understood as technologies and via the resources identiﬁed in the sexual imaginary. This chapter established the ﬁrst of my two objects of inquiry, that is, how gender and cosmetic surgery are constituting each other through discourse. In the next chapter, ‘Pressures of the Text: Intertextuality and Preferred Readings’, my second main object of inquiry was explored theoretically. Here, the contemporary embracing of models of polysemy within cultural studies was identiﬁed, and a related question was raised. To what extent can discourse around cosmetic surgery be found to contain preferred readings? In considering this question, the notion of intertextuality was raised, and I argued that intertextuality is a means through which the production of preferred readings occurs. This understanding of intertextuality informed the structure of the entire book by setting up the exchange between texts and discourses as relevant to the production of preferred readings. Stuart Hall’s work on reading and on ‘preferred readings’ in particular was investigated, and Potter and Wetherell’s repertoires approach was detailed. As noted above, the notion of repertoires allowed me to expand upon the surface model favoured in Chapter 1 and to develop a view of texts and their contents that does not assume an underlying subject as author of meaning. All these tools combined to produce a framework in which ‘the banal and commonsensical’4 could be examined as indicators of the current and contingent state of culture in general and gender in particular, as well as the existence or otherwise of preferred readings in texts about cosmetic surgery.

Authorisation and preclusion: preferred readings In the second section a detailed examination of four discourses around cosmetic surgery, women’s magazines, feminist scholarship, medical material and regulatory debate was undertaken. Throughout these discourses, the ways in which the repertoires of nature, agency and vanity featured were mapped, both as a means of identifying the production of preferred readings and in order to understand how gender and cosmetic surgery may be becoming in relation to one another. This investigation revealed that preferred readings can most certainly be identiﬁed within these discourses, produced both through repetition and through the obscuring or preclusion of alternative perspectives.

Reproducing nature Throughout all four chapters nature was found to be a richly articulated repertoire. It is used in an extremely broad range of contexts and ways,

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although that variety is strictly limited by the assumption that nature forms the ground for culture. Perhaps because of this, although nature is invoked as a means of both defending and criticising cosmetic surgery, its own meaning was found rarely to be questioned. Here, nature is shown to be a highly inﬂuential concept, not only because of its disciplinary power, but also because it remains substantially beyond critical investigation. In spite of contemporary critical scepticism towards the category of nature, this research demonstrates precisely how, in the most everyday contexts, nature and what it entails is reproduced over and over. Thus, a very stable preferred reading was identiﬁed, that is, the centrality and givenness of nature; its status as entirely beyond question. In that the natural is routinely used as a normative category against which to arbitrate on the acceptability of any number of practices, this immunity of nature to interrogation proves in urgent need of challenging. Certainly, wherever it is cited, a complex of compelling and important issues, such as safety, efﬁcacy and responsibility are obscured.

Agency internalised The second repertoire examined throughout this section was that of agency. Again, as with nature, a degree of variety was observed in terms of the ways in which this concept is taken up in material on cosmetic surgery. For example, agency is variously represented as the single minded pursuit of career success, the willingness to take risks and the simple assertion that one is undertaking surgery ‘for oneself’. Unlike nature, however, there proved to be little inherent contradiction in the ways agency is drawn upon. While it might be ‘natural’ to undergo surgery at one point and ‘unnatural’ to undergo it at another, those practices which signify agency, whilst not always appearing in all contexts, were rarely overtly at odds. Despite signiﬁcant variety, however, a serious gap exists in the ways in which agency is conceptualised in all these contexts, and this has implications, I have argued, for the provision and regulation of cosmetic surgery. This gap centres on the assumption that agency is located within the individual, and that as such, all expressions of agency or victimhood emanate from, and demonstrate, internal dispositions. Thus, women as agents require little regulatory protection, while women as victims should not enjoy too much freedom. Here, the location of degrees of agency within women (as agents, as victims) impacts on material considerations. Where agency is understood to be the product of culture, just as the subject is, forms of regulation, legislation and debate can be understood to produce certain kinds of subjects, rather than constraining or managing them. This perspective, however, is entirely absent from contemporary material. As Rose has noted, ‘at the very moment when this image of the human being is pronounced passé by social theorists, regulatory practices seek to govern individuals in a way more tied to the “selfhood” than ever before, and the ideas of iden-

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tity and its cognates have acquired an increased salience in so many of the practices in which human beings engage’.5

The denial of vanity The third repertoire of vanity provided an important departure from those above in that although it appears with some regularity within magazine discourse, it occupies an extremely ambiguous location elsewhere. While vanity has historically been linked with cosmetic surgery, its contemporary treatment is characterised by denial. In each of the discourses examined, the link between vanity and surgery is often painstakingly refuted, and a concomitant anxiety that assumptions about vanity are driving public policy is enacted.6 I have argued that vanity ‘haunts’ this discourse, although it is more accurate perhaps to say that fear of the accusation of vanity does the haunting. Although at some points, particularly in relation to men, vanity is constructed as essentially harmless, the frequent denial of it works to reinforce its negative status. Where women continually deny vanity’s relevance, vanity is constructed as unacceptable. The preferred reading that is found within this discourse on cosmetic surgery in relation to vanity centres on the fact that although some individuals may ‘admit’ to being vain without risk of serious recrimination (this is mainly within advertising and magazine material), it is nevertheless a concept that is reviled within culture (and strongly linked with the feminine). Most striking perhaps, in relation to the effects of preferred readings examined here, is the role feminist work on cosmetic surgery can be shown to be playing. By reproducing preferred readings around nature, agency and vanity, this body of material works to align femininity with cosmetic surgery at the same time that such surgery is viewed with suspicion or even disapproval. Preferred readings are not always constructed consciously in the process of writing. They reﬂect the preferences not of an individual author, but the preferences contingently set within the workings of the complex, multi-articulating machinic assemblage of culture. Through these three repertoires, three important preferred readings are brought into focus. Where many texts contain substantially the same understandings of central concepts such as nature, agency and vanity, that is, where continuous repetition and intertextual authorisation occurs, preferred readings can be said to exist. Further, where those texts almost universally neglect to provide even the smallest insight into alternative understandings, these preferred readings are even more strongly constructed. As I argued in earlier chapters, polysemic interpretations of reading are highly optimistic is such cases. Famously ‘optimistic’ theorist of reading Michel de Certeau describes readers as ‘travellers; they move across lands belonging to someone else, like nomads poaching their way across ﬁelds they did not write, despoiling the

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wealth of Egypt to enjoy it themselves’.7 I have no argument with this description. Nevertheless, my own research would suggest that the ‘wealth of Egypt’ apparently available to readers needs to be audited. Judgements about the range of material available can only be made where speciﬁc research has been undertaken. Riches there may be, but these are by no means limitless. De Certeau goes on to liken reading to Lévi-Strauss’s notion of bricolage, arguing that reading is an arrangement made with ‘the materials at hand’.8 What I have sought to examine in this book are those very materials. If reading is bricolage, what, then, is actually at hand? This project has provided some answers to this question.

Becomings: gender directions Having found that preferred readings centring on privileged cultural concepts do most certainly exist within discourse on cosmetic surgery, I want to review my other line of investigation which asked what directions gender may be taking in relation to cosmetic surgery. Here I found that the repertoires of nature, agency and vanity are caught up very intensely within struggles over gender. The repertoire of nature was tracked very closely throughout this project and found to saturate material of all kinds. Not only is nature signiﬁcant here because it is taken up in a variety of ways that preclude the crucial question of what nature might mean, but also because it exists on an extremely dense chain of equivalences with femininity. From this point of view, the oft-invoked nature/culture dualism is always in some way about gender. In Chapter 3 I described nature as a highly ideological category due to its status as beyond conscious reﬂection. Stuart Hall deﬁnes ideology as ‘this work of ﬁxing meaning through establishing, by selection and combination, a chain of equivalences’.9 Such a process is clearly at work in the range of material examined in this book. In relation to the natural, a large number of sub-repertoires are taken up, most of which emphasise either the (feminine) agency of nature, or the status of the body as natural (read passive). Through these usages found in such clichés as ‘the natural look’, ‘what Mother Nature intended’, ‘what your genes doled out’ or more subtly, the ‘inscribed body’, two familiar chains of equivalences are invoked. These chains can be seen to reﬂect popular understandings of the two main faces of femininity; passivity and unpredictable (potentially malign) agency. Not only does the continual invocation of the natural serve to gender cosmetic surgery in the feminine, but it reproduces ideas about the essential openness of the passive (female) body as raw material to intervention and improvement. At the same time, nature as capricious mother is often invoked, emphasising stereotypes of feminine unpredictability in need of management.

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Importantly, both passivity and unpredictability function to justify intervention and management. More clearly, perhaps, than in the repertoires of vanity or agency, the repertoire of nature reveals the ways in which entirely contradictory statements (cosmetic surgery is natural/cosmetic surgery is unnatural) can work to produce related effects. Thus, apparent variety can mask similar or mutually supporting investments and results. As Nikolas Rose comments in relation to his rejection of ‘materialist’ appeals to the body (and by implication, to nature), ‘this is not to suggest that humans could be angels, ﬂy out of windows, or wriggle down earthworm burrows. But it is to suggest that “materialist” appeals to corporeality as the “material” upon which culture works are not very good to think with’.10 As feminist writing on cosmetic surgery has tended to demonstrate, such appeals are likely to reinvoke the very spectres they are employed to challenge. Indeed, the natural imaginary body is most often a passive feminine one. The repertoire of agency is produced through a much wider range of subrepertoires than the latter. As I noted in Chapter 3, this repertoire is rarely referred to by the somewhat academic term ‘agency’, but instead can be found in a range of related words and phrases. Across the four discourses examined, many of the same sub-repertoires were identiﬁed. These serve to produce masculinity and femininity in particular, sometimes relatively novel, ways. For instance, an important way of talking about cosmetic surgery for both men and women (although it is women who are by far most frequently addressed here) revolves around the notion of career success and the body, and appearance as a career investment. This sub-repertoire is apparent across all four discourses and in some ways suggests a shift away from expectations that femininity be reiterated through the family and motherhood. In one sense, femininity is redrawn here as goal-oriented and competitive. Indeed, in this particular case, it closely parallels the ways in which men are addressed. This may represent a signiﬁcant shift for femininity in general, although an important point needs to be remembered here. Competitiveness in terms of appearance is by no means a new element within constructions of femininity, and as I have noted elsewhere, such an emphasis on appearance in relation to employment has been used to discredit women’s achievements in the workplace. While an emphasis on careers may indicate a relatively novel direction for femininity, its articulation through the familiar vehicle of appearance works to undermine that novelty. Other related agency repertoires such as those circulating around the concept of ‘internal motivation’ or ‘doing it for me’ set up attractive avenues through which cosmetic surgery may be understood in relation to women, but they do so by invoking an almost impossible ideal of autonomy. The routine ‘weighing up of risks and rewards’ concomitant with this autonomy is itself a highly problematic notion given that surgeons retain a signiﬁcant degree of control over what is communicated to the prospective patient.

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Also linked with these sub-repertoires is that of ‘pleasure’, favoured by some feminists. These agency repertoires offer women valuable tools with which to construct the self as both desiring and deserving of pleasure, and able to exercise rational decision-making in order to direct their destinies. As I have noted throughout, however, these versions of agency almost without exception position the surgeon in a paternal role, providing advice, approving or vetoing aesthetic choices, invested with the power to withhold surgery altogether. From this point of view, women’s ‘autonomy’ comes to be rearticulated within the supposedly reasonable limits set by the surgeon. This is an interesting dynamic because while femininity may be being redrawn with greater autonomy, the ‘bottom line’ reiterated again and again is male authority. Through cosmetic surgery as a technology of gender, very conventional gender dynamics are played out within an apparently liberal script of women’s self-deﬁnition. The repertoire of vanity exhibited a fascinatingly elusive quality within discussions of cosmetic surgery. Contrary both to indications from historical works such as Elizabeth Haiken’s Venus Envy and Sander Gilman’s Making the Body Beautiful and to my own expectations around representations of gender and cosmetic surgery, the repertoire of vanity was found to be relatively rarely invoked in an uncritical sense. This does not mean, however, that it did not feature at all in this material. Rather, an interesting shift appears to have occurred, in which links once demonstrable between femininity, cosmetic surgery and vanity are now under debate. More often than not, vanity is referred to only in the process of denying its relevance to cosmetic surgery. While women’s magazines were found to most frequently level accusations of vanity at participants, here, too, such references were relatively rare, and more than evenly balanced with denials. This observation is signiﬁcant not as evidence that a revaluation of vanity as a positive good has begun to develop (although in some instances, such a revaluation – while not new – has indeed appeared) but because it represents a very determined rejection of links between vanity and undergoing surgery. Undoubtedly this rejection has been partly fuelled by material generated by cosmetic surgeons, aimed both at increasing the respectability of cosmetic surgery within medicine and at selling it to the public, but it must be said that in part, this tendency has its roots in feminist campaigning. Particularly in relation to campaigns beginning in the 1970s around the provision of reconstructive surgery after mastectomy, feminists have contributed to a redeﬁnition of elective surgery aimed at aesthetic changes.11 Two divergent conclusions may be drawn from this development. First, it might be concluded that by breaking the link between cosmetic surgery and vanity, a similar longstanding link between vanity and femininity is weakened. This may be the case and certainly, agency repertoires based on career motivations and self-deﬁnition provide some support for this reading. At the same time, it is clear that the vehement denials of vanity accompany-

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ing the undergoing of cosmetic surgery hint at the degree of contempt in which vanity is still held in culture. While this repertoire of denial cannot be understood to indicate an ‘underlying’ contempt on the part of the individual, it can indicate a cultural context in which denying the role of vanity is both possible and desirable. Although the concept of vanity is not exclusively related to women (as Sander Gilman carefully points out),12 there is no doubt that it is primarily feminised. Indeed, where vanity is used as a repertoire in relation to men, it appears in a singularly playful, lighthearted register. In any case, where vanity is so vehemently and continuously denied (often, as I have argued, in the absence of accompanying accusations) it must be recognised as thoroughly inhabiting, or ‘haunting’ this discourse. Of the three repertoires examined here, the direction in which gender is becoming in relation to vanity is the least clear. In some ways it is a repertoire taken up in the citing of other repertoires, such as nature and agency. Sometimes vanity is seen as natural, sometimes as unnatural. Sometimes it indicates agency, sometimes victimhood. As a technology of gender, however, the repertoire of vanity functions in a very speciﬁc way. Currently it serves to reiterate very different expectations, and thus persistently binary models, in relation to masculinity and femininity. Gender undergoes constant becomings in discourse on cosmetic surgery. This occurs both through the particular preferred readings constructed intertextually in the material examined here, and through the speciﬁc machinations of notions of nature, agency and vanity that saturate the material. In three important ways – the naturalising of the surgical body, the persistent reinstating of the (male) expert into the rhetoric of (feminine) selfdeﬁnition, and the abjection of vanity – femininity appears to be reiterated quite conventionally. However, as the recent legal exploitation of feminist orthodoxies described in Chapter 6 makes clear, no political direction is immune from reterritorialisation. From this point of view, the discourse I have examined inevitably makes space as much for radical departures as for stabilisations of conventional reﬂexes. Blanket assumptions about the future of discourse and thus of material lives are not viable, although investigation of the present and its opportunities and limitations is important. As Haraway insists: ‘[k]nowledge-making technologies, including crafting subject positions and ways of inhabiting such positions, must be made relentlessly visible and open to critical intervention.’13 This book represents one such critical intervention.

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Notes Introduction 1. Jon Casimir, James Cockington and Richard Guilliatt interpret cosmetic surgery in ‘Ninety Things that Deﬁned the ’90s’, Sydney Morning Herald Good Weekend, 9 October 1999, p. 19. 2. Simply put, ‘cosmetic surgery’ can be distinguished from ‘plastic surgery’ in that the former refers solely to procedures designed to improve the appearance of features otherwise considered healthy and within the normal rage of aesthetic variation. The latter term also incorporates reconstructive procedures, which alter the appearance of features affected by accident, disease or birth defect. The term ‘aesthetic surgery’ most closely resembles ‘cosmetic surgery’ in meaning. A more detailed discussion of the term ‘cosmetic surgery’ will occur later in the chapter. 3. For example, cosmetic surgery-related stories appear regularly on the popular Australian current affairs programmes ‘A Current Affair’ and ‘Good Medicine’. 4. For instance, ABC Radio National covered the NSW Health Care Complaints Commission (HCCC) Inquiry into Cosmetic Surgery, and debated issues around cosmetic surgery on its Life Matters programme. 5. These will be examined closely in Chapter 5 and include The Good Medicine Handbook: The Complete Guide to Cosmetic Surgery and Anti-Ageing: The Complete Guide to Cosmetic Surgery and Anti-ageing, Sydney, 1998 and The Art of Cosmetic Beauty: Australia’s Guide to Cosmetic Surgery, vol. 1, Sydney, 1998. 6. The Sydney Morning Herald Good Weekend magazine listed cosmetic surgery as a deﬁning feature of the 1990s in its ‘Ninety Things that Deﬁned the Nineties’ p. 19. 7. Kathy Davis highlights this issue in her article about the early feminist cosmetic surgeon Suzanne Noël. See her ‘Cosmetic Surgery in a Different Voice: The Case of Madame Noël’, Women’s Studies International Forum, vol. 22, no. 5, September–October 1999, pp. 473–88. Davis goes further to argue that cosmetic surgery is masculine medicine par excellence, and that Noël brought a distinctly feminine and feminist approach to her work. 8. The term interdisciplinarity was used by surgeons speaking at the HCCC Inquiry. 9. This section relies upon the verbal and written testimonies presented by surgeons and representatives of professional bodies at the HCCC Inquiry. 10. The Cosmetic Surgery Report, HCCC, 1999, estimates that there are 350 doctors with a substantial practice in cosmetic surgery in Australia; 190 of these are plastic surgeons, 30 are cosmetic surgeons (no speciﬁc qualiﬁcation apart from general medicine), 70 are cosmetic surgery dermatologists and around 60 are otolaryngologists and opthalmologists. See p. 6. 11. The issue of the administration of minor sedation and local anaesthetics by surgeons operating alone arose a number of times at the HCCC Inquiry. 12. Elspeth Probyn’s ‘The Taste of Power’, in Jenna Mead (ed.) Bodyjamming: Sexual Harassment, Feminism and Public Life, Vintage, Milson’s Point, 1997, touches on this tendency.

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196 Cosmetic Surgery, Gender and Culture 13. Kathy Davis, Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Routledge, New York and London, 1995. 14. Sander Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery, Princeton University Press, Princeton, 1999. 15. Here, the Black or Jewish individual ‘passes’ as white or gentile. Ibid., p. 22. Statistics vary, but a survey commissioned by the HCCC in 1999 found that 86 per cent of recent cosmetic surgery participants were female. See The Cosmetic Surgery Report, p. 10. Also see Haiken, Venus Envy: A History of Cosmetic Surgery, Johns Hopkins University Press, Baltimore, 1997, pp. 11–12, who points out that in the US, most surgeons by far are male and most patients by far are female. Unsurprisingly, all members of the 2002 Australian College of Cosmetic Surgery council executive, council and board of censors, as well as all special council emissaries, were men. 16. The co-construction of race and gender is discussed in more detail in Chapter 1. 17. Taken from Nikolas Rose’s interpretation of Deleuze where he says, ‘[t]o write in the spirit of Deleuze would, I think, imply that it was more productive to pose our questions in terms of what humans can do, rather than what they are.’ Nikolas Rose, Inventing Our Selves: Psychology, Power and Personhood, Cambridge University Press, Cambridge, 1996, p. 172. 18. As is the case in Davis, Reshaping the Female Body. 19. This language is used in comments found in women’s magazines (see Chapter 3). 20. See Teresa de Lauretis, Technologies of Gender, Indiana University Press, Bloomington, 1987. Cosmetic surgery is a technology of race, class and age as well as gender, though this book will concentrate on its role as a technology of gender. This is not to argue that race, age and class do not inﬂect notions of gender. Rather, this project will focus on gender, taking into account these inﬂections where relevant. The notion of technologies of gender will be explained in detail in Chapter 1. 21. Rose, Inventing Our Selves, p. 178. 22. Though he does separate aesthetic surgery from reconstructive surgery which ‘restores function’. 23. See Gilman, Making the Body Beautiful, p. 22 where he adopts the notion of ‘passing’ (as white), ‘taken from the history of the construction of race, not gender’ as the most suitable model for understanding aesthetic surgery. 24. Certainly, the report from the HCCC Inquiry, The Cosmetic Surgery Report, HCCC, Strawberry Hills, Sydney, 1999, makes the same distinction that is evident within the work of feminists. It states that ‘[c]osmetic surgery’ excludes reconstructive surgery, being surgery which is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumours or disease. It is generally performed to improve functions, but may also be done to approximate a normal appearance.’ See p. 1. 25. Gilman, Making the Body Beautiful, p. 50. 26. This body of work will be examined closely in Chapter 4. 27. Gilman, Making the Body Beautiful, pp. 6–7. 28. The HCCC Inquiry report, The Cosmetic Surgery Report, bears this out by stating that the inquiry excluded ‘gender reassignment’ because of ‘the complex clinical issues involved’ (p. 1). Unlike Gilman’s list, the report also includes botox

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29.

30. 31.

32. 33. 34. 35. 36. 37.

38.

39. 40. 41. 42.

43. 44.

therapy (the injection of botox, a puriﬁed neurotoxin into the forehead to paralyse muscles that cause wrinkling) and sclerotherapy (the treatment of varicose and spider veins) in its list of procedures. Another distinction is also recognised in the report, this time between cosmetic surgery – that is, major procedures such as liposuction, breast augmentation, facelifts and nosejobs – and cosmetic medicine – which includes procedures such as chemical peels, collagen injections, laser skin resurfacing, vein removal and laser hair removal. Susan Leigh Star quoted in Donna Haraway, Modest_Witness@Second_Millenium. FemaleMan©_Meets_OncomouseTM: Feminism and Technoscience, Routledge, New York and London, 1997, p. 39. Ibid., p. 3. Donna Haraway, ‘A Cyborg Manifesto: Science, Technology and Socialist Feminism in the Late Twentieth Century’, Simians, Cyborgs and Women: The Reinvention of Nature, Routledge, New York and London, 1991, p. 161. Haraway, Modest Witness, p. 3. Ibid., p. 2. Gilles Deleuze and Felix Guattari, A Thousand Plateaus, Brian Massumi (trans.), University of Minnesota Press, Minneapolis, 1987, p. 9. Diane MacDonell, Theories of Discourse, Blackwell, Oxford, 1986, p. 3. Michel Foucault, The History of Sexuality, Volume 1: The Will To Knowledge, Penguin, Harmondsworth, 1978, p. 100. Polysemy has been described as ‘[t]he text’s many meanings’. In Tools for Cultural Studies: An Introduction, Macmillan, Melbourne, 1994, Tony Thwaites, Lloyd Davis and Warwick Mules state that ‘[t]exts are combinations of signs with multiple, social meanings’ (p. 86), though a later description also suggests that ‘ideology limits and contains [the text’s] polysemic structure’ through the use of myths and stereotypes (p. 161). Maureen Caine, ‘Foucault, Feminism and Feeling: What Foucault Can and Cannot Contribute to Feminist Epistemology’, Caroline Ramazanoglu (ed.), Up against Foucault: Explorations of Some Tensions between Foucault and Feminism, Routledge, London and New York, 1993, p. 80. For example, it is important to bear in mind that cosmetic surgery is currently predominantly performed by men upon women. Haraway, Modest_Witness, p. 190. Celia Roberts, ‘Messengers of Sex’, PhD thesis, University of Sydney, 1998, provides an excellent short overview of this area of scholarship. See Evelyn Fox Keller, Reﬂections on Gender and Science, Yale University Press, New Haven and London, 1995; Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction, Beacon Press, Boston, 1987; Emily Martin, Flexible Bodies: The Role of Immunity in American Culture from the Days of Polio to the Age of AIDS, Beacon Press, Boston, 1994. See, for example, Anne Fausto-Sterling, Myths of Gender: Biological Theories about Women and Men, Basic Books, New York, 1992. See Sandra Harding, The Science Question in Feminism, Cornell University Press, Ithaca, NY and London, 1986; Sandra Harding, ‘Rethinking Standpoint Epistemology: What Is ‘Strong Objectivity’?’, in Linda Alcoff and Elizabeth Potter (eds), Feminist Epistemologies, Routledge, London and New York, 1993, pp. 49–82.

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198 Cosmetic Surgery, Gender and Culture 45. For example, in her ‘The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others’, in Lawrence Grossberg, Cary Nelson and Paula Treichler (eds), Cultural Studies, Routledge, London and New York, 1992. 46. Deleuze and Guattari, A Thousand Plateaus, p. 21. 47. Foucault, The History of Sexuality, p. 100. 48. Ibid., p. 100. 49. Ibid., p. 100. 50. Rose, Inventing Our Selves, p. 53. 51. Haiken, Venus Envy. 52. Gilman, Making the Body Beautiful. 53. Ibid., p. 11, Haiken, Venus Envy, p. 1. 54. Gilman, Making the Body Beautiful, p. 10. 55. Ibid., p. 17. 56. Haiken, Venus Envy, p. 4. 57. Ibid. 58. Bruce Walton Taylor, ‘The Development of Australasian Plastic Surgery’, Australian Society of Plastic Surgeons homepage, www.plasticsurgery.org.au (1999). 59. See Jill Julius Matthews, ‘They Had Such a Lot of Fun: The Women’s League of Health and Beauty Between the Wars’, History Workshop Journal, no. 30, 1990, pp. 22–54, and her ‘Building the Body Beautiful’, Australian Feminist Studies, no. 5, Summer, 1987, pp. 17–33. Interestingly, the name of the organisation was changed to the League of Health when it arrived in Australia, suggesting that beauty was considered of less interest to Australian women than to British women. This emphasis on health can be identiﬁed in Thea Stanley Hughes, The League of Health in Australia, League of Health, Sydney, 1961. 60. Neville Meaney demonstrates Australia’s longstanding loyalty to British culture in his ‘Australia and the World’, Neville Meaney (ed.), Under New Heavens: Cultural Transmission and the Making of Australia, Heinemann, Melbourne, 1989. 61. As Libby Harkness notes in her Australian consumers’ survey of cosmetic surgery, ‘[a]lthough plastic surgeons are not the only medical specialists who perform cosmetic surgery they have always claimed it as their own’. Libby Harkness, Skin Deep: A Consumer’s Guide to Cosmetic Surgery in Australia, Doubleday, Sydney, 1994, p. 32. 62. Nora Jacobson, Cleavage, Rutgers University Press, New Brunswick, New Jersey and London, 2000, p. 79. 63. Thomas Biggs et al., ‘Augmentation Mammoplasty: A Review of 18 years’, Plastic and Reconstructive Surgery, vol. 69, no. 3, March 1982. 64. Davis, Reshaping the Female Body, pp. 18–19. 65. Robin Bromby, ‘Cosmetic Surgery – The New Medical Bonanza’, The National Times, 21–27 December 1980, p. 16. 66. Gilman, Making the Body Beautiful, pp. 3–4. 67. Nora Jacobson provides a detailed account of the process by which silicone implants moved from widely used to heavily regulated in her book, Cleavage, which also focuses on the US context. 68. See the Independent Review Group web-site, at www.siliconereview.gov.uk/ history/index.htm (1 November 2002). 69. Faludi, quoted in Davis, Reshaping the Female Body, p. 21. 70. See Stuart Hall, ‘Encoding/Decoding’, in Culture, Media, Language, Hutchinson, London, 1980.

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Notes 199 71. Jonathan Potter and Margaret Wetherell, Discourse and Social Psychology: Beyond Attitudes and Behaviour, Sage, London, 1987.

Chapter 1 1. See, for instance, Kathy Davis, Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Routledge, New York and London, 1995; Susan Bordo, Unbearable Weight: Feminism, Western Culture and the Body, University of California Press, Berkeley, 1993; Kathryn Pauly Morgan, ‘Women and the Knife: Cosmetic Surgery and the Colonisation of Women’s Bodies’, Hypatia, vol. 6, no. 3, Fall 1991, pp. 25–53; Naomi Wolf, ‘Keep them Implanted and Ignorant’, in P. Foster (ed.) Minding the Body, Anchor, New York, 1995. 2. Denise Riley provides an important discussion of the theoretical and strategic issues involved in the invocation of the category of ‘women’ in her book, ‘Am I That Name?’: Feminism and the Category of ‘Women’ in History, University of Minnesota Press, Minneapolis, 1988. 3. Gilles Deleuze and Michel Foucault, ‘Intellectuals and Power’, in D. Bouchard (ed.), Language, Counter-Memory, Practice, Cornell University Press, Ithaca, NY, 1977, p. 206. 4. Ibid., p. 206. 5. Brian Massumi, A User’s Guide to Capitalism and Schizophrenia: Deviations from Deleuze and Guattari, MIT Press, Cambridge, Mass., 1993, endnote no. 60, p. 158. 6. Ibid., p. 24. 7. Gilles Deleuze and Felix Guattari, A Thousand Plateaus, Brian Massumi (trans.), University of Minnesota Press, Minneapolis, 1987, p. 37. 8. Ibid., p. 9. 9. Ibid., pp. 508–9. 10. Ibid., p. 9. 11. Ibid., p. 8. 12. Gilles Deleuze, ‘What is Becoming?’, in C.V. Boundas (ed.), The Deleuze Reader, Columbia University Press, New York, 1993, p. 39. 13. Elizabeth Grosz, ‘Reﬁguring Lesbian Desire’, in her Space, Time and Perversion, Routledge, New York and London, 1995, p. 184. 14. Ibid., p. 184. 15. Deleuze and Guattari, A Thousand Plateaus, p. 239. 16. Patton, Paul, ‘Deleuze and Guattari’s Philosophy’, unpublished paper, University of Sydney, 1995, pp. 6–7. 17. Deleuze and Guattari, A Thousand Plateaus, p. 21. 18. Lewis Carroll’s Alice is located ‘in the middle’ during her sudden growth and shrinkage: she is at once both larger than she had been and smaller than she would become. 19. Ibid., p. 21. 20. Ibid., p. 23. 21. These are all procedures which strip the top layers of skin (usually from the face and chest) so as to reveal smoother, ‘younger’-looking skin beneath. 22. Massumi, A User’s Guide to Capitalism and Schizophrenia, p. 102. 23. Teresa de Lauretis, Technologies of Gender, Indiana University Press, Bloomington, 1987, p. 3.

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200 Cosmetic Surgery, Gender and Culture 24. Deleuze and Guattari, A Thousand Plateaus, p. 241. 25. Moira Gatens, Imaginary Bodies: Ethics, Power and Corporeality, Routledge, London and New York, 1996, p. 73. 26. Margaret Whitford, Luce Irigaray: Philosophy in the Feminine, Routledge, London and New York, 1991, p. 65. 27. Gatens, Imaginary Bodies, p. viii. 28. Whitford, Luce Irigaray, p. 53. 29. Ibid., p. 56. 30. Gatens, Imaginary Bodies, p. viii. 31. Ibid., p. 70. 32. Ibid., p. 71. 33. Ibid., p. 83. 34. Ibid., p. x. 35. Ibid., p. 135. 36. Ibid., p. 127. 37. de Lauretis, Technologies of Gender, p. 3. 38. With strong industrial implications, the word suggests both complexity and productivity. Cosmetic surgery can be seen literally as technology but also metaphorically so. It constructs gendered bodies using complex equipment and materials. It also constructs the gendered subject and accepted notions of gender through its status as cultural technology. In this case it exists in and functions through the complex equipment and materials of the media and other discourses. 39. Ibid., p. 5. 40. Ibid., p. 3. 41. Ibid., p. 10. 42. Ibid., p. 12. 43. Ibid., p. 12. 44. This is a term taken from ﬁlm theory. It refers to the space around the camera frame which contains the marginalised elements that make the contents of the frame possible. As the frame moves, so does the space-off. Here, inside and outside are temporary. 45. See her Gender Trouble: Feminism and the Subversion of Identity, Routledge, New York and London, 1990, and her Bodies that Matter: On the Discursive Limits of Sex, Routledge, New York and London, 1993. 46. See Fay Weldon’s Life and Loves of a She-Devil, Hodder and Stoughton, London, 1983, for an example of cosmetic surgery as a technology of gender constructed in part from a familiar sexual imaginary of feminine self-blame, revenge and competition over male attention. 47. De Lauretis, Technologies of Gender, p. 10. 48. The notion of articulation is variously theorised by Deleuze and Guattari in A Thousand Plateaus; Donna Haraway, in ‘The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others’, in Lawrence Grossberg, Cary Nelson and Paula Treichler (eds), Cultural Studies, Routledge, New York and London, 1992; and Stuart Hall in ‘On Postmodernism and Articulation: an Interview with Stuart Hall’, edited by Lawrence Grossberg, in David Morley and Kuan-Hsing Chen’, Stuart Hall: Critical Dialogues in Cultural Studies, Routledge, London and New York, 1996. 49. The Cosmetic Surgery Report: Report to the NSW Minister for Health – October 1999, HCCC, Strawberry Hills, Sydney, 1999, cites a survey commissioned by the

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Notes 201 Health Care Complaints Commission which indicates that most participants in cosmetic surgery were actually aged between 45 and 59 (32.1 per cent), while a further 30 per cent were aged between 35 and 44. See p. 11. 50. Interestingly, The Cosmetic Surgery Report found that almost half of cosmetic surgery participants they surveyed quoted incomes below the national average of $39,800 per annum, with 17 per cent quoting an income below $20,000 per annum. Over 60 per cent paid for the procedure from savings, while around 23 per cent used a credit card or took out a bank loan. These ﬁgures suggest that, despite popular perceptions, cosmetic surgery is not conﬁned to the wealthy. See pp. 11–12. 51. See, for example, Nira Yuval-Davis, ‘Women and the Biological Reproduction of the Nation’, in her Gender and Nation, Sage, 1997; Ann Laura Stoler, ‘Making Empire Respectable: The Politics of Race and Sexual Morality’, in Ann McClintock et al. (eds), Dangerous Liaisons: Gender, Nation and Postcolonial Perspectives, University of Minnesota Press, London, 1997; Mrinalini Sinha, ‘Gender and Imperialism: Colonial Policy and the Ideology of Moral Imperialism in Late Nineteenth-century Bengal’, in Michael Simmel (ed.), Changing Men, London, Sage, 1987; Joanna de Groot, ‘ “Sex” and “Race”: the construction of language and image in the nineteenth century’, in Susan Mendus and Jane Rendall (eds), Sexuality and Subordination, Routledge, London and New York, 1989.

Chapter 2 1. The second section will provide a detailed explanation of this term. Here, ‘repertoire’ can be understood simply as a word, phrase or literary element found repeatedly in a text, discourse or group of discourses. 2. David Morley, Television Audiences and Cultural Studies, Routledge, London and New York, 1992, p. 20. Morley cites C. Condit, ‘The Rhetorical Limits of Polysemy’, Critical Studies in Mass Communication, vol. 6, no. 2, 1989 as an example here. 3. This understanding of intertextuality arises out of the ﬁeld of cultural studies and bears only a superﬁcial relationship to the more traditional use of the term in literary theory which describes formal textual elements such as citation and shared literary conventions. At the same time these literary deﬁnitions do contain elements useful to my project when they take a broad view; for example, Barthes is quoted in Hawthorn’s glossary thus: ‘Any text is a tissue of past citations . . . there is always language before and around the text’. See I. Makaryk (ed.), Encyclopaedia of Contemporary Literary Theory, University of Toronto Press, Toronto, 1994, pp. 568–72; W. Harris, Dictionary of Concepts in Literary Criticism and Theory, Greenwood, New York, 1992, pp. 175–8; J. Hawthorn, A Concise Glossary of Contemporary Literary Theory, Edward Arnold, London, 1992, pp. 85–7. 4. Michael Worton and Judith Still, ‘Introduction’, in Michael Worton and Judith Still (eds), Intertextuality: Theories and Practices, Manchester University Press, Manchester and New York, 1990, p. 21. 5. Stuart Hall, ‘Encoding/Decoding’, in Culture, Media, Language, Hutchinson, London, 1980, p. 134. 6. Simon During, The Cultural Studies Reader, Routledge, London and New York, 1993, p. 9.

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202 Cosmetic Surgery, Gender and Culture 7. Hall, ‘Encoding/Decoding’ p. 131. 8. Jennifer Daryl Stack, ‘The Theory and Method of Articulation in Cultural Studies’, in David Morley and Kuan-Hsing Chen (eds), Stuart Hall: Critical Dialogues in Cultural Studies, Routledge, London and New York, 1996, p. 117. 9. Stuart Hall, ‘On Postmodernism and Articulation: an interview with Stuart Hall’, Lawrence Grossberg (ed.), in Morley and Chen (eds), ibid., p. 136. 10. Joke Hermes, Reading Women’s Magazines, Polity, Cambridge, 1995, p. 10. 11. Ibid., p. 25. 12. Ibid., p. 21. 13. Ibid., p. 15. 14. Ibid., p. 4. 15. Catharine Lumby, Bad Girls, Allen and Unwin, St Leonards, 1997, p. xxiv. 16. Ibid., p. xxv. 17. Ibid., p. 93. 18. Ibid., p. 13. 19. Ibid., p. 25. 20. Ibid., p. 8. 21. John Frow, ‘Intertextuality and Ontology’, in Worton and Still, Intertextuality, p. 45. 22. Ibid., p. 45. 23. Michael Riffaterre, ‘Interpretation and Undecidability’, New Literary History, 1981, pp. 227–234. 24. Worton and Still, ‘Introduction’, Intertextuality: Theories and Practices, p. 9. 25. Catherine Waldby, AIDS and the Body Politic, Routledge, London and New York, 1996, p. 5. 26. Quoted in Morley, Television Audiences, p. 27. 27. Norman Fairclough, ‘Discourse and Text: Linguistic and Intertextual Analysis within Discourse Analysis’, in Critical Discourse Analysis: The Critical Study of Language, Longman, London and New York, 1995, p. 188. 28. Michael Riffaterre, Text Production, Terese Lyons (trans.), Columbia University Press, New York, 1983, p. 120. 29. Waldby, AIDS and the Body Politic, p. 5. 30. Quoted in ibid., p. 124. 31. See Lumby, Bad Girls, p. 8 for her suggestion that feminists can affect the way women read, and p. 156 for her argument that feminists currently occupy a ‘patriarchal’ role as ideologues. 32. Roland Barthes, The Pleasure of the Text, (trans. R. Miller), Jonathan Cape, London, 1976, p. 3. 33. Klaus Bruhn Jensen, The Social Semiotics of Mass Communication, Sage, London and Thousand Oaks, Cal., 1995. 34. Margaret Wetherell, ‘Linguistic Repertoires and Literary Criticism: New Directions for a Social Psychology of Gender’, in Sue Wilkinson (ed.), Feminist Social Psychology: Developing Theory and Practice, Open University Press, Milton Keynes, 1986, p. 90. 35. Jonathan Potter and Margaret Wetherell, Discourse and Social Psychology: Beyond Attitudes and Behaviour, Sage, London, 1987, pp. 157 and 149. 36. G. Vaughan and M. Hogg, Introduction to Social Psychology, Prentice Hall, Sydney, 1995, p. 2. 37. Ibid., p. 5.

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Notes 203 38. 39. 40. 41. 42.

Potter and Wetherell, Discourse and Social Psychology, p. 95. Wetherell, ‘Linguistic Repertoires and Literary Criticism’, p. 85. Potter and Wetherell, Discourse and Social Psychology, p. 157. Wetherell, ‘Linguistic Repertoires and Literary Criticism’, p. 78. Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction, Beacon Press, Boston, 1987. 43. Wetherell, ‘Linguistic Repertoires and Literary Criticism’, p. 93.

Chapter 3 1. ‘ “I Starve Myself” (And I’ve Had Cosmetic Surgery Too)’, New Idea, 19 October 2002, pp. 4–5. 2. See for instance, ‘Lunchtime Lifts’, Marie Claire Australia, February 1998, pp. 154–64 ; She Cosmetic Surgery (supplement), December 1994; ‘Future Perfect’, Elle, February 1997, pp. 48–52; ‘Cosmetic Surgery Changed My Life!’, For Me, 9 June 1997, pp. 12–17; ‘Borrowing Time’, Vogue Australia, January 1996, pp. 37–9; ‘Look at Me Now!’, Cosmopolitan, March 1994, pp. 60–3. Cosmetic surgery may even be offered as prizes, for example, ‘Win Cosmetic Treatments Worth $20,000’, She Australia, June 1999, p. 120, although the 1999 Health Care Complaints Commission Inquiry into Cosmetic Surgery report recently recommended that the NSW government refuse permits to competitions that offer such prizes. See The Cosmetic Surgery Report: Report to the NSW Minister for Health – October 1999, HCCC, 1999, p. iv. 3. For example, ‘Fantastic Plastic’, Who Weekly, 4 November 1996, p. 87; ‘Melanie Grifﬁth Looks Stunning Thanks to Plastic Surgery’, Women’s Weekly, August 1997, pp. 10–13; ‘Breasts: Fake vs Flesh’, New Weekly, 9 June 1997, pp. 48– 51. 4. See ‘Mirror Mirror on the Wall’, New Woman, March 1996, pp. 107–9; ‘Scarred for Life’, Who Weekly, 10 May 1993, pp. 24–7; ‘What Price Perfection?’, Mode, October/November 1993, pp. 128–32; ‘Breast Implants: Beauty or Barbarity?’, Ita, February 1992, pp. 18–23. 5. See The Australian Women’s Weekly. 6. She Cosmetic Surgery supplement. 7. The Art of Cosmetic Beauty, vol. 1, Sydney, 1998. 8. This is an interesting reversal of a state of affairs in newspaper publishing not yet entirely extinct where ‘women’s pages’ containing recipes, health and beauty material and fashion advice are included. This assumes the irrelevance of the majority of the content (politics, national and international news, ﬁnance, and so on) to women, and of women to broader news-making. 9. This is an idea put forward in advertising aimed at men and can be found elsewhere such as in Sander Gilman’s Making the Body Beautiful: A Cultural History of Aesthetic Surgery, Princeton University Press, Princeton, 1999, where he argues that ‘Aesthetic surgery seems to be approaching a time when it will not be gendered at all’, p. 33. Kathy Davis directly challenges this viewpoint in her article, ‘ “A Dubious Equality”: Men, Women and Cosmetic Surgery’, Body and Society, vol. 8 no. 1, 2002, pp. 49–65.

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204 Cosmetic Surgery, Gender and Culture 10. Donna Haraway, ‘The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others’, in Lawrence Grossberg, Cary Nelson and Paula Treichler (eds), Cultural Studies, Routledge, New York and London, 1992, p. 312. 11. Mary Jacobus, Evelyn Fox Keller and Sally Shuttleworth, ‘Introduction’, Body/ Politics: Women and the Discourses of Science, Routledge, New York and London, 1990, p. 2. 12. Haraway invokes many of the uses of nature identiﬁed in this book when she deﬁnes it as ‘the foil for culture . . . the zone of constraints, of the given, and of matter as resource; nature is the necessary raw material for human action, the ﬁeld for the imposition of choice, and the corollary of mind’, in Modest_Witness@Second_Millennium.FemaleMan©_Meets_Oncomouse™: Feminism and Technoscience, Routledge, New York and London, 1997, p. 102. 13. For a discussion of this development, see Maurice Bloch and Jean Bloch, ‘Women and the Dialectics of Nature in Eighteenth-century French Thought’, in C. McCormack and M. Strathern (eds), Nature, Culture and Gender, Cambridge University Press, Cambridge and New York, 1980. 14. Elizabeth Grosz, Volatile Bodies: Toward a Corporeal Feminism, Allen and Unwin, St Leonards, 1994, p. 14. 15. Moira Gatens, ‘Towards a Feminist Philosophy of the Body’, Imaginary Bodies: Ethics, Power and Corporeality, Routledge, London and New York, 1996, p. 51. 16. See, for instance, Grosz, Volatile Bodies, p. 21. 17. Haraway, ‘The Promises of Monsters’, p. 296. 18. Ibid., p. 296. 19. Haraway, Modest_Witness, p. 62. 20. Ibid., p. 75. 21. Haraway, ‘The Promises of Monsters’, p. 295. 22. Ibid., p. 297. 23. Ibid., p. 297. 24. Haraway, Modest_Witness, p. 106. 25. Haraway, ‘The Promises of Monsters’, p. 297. 26. Ibid., p. 304. 27. Ibid., p. 324. 28. See Gilles Deleuze and Felix Guattari, A Thousand Plateaus: Capitalism and Schizophrenia, Brian Massumi (trans.), University of Minnesota Press, Minneapolis, 1987; and Stuart Hall, ‘ “On Postmodernism and Articulation”, an Interview with Stuart Hall’, edited by Lawrence Grossberg in David Morley and Kuan-Hsing Chen (eds), Stuart Hall: Critical Dialogues in Cultural Studies, Routledge, London and New York, 1996. 29. Haraway, ‘The Promises of Monsters’, p. 324. 30. Ibid., p. 314. 31. Ibid., p. 324. 32. I will use the terms ‘discipline’ and ‘disciplinary’ throughout the book to refer in one sense to what Diane Macdonell, in her Theories of Discourse: An Introduction, Blackwell, Oxford, 1986, p. 17 describes as ‘the discursive as well as nondiscursive techniques through which modern societies train and regulate individuals’. At the same time such regulation or training is perhaps more properly understood in the context of this book as production. Thus, disciplinary techniques produce and reproduce individuals in particular ways. 33. This appears in a cosmetic surgery advertorial supplement, She magazine, December 1994.

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Notes 205 34. 35. 36. 37. 38. 39.

40.

41.

42. 43. 44. 45.

46.

47. 48. 49. 50. 51. 52. 53. 54. 55.

56. 57.

‘What Price Perfection’?, Mode, October/November, 1993, p. 130. ‘What Will it Cost to Make Me Beautiful?’, Look, June 1988, p. 118. ‘What Do You Think about Cosmetic Surgery?’, For Me, 7 June 1997, p. 17. ‘Our Politically Correct Guide to Cosmetic Surgery’, New Woman, May 1996, p. 109. See Gilman, Making the Body Beautiful, Chapter 2. A common question, ‘You wonder: Is it art? You wonder: Is she nuts?’ is articulated by Sharon Waxman, Washington Post, quoted in Miryam Sas, ‘The Doyenne of Divasection’, Mondo 2000, no. 13, Winter 1995, pp. 106–11. For a critique of this tendency, see Ruth Hubbard, ‘Genes as Causes’, in Vandana Shiva and Ingunn Moser, Biopolitics: A Feminist and Ecological Reader on Biotechnology, Zed Books, London and New Jersey, 1995, pp. 38–51. Hubbard argues that ‘[n]othing we have learned since Mendel’s time about how genes function justiﬁes the conclusion that genes cause traits or control development. They make signiﬁcant contributions to both, but so do lots of other substances, including other genes’ (p. 42). Dorothy Nelkin and Susan Lindee, The DNA Mystique: The Gene as a Cultural Icon, W.H. Freeman, New York, 1995, p. 198. Jon Turney’s Frankenstein’s Footsteps: Science, Genetics and Popular Culture, Yale University Press, New Haven and London, 1998 likewise notes the ascendency of genetics within science and popular culture. ‘The Future Perfect: The Age of the Superbody’, Elle, February 1997, p. 49. ‘I Had Plastic Surgery to Look Like a Barbie Doll’, appears in cosmetic surgery advertorial, She magazine. ‘Men Who Have Cosmetic Surgery’, Cosmopolitan, June, 1997, p. 24. Paul Rabinow, ‘Artiﬁciality and Enlightenment: From Sociobiology to Biosociality’, in J. Crary and S. Kwinter (eds), Incorporations, Zone Books, New York, 1992, p. 236. Kathy Davis argues the corollary of this point when she asserts that cosmetic surgery can never enhance masculinity in the same way that it can femininity, because it involves linking male participants with their bodies in ways that transgress masculine norms of mastery over and detachment from the body. See ‘ “A Dubious Equality” ’, p. 59. ‘Nips and Tucks’ regular column in Australian Women’s Weekly, August 1997, p. 115. ‘Finding a Cosmetic Surgeon’, in She Cosmetic Surgery supplement, p. 48. ‘Stay Young Hollywood Style’, New Idea, 8 June 1996, p. 33. ‘The Body Beautiful (naturally)’, New Woman, May 1996, p. 110. ‘What Do You Think About Cosmetic Surgery?’, p. 17. ‘Men Who Have Cosmetic Surgery’, p. 23. See, for instance, Judith Butler’s recent The Psychic Life of Power: Theories in Subjection, Stanford University Press, Stanford, California, 1997. Chilla Bulbeck, Social Sciences in Australia: An Introduction, Harcourt Brace, Sydney, 1993, p. 386. Michael Haralambos, Robert van Krieken, Philip Smith and Martin Holborn, Sociology: Themes and Perspectives, Australian edition, Longman, Melbourne, 1996, p. 716. See Michel Foucault, The History of Sexuality: The Will to Knowledge, Robert Hurley (trans.), volume 1, Penguin, Harmondsworth, 1978. Germaine Greer, The Whole Woman, Doubleday, London, 1999.

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206 Cosmetic Surgery, Gender and Culture 58. Kathy Davis, Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Routledge, New York and London, 1995. 59. Nikolas Rose, Inventing Our Selves: Psychology, Power and Personhood, Cambridge University Press, Cambridge, 1996, p. 160. 60. quoted in ibid., p. 5. 61. See Deleuze and Guattari, A Thousand Plateaus, and Foucault, The History of Sexuality. 62. Rose, Inventing Our Selves, p. 11. 63. Ibid., p. 17. Emphasis in the original. 64. Ibid., p. 160. 65. Ibid., p. 27. 66. Ibid., p. 152. 67. Ibid., p. 154. 68. Ibid., p. 87. 69. See Gilman, Making the Body Beautiful, pp. 167–8; Sander Gilman, Creating Beauty to Cure the Soul, Duke University Press, Durham, NC and London, 1998, p. 11. 70. Informal exchange between panel members. 71. Rose, Inventing Our Selves, p. 10. 72. Ibid., p. 35. 73. Ibid., p. 182. 74. The term ‘agency’ is a speciﬁcally academic one. As such, it is rarely if ever used in women’s magazines, or in most of the other discourses examined in this book. Despite this, the concept is readily identiﬁable within women’s magazines. (Jane Ussher suggests that feminism has helped reshape magazine discourse around the issue of agency. See her Fantasies of Femininity: Reframing the Boundaries of Sex, Penguin, Harmondsworth, 1997, p. 64.) In order to trace the occurrence of agency repertoires, I examine the use of concepts around women’s power, rather than look only for speciﬁc terms. 75. See Michel Foucault, Technologies of the Self, University of Massachusetts Press, Amherst, 1988. 76. ‘Stay Young Hollywood Style’, New Idea, 8 June 1996, p. 32. 77. ‘Could Cosmetic Surgery Save Your Career?’, She, March 1996, p. 48. 78. ‘I Had Cosmetic Surgery to Look Like a Barbie Doll’, Cleo, December 1993, p. 80. 79. ‘Indulgence’, New Weekly, 14 July 1997, p. 54. 80. ‘Could Cosmetic Surgery Save Your Career?’, p. 50. 81. Rosemary Pringle, Secretaries Talk: Sexuality, Power and Work, Allen and Unwin, Sydney, 1998, notes that in the workplace ‘women are perceived as using sex to their advantage’, though in reality, ‘[t]hey are much less likely to initiate sexual encounters and more likely to be hurt by sex at work’, p. 94. 82. Ibid., p. 50. 83. ‘I Had Cosmetic Surgery to Look Like a Barbie Doll’, p. 80. 84. ‘New Breasts are the Best!’, New Weekly, 29 April 1996, p. 18. 85. Ibid., p. 18. 86. Ibid., p. 18. 87. ‘Get Real! Silicone Sucks’, New Weekly, 9 June 1997, p. 49. 88. ‘You Can Change Your Looks’, For Me, 7 June 1997, p. 12. 89. ‘I’ve Had Eleven Operations’, Cosmopolitan Cosmetic Surgery Special, date unspeciﬁed, p. 84.

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Notes 207 90. According to Mary Douglas, the term ﬁrst came into use during the seventeenth century. See Mary Douglas, Risk and Blame: Essays in Cultural Theory, Routledge, London and New York, 1992, p. 23. 91. Ibid., p. 15. 92. Deborah Lupton, The Imperative of Health: Public Health and the Regulated Body, Sage, London, 1995, p. 79. 93. John Adams notes the connections between risk taking and heroism in his Risk, UCL Press, London, 1995, p. 2. 94. ‘I Did it All for Antonio’, Australian Women’s Weekly, August 1997, p. 11. 95. ‘Plastic Surgery: What if You Could Try Before You Buy?’, Cleo, July 1992, p. 76. 96. ‘Breast Implants: Beauty or Barbarity?’, Ita, February 1992, p. 23. 97. ‘Men Who Have Cosmetic Surgery: Would You Respect Him in the Morning?’, Cleo, December 1993, p. 20. 98. Teresa de Lauretis, Technologies of Gender, Indiana University Press, Bloomington, 1987, p. 5. 99. Susan Bordo, Unbearable Weight: Feminism, Western Culture and the Body, University of California Press, Berkeley, 1993. 100. Naomi Wolf, The Beauty Myth: How Images of Beauty Are Used Against Women, Vintage, London and New York, 1991. 101. Simone de Beauvoir, The Second Sex, H.M. Parshley (trans.), Penguin, Harmondsworth, 1972. 102. Martin Danahay, ‘Mirrors of Masculine Desire: Narcissus and Pygmalion in Victorian Representation’, Victorian Poetry, vol. 32, no. 1, Spring, 1994, p. 35. Kathy Davis makes a similar point in ‘ “A Dubious Equality” ’. 103. Danahay, ibid., p. 47. 104. Ibid., p. 35. 105. The DSM-IV includes the following in its description of schizophrenia; ‘[t]he person may appear markedly disheveled [or] may dress in an unusual manner’. In addition, the person may fail in ‘performing activities of daily living such as . . . maintaining hygiene’. See Diagnostic and Statistical Manual of Mental Disorders, (fourth edn.), American Psychiatric Association, Washington DC, 1994, p. 276. 106. The DSM-IV deﬁnition of Narcissistic Personality Disorder describes the sufferer as ‘often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love’ and of possessing ‘inﬂated judgments’ of themselves. Ibid., p. 658. 107. John Woodforde, The History of Vanity, St Martin’s Press, New York, 1992, p. XX. 108. Valerie Tiberius and John D. Walker, ‘Arrogance’, American Philosophical Quarterly, vol. 35, no. 4, October 1998, p. 379. 109. Sander Gilman identiﬁes both hypocrisy and inauthenticity as associated with vanity, in Making the Body Beautiful, p. 34. 110. Tiberius and Walker, ‘Arrogance’, p. 379. 111. Ibid., p. 383. My emphasis. 112. See Anne Ring, ‘The Countdown to New Heights of Sexist Ageism in the Media of the New World Order’, in M. Alexander et al. (eds), Refashioning Sociology, Australian Sociological Association Conference Proceedings, Brisbane, 1998 for a discussion of this phenomenon in the context of the media. 113. Gilman, Making the Body Beautiful, p. 311.

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208 Cosmetic Surgery, Gender and Culture 114. The role of the women’s movement in redeﬁning breast reconstruction after mastectomy away from criticisms of vanity is exemplary here. See Haiken’s comments in Venus Envy, p. 259. 115. ‘Stay Young Hollywood Style’, p. 32. 116. ‘Our Politically Correct Guide to Cosmetic Surgery’, p. 109. 117. See Ussher, Fantasies of Femininity, p. 131. 118. ‘Men Who Have Cosmetic Surgery . . .’, p. 22. 119. ‘Men, Sex and Surgery: Getting Bigger All the Time!’, Cosmopolitan, December 1992, p. 135. 120. ‘Men Who Have Cosmetic Surgery . . .’, p. 24. 121. Ibid., p. 23. 122. Ibid., p. 24. 123. See Gilman, Making the Body Beautiful, for a thorough account of racial aspects of cosmetic surgery in the United States. An alternative view sees the manipulation of racial characteristics as less about the denial of racial origins and more about the modiﬁcation of the markers of that origin. One African-American surgeon states: ‘In my experience, most patients are not wanting a drastic change, but a slight reﬁnement of one or two features while still maintaining their ethnicity.’ See Kevin Smith, ‘Rhinoplasty for African-Americans on the Rise’, Crisis, January 1994, p. 14. Susan Bordo looks at race and beauty in the United States in Unbearable Weight, pp. 251–8. 124. Marjorie Garber discusses the status of the penis as ‘absolute insignia of maleness’, in Vested Interests: Cross-Dressing and Cultural Anxiety, Penguin, Harmondsworth, 1992, pp. 94–101. Her discussion relates speciﬁcally to transgender surgery, but indicates the centrality of the penis in culture as a sign of masculinity. 125. In fact, the production of this category is itself a signiﬁcant form of cultural work, though this line of inquiry would ﬁll another book.

Chapter 4 1. Moira Gatens, Imaginary Bodies: Ethics, Power and Corporeality, Routledge, London and New York, 1996, p. viii. 2. See Eugenia Kaw’s examination of Asian American women’s participation in cosmetic surgery in her ‘Opening Faces, The Politics of Cosmetic Surgery and Asian American Women’, in Nicole Sault (ed.), Many Mirrors: Body Image and Social Relations, Rutgers University Press, New Brunswick, New Jersey, 1994; and E. Ann Kaplan, ‘Resisting Pathologies of Age and Race: Menopause and Cosmetic Surgery in Films by Rainer and Tom’, in Paul Komesaroff et al. (eds), Reinterpreting Menopause: Cultural and Philosophical Issues, Routledge, New York and London, 1997. 3. It is worth noting here that the feminists discussed in this chapter are not authors of any of the magazine material analysed in Chapter 3. 4. Judith Butler, Bodies that Matter, Routledge, New York and London, 1993, p. xi. 5. Deborah Lupton, The Imperative of Health: Public Health and the Regulated Body, Sage, London, 1995, p. 101. Lupton notes the use of genetic testing in China and India for the sexing of foetuses, often leading to the abortion of female foetuses.

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Notes 209 6. Australia’s twentieth-century policy of ‘assimilation’ of Aboriginal people into white society and its concomitant removal of Aboriginal children (especially light-skinned children) is a clear example of this. See the report, Bringing them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Parents, Human Rights and Equal Opportunity Commission, Sydney, 1997. Also see P. Read, ‘The Stolen Generations: the Removal of Aboriginal Children in NSW 1883–1969’, NSW Ministry of Aboriginal Affairs Occasional Paper no. 1 (n.d.); Heather Goodall, ‘Saving the Children: Gender and the Colonization of Aboriginal Children in NSW, 1788–1990’, Aboriginal Law Bulletin, vol. 2, no. 44, June 1990, pp. 6–9. 7. Indeed, there is a strong disavowal of this important aspect of the notion of nature – biological determinism – in major strands of contemporary feminism. 8. Kathryn Pauly Morgan, ‘Women and the Knife: Cosmetic Surgery and the Colonisation of Women’s Bodies’, Hypatia , vol. 6 no. 3, Fall 1991, p. 35. 9. Kathy Davis critiques Morgan’s ‘utopian’ solutions in ‘ “My Body is my Art”: Cosmetic Surgery as Feminist Utopia’, in Kathy Davis (ed.), Embodied Practices: Feminist Perspectives on the Body, Sage, London, Thousand Oaks and New Delhi, 1997. 10. Morgan, ‘Women and the Knife’, p. 31. 11. Ibid., p. 41. 12. Ibid., p. 28. 13. Ibid., p. 41. 14. Ibid., p. 44. 15. Ibid., p. 30. 16. Ibid., p. 30. 17. See, for instance, Alison Jaggar, ‘Human Biology in Feminist Theory: Sexual Equality Reconsidered’, in C. Gould (ed.), Beyond Domination, Rowman and Littleﬁeld, 1983; and Bob Connell, ‘The Body and Social Practice’, Gender and Power, Polity, Oxford, 1987. As was demonstrated in the Introduction, Donna Haraway’s work continually grapples with the concept of nature, refusing to deny the validity of (a version of) the category altogether. See her ‘The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others’, in Lawrence Grossberg, Cary Nelson and Paula Treichler (eds), Cultural Studies, Routledge, New York, 1992, pp. 295–337 and more recently, Modest_Witness@Second_ Millennium.FemaleMan©_Meets_OncomouseTM. Feminism and Technoscience, Routledge, New York and London, 1997, p. 108. 18. Naomi Wolf, The Beauty Myth, Vintage, London and New York, 1991. As an illustration of this inﬂuence, The Beauty Myth, then nine years old, was referred to repeatedly and at length by several participants (including a lawyer and a media analyst) at the 1999 NSW Health Care Complaints Commission Inquiry into Cosmetic Surgery, for example in the presentation made by media analyst Anne Ring, in drawing attention to pressures women face around beauty. The book is also referred to in magazine and newspaper critiques of beauty culture, for example, see Deborah Bogle, ‘Vain?’ Weekend Australian Review, 11–12 April 1992, review 1. More recently, a pamphlet distributed at the 1999 Sydney Reclaim the Night feminist rally also referred to Wolf’s book. 19. Wolf, ibid., p. 232. 20. Ibid., pp. 258–9. 21. This point is also made in her short essay written in 1992, ‘Keep Them Implanted and Ignorant’, in P. Foster (ed.), Minding the Body, Anchor, New York, 1995. 22. Wolf, The Beauty Myth, pp. 258–9.

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210 Cosmetic Surgery, Gender and Culture 23. Ibid., p. 12. 24. See Harmon R. Holcomb, Sociobiology, Sex and Science, State University of New York Press, Albany, 1993, for a discussion of sociobiology’s account of sexual selection and the ‘double standard’. 25. Wolf, The Beauty Myth, p. 253. 26. Germaine Greer’s The Whole Woman, Doubleday, London, 1999, exhibits a strikingly similar view in relation to cosmetic surgery. Greer states, ‘If the womanmade woman is never good enough, the man-made woman is no better than a toy, built to be played with, knocked about and ultimately thrown away’ (p. 34). She echoes many of Wolf’s arguments, stating that ‘[n]owadays none of the varieties of natural is good enough’ (p. 28) and characterising breast implants as ‘something more pneumatic than nature intended’ (p. 29). 27. Wolf, The Beauty Myth, p. 266. 28. Ibid., p. 267. 29. Ibid., p. 269. 30. Ibid., p. 291. 31. Ibid., p. 289. 32. Susan Bordo, Unbearable Weight: Feminism, Western Culture and the Body, University of California Press, Berkeley, 1993, p. 104. 33. Ibid., p. 248. 34. Ibid., p. 165. 35. Pippa Brush makes a similar argument about the implications of Foucault’s ‘inscription’ metaphor, stating that through this metaphor, ‘Foucault assumes the existence of a pre-inscriptive body’. See her article, ‘Metaphors of Inscription: Discipline, Plasticity and the Rhetoric of Choice’, Feminist Review, no. 58, Spring 1998, p. 22. 36. Elsewhere Bordo has launched trenchant critiques of the Cartesian model of the mind/body relationship and is not unaware of the pitfalls of binary thinking. See for instance, Bordo, Unbearable Weight, pp. 72–3. 37. Ibid., p. 212. 38. Ibid., p. 104. 39. Annette Corrigan and Denise Meredyth, ‘The Body Politic’, in Kate Pritchard Hughes (ed.), Contemporary Australian Feminism, Longman Cheshire, Melbourne, 1994, p. 46. 40. Ibid., p. 43. 41. Ibid., p. 39. 42. Ibid., p. 40. 43. Ibid., p. 41. 44. Anne Balsamo, Technologies of the Gendered Body, Duke University Press, Durham, NC and London, 1996, p. 5. 45. Ibid., p. 58. 46. Ibid., p. 63. 47. Ibid., p. 74. 48. Steven Vogel, Against Nature: The Concept of Nature in Critical Theory, State University of New York Press, Albany, 1996, p. 9. This is not to say that the natural has never been used to defend homosexuality. 49. Louis Althusser, ‘Ideology and Ideological State Apparatuses: Notes towards an Investigation’, in Lenin and Philosophy and Other Essays, New Left Review of Books, London, 1970.

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Notes 211 50. Ibid., p. 140. 51. Ibid., p. 162. 52. Kathy Davis notes that traditional feminist accounts of such beauty practices would have dismissed them as instances of ‘false consciousness’. See Reshaping the Female Body, Routledge, New York and London, 1995, p. 4. See also Bordo, Unbearable Weight, pp. 22–3. 53. Gilles Deleuze and Michel Foucault, ‘Intellectuals and Power’, Language, CounterMemory, Practice, D. Bouchard (ed.), D. Bouchard and Sherry Simon (trans.), Cornell University Press, Ithaca, NY, 1977, p. 212. 54. Ibid., p. 215. 55. Michel Foucault, The History of Sexuality, The Will to Knowledge, Robert Hurley (trans.): volume 1, Penguin, Harmondsworth, 1978, p. 86. 56. Michel Foucault, Discipline and Punish: The Birth of the Prison, Alan Sheridan (trans.), Penguin, Harmondsworth, 1991. 57. As was suggested in Chapter 3 in my discussion of Nikolas Rose’s insights into agency in Inventing Our Selves: Psychology, Power and Personhood, Cambridge University Press, Cambridge, 1996. 58. Kathy Davis, ‘Remaking the She-Devil: A Critical Look at Feminist Approaches to Beauty’, Hypatia, vol. 6, no. 2, Summer 1991, p. 22. 59. Ibid., p. 32. 60. Ibid., p. 23. 61. Ibid., p. 29. 62. Ibid., p. 33. 63. Her later article, ‘Cosmetic Surgery in a Different Voice: The Case of Madame Noël’, Women’s Studies International Forum, vol. 22, no. 5, September–October 1999, pp. 473–88 indicates a similar preoccupation with feminine agency in that it argues strongly for the particular feminist agency of early female cosmetic surgeon, Suzanne Noël. 64. Davis, ‘Remaking the She-Devil’, p. 48 65. Ibid., p. 118–19. 66. Ibid., p. 62. 67. Ibid., p. 113. 68. Ibid., p. 133. 69. Ibid., p. 135. 70. Michael Riffaterre, Text Production, Terese Lyons (trans.), Columbia University Press, New York, 1983, p. 120. This point is starkly illustrated in quite a different context, where Maclean discusses the complicity of white women with the Ku Klux Klan. She recognises women’s agency, arguing that appeals to the Klan constituted ‘women’s behind-the-scenes initiatives . . . to defend themselves and their perceived interests’ at the expense of other oppressed groups. She also points out, however, that support for Klan power meant perpetuating women’s limited role and status within right-wing politics. Clearly, while agency may mean action, it does not necessarily imply a resistance to existing power relations. See N. Maclean, ‘White Women and Klan Violence in the 1920s’, Gender and History, vol. 3, no. 3, Autumn 1991, pp. 285–301. 71. Exceptions are also evident. Greer’s The Whole Woman, is an interesting case in that it was written by a feminist who made a major contribution to early ‘secondwave’ feminism, and whose approach in this book resembles earlier work in its tendency to elide the agency of women in relation to cosmetic surgery.

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212 Cosmetic Surgery, Gender and Culture 72. Certainly, the book was reviewed favourably in a range of disciplines, perhaps especially because it refused a simplistic analysis of cosmetic surgery as unarguably about victimhood and oppression and introduced the possibility of agency. See Erica Blacksher, ‘Uneasy Listening’, Hastings Centre Report, vol. 26, no. 3, May–June 1996, p. 42; Richard Davenport-Hines, ‘Beauty Contested’, Times Literary Supplement, no. 4808, 26 May 1995, p. 32; Lucy Johnstone, ‘Reshaping the Female Body (book review)’, Sociology, vol. 30, no. 3, August 1996, p. 624; Heather Munro Prescott, ‘Reshaping the Female Body (book review)’, Women and Health, vol. 24, no. 2, 1996, pp. 83–6; Ann-Mari Sellerberg, ‘Reshaping the Female Body (book review)’, Society, vol. 33, no. 4, March/April 1996, pp. 89–91; Kerstin Shands, ‘Reshaping the Female Body (book review)’, Sociological Inquiry, vol. 66, no. 3, 1996, pp. 379–82; Mary G. Winkler, ‘Reshaping the Female Body (book review)’, Journal of Health Politics, Policy and Law, vol. 22, no. 1, February 1997, pp. 245–8. Leora Tannenbaum’s review for the Women’s Review of Books, vol. xii, no. 12, September 1995, pp. 9–10 is the most negative that I came across, arguing that questions about the social context for women’s decisions to undergo surgery required closer examination in a feminist work such as this. 73. Corrigan and Meredyth, ‘The Body Politic’, p. 43. 74. Longstanding debates about the meaning and legitimacy of lesbian S & M sex provide one example. Jeffrey Weeks addresses the feminist debate over S & M in his Sexuality and its Discontents, Routledge and Kegan Paul, London, 1985, pp. 236–41. 75. Foucault, The History of Sexuality, pp. 85–96. 76. Corrigan and Meredyth, ‘The Body Politic’, p. 43. 77. Balsamo, Technologies of the Gendered Body, p. 78. 78. Ibid., p. 78. 79. Davis, Reshaping the Female Body, p. 4. 80. See Lynne Segal, ‘Sexual Liberation and Feminist Politics’, in her Straight Sex: The Politics of Pleasure, Virago, London, 1994; and Carol Smart, ‘Collusion, Collaboration and Confession: On Moving beyond the Heterosexuality Debate’, in Diane Richardson (ed.), Theorising Heterosexuality: Telling It Straight, Open University Press, Buckingham and Philadelphia, 1996 for contributions to this discussion. 81. Greer’s diagnosis of silicone breast implantation is interesting in this light. She argues that ‘[i]t does not take a feminist to see that initially women were manipulated by a sexual culture that demanded bigger and better breasts, then by a medical establishment that encouraged unrealistic expectations, by the media that make money out of orchestrating female panic and lastly by lawyers for whom these cases [against implant manufacturers] are a bonanza. The only losers on this extremely lucrative merry-go-round are the women.’ The Whole Woman, p. 31. Greer’s view is intensely ‘victim’ oriented, and many feminists would not currently choose to frame the issues in the above way. 82. Susan Bordo’s critique of Judith Butler’s formulation of performativity is an interesting example of the complex struggles currently taking place in feminist accounts of agency. See Bordo, Unbearable Weight, pp. 295–6. 83. Iris Marion Young, ‘Breasted Experience’, in her Throwing Like A Girl and Other Essays, Indiana University Press, Bloomington, 1990, p. 202. 84. Teresa de Lauretis, Technologies of Gender, Indiana University Press, Bloomington, 1987, p. 24.

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Notes 213

Chapter 5 1. See Kevin Smith (MD), ‘Rhinoplasty for African-Americans on the Rise’, The Crisis, vol. 101, no. 1, 1994, p. 14. Interestingly, 80 per cent of these patients undergoing rhinoplasty to modify the ‘ethnicity’ of the nose are women. Also see ‘Plastic Surgeons’ Ethnic Challenges’, USA Today, vol. 121–2, no. 2572, January 1993. 2. See Donald Marshall’s Your Face in Their Hands, Hill of Content, Melbourne, 1998; Darryl Hodgkinson, ‘A Place for Cosmetic Surgery: Part 1. The Face’, Modern Medicine of Australia, vol. 36, no. 3, March 1993, p. 37. On another tack, Libby Harkness, in Skin Deep: A Consumer’s Guide to Cosmetic Surgery in Australia, Doubleday, Sydney, 1994, provides a short section on cultural differences in preferences for surgical procedures, though here the question is not related speciﬁcally to altering those features understood to be cultural markers. 3. See Hodgkinson, ‘A Place for Cosmetic Surgery; Part 1, The Face’, p. 40; Leila Henderson, Cosmetic Surgery: Your Questions Answered, Gore and Osment, Sydney, 1993, p. 45: Good Medicine Handbook, The Complete Guide to Cosmetic Surgery and Anti-Ageing, ACP Publishing, Sydney, 1998, p. 45. 4. Julian Reich, ‘The Surgical Improvement in Appearance of the Female Body’, MJA, vol. 1, 23 November, 1974, p. 771. 5. Randolph H. Guthrie, The Truth About Breast Implants, John Wiley and Sons, New York, 1994. 6. The Good Medicine Handbook, pp. 12–13. 7. Informed consent is described by the American Medical Association (AMA) in a way that allows for the withholding of information. According to the AMA website, which provides guidelines on constructing informed consent documents, ‘listing all of the risks may not be wise either. A comprehensive listing will be difﬁcult for the patient to understand and any omission from the list will likely be presumed undisclosed.’ Evidently, the tendency to minimise risks is not conﬁned to cosmetic surgery, but it takes on particular meanings in this highly gendered, commercially driven medical context. For instance, as will become clear later, unlike the approach described above, it is also linked with minimising the creation of ‘fear’ and ‘hysteria’ among women in the case of silicone breast implants. How the guideline is interpreted in relation to different treatments, and issues such as gender, is likely to vary. In the US, the legal obligation for doctors to provide informed consent is detailed in state statutes and case law. See www.ama-assn.org/ama/pub/category/4608.html (7 November 2002). The issue of informed consent for surgery in Australia is covered by a National Health and Medical Research Council (NH&MRC) policy document. A policy statement provided by the Australasian College of Surgeons (ACS) states that ‘Probably most Fellows already give adequate information to patients about their condition and proposed treatment’ but emphasise the importance of verbal as well as written communication. While this document recommends a high degree of honesty about risks, it does not lay out in any systematic way how informed consent should be ensured. The process of ensuring informed consent is not explicitly regulated through legislation however, and so remains substantially voluntary. Recognising this, The Cosmetic Surgery Report, HCCC 1999, recommends that a Cosmetic Surgery Credentialling Council be established and that it prepare a Code of Conduct on Communicating with Patients and Informed Consent. See p. iii. The council has since been set up.

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214 Cosmetic Surgery, Gender and Culture 8. Gilman identiﬁes this alignment of cosmetic surgery with emotional and psychological therapy in its earliest days, quoting Gaspare Tagliacozzi (pp. 1545–99), who deﬁned the surgeon’s task as intended to ‘buoy up the spirits and help the mind of the afﬂicted’. See Sander Gilman, Making the Body Beautiful, Princeton University Press, Princeton, 1999, p. 68. Nora Jacobsen makes a similar point about cosmetic surgery as therapy in Cleavage, Rutgers University Press, New Brunswick, New Jersey and London, 2000, p. 116. 9. Thomas Pruzinsky, ‘Psychological Factors in Cosmetic Plastic Surgery: Recent Developments in Patient Care’, Plastic Surgical Nursing, 1993, vol. 13, no. 2, p. 64. 10. Julian Reich, ‘The Aesthetic Surgical Experience’, in J.W. Smith and S.J. Ashton (eds), Plastic Surgery, Little, Brown and Co., Boston, 1991, p. 136. 11. Julian Reich, ‘Aesthetic Plastic Surgery: Development and Place in Medical Practice’, MJA, 27 May 1972, p. 1156. 12. Benjamin C. Cohney, ‘Silicone Breast Implants’ (letter), MJA, Vol. 156, 2 March 1992, p. 365. 13. Marcia Angell, ‘Shattuck Lecture – Evaluating the Health Risks of Breast Implants: The Interplay of Medical Science, the Law and Public Opinion’, New England Journal of Medicine, vol. 334, no. 23, 6 June 1996, p. 1515. 14. Cholm Williams, ‘Litigation, Hysteria Cloud Truth over Silicone Implantation’, The Australian Surgeon, August 1991, p. 17. 15. Guthrie’s The Truth about Breast Implants is an exception here, but it proves my point in that it is clearly positioned as intent on telling what is otherwise never told. 16. Diana Brahams, ‘Greater Duty to Warn of Risks’, The Lancet, 17 December 1988, vol. 2, p. 1434. 17. Peter M. Brooks, ‘Silicone Breast Implantation: Doubts about the Fears’, MJA, vol. 162, 17 April 1995, p. 433. 18. Cholm Williams, ‘Silicone Breast Implants’ (letter), MJA, vol. 156, 6 April 1992, p. 508. 19. Kathy Davis’s ﬁndings support this view. She states that ‘[p]hysicians systematically withhold information or downplay the risks of surgery’. See Kathy Davis, Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Routledge, New York and London, 1995, p. 157. Informed consent, for Davis, is the evaluation of information provided and considered under less than ideal conditions. See pp. 157–8. 20. See Moira Gatens, Imaginary Bodies: Ethics, Power and Corporeality, Routledge, London and New York, 1996, which demonstrates the status of femininity as posed against rationality, for instance, in ‘Corporeal Representation in/and the Body Politic’, p. 26; and ‘Towards a Feminist Philosophy of the Body’, p. 50. See also Janna Thompson, ‘Women and Political Rationality’, in Carole Pateman and Elizabeth Gross (eds), Feminist Challenges: Social and Political Theory, Allen and Unwin, Sydney 1986, pp. 99–111. 21. Teresa de Lauretis, Technologies of Gender, Indiana University Press, Bloomington, 1987, p. 3. 22. Marshall, Your Face in Their Hands, p. 28. 23. The NSW Health Care Complaints Commission Inquiry into Cosmetic Surgery 1999 attributes the paucity of complaints against surgeons at least in part to continued embarrassment around having undergone cosmetic surgery.

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Notes 215 24. Good Medicine Handbook, p. 49. 25. Marc Spiegler, ‘Breast Implants: Once is Not Enough’, American Demographics, vol. 18, no. 1, January 1996, p. 13. 26. Leila Henderson, Cosmetic Surgery: Your Questions Answered, Gore and Osment, Sydney 1993, p. 29. 27. Good Medicine Handbook, p. 25. 28. Ibid., p. 104. 29. Stuart Renwick, ‘Silicone Breast Implants: Implications for Society and Surgeons’, MJA, vol. 165, 16 September 1996, p. 338. 30. Guthrie, The Truth About Breast Implants, p. 48. 31. Good Medicine Handbook, p. 105. 32. Ibid., p. 83. 33. Guthrie, The Truth About Breast Implants, p. 36. 34. Marsha F. Gold, ‘Image of Perfection once the Goal – Now Some Women Just Seek Damages’, JAMA, vol. 267, no. 18, 13 May 1992, p. 2439. 35. See Steven Vogel, Against Nature: The Concept of Nature in Critical Theory, State University of New York Press, Albany, 1996, p. 9; also Jeffrey Weeks, Against Nature: Essays on History, Sexuality and Identity, Rivers Oram Press, London, 1991, p. 102. 36. Marcene Goodman, ‘Social, Psychological and Developmental Factors in Women’s Receptivity to Cosmetic Surgery’, Journal of Aging Studies, vol. 8, no. 4, 1994, pp. 380 and 388. 37. Guthrie, The Truth About Breast Implants, p. 42. 38. Similarly, in The Imperative of Health: Public Health and the Regulated Body, Sage, London, 1995, Deborah Lupton notes that genetic explanations for disease carry with them the implication of medical, rather than social intervention. Regarding the Human Genome Project, she argues that ‘[a]s more and more conditions are linked to speciﬁc genes, there will be raised questions concerning ways of “treating” or “preventing” the genetic “disease” that deal with eugenic issues around the types of people that are considered desirable to reproduce’ (p. 103). Here, genetics becomes both the means through which science treats the ‘natural’ body as its object, and the rationale for further, more profound intervention. See Richard Lewontin, ‘The Dream of the Human Genome’, in G. Bender and T. Druckrey (eds), Culture on the Brink, Bay Press, Seattle, 1994 for a critique of genes as causes and of the aims and political implications of the project. Also see also Ruth Hubbard, ‘Genes as Causes’, in Vandana Shiva and Ingunn Moser (eds), Biopolitics: A Feminist and Ecological Reader on Biotechnology, Zed Books, London and New Jersey, 1995 for a discussion of the implications of the Human Genome Project in terms of its positing of genes as causes. 39. Reich, ‘The Aesthetic Surgical Experience’, p. 133. 40. Henderson, Cosmetic Surgery, p. 30. 41. Goodman, ‘Social, Psychological and Developmental Factors’, p. 383. 42. Good Medicine Handbook, p. 75. 43. William E. Brown, Cosmetic Surgery, Stein and Day, New York, 1979, p. 12. Also, in her Venus Envy: A History of Cosmetic Surgery, Johns Hopkins University Press, Baltimore and London, 1997, Elizabeth Haiken notes the appearance of the sculpture metaphor in Jacques Maliniak’s book, Sculpture in the Living, published in 1934. See p. 34. 44. Gilman, Making the Body Beautiful, p. 328.

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216 Cosmetic Surgery, Gender and Culture 45. See Laura Mulvey, ‘Visual Pleasure and Narrative Cinema’, in her Visual and Other Pleasures, Indiana University Press, Bloomington and Indianapolis, 1989. 46. Rozsika Parker and Griselda Pollock, Old Mistresses: Women, Art and Ideology, Routledge and Kegan Paul, London, 1981, p. 116. 47. See, for example, Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine Between the Eighteenth and Twentieth Centuries, University of Wisconsin Press, Madison, 1989. 48. Dorland’s Illustrated Medical Dictionary, 28th edition, W.B. Saunders and Co., Philadelphia, 1994 deﬁnes ‘natural’ as ‘[n]either artiﬁcial nor pathologic’. As both these terms are ambiguous, such deﬁnitions allow considerable scope for adaptation to particular political purposes. 49. Interestingly, Kathy Davis’s article, ‘Cosmetic Surgery in a Different Voice: The Case of Madame Noël’, Women’s Studies International Forum, vol. 22, no. 5, September–October 1999, pp. 473–88, notes that the need to appear young to get work was in circulation as a reason among surgeons as early as 1926, where it appears in a book by cosmetic surgeon and feminist Suzanne Noël. 50. Hodgkinson, ‘A Place for Cosmetic Surgery: Part 7’, p. 33. 51. Reich, ‘Aesthetic Plastic Surgery,’ p. 1152. 52. Brown, Cosmetic Surgery, p. 13. 53. Ibid., p. 27. 54. Marshall, Your Face in Their Hands, p. 23. 55. See David Kessler, ‘Special Report: The Basis of the FDA’s Decision on Breast Implants’, New England Journal of Medicine, vol. 326, no. 25, 18 June 1992, p. 1715. 56. As I noted in Chapter 3, the language of risk allows for the patient to be the primary decision-maker in a context where surgeons fear malpractice litigation. 57. Hans-Peter Wengle, ‘The Psychology of Cosmetic Surgery: Old Problems in Patient Selection Seen in a New Way – part II’, Annals of Plastic Surgery, vol. 16, no. 6, June 1986, p. 489. 58. Marshall, Your Face in Their Hands, p. 21. 59. Guthrie, The Truth About Breast Implants, p. 29. 60. Good Medicine Handbook, p. 49. 61. Good Medicine, no. 5, August 1998, p. 27. 62. Gold, ‘Image of Perfection Once the Goal’, p. 2441. 63. Biggs, Thomas et al., ‘Augmentation Mammaplasty: A Review of 18 Years’, Plastic and Reconstructive Surgery, vol. 69, no. 3, March 1982, p. 448. 64. Goodman, ‘Social, Psychological and Developmental Factors’, p. 380. 65. Therefore, my own examination of representations of cosmetic surgery has followed this approach, except where distinctions are apparent in the sources. 66. Julian Reich, ‘The Surgical Improvement in Appearance of the Female Body’, MJA, 23 November 1974, p. 774. 67. Reich, ‘The Aesthetic Surgical Experience’, p. 129. 68. Goodman, ‘Social, Psychological and Developmental Factors’, p. 380. 69. Wengle, ‘The Psychology of Cosmetic Surgery’, p. 490. 70. Reich, ‘The Aesthetic Surgical Ideal’, p. 135. 71. Goodman, ‘Social, Psychological and Developmental Factors’, p. 380. 72. Ibid., p. 377. 73. Henderson, Cosmetic Surgery, p. 12.

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Notes 217 74. An early example of this can be found in Reich, ‘Aesthetic Plastic Surgery’, p. 1153. He states that in the post-war period, surgeons who performed aesthetic surgery ‘chose not to let it be known – largely because of the popular use of the term ‘cosmetic surgery’ and its supposed aim of pandering to the vanity of those seeking it.’ 75. The Art of Cosmetic Beauty, p. 50. 76. Good Medicine Handbook, p. 10. 77. Henderson, Cosmetic Surgery, p. 10. 78. Nora Jacobsen notes that cosmetic surgeons are keen to deny (or redeﬁne) vanity, not only for the sake of would-be patients, but also for their own beneﬁt: ‘The epithet “vanity doctor” cut to the quick.’ Jacobson, Cleavage, p. 107. Haiken also notes the tendency to view vanity as ‘a positive good’, Venus Envy, p. 231. 79. Potter and Wetherell point out that reference to a repertoire made in order to deny its explanatory relevance cannot be seen as a legitimate ‘use’ of the repertoire. For instance, if all texts in this section merely stated that ‘vanity has nothing at all to do with cosmetic surgery’, this is not a legitimate use of the repertoire. See Jonathan Potter and Margaret Wetherell, Discourse and Social Psychology: Beyond Attitudes and Behaviour, Sage, London, 1987. 80. Restoration Clinics of Australia, surgical hair replacement pamphlet, p. 1. 81. Good Medicine Handbook, p. 57. 82. Dunofsky, ‘Psychological Characteristics’, p. 226. 83. Reich, ‘Surgery of Appearance’, p. 9. 84. John Van Duyn, ‘Psyche and Plastic Surgery’, Southern Medical Journal, vol. 58, October 1965, p. 1255. 85. Lupton, The Imperative of Health, p. 92. 86. This role is also recognised elsewhere. See Diana Dull and Candace West, ‘Accounting for Cosmetic Surgery: The Accomplishment of Gender’, Social Problems, vol. 38, no. 1, 1991, pp. 54–70; Rosemary Gillespie, ‘Women, the Body and Brand Extension in Medicine: Cosmetic Surgery and the Paradox of Choice’, Women and Health, vol. 24, no. 4, 1996, p. 76. 87. Indeed, Anna Kirkland and Rosemarie Tong tackle the role of the physician in women’s decisions about cosmetic surgery in their article, ‘Working within Contradiction: The Possibility of Feminist Cosmetic Surgery’, Journal of Clinical Ethics, vol. 7, no. 2, Summer 1996, pp. 151–9. They identify four models of doctor/patient relations; paternalistic, informative, interpretive and deliberative, rejecting all but the last model, which emphasises the need for honesty and a willingness to negotiate on the part of the surgeon. 88. Gatens, Imaginary Bodies, p. 78. 89. Nikolas Rose, Inventing Our Selves, Cambridge University Press, Cambridge and New York, 1996.

Chapter 6 1. The FDA obtains the majority of its regulatory authority from the US Federal Food, Drug, and Cosmetic Act, along with other acts which bear on the FDA’s charter. In evaluating materials and devices, the FDA conducts hearings in three formats. These are: industry information and education meetings, public hearings such as that held in relation to silicone breast implants, and public

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2.

3.

4.

5. 6.

7. 8.

9. 10.

11.

advisory committees and panels. These hearings function both to gather information for the purposes of regulation and to inform the public. Minutes from the TDEC meeting dated 5 December 1991 (and other meetings) indicate the centrality of US debates and decisions to the Australian context, at one point stating in any case that ‘legal opinion . . . required the US decision to be taken into account’ (p. 8). In early January 1992, the US FDA recommended a moratorium on the sale and distribution of silicone breast implants. Established in 1994 via the Health Care Complaints Act 1993, the NSW HCCC is an independent statutory body which investigates and prosecutes health care complaints and reports to the Minister for Health and the Parliamentary Joint Committee on the HCCC. It produces information to the public on health related issues, such as the 1999 report arising from the Inquiry into Cosmetic Surgery. See Stephanie Alexander, ‘Heidi Lindsay et al. v. Dow Corning Corp. et al.: The Exclusion of Claimants from Australia, Ontario and Quebec’, Paciﬁc Rim Law and Policy Journal, vol. 4, no. 2, May 1995, pp. 419–41 for a review of the 1994 ruling on the global class action brought against Dow Corning. See Nora Jacobson, Cleavage, Rutgers University Press, New Brunswick, New Jersey and London, 2000, for a detailed description of the hearings. For example, FDA discussion on continued availability of implants in the context of safety research requirements was in part shaped by an awareness that an onerous research burden imposed on the industry in the absence of opportunities to maintain the market was likely to see implants shelved altogether. FDA 2nd General Plastic Surgery Devices Panel transcript, 18, 19 and 20 February 1992, vol. 3, p. 315, reprint editor Bernard D. Reams, Jnr. See, for example, Ann Davis, ‘Plaintiffs: We’ll Junk “Junk Science” Tag’, National Law Journal, Monday, 2 December 1996, p. A6; Gina Kolata, ‘Judge Rules Breast Implant Evidence Invalid’, New York Times, 19 December 1996; Jack Snyder, ‘Silicone Breast Implants: Can Emerging Medical, Legal, and Scientiﬁc Concepts Be Reconciled?’, Journal of Legal Medicine, vol. 18, 1997, p. 196. J. Nocera, ‘Fatal Litigation’, Fortune, 1995, obtained from Fortune web-site at www.pathﬁnder.com/fortune/archive (1999). In this case, a woman complaining of chronic fatigue and joint pain was awarded $1.7 million, though this was later settled for less during appeal. (See ‘Fatal Litigation’.) In late June 1999, the National Academy of Sciences in Washington DC concluded that breast implants do not cause immune disease, neurological problems or cancer. Nell Boyce, ‘Rough Justice’, New Scientist, no. 2193, 3 July 1999, p. 18. However, silicone implants remain unavailable for general sale in the US and Australia. See the 2000 FDA publication, Breast Implants: An Information Update, accessed electronically at www.fda.gov/cdrh/breastimplants/biintro.html, and the Department of Health and Aged Care, TGA, Breast Implant Information Booklet, 2001 accessed electronically at www.health.gov.au/tga/devices/devices/htm, respectively. By contrast, no restrictions on the sale of silicone implants have ever been in place in the UK. See the UK Department of Health, Medical Devices Agency Device Update: Breast Implants, 2002 accessed electronically at www.medical-devices.gov.uk/bimplants

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Notes 219 12. Nora Jacobson also notes this tendency in her book, Cleavage, Rutgers University Press, New Brunswick, New Jersey and London, 2000, p. 160. 13. FDA 1992, vol. 2, p. 217. 14. Ibid., vol. 2, p. 209, Member of Congress. 15. Ibid., p. 347, American Society of Aesthetic Plastic Surgery presenter. 16. Mary Douglas, Risk and Blame: Essays in Cultural Theory, Routledge, London and New York, 1992, p. 33, points out that ‘[t]he predictable consequence of using science in politics is that both sides consult their own scientiﬁc experts’. This statement is highly relevant to the breast implants issue in that the debate is so heavily characterised by appeal to and disagreement among scientiﬁc experts. She goes on to note that ‘[s]cientists are being pressed to take the role of ultimate arbiter in political contests when there is no hope of die-hard adversaries coming to agreement. This thankless role can only embroil science and bring it into disrepute . . .’ (p. 49). This has certainly been the case in implant litigation in that juries have often chosen to ignore scientiﬁc evidence. However, it seems to me that scientists often pursue this role of arbiter as much as having it pressed upon them, as for instance, in the case of the Human Genome Project and the subsequent search for the ‘gay gene’ to which its logic of biological (or genetic) determinism has given rise. 17. As Douglas, Risk and Blame, p. 31, argues, risk discourse assumes that an objective ‘science’ can be made of decision-making under uncertain conditions. 18. While many women appeal to the panel to be considered precisely in these terms as rational decision-makers, others characterise themselves in nonrational terms; for instance, one reconstruction patient states, ‘if I had to do it [mastectomy] all over again without the option of silicone implants, I would choose death over disﬁgurement . . . These words may seem ludicrous or even vain to the unafﬂicted, but again this is my reality.’ FDA 1992, vol. 2, p. 487. 19. For example, a speaker for implant manufacturer Bioplasty Inc. argues that compared with psychotherapy, ‘the plastic surgeons do a much better job, much cheaper, much quicker: they actually get to help these people [augmentation candidates]’. FDA 1st General Plastic Surgery Devices Panel transcript, 12, 13 and 14 November 1991, vol. 3, p. 194, reprint editor Bernard D. Reams Jnr. 20. See Bruno Latour and Steve Woolgar, Laboratory Life: The Social Construction of Scientiﬁc Facts, Sage, Beverly Hills and London, 1979; Donald Mackenzie and Judy Wajcman (eds), The Social Shaping of Technology, Open University Press, Buckingham and Philadelphia, 1999. 21. See Nocera, ‘Fatal Litigation’, p. 6. where a case of a woman allegedly attempting to remove her own implants with a razor is described. 22. FDA 1991, vol. 1, p. 112, consumer advocate. 23. Ibid., p. 330, individual consumer. 24. Ibid., p. 384, cosmetic surgery nurse. 25. FDA 1992, vol. 2, p. 267, plastic surgeon. 26. Ibid., p. 268, plastic surgeon above. 27. FDA 1991, vol. 2, p. 357, Mentor Corp. presenter. 28. FDA 1992, vol. 1, p. 187, FDA taskforce member. 29. Indeed, The Cosmetic Surgery Report, HCCC, 1999, found in its survey that 25 per cent of participants (the largest proportion) heard about the procedure they

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30.

31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44.

45. 46. 47. 48. 49. 50. 51. 52. 53.

underwent from a story in the media. See p. 44. For discussions of issues related to medical reporting in the media, see Joan E. Bertin and Laurie R. Beck, ‘Of Headlines and Hypotheses: The Role of Gender in Popular Press Coverage of Women’s Health and Biology’, in Kary L. Moss (ed.), Man-Made Medicine: Women’s Health, Public Policy, and Reform, Duke University Press, Durham, NC and London, 1996; Deborah Lupton, ‘Ideology and Health Reporting’, Media Information Australia, no. 65, August 1992; Simon Chapman and Deborah Lupton, ‘Freaks, Moral Tales and Medical Marvels: Health and Medical Stories on Australian Television’, Media Information Australia, no. 72, May 1994; Camille Galvin and Mark Pearson, ‘Cosmetic Surgery’, Australian Journal of Communication, vol. 21, no. 2, 1994; Christopher Rissel, ‘Health Information and the Media’, Media Information Australia, no. 61, August 1991; S. Redman, E.A. Spencer and R.W. Sanson-Fisher, ‘The Role of Mass Media in Changing Health-related Behaviour: a Critical Appraisal of Two Models’, Health Promotion International, vol. 5, no. 1, 1990, pp. 85–101. See Loan Skene, ‘In Their Mind’s Eye: A Different Direction for Cosmetic Surgery Consent Cases?’, Torts Law Journal, vol. 4, 1996; Mark Ballard, ‘Class Action Implant Trial Opens in Big Easy’, National Law Journal, 31 March 1997, p. A10; HCCC Inquiry verbal submission by Bill Madden, Australian Plaintiff Lawyers Association. Skene, ibid., p. 285. This point was discussed in more detail in the introduction. Susan Bordo, Unbearable Weight: Feminism, Western Culture and the Body, University of California Press, Berkeley, 1993, p. 104. FDA 1992, vol. 1, p. 211, FDA taskforce doctor. Ibid., p. 305, taskforce doctor. Ibid., vol. 2, p. 289, scientist for implant manufacturer. Ibid., vol. 3, p. 185, panellist. FDA 1991, vol. 2, p. 48, Dow Corning presenter. Ibid., vol. 3, p. 112, McGhan presenter. FDA 1992, vol. 1, p. 109, FDA taskforce member. Ibid., vol. 3, p. 19, FDA taskforce member. Jacobson also discusses the naturalisation of breast implants in Cleavage, See for example, p. 144. Leon Gordis, Epidemiology, W.B. Saunders Company, Philadelphia 1996, p. 3. It is perhaps indicative of the way the meaning of ‘nature’ is presently taken to be self-evident in Western culture that the Webster’s Medical Dictionary, Merriam Webster Inc., 1986, deﬁnes ‘natural history’ as ‘[t]he natural development of something (as an organism or disease) over a period of time’ without providing a corresponding deﬁnition of ‘nature’. See p. 465. FDA 1992, vol. 1, p. 137, panellist. Ibid., p. 140, taskforce member. Ibid., vol. 3, p. 195, panellist. Ibid., vol. 1, p. 247, taskforce member. Ibid., p. 275, taskforce member. Ibid., p. 302, taskforce member. FDA 1991, vol. 1, p. 234, consumer advocate. Ibid., p. 364, individual consumer. Ibid., vol. 3, p. 32, McGhan presenter.

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Notes 221 54. Aaron Levine, ‘Fundamental Issues in Litigating Breast Implant Cases’, Litigation Course Handbook, Litigation and Administration Practice Series, Series no. 451, 1992, p. 62. 55. Jacobson, Cleavage, also notes the conﬂation of natural, normal and ideal in relation to surgery on the breast. See p. 94. 56. HCCC Inquiry, written submission by Body Image Inc. 57. Anne Ring, ‘The Countdown to New Heights of Sexist Ageism in the Media of the New World Order’, in M. Alexander et al. (eds) Refashioning Sociology: Responses to a New World Order, Australian Sociological Association Conference Proceedings, Brisbane 1998. Article submitted to HCCC Inquiry as part of Anne Ring’s presentation on cosmetic surgery magazines, p. 94. 58. The commissioner made clear that the inquiry was not established because of excessive complaints against cosmetic surgeons. 59. FDA 1992, vol. 1, p. 345, FDA taskforce doctor. 60. Sharon Batt provides an indication of mastectomy and reconstruction surgery as a technology of gender in her article on participation in cancer charities, ‘ “Perfect People”: Cancer Charities’, in Rose Weitz (ed.), The Politics of Women’s Bodies: Sexuality, Appearance and Behavior, Arizona State University, New York and Oxford, 1998. 61. HCCC ‘Inquiry into Cosmetic Surgery’ prospectus, p. 2. 62. Nicki Greenberg, ‘Imposing Fiduciary Obligations on Providers of Cosmetic Surgery’, Slater and Gordon Law Firm written submission to HCCC Inquiry, p. 22. 63. FDA 1991, vol. 1, p. 326, consumer advocate. 64. Ibid., p. 335, individual consumer. 65. Ibid., p. 357, individual consumer. 66. Skene, ‘In Their Mind’s Eye’, p. 284. 67. HCCC Inquiry, Slater and Gordon Law Firm expert testimony. 68. HCCC Inquiry, Department of Fair Trading testimony. 69. HCCC Inquiry, Body Image and Health Inc. written submission. 70. FDA 1991, vol. 2, p. 509, medical panellist. 71. FDA 1992, vol. 2, p. 194, member of Congress. 72. FDA 1991, vol. 1, p. 87, consumer testimony. 73. Rosemary Gillespie, ‘Women, the Body and Brand Extension in Medicine: Cosmetic Surgery and the Paradox of Choice’, Women and Health, vol. 24, no. 4, 1996, p. 74. 74. Kathy Davis examines the risk model of cosmetic surgery provision in Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Routledge, New York and London, 1995, pp. 29–32. 75. Douglas, Risk and Blame, p. 24. 76. FDA 1991, vol. 1, p. 246, surgeon’s testimony. 77. Ibid., p. 300. 78. Ibid., p. 307, health professional testimony. 79. Ibid., p. 365, consumer testimony. 80. Ibid., p. 394. 81. Jonathan Gabe’s question, ‘[h]ow are the processes of deﬁning health risks related to cultural attributes of blame and responsibility?’ is highly relevant here. See Jonathan Gabe, ‘Health, Medicine and Risk’, in Jonathan Gabe (ed.), Medicine, Health and Risk: Sociological Approaches, Blackwell, Oxford and Cambridge, 1995, p. 11. The Cosmetic Surgery Report: Report to the NSW Minister for Health –

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82.

83. 84.

85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96.

97. 98. 99.

October 1999, HCCC, 1999 notes that ‘the courts have recognised that because cosmetic surgery patients have a choice about whether to have the procedure there is a more onerous obligation on doctors to inform them of all possible risks’. See p. 47. Here, participants’ free ‘choice’ is tempered with the medical responsibility to disclose all risks fully. At the same time, doctors are not required by law to follow speciﬁc procedures to ensure informed consent, although recommendations, such as those offered by the Royal Australasian College of Surgeons, do exist. Douglas, Risk and Blame, p. 22, notes that ‘Praise of risk-taking invokes the virtues of frontier morality to interrupt the long, slow move to establish collective responsibility for accidents’. This may hold as true for practices such as cosmetic surgery as for accidents. The notion of risk deftly draws our focus back towards individual agency and rights when social, political and cultural questions are raised about why individuals participate in dangerous practices (such as cosmetic surgery) for uncertain beneﬁts. HCCC Inquiry, Anne Ring, media analyst: verbal submission. See Louise Armstrong, Rocking the Cradle of Sexual Politics: What Happened When Women Said Incest, Women’s Press, London, 1996, p. 63 and pp. 208–9 for a discussion of this issue. Tami Spry discusses the limits of both terms, victim and survivor in her article ‘In the absence of word and body: hegemonic implications of “victim” and “survivor” in women’s narratives of sexual violence’, Women and Language, Fall 1995, vol. 8, no. 2, pp. 27–35. This article critiques both terms on the grounds that they equally instate the attacker as the only agent, and calls for the crediting of women with agency as a necessary step to the opening up of adequate language through which women’s experiences of sexual attack can be expressed. Linda Alcoff and Laura Gray offer a postmodern perspective on the role of language in women’s relationship to sexual abuse in ‘Survivor Discourse: Transgression or recuperation?’, Signs, vol. 18, no. 21, 1993. HCCC Inquiry, Breast Implant Resource Service presenter: verbal submission. Ibid., implant recipient: verbal submission. FDA 1991, vol. 1, p. 50. Ibid., p. 412. HCCC Inquiry, verbal submission by Anne Ring, media analyst. Ibid., migrant women’s advocate: verbal submission. Ibid., HCCC’s own submission to the Inquiry. Ibid., convenor’s comment. Ibid., migrant women’s advocate: verbal submission. FDA 1991, vol. 1, p. 35. Ring, ‘The Countdown to New Heights of Sexist Ageism’, p. 94. See Sharon Marcus’s critique of this tendency in ‘Fighting Bodies, Fighting Words: A Theory and Politics of Rape Prevention’, in Judith Butler and Joan Scott (eds), Feminists Theorise the Political, Routledge, London and New York, 1992; Ellen Willis, ‘Villains and Victims: “Sexual Correctness” and the Repression of Feminism’ (pp. 44–53) and Katie J. Hogan, ‘ “Victim Feminism” and the Complexities of AIDS’ (pp. 68–89), in Nan Bauer Maglin and Donna Perry (eds), ‘Bad Girls’: ‘Good Girls’: Women, Sex and Power in the Nineties, Rutgers University Press, New Brunswick, New Jersey, 1996. FDA 1991, vol. 3, p. 56, McGhan Corporation representative. HCCC Inquiry, verbal presentation of research results. FDA 1991, vol. 1, p. 171, ASPRS psychologist.

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Notes 223 100. Ibid., vol. 1, p. 72, consumer advocate. 101. Indeed, The Cosmetic Surgery Report, HCCC, 1999, reproduces the comments of a Melbourne social worker and counsellor to prospective patients who suggests that ‘cosmetic surgery consumers are reluctant to discuss complications or disappointment with outcomes because they feel it is their fault, that they have been vain’. See p. 52. 102. FDA 1992, vol. 2, p. 195, Member of Congress. 103. FDA 1991, vol. 1, p. 319, consumer advocate. 104. FDA 1992, vol. 3, p. 265, panellist. 105. Ibid., p. 292, panellist. 106. FDA 1991, vol. 1, p. 63, consumer advocate. 107. FDA 1992, vol. 2, p. 404, medical representative. 108. FDA 1991, vol. 1, p. 92, consumer advocate. 109. Skene, ‘In Their Mind’s Eye’, p. 277. 110. HCCC Inquiry, doctor’s verbal submission. 111. A term used repeatedly at the HCCC Inquiry.

Conclusion 1. Donna Haraway, Modest_Witness@Second_Millennium.FemaleMan©_Meets_ OncomouseTM: Feminism and Technoscience Routledge, London and New York, 1997, p. 69. 2. Ibid., p. 172. 3. Nikolas Rose, Inventing Our Selves: Psychology, power and personhood, Cambridge University Press, Cambridge, 1996, p. 3. 4. Margaret Wetherell, ‘Linguistic Repertoires and Literary Criticism: New Directions for a Social Psychology of Gender’, in Sue Wilkinson, (ed.), Feminist Social Psychology: Developing theory and practice, Open University Press, Milton Keynes, 1986, p. 90. 5. Rose, Inventing Our Selves, p. 169. 6. Both Haiken and Gilman interpret FDA Commissioner David Kessler’s decisions on silicone breast implants in this way, although a close reading of the transcripts of the hearings that underpin these decisions does not support such a view. Certainly, while serious anxiety on the part of the public that implants are seen to be vain is indicated, panellists and other presenters consistently fail to take up this repertoire. Distinctions between the cases of augmentation and reconstruction, rather than being made in terms of vanity as Gilman and Haiken suggest, were consistently (and quite convincingly) rendered in terms of healthrelated concerns, such as age at which implants are placed and life expectancy of the device itself. It seems that both Haiken and Gilman have read the anxiety around accusations of vanity as evidence of the presence of these accusations. Signiﬁcantly, neither make reference to the hearing transcripts. See Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery, Johns Hopkins University Press, Baltimore and London, 1997, p. 231; Sander Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery, Princeton University Press, Princeton, 1999, p. 244. 7. Michel de Certeau, The Practice of Everyday Life, Steven Rendell (trans.), University of California Press, Berkeley, 1988, p. 174.

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224 Cosmetic Surgery, Gender and Culture 8. Ibid., p. 174. 9. Stuart Hall, ‘Signiﬁcation, Representation, Ideology: Althusser and the Poststructuralist Debates’, Critical Studies in Mass Communication, vol. 2, no. 2, 1985, p. 93. 10. Rose, Inventing Our Selves, p. 185. 11. Haiken, Venus Envy, p. 259. 12. Gilman, Making the Body Beautiful, p. 34. 13. Haraway, Modest_Witness, p. 36.

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Bibliography 233 Olley, P.C., ‘Aspects of Plastic Surgery: Social and Psychological Sequelae’, British Medical Journal, 3 August 1974, pp. 322–4. ‘Our Politically Correct Guide to Cosmetic Surgery’, New Woman, May 1996. Parker, Roszika and Griselda Pollock, Old Mistresses: Women, Art and Ideology, Routledge and Kegan Paul, London, 1981. Patton, Paul, ‘Deleuze and Guattari’s Political Philosophy’, unpublished paper, University of Sydney, 1995. ‘Plastic Surgeons’ Ethnic Challenges’, USA Today, vols. 121–2, no. 2572, January 1993. ‘Plastic Surgery: What if You Could Try before You Buy?’, Cleo, July 1992. Potter, Jonathan and Margaret Wetherell, Discourse and Social Psychology: Beyond Attitudes and Behaviour, Sage, London, 1987. Prescott, Heather Munro, ‘Reshaping the Female Body’ (book review), Women and Health, vol. 24, no. 2, 1996, pp. 83–6. Probyn, Elspeth, ‘The Taste of Power’, in Jenna Mead (ed.), Bodyjamming: Sexual Harassment, Feminism and Public Life, Vintage, Milson’s Point, 1997. Pruzinsky, Thomas, ‘Psychological Factors in Cosmetic Plastic Surgery: Recent Developments in Patient Care’, Plastic Surgical Nursing, vol. 13, no. 2, Summer 1993, pp. 64–9. Rabinow, Paul, ‘Artiﬁciality and Enlightenment: From Sociobiology to Biosociality’, in J. Crary and S. Kwinter (eds), Incorporations, Zone Books, New York, 1992. Raymond, Harry, ‘The Changing Face of Woman’, Sydney Morning Herald, 5 May 1957. Read, P., ‘The Stolen Generations: the Removal of Aboriginal Children in NSW 1883–1969’, NSW Ministry of Aboriginal Affairs Occasional Paper no. 1 (n.d.). Redman, S., E.A. Spencer, and R.W. Sanson-Fisher, ‘The Role of Mass Media in Changing Health-related Behaviour: A Critical Appraisal of Two Models’, Health Promotion International, vol. 5, no. 1, 1990, pp. 85–101. Reed, Michael E., ‘Daubert and the Breast Implant Litigation: How is the Judiciary Addressing the Science?’, Plastic and Reconstructive Surgery, vol. 100, no. 5, October 1997, pp. 1322–6. Reich, Julian, ‘The Surgery of Appearance: Psychological and Related Aspects’, MJA, July 5, 1969, pp. 5–13. Reich, Julian, ‘Aesthetic Plastic Surgery: Development and Place in Medical Practice’, MJA, 27 May 1972, pp. 1152–6. Reich, Julian, ‘The Surgical Improvement in Appearance of the Female Body’, MJA, 23 November 1974, pp. 767–74. Reich, Julian ‘The Aesthetic Surgical Experience’, in J.W. Smith and S.J. Aston (eds), Plastic Surgery, Little, Brown and Co., Boston, 1991. Renwick, Stuart B., ‘Silicone Breast Implants: Implications for Society and Surgeons’, MJA, vol. 165, 16 September 1996, pp. 338–40. Restoration Clinics of Australia, surgical hair replacement pamphlet: advertising material, 1997. Richards, E., ‘Darwin and the Descent of Woman’, in D. Oldroyd and I. Langham (eds), The Wider Domain of Evolutionary Thought, Reidel Publishing, Dordrecht, 1983. Riffaterre, Michael, ‘Interpretation and Undecidability’, New Literary History, 1981, pp. 217–24. Riffaterre, Michael, Text Production, Terese Lyons (trans.), Columbia University Press, New York, 1983. Riley, Denise, Am I That Name?: Feminism and the Category of ‘Women’ in History, University of Minnesota Press, Minneapolis, 1988.

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234 Cosmetic Surgery, Gender and Culture Ring, Anne, ‘Submission to the NSW Committee of Inquiry into Cosmetic Surgery’, unpublished submission to the HCCC, 1999. Ring, Anne, ‘The Countdown to New Heights of Sexist Ageism in the Media of the New World Order’, in M. Alexander et al. (eds), Refashioning Sociology: Responses to a New World Order, Australian Sociological Association Conference Proceedings, Brisbane 1998. Rissel, Christopher, ‘Health Information in the Media’, Media Information Australia, vol. 61, 1991, pp. 36–41. Roberts, Celia, ‘Messengers of Sex’, PhD thesis, University of Sydney, 1998. Roberts, Cleora et al., ‘Outcome Study of the Psychological Changes after Silicone Breast Implant Removal’, Plastic and Reconstructive Surgery, vol. 100, no. 3, September 1997, pp. 595–9. Rose, Nikolas, Inventing Our Selves: Psychology, Power and Personhood, Cambridge University Press, Cambridge and New York, 1996. Rose, Noel, R., ‘The Silicone Breast Implant Controversy: The Other Courtroom’, Arthritis and Rheumatism, vol. 39, no. 10, October 1996, pp. 1615–18. Sas, Miryam, ‘The Doyenne of Divasection’, Mondo 2000, no. 13, Winter 1995, pp. 106–11. Schnur, Paul L. et al., ‘Reduction Mammaplasty: An Outcome Study’, Plastic and Reconstructive Surgery, vol. 100, no. 4, September 1997, pp. 875–83. Segal, Lynne, ‘Sexual Liberation and Feminist Politics’, in her Straight Sex: The Politics of Pleasure, Virago, London, 1994. Sellerberg, Ann-Mari, ‘Reshaping the Female Body’ (book review), Society, vol. 33, no. 4, March/April 1996, pp. 89–91. Shands, Kerstin, ‘Reshaping the Female Body’ (book review), Sociological Inquiry, vol. 66, no. 3, 1996, pp. 379–82. She Cosmetic Surgery Supplement, ACP Publishing, Sydney, December 1994. Sheridan, Susan, ‘Reading the Women’s Weekly: Feminism, Femininity and Popular Culture’, in Barbara Caine and Rosemary Pringle (eds), Transitions: New Australian Feminisms, Allen and Unwin, St Leonards, 1995. Sinha, Mrinalini, ‘Gender and Imperialism: Colonial Policy and the Ideology of Moral Imperialism in Late Nineteenth-Century Bengal’, in Michael Simmel (ed.), Changing Men, Sage, London, 1987. Skene, Loan, ‘In Their Mind’s Eye: A Different Direction for Cosmetic Surgery Consent Cases?’, Torts Law Journal, vol. 4, 1996, pp. 275–85. Smart, Carol, ‘Collusion, Collaboration and Confession: On Moving beyond the Heterosexuality Debate’, in Diana Richardson (ed.), Theorising Heterosexuality: Telling it Straight, Open University Press, Buckingham, Philadelphia, 1996. Smith, Kevin (M.D)., ‘Rhinoplasty for African-Americans on the Rise’, Crisis, January 1994. Smith, Robert, ‘Dermabrasion: Is it an Option?’, Australian Family Physician, vol. 26, no. 9, September 1997, pp. 1041–4. Snyder, Jack W., ‘Silicone Breast Implants: Can Emerging Medical, Legal and Scientiﬁc Concepts Be Reconciled?’, Journal of Legal Medicine, no. 18, 1997, pp. 133–220. Spiegler, Marc, ‘Breast Implants: Once is not Enough’, American Demographics, vol. 18, no. 1, January 1996, p. 13. Spry, Tami, ‘In the Absence of Word and Body: Hegemonic Implications of “Victim” and “Survivor” in Women’s Narratives of Sexual Violence’, Women and Language, vol. 8, no. 2, Fall 1995, pp. 27–35.

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Bibliography 235 Stack, Jennifer Daryl, ‘The Theory and Method of Articulation in Cultural Studies’, in David Morley and Kuan-Hsing Chen (eds), Stuart Hall: Critical Dialogues in Cultural Studies, Routledge, London and New York, 1996. ‘Stay Young Hollywood Style’, New Idea, 8 June, 1996. Stoler, Ann Laura, ‘Making Empire Respectable: The Politics of Race and Sexual Morality’, in Ann McClintock et al. (eds), Dangerous Liaisons: Gender, Nation and Postcolonial Perspectives, University of Minnesota Press, London, 1997. Tannenbaum, Leora, ‘Reshaping the Female Body’ (book review), Women’s Review of Books, vol. XII, no. 12, September 1995, pp. 9–10. Tasmanian Women’s Health – Breast Implant Booklet, www.tased.edu.au/tasonline/ twhn/regulate.htm (10 May 2003). Taylor, Bruce Walton, ‘The Development of Australasian Plastic Surgery’, Australian Society of Plastic Surgeons homepage, www.asps.asn.au/~asps/history/ (1999). Therapeutic Device Evaluation Committee, minutes of meeting dated 5 December 1991. Therapeutic Devices Bulletin, Australian Department of Health and Aged Care, www.health.gov.au:80/tga/docs/pdf/tdbultn/atdb33.pdf (10 May 2003). Thompson, Janna, ‘Women and Political Rationality’, in Carole Pateman and Elizabeth Gross (eds), Feminist Challenges: Social and Political Theory, Allen and Unwin, Sydney 1986. Thwaites, Tony, Lloyd Davis and Warwick Miles, Tools for Cultural Studies: An Introduction, Macmillan, Melbourne, 1994. Toy, Mary-Anne, ‘Two Sides Get under Each Other’s Skin’, The Age, 14 April 1999. Toy, Mary-Anne, ‘State Clamp on Surgery Advertising’, The Age, 14 April 1999. Turney, Jon, Frankenstein’s Footsteps: Science, Genetics and Popular Culture, Yale University Press, New Haven and London, 1998. United States Food and Drug Administration, 1st General Plastic Surgery Devices Panel, transcript, 12, 13 and 14 November 1991, reprint editor Bernard D. Reams Jnr. United States Food and Drug Administration, 2nd General Plastic Surgery Devices Panel, transcript, 18, 19 and 20 February 1992, reprint editor Bernard D. Reams Jnr. Ussher, Jane, Fantasies of Femininity: Reframing the Boundaries of Sex, Penguin, Harmondsworth, 1997. Van Duyn, John, ‘Psyche and Plastic Surgery’, Southern Medical Journal, October 1965, pp. 1255–6. Vaughan, G. and M. Hogg, Introduction to Social Psychology, Prentice Hall, Sydney, 1995. Vogel, Steven, Against Nature: The Concept of Nature in Critical Theory, State University of New York Press, Albany, 1996. Waldby, Catherine, AIDS and the Body Politic: Biomedicine and Sexual Difference, Routledge, London and New York, 1996. Walden, Katherine J. et al., ‘Body Image and Psychological Sequelae of Silicone Breast Explantation: Preliminary Findings’, Plastic and Reconstructive Surgery, vol. 100, no. 5, October 1997, pp. 1299–308. Webster’s Medical Dictionary, Merriam-Webster Inc., 1986. Weeks, Jeffrey, Against Nature: Essays on History, Sexuality and Identity, Rivers Oram Press, London, 1991. Weeks, Jeffrey, Sexuality and its Discontents, Routledge and Kegan Paul, London, 1985. Weldon, Fay, Life and Loves of a She-Devil, Hodder and Stoughton, London, 1983.

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236 Cosmetic Surgery, Gender and Culture Wengle, Hans-Peter, ‘The Psychology of Cosmetic Surgery: Old Problems in Patient Selection Seen in a New Way – Part II’, Annals of Plastic Surgery, vol. 16, no. 6, June 1986, pp. 487–93. Wetherell, Margaret, ‘Linguistic Repertoires and Literary Criticism: New Directions for a Social Psychology of Gender’, in Sue Wilkinson (ed.), Feminist Social Psychology: Developing Theory and Practice, Open University Press, Milton Keynes, 1986. ‘What Do You Think about Cosmetic Surgery?’, For Me, 7 June 1997. ‘What Price Perfection?’, Mode, October/November 1993. ‘What Will it Cost to Make Me Beautiful?’, Look, June 1988. Whitford, Margaret, Luce Irigaray: Philosophy in the Feminine, Routledge, London and New York, 1991. Williams, Cholm, ‘Litigation, Hysteria Cloud Truth over Silicone Implantation’, The Australian Surgeon, August 1991, pp. 16–18. Williams, Cholm, ‘Silicone Breast Implants’ (letter), MJA, vol. 156, 6 April 1992, p. 508. Willis, Ellen, ‘Villains and Victims: “Sexual Correctness” and the Repression of Feminism’, in Nan Bauer Maglin and Donna Perry (eds), ‘Bad Girls’/‘Good Girls’: Women, Sex, and Power in the Nineties, Rutgers University Press, New Brunswick, New Jersey, 1996. Winkler, Mary G., ‘Reshaping the Female Body’ (book review), Journal of Health Politics, Policy and Law, vol. 22, no. 1, February 1997, pp. 245–8. Wolf, Naomi, The Beauty Myth: How Images of Beauty Are Used against Women, Vintage, London and New York, 1991. Wolf, Naomi, ‘Keep them Implanted and Ignorant’, in P. Foster (ed.), Minding the Body, Anchor, New York, 1995. Worton, Michael and Judith Still (eds), ‘Introduction’, Intertextuality: Theories and Practices, Manchester University Press, Manchester and New York, 1990. Yalom, Marilyn, A History of the Breast, Ballantine Books, New York, 1997. ‘You Can Change Your Looks’, For Me, 9 June 1997. Young, Iris Marion, ‘Breasted Experience’, in Throwing Like A Girl and Other Essays, Indiana University Press, Bloomington, 1990. Yuval-Davis, Nira, ‘Women and the Biological Reproduction of the Nation’, in Gender and Nation, Sage, London, 1997.

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Index

abdominal apronectomy, 7 see also tummy tuck abdominoplasty see tummy tuck abortion, 170 actants, 67, 68 active reading, 46, 47, 49, 51 active subject, 143 advertising, 27, 94, 117, 123, 146, 174, 175, 190 and polysemy, 46 and sexual imaginaries, 38 small proportion targeted at men, 30, 64, 94 in women’s magazines, 63, 64 women as ‘vulnerable’ to, 54, 174 aesthetic surgery, 5, 14, 71 deﬁnition of, 6–7 ageing, 74, 75, 95, 96, 143 ‘agency’, 2, 50, 72, 76–89, 110–18, 137–46, 169–78, 189–90, 192, 206 feminist agency, 150, 151, 193 and feminist discourse, 27, 30, 77, 78, 144, 150, 151, 181, 193 feminist focus on, in discussion of cosmetic surgery, 24, 112 and nature, 68 and self-representation, 36 Alice in Wonderland (Carroll), 27 Althusser, Louis, ‘Ideology and Ideological State Apparatuses’, 110 American Association of Plastic Surgery, 16 American Board of Plastic Surgery, 16 anecdotal evidence, gendering of, 156 anaesthesia, 2, 15 anorexia, 3 apronectomy, abdominal, 7 arm-lift (brachioplasty), 7 arrogance, 90, 91 art, 134, 135 Art of Cosmetic Surgery (journal), 134 articulation, 44, 48, 50, 70, 187, 200 artifactual body, 100

artifactualism, 67, 68, 69 ‘artist surgeon’, 134–6 Australia and plastic surgery, 16 ‘authentic self’, 107 autonomy, 79 Bachelard, Gaston, 33 Bacon, Francis, 65 Balsamo, Anne, 116 Technologies of the Gendered Body, 108–10 Banderas, Antonio (husband of Melanie Grifﬁths), 87 Baudrillard, Jean, 105 beauty, 62, 112, 145, 158 ‘beauty myth’, 102–5 beauty parlour treatments, 29 and becoming, 30 and femininity, 15, 84, 120 and pleasure, 113 and racial modiﬁcation, 95 see also femininity Beauvoir, Simone de, 89 ‘becoming’, 12, 17, 23, 24–32, 36, 102, 104, 136, 187, 191, 194 beneﬁt and risk analysis see risk evaluation biomedicine, 50 biotechnology, 101 bladder operations, 1 blepharoplasty see eyelid tightening Bloch, John, 65 Bloch, Maurice, 65 body, 30, 107 body image, 146 body imaging technologies, 108 body morphologies, 34 Bordo, Susan, 161 Unbearable Weight, 89, 105–7 brachioplasty (arm-lift), 7 breast augmentation, 7, 16, 74, 83, 86, 96, 118, 179 as source of ‘happiness’, 158

237

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238 Cosmetic Surgery, Gender and Culture breast implants, 99, 123, 179 removal, 7 breast-lifts, 98 breast reconstruction, 13, 118, 179 breast reduction (mammaplasty), 7, 74 breast tightening (mastopexy), 7 bricolage, reading as, 191 burn marks, removal, 7 Butler, Judith, 6, 14, 37, 38, 99, 176 buttock-lift, 7 Caine, Maureen, 10 calf implants, 7 Canada, 16 capsules, 163, 164, 165 ‘career investment’ in cosmetic surgery, 83, 84, 138, 139, 192 Castoriadis, Cornelius, 33 caveat emptor, 139 celebrities, 62 Certeau, Michel de, 190, 191 chemical peels, 4, 17, 28, 74 chemistry, especially of implants, 162 Cher, 106, 161 chest implants (men’s), 96 see also men’s surgery Cheung, Connie, 155 Ciconne, Madonna, 73 class, 111, 182 Cleo (magazine), 61 collagen, 7, 17, 83 compassionate science, 158 consent, informed, 128, 157, 160, 169, 171, 173, 213, 222 construction of gender, 36, 42, 44 construction of the self, 193 consumerism in medicine, 171 Corrigan, Annette, 109, 115, 116 ‘The Body Politic’, 107, 108 cosmetic surgery, deﬁnitions of, 2, 28 Cosmopolitan (magazine), 63 counter-discourses, 9 ‘cultural product’, the body as, 107 cultural studies, 42 culture (in contrast with ‘nature’), 65, 67, 69, 72, 75, 104, 107, 108, 137, 187, 191 Danahay, Martin, 90 Davis, Kathy, 16, 25, 30, 78, 113, 114, 116, 117, 143

Davis, Kathy, continued ‘Remaking the She-Devil’, 106, 112 Reshaping the Female Body, 3, 78, 113 de Beauvoir, Simone, 89 de Certeau, Michel, 190, 191 de Lauretis, Teresa, 17, 77, 88, 119, 120, 128 and technologies of gender, 35–40, 77, 79–80, 98, 128 wet silk dress, femininity as, 35–40 see also technologies of gender degeneracy, 71 Deleuze, Gilles, 4, 37, 38, 43, 69, 79, 150, 168 and ‘becoming’, 12, 17, 23, 24–32, 102, 187 ‘rhizome’, 9, 12, 25, 26, 27, 41, 120, 145, 187 Department of Health (UK), 17 depth model, 4, 37, 124, 187 dermabrasion, 28, 83 dermolipectomy, 7 destabilisation, 24 disabled bodies, 108 disclosure, full, medical reservations on, 127 discourse, 10, 11, 13, 14, 185 discourse analysis, 8, 9, 41, 107, 110 DNA (see also genetics), 71–4 docile bodies, 100, 112 doctor/patient relationship, 9 Douglas, Mary, 86, 172 Dunofsky, Mechthild, 147, 148 During, Simon, 43 ear operations, 1 ear pin back (otoplasty), 7 Elle (magazine), 63 Enlightenment, the, 65, 68, 78, 81, 82 ‘enterprising self’, 80, 87 epispasm, 7 Europe, cosmetic surgery in history, 14 Everybody Loves Raymond (US television comedy), 61 ‘expertise’, 154 exploitation, 174, 175 eyelid tightening (blepharoplasty), 7, 74 see also race facelifts (rhytidectomy), 4, 7, 16, 70, 74, 83

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Index 239 failed surgery, 120 Fairclough, Norman, 49 ‘false consciousness’, 110 fat injections, 7 fat removal, 7 FDA see Food and Drug Administration female body, open to manipulation, 168 female self-determination, 3 femininity, 42, 93, 98, 128, 183, 186 and agency, 142, 144, 145, 178, 181, 182, 192 and beauty, 15, 84, 120 and becoming, 30 and breasts, 158 and dependence, 86 feminism and, 36, 98, 118, 120 and hysteria, 177, 178 as ‘natural’, 66, 76, 137 and passivity, 72, 95, 118, 135, 191 and race, 39, 95, 123 ‘reproduction of femininity’ (Bordo), 106 and susceptibility, 88, 160, 168 and vanity, 148, 150, 181, 182, 190, 194 and victimhood, 174, 177, 181, 182 and youthfulness, 39, 75, 138 feminist discourse/scholarship, 24, 28, 42, 63, 74, 82, 97–121, 187, 193 accused of ‘patronising women as readers’, 45, 46, 47 and agency, 27, 30, 77, 78, 144, 150, 151, 181, 193 avoids topic of ‘vanity’, 89 and femininity, 36, 98, 118, 120 within regulatory discourse, 167 as technology of gender, 36, 37, 38 First World War, and acceptance of cosmetic surgery, 15 Food and Drug Administration (FDA), 139 hearings on silicone breast implants, 13, 17, 153, 155–9, 162–178 footbinding, 103 forehead lifts, 7 foreskin reconstitution (epispasm or posthioplasty), 7 Foucault, Michel, 9, 10, 13, 79, 83, 116, 151, 160 Discipline and Punish, 106 ‘docile bodies’, 100 History of Sexuality, 111

Foucault, Michel, continued technologies of the self, 35 view of power, 77, 111, 112, 115 ‘freedom of choice’, 169, 171, 172, 173 Freud, Sigmund, 33 Frow, John, 47 full disclosure, medical reservations on, 127 Gatens, Moira, 17, 18, 23, 32, 33, 34, 39, 66, 97, 99, 151 gay male community, 31–2 Geertz, Clifford, 78 Geldof, Bob, 85 gender construction of, 27, 33, 63, 119, 122, 185, 186, 188, 191, 194 medical understandings of, 123 relations, 9, 10 gendered subject, 98 general practitioners, 2 genetic determinism, 72 genetic engineering, 68 genetics, 72, 133, 134, 136, 205 genital mutilation, 103 Gere, Richard, 134 Gillespie, Rosemary, 171 Gillies, Harold Delf, 15 Gilman, Sander, 4, 6–7, 14, 15, 16, 17, 71, 74, 80, 91, 135, 194 ‘aesthetic surgery’, 5 Creating Beauty to Cure the Soul, 81 Making the Body Beautiful, 3, 14, 193 race, 5, 14, 16 ‘girl power’, 116 Goethe, Johann Wolfgang von, 90 Gold, Marsha F. 149 Goodman, Marcene, 134, 141, 142, 143 government regulations, 9, 11, 13, 19, 30, 82, 89, 153–83 Grifﬁths, Melanie, 87 Grossberg, Lawrence, 48 Grosz, Elizabeth, 65 ‘growing old gracefully’ see ageing Guattari, Felix, 4, 37, 38, 43, 69, 79, 150, 168 and ‘becoming’, 12, 17, 23, 24–32, 102, 187 ‘rhizome’, 9, 12, 25, 26, 27, 41, 120, 145, 187

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240 Cosmetic Surgery, Gender and Culture Guthrie, Randolph H. 131 gynecomastia, 7 Haiken, Elizabeth, Venus Envy, 14, 15, 193 hair transplants, 7, 64 Hall, Stuart, 18, 42, 43, 44, 49, 50, 51, 69, 188, 191 Haraway, Donna, 10, 11, 12, 65, 66, 69, 70, 75, 185, 194 ‘A Cyborg Manifesto’, 8 ‘modest witness’, 8 Modest Witness, 158 Modest_Witness@Second_Millenium.Fem aleMan©_Meets_OncoMouse™, 67 ‘The Promises of Monsters’, 68 Harding, Sandra, 12 Health Care Complaints Commission (HCCC) Inquiry into Cosmetic Surgery (Australia), 2, 33, 63, 81, 153, 156, 167, 169, 170, 177 Health, Department of (UK), 17 Heaton, Patricia (star of Everybody Loves Raymond), 61 Hermes, Joke, 42–9, 51, 52, 178 ‘heroism’, 3, 114, 137, 143, 144 Hodgkinson, Darryl, 138 Hogg, Michael, 53 homosexuality, 165 Hong Kong, 16 ‘human authorship’, 69 Human Genome Project, 66, 72, 215 humanity, 68 hybridisation, 68 hyperreality, 105 ‘hysteria’ in women’s response to silicone implant risks, 158–61, 182 and femininity, 177, 178 iatrogenic diseases, 166 identity, not static, 32 ideological state apparatuses (ISAs), 110, 111 ‘ideology’, 110, 111, 191 imaginary bodies, 32–5, 39, 48, 95–6, 97–121, 188, 192 see also sexual imaginary ‘immorality’, 71 implants, 7, 9 see also silicone breast implants ‘implicatedness’, 8

individualism, 87 infection control, 15 informed consent see consent, informed Inquiry into Cosmetic Surgery (Australia) see Health Care Complaints Commission (HCCC) interdisciplinarity, 3, 4, 17, 154 ‘internal motivation’, 140–2, 177, 178, 192 interpretive repertoires see repertoires, interpretive intertextuality, 18, 41–57, 125, 136, 144, 154, 187, 188, 190, 201 Irigaray, Luce, 32, 33, 119 ISAs see ideological state apparatuses Jacobus, Mary, 65 Jensen, Klaus Bruhn, 52 Journal of the American Medical Association (JAMA), 133 ‘junk science’, 155 Keller, Evelyn Fox, 10, 65 Kessler, David, 139 Kristeva, Julia, 48 Lacan, Jacques, 33 language, signiﬁers and signiﬁeds, 6 laser resurfacing, 28 League of Health and Beauty (Australia), 15 Lévi-Strauss, Claude, 191 liberal democracy, 78, 79, 82 lifestyle programmes, 1 Lindee, Susan, 72 linguistic repertoire methodology, 14 lipectomy, 7 liposuction, 7, 74, 83, 105 Lumby, Catharine, 42, 43, 44, 46, 47, 49, 51, 178 Lupton, Deborah, 87, 149 lupus erythematosus (SLE), 165 machinic assemblages, 24, 26, 27, 28, 30, 190 Madonna, 73 magazines see women’s magazines male breast reduction (for gynecomastia), 7

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Index 241 mammaplasty see breast reduction Marshall, Donald, 129, 139 Martin, Emily, 10, 56 masculinity, 30, 76, 178, 186, 192, 205 alignment with culture and science, 137, 158 and vanity, 94, 194 Massumi, Brian, 24, 29, 31 mastectomy, 179, 180, 193 mastopexy (breast tightening), 7 materiality, 10, 11, 185, 192 McGhan Medical Corporation, 176 McPherson, Elle, 73 medical engineering, 11 medical expertise, 170 Medical Journal of Australia (MJA), 127 medical literature, 9, 11, 12, 13, 19, 30, 82, 89, 122–52 internal and popular literature, 124, 137, 144 medical model, 100 men’s magazines, 64 men’s surgery, 64, 75, 88, 93, 94, 138, 182 Meredith, Denise, 109, 115, 116 ‘The Body Politic’, 107–8 Merleau-Ponty, Maurice, 33 ‘metaphysics of ﬂuids’, 119 MJA, 127 ‘modest witness’ model of science, 8 see also Haraway, Donna Monroe, Marilyn, 73 Morgan, Kathryn Pauly, 100, 101, 102, 103, 105, 106, 116 ‘Women and the Knife’, 100 Morley, David, 44 ‘Mother Nature’, 132, 133, 135, 151, 191 Mulvey, Laura, 135 ‘narcissism’, 146, 147, 148, 150 ‘narcissistic women’, depicted in Victorian art, 90 see also vanity ‘natural’, the, 18, 101, 105, 108, 136 natural (or precultural) body, 97, 107, 109 ‘naturalistic fallacy’, 110 questioning the category ‘natural’, 102, 103, 131, 132, 137 see also ‘nature’ ‘natural look’, 70, 71, 128–30, 136, 191

‘nature’, 44, 56, 61, 63, 64–76, 120, 128–37, 161–69, 186, 191, 192, 220 anthropomorphisation of, 133 and gender essentialism, 100 source of normative justiﬁcation, 110, 151, 189 see also ‘natural’, the Nelkin, Dorothy, 72 New Idea (magazine), 91 New Weekly (magazine), 62 New Woman (magazine), 92 nose jobs (rhinoplasty), 7, 16 noses, 5 Oakar, Congresswoman Mary Rose, 171 objectiﬁcation, 135 ‘objectivity’, 8, 12 Olbourne, Dr Norman (plastic surgeon), 126 ‘Old Masters’, 135 Orientalism, 65 ‘originality’, 166 Orlan, 71 otoplasty (ear pin back), 7 overdetermined words, 49 pain, 115 panopticon, 112 Parker, Roszika, 135 ‘passing’, 3, 196 passivity, 73, 74, 88, 114, 145, 192 and femininity, 72, 95, 118, 135, 191 ‘pathologic science’, 157 patriarchal authority (of surgeons), 73 Patton, Paul, 27, 30 penile implants, 7 penis enlargement, 7, 64, 93 performativity, 6, 14, 37, 38, 176 photographs as persuasion, 126 Plastic and Reconstructive Surgery (journal), 141 plastic surgery, 2 distinguished from cosmetic surgery, 195 Plastic Surgery Nursing journal, 126 pleasure, 113, 115, 116, 117, 118, 119, 120, 193 Pollock, Griselda, 135 polysemic character of discourse, 10, 41–3, 46, 47, 82, 99, 136, 190, 197

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242 Cosmetic Surgery, Gender and Culture popular culture, 12 posthioplasty (foreskin reconstitution), 7 Potter, Jonathan, 18, 41, 52, 53, 54, 188 power see Foucault, Michel preferred readings, 42–52, 56, 57, 145, 185, 187, 188, 189, 190 production of gender, 23, 188 production of the self see self, production of prostheses, 9 Pruzinsky, Thomas, 126 ‘pseudoliberation’, 114 ‘pseudo-science’, 156 psy disciplines, 79, 80 psychiatry, 11 psychoanalysis, 80 psychological intervention, cosmetic surgery as, 128–9 psychological therapy, 150 Rabinow, Paul, 72 race, 3, 5, 6, 14, 16, 39, 122, 123, 182, 208, 209 and eyelid surgery, 39, 95, 98 and femininity, 39, 95, 123 and noses, 98 and scarring, 98 ‘rational decision-makers’, 176 Reich, Julian, 127, 133, 138, 142, 143 ‘rejuvenation’, 74 repertoires, interpretive, 10, 18, 44, 52, 54, 55, 57, 186, 187 repressive state apparatuses (RSAs), 111 ‘resistance’, 115, 116, 117 rhinoplasty, 64, 83, 96 rhizomes, 9, 12, 25, 26, 27, 28, 41, 120, 145, 168, 187 rhydidectomy see facelifts Riffaterre, Michael, 47, 49, 115 risk evaluation, 28, 86–9, 128, 137, 149, 157, 169, 171–3, 192, 222 and fear, 102 see also silicone breast implants romantic relationships, 84 Rose, Nikolas, 3, 4, 14, 78–82, 87, 151, 186, 189, 192 Inventing Ourselves, 78 Royal Australasian College of Surgeons, 15, 16

RSAs see repressive state apparatuses rupture of implants, 165 safety, concerns over see risk evaluation; silicone breast implants scar revision, 7 scar tissue around implant see capsules Schneider, Monique, 34 Schwarzenegger, Arnold, 134 science, compassionate, 158 scientiﬁc discourse, 68, 123 scientiﬁc method, 53, 65, 72, 100, 156, 219 claimed value neutrality of, 157 scleroderma, 165, 166 ‘second-wave’ feminism, 92 Segal, Lynne, 117 self, production of, 18, 77, 185, 187 self-conﬁdence, 91 self-esteem, 85, 175, 177 self-motivation, 141 self-representation, 36 sexual imaginary, 18, 23, 33–5, 38, 123, 124, 138, 140, 145, 182 as collection of intertexts, 41, 55 and technologies of gender, 64, 96, 98, 188 see also imaginary bodies Shuttleworth, Sally, 65 Sidcup, Kent, establishment of plastic surgery hospital at, 15 silicone breast implants, 8, 16, 30, 99, 103, 123, 212, 218 Food and Drug Administration hearings on, 13, 17, 153, 155–9, 162–178 litigation over, 17, 133, 155 moratorium on (Australia), 17 moratorium on (US), 139 safety concerns, 17, 48, 88, 125, 126 safety concerns as ‘hysterical’, 127 and women’s magazines, 63 see also risk evaluation Skene, Loan, 160 ‘skilled consumers’, 139 skin resurfacing, 7, 74 Smart, Carol, 117 ‘social death’, 100 Society of Plastic Surgeons (Australia), 16 specialisation, 2

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Index 243 Spinoza, Baruch, 34, 38, 102 Stack, Jennifer Daryl, 44 standpoint theory, 12 Still, Judith, 42 subjectivity, 54, 55, 161 surface model, 4, 6, 14, 37, 124, 188 surgeon as artist, 134–6 surgery, failed, 120 syphilis, and damage to nose, 5, 71 tattoos, 7, 17 teaching hospitals, Australian, 16 technologies of gender, 18, 23, 35–40, 41, 55, 56, 63, 76–80, 94, 96, 98, 128, 188, 194, 200 art as technology of gender, 135 cosmetic surgery as technology of gender, 63, 76, 98, 155, 158, 193 feminism as technology of gender, 98, 102, 104, 117, 119, 120, 121 magazine discourse as technology of gender, 94 technologies of the self, 35 testicle tuck, 64 textual analysis, 11 Therapeutic Device Evaluation Committee (TDEC), 153 Therapeutic Goods Administration (TGA), 153 therapy, cosmetic surgery as, 142 thigh-lift, 7 Tiberius, Valerie, 90 training, 2 transgender surgery, 7 ‘truth’, 154 tummy tuck (abdominoplasty), 1, 7, 98 ‘ugly’, the, 104 revalorisation of the, 100 United Kingdom, and cosmetic surgery, 15 ‘unnatural’, the, 67, 68 see also ‘natural’; ‘nature’

Van Duyn, John, 148 vanity, 13, 18, 89–96, 98, 118–21, 138, 146–52, 178–83, 186, 188, 190–4, 223 Vaughan, Graham, 53 ‘viability’, 100 victimhood, 63, 77, 173–8, 181, 182, 189, 194, 222 and agency, 25, 31, 89, 91, 112 and women’s magazines, 87, 88 ‘violence’, 104 Vogel, Steven, 110 vulnerability, 174, 175, 182, 183 Waldby, Catherine, 48, 50 Walker, John, 90 waxing (removal of body hair), 28 Weber, Max, 77 Weldon, Fay, Life and Loves of a She-Devil, 112 Wengle, Hans-Peter, 140, 143 ‘wet silk dress’, femininity as, 35–40 Wetherell, Margaret, 18, 41, 52, 53, 54, 55, 56, 162, 188 Whitford, Margaret, 32, 33 Who Weekly (magazine), 62 Wolf, Naomi, 89, 106, 109 The Beauty Myth, 89, 102–5 ‘woman-made female body’, 104, 120 women’s magazines, 13, 39, 53, 61–95, 99, 110, 119, 122, 125, 136, 138, 144, 145, 151, 174 and polysemy, 44, 45, 46 women’s right to their bodies, 170 Worton, Michael, 42 Yates, Paula, 85 Young, Iris Marion, 85, 98, 119 ‘Breasted Experience’, 118 youthfulness, as ideal, 3, 39, 74, 75, 93, 138, 167 Yovel, Yirmiyahu, 34

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