The Fat Came Back?

My next-door neighbour to my wife, on cosmetic surgery: “Once you start getting that stuff, you’re gonna have to go back in every year for a tune-up!”

Looking askance at it is the normal social way of preventing it from becoming first normal and then semi-mandatory. You can’t get certain jobs unless you’re willing to wear a suit, it’s possible to imagine convention requiring a bit of surgery to fit in at the office.

You can already see Brits and Americans differing in how much cosmetic dentistry is normal.

You can already see Brits and Americans differing in how much cosmetic dentistry is normal.

British and American dentists, too, I suspect. When I had a tooth pulled I was the one asking about a bridge, and my dentist was the one who argued against it. The gap isn’t normally visible – which was a large part of my dentist’s argument against plugging it – but even so.

What’s your take on intended to give you that “European” look? Michael Jackson’s surgery was creepy not just because he looked terrible by the end but that everything he did was intended to make him look white. Is this something to shrug at?

You can already see Brits and Americans differing in how much cosmetic dentistry is normal.

Ironically, British oral health is much better than American oral health and has been for some time. Probably a combination of poverty, expensive health care and meth.

You need to do something about that chin, man.

“Ironically, British oral health is much better than American oral health and has been for some time. “

Ironically, I work for a company which employs a fair number of British immigrants. Every time they open their mouths, I have cause to doubt this assertion, and they themselves comment occasionally on the differences between American and British dentistry. Perhaps it comes down to a different definition of “oral health”? I suppose teeth that aren’t there anymore must, by definition, not be unhealthy.

One problem with something like a nose job is that, often enough, they end up looking just a bit odd. That’s no surprise, really. But then, what do you do? If you don’t like the TV, you can get rid of it w/o serious trouble. But the nose, it’s hard to go back on. And further surgery often only makes things worse. Add to this that there are often non-trivial health risks with surgery of any kind, and there seems a plausible reason to have a bias against non-necessary surgery. I don’t suppose that covers all opposition to such things, but it covers most of mine. Now, as for the gym, it not only has aesthetic benefits, but health ones, too. And, you feel better, less stress, and so on. If this isn’t so for you, then don’t go. (But as with many things, it’s hard at the start and gets easier and better.) But it’s really not a mystery, and acting like it is is a bit funny, and not in a good way. (There can, of course, be “side effects” to exercise, too. Sports injuries can be significant problems, and even minor ones unpleasant, but it’s not too hard to avoid them with a bit of care.)

Last night I watched the 1990 Jekyll & Hyde film, and I was reminded of how at most every turn in medical science innovators come up against the “playing god” objection, which is just a more parochial version of the naturalistic fallacy. Dr. Jekyll’s (a la Michael Caine) modest proposal was that undesirable features of the human mind and body could be altered by the use of drugs. His detractors raised much the same objection that we hear today against psychiatric drugs, cosmetic surgery, genetically modified foods, in-vitro fertilization, and nuclear energy.
I suspect that invocation of the naturalistic fallacy gives voice to fear of the recency and far-reaching consequences of a given scientific innovation. No one objects to the planting of tomatoes in rows as an act of playing god, and yet this particular innovation in agriculture helped make modern civilization possible.

13: I guess you don’t meet that many poor Americans. I’m sure that rich Americans spend a lot more on teeth-straightening, etc than their rich British counterparts, but that isn’t quite the same thing.

RE: Dentistry, I don’t think you can decide this question anytime soon as you not only have to deal with the question of the quality of the profession, but also the dental habits of the population and variances in genetics, which is made even more interesting by the “melting pot” effect of immigration on the American population. While I’m sure there is a reason for “bad British dentists/teeth” to be a cliche, I doubt that they were much worse to start with than their peers, and I wouldn’t be surprised if it’s a bit of mis-information at its root.

RE: Cosmetic Surgery, since the industry, for the most part, falls under “rich people things”, I believe you can rule out inter-class warfare as the root for most objections. Rather, I think this is rooted in “old money vs. new money” intra-class signaling. The “old money” tribe uses their lack of extensive surgery as a way to distinguish themselves from the new money (not to say that they never get any surgery, just less of it). I think this acts in much the same way as their more conservative choices in cars or clothes.

Another question that I’ve pondered is how legitimate this surgery is for actors. If having a little nip or tuck would allow them to gain another 5 years of working at a high salary, can we raise a fair objection? I’m not so sure. There is one thing about all of this that makes me less upset about the existence of this kind of vanity industry: a legitimate need exists for these services as well and often the people who need it the most wouldn’t be able to afford it. So it is good, in some ways, that the more frivolous consumers get a chance to subsidize the more legitimate patients.

Question:

Do Brits just not do orthodontistry or something? Is this a cultural tic? It’s just really bizarre. Like in America (and pretty much everywhere else in the English-speaking world) middle-class parents would be ashamed if they didn’t spent at least $4,000 on the kids’ teeth. It’s just not done. It’s not even so much anything relating to standards of beauty, not getting orthodontistry (unless one’s already got perfect teeth) is bad parenting.

I am honestly flummoxed.

I am a middle class American who had no othodontistry as a child. My teeth were straight enough to not cause problems, and my parents weren’t about to pay thousands of dollars for a purely cosmetic procedure. Interestingly, everyone I meet assumes I am European, and I am beginning to wonder if maybe it’s the teeth. Most Americans in my class bracket have straighter and whiter teeth than me, and really poor Americans have much worse teeth–missing, rotten, tobacco stained, etc.

On cosmetic surgery in general, I think the concept of “cheating” is important. It goes against both mortification of the flesh/anti-sloth (“no pain no gain”) as well as “no artifice,” two concepts that underly many Western European notions of morality.

In terms of the Michael Jackson phenomenon, I agree that arguing “because someone did X for the wrong reasons, X is morally suspect” is faulty logic, but there is the larger issue of the problem of beauty standards. People generally get cosmetic surgery to meet social norms of beauty, which can’t be separated out from class or race hierarchies. While beauty standards may have broadened, there’s still a sense of a Northern European ideal underlying much of what is considered default attractive. So, while individuals might make personal choices to change their noses/eyelids/cheekbones, those individual choices can’t be viewed in a vacuum. The truth is, a vast majority, if not almost all, people who get nose surgery choose to make their noses smaller, or narrower, or of a shape found more often in certain parts of the world; Asian women frequently choose to get eyefold surgery, but white women rarely/never choose to have their eyefolds removed; blonde is by far the most popular hair color to dye/bleach one’s hair, etc. I think it’s important not to shame people who make these choices, but also to question societal beauty norms which compel people to feel the need to commit violence to their body.

Well, one difference is that if you go to the gym, you suffer and then you start looking good; if you have surgery, then the improvement comes first (some bruising aside) and you pay later. Maybe it’s to do with the old saw about “if the hangover came after the drunkenness, then drinking would be counted a virtue, not a vice”?
Might be something to it, but on the other hand the results from surgery usually start to look good only when the wounds have healed. And a large part of the “pain” of mild surgery is the scariness of doing it in the first place.

I think both aspects could be easily turned into perceived virtues, if we were so inclined. Where the nicer nose is the deserved result of being brave and facing the pain. I mean, people have no problem to use the “pain” of investing your millions as a virtue that leads to deserved riches.

Ha, found a better way to restate my objection: I’m against cosmetic surgery for the same reason Derek Jeter is presumably against the use of performance-enhancing steroids in major-league baseball.

Sam (#34),

I like your list very much. FWIW, here’s how I, in part, tried to spell out my own “vague moral unease” about cosmetic surgery in a post from about three years ago. (Be warned that my argument arose in the context of a debate over the power of media images in the upbringing of daughters, of which I have four. It’s something that moves my unease out of the “vague” category and into the “vicious rant” one. And John, thanks for the kind words.)

Perhaps we can put these things on a continuum: some methods of making oneself over to fit a pleasing image (hopefully pleasing to oneself or to some community one is a member of, one with its own organic, aesthetic sense, as opposed to one which simply reflects and amplifies whatever Cosmopolitan magazine tells it to value) are invasive and essentially permanent, whereas others are not. Some involve major investments of one’s “self” in the broadest sense, and others do not. Some are somewhere in the middle, perhaps easing in one direction or another. These are not the sort of hard-and-fast distinctions that would make me comfortable with getting the law involved, but yes: I believe I can reasonably say that it is unnatural, unusual, and often a little disgusting to allow one’s looks and, to a not-insignificant degree, one’s bodily “self” to be guided in an invasive and permanent way by a thinking that is not your own, whereas allowing it to be guided in a merely superficial, experimental, temporary way would be, to my mind, at worst something foolish. Moreover, some image-driven manipulations and improvements, like dieting and exercise, can sometimes have pretty significant positive benefits in terms of health and well-being, while others, like the great majority of plastic surgery operations (i.e., those alternations that do not involve addressing deformities or serious or at least legitimate health and functionality concerns), are not. Some manipulations, like make-up or dying your hair, are (probably) temporary and changeable; others, like plastic surgery, are not. In the end, when all is said and done, I think you can (and should) make distinctions about those ways of aspiring to conform oneself to an ideal which are responsible and reasonable, and those which are not.

[A friend]…wondered about my distinction between temporary alterations and permanent, invasive ones–does the distinction hole water? I think it does. The body isn’t fundamentally altered by something that you can wipe off or take off. Permanent alternations are more than decoration, which is all wearing an earring; rather it’s essentially making the claim that something you have, something you are, some age you are, just doesn’t fit–that you need to draw upon some other resource, some other image, to accomplish whatever it is you desire, and that means handing your own conception of yourself over to someone or something else. And since the types of plastic surgery I’m actually concerned with, the types sold as ordinary and worthy of celebration by the aforementioned book, are the types which I believe are mostly introduced to the thinking of the women of America as “needed” primarily by men engaged in sexual objectification, by chatty and judgmental and competitive peers, by fashion magazines, by pornographic videos, by repellent talk-show hosts and insufferable aerobic instructors, I’m consequently deeply bothered by such practices, because I don’t think anyone should–“freely” or otherwise–hand over the shape of their bodies and lives so willingly to such a pack of self-gratifying vultures and reprobates. And no, I don’t think I’m being overly simplistic here: for the record, I don’t think human agency is a slave to the environmental or cultural influences which surround all of us. But I think such influences are a huge factor in shaping the people we are and the choices we make, nonetheless. The media is what selectively reinforces upon all of us certain assumptions and preferences that are probably there in our community anyway, but without the benefit of a whole contradictory world of influences to moderate and/or contextualize them. The media can warp our thinking, in other words. As such, I worry about it, even if it isn’t the ultimate causal factor in our actions, and I especially worry about it when it seems to me that people are internalizing some of that warping into their bodies in expensive, invasive, permanent ways.

RE: Cosmetic Surgery, since the industry, for the most part, falls under “rich people things”, I believe you can rule out inter-class warfare as the root for most objections.

Not true (at least within the US), I was just about the (huge) market in credit for cosmetic surgery.

Also, “According to a 2005 survey, almost 30 percent of cosmetic surgery patients earned less than $30,000 a year, and an additional 41 percent earned between $31,000 and $60,000. “

it’s deceptive or insincere: to have CS is to attempt to present yourself as other than you are.

No, it’s an attempt to *become* something other than you *were* (even if only in a physical sense). No less so than exercising to lose weight/build muscles, removing unwanted body hair, shaving, haircuts, etc. It’s on a continuum with all of those things (in terms of the time/effort/cost involved), and attempts to build a clear dividing line between them are funny, but futile.

it’s narcissistic: to have CS is to reveal an excessive concern with your appearance and amour propre.

Other people will obsess about your appearance whether you join them in that or not. (Sure, only if they’re superficial jerks, but there’s a lot of superficial jerks in the world and I can’t get an operation to remove them.) And who are you to decide when someone else’s concern with their appearance is “excessive”, anyway?

it’s a corrupting luxury: this isn’t the point that one could spend the money better by giving it to Oxfam, it’s Epicurus’s and Thoreau’s point against pandering to unending desire, and for limitation to one’s needs.

In other words, the fear that someone somewhere might be enjoying themselves. Pointing to any one particular thing as “unending” desire is either a very abbreviated slippery slope argument, or just plain nonsense. And, again, it’s arrogant to tell someone else where they should draw their boundaries.

I’ve never had CS and have no plans to have it, but I don’t find your arguments against it convincing. And they prove too much; practically any modern man is a fop by the standards of some societies, and any or all of the same arguments could be (and possibly have been) deployed against practices we today take for granted.

P.S. Russell @37 seems to have put tattoos in the “unnatural and disgusting” category; I wonder if that was intentional.

Covert versus overt. With a tattoo or piercing you’re not trying to pass it off as if your skin always looked that way.

But with many sets of fake boobs it’s pretty obvious that they are fake boobs. Therefore the most obvious and derided CS is less deceptive and more acceptable in some sense?

My understanding is that cosmetic surgery encompasses reconstructive surgery in cases of burn victims, severe birth defects, amputations, mastectomies, and things like breast reductions to alleviate back pain (for example, after drastic weight loss). I even know of a case in which an eye lift was recommended because the person’s eyelids were beginning to obstruct their vision. I doubt, however, cases like these are enough to account for the difference between the US and other countries.

I try to hold out against the replacement TV as long as possible, however the World Cup is once every 4 years and that’s the point at which I concede.

Also the space and conservation considerations. LCD/plasma technology are generational changes in television technology, so one will get one sooner or later. Getting it sooner saves energy and frees up space.

Chris @ 41: I haven’t made any attempt to ‘tell someone else where they should draw their boundaries’. As I said, I was trying to articulate my own unease, as a way of thinking about whether there are ethical reasons in play here as well as reasons of desire and prudence. I have no legislative powers, and this isn’t a government white paper: I’m a moral philosopher thinking out loud.

On deception: are you claiming that there’s no difference between working on your pectorals in the gym and getting pectoral implants?

On narcissism: we can disagree about whether getting pectoral implants is narcissistic, of course. If you think not, I’d be interested to hear why. But are you claiming that there’s nothing wrong with narcissism? Or that there’s no such thing? Or that no-one is ever allowed to call someone else narcissistic?

On luxury: some desires are bad for us to indulge (smoking); some desires can’t be satisfied (complete control over how others see us); some only lead to desire after desire (money); some don’t make us happy even when we satisfy them (the latest fashionable gadget). Desire is complex, and getting some measure of control over it is a central aim of a great deal of philosophy, including Epicurus’s. Are you claiming that our desires should never be limited? Or that no desire is ever a mistake to pursue or satisfy?

John: I don’t think the fact that ‘Having an ugly nose, through no fault of one’s own, isn’t morally better or worse than being a bit skinny or a bit fat, through no fault of your own’ shows that there’s no moral difference between different responses to those ‘minor cosmetic defects’.

I am pretty certain that the last two of my examples are considered elective, and I believe that in the past the first two would have been treated much less frequently than they are now. These are all matters of simple vanity on the view that was taken on this thread. And also expensive. In most times and places the “problems” would be untreated and would all be considered entirely normal.

But by raising the question of culture, you seem to risk opening up the question how much effort people should make to meet socially prescribed standards. We seem increasingly to place more responsibility on individuals for their own appearance as for their own health. If society prefers smooth bodies, it’s unfair that heavier women have to wear support garments to weddings, but it would upset the other guests if they weren’t dressed appropriately. If society prefers smooth hair, it’s unfair that women with frizzy hair should have to expend more time and money than those with naturally straight hair, and it’s their choice whether or not to do so, of course. But if they can’t be news anchors, they did have the opportunity to do something about it. Why is weight different?

John Holbo @
Your answer has two parts. Regarding the first one, I don’t know where the dividing line is between physical or medical problems that have only cosmetic, or if you like psychological, impact on a person’s life, and problems that have a mild impact in terms of physical or medical areas like pain, shortness of breath, and so on. I agree with you on the narrow liposuction point, but this is a discussion in which orthodontia has been stigmatized as a narcissistic luxury, and on the other hand, how many hours a day would you devote to physical therapy exercises that you knew would prevent pain the following day; how many side effects of a pain medication would you tolerate? Though on the other hand again, overweight being medicalized is hardly something we’re in danger of having happen in the future.

The other part is about conforming to social “prescriptions,” and I think there are too many issues raised here for a comment box. However, I think the possibility should be considered that what’s under discussion is something other than “cultural craziness” that we might reassure people it’s safe to ignore. (Or, which I think is not the same thing, whether it’s merely a discussion about which of exactly two cultures and sets of prescriptions is the better one.)

Chris: there is a fair bit of tension between your claims (1) that to make a claim about ethics, I’d have to ‘start by solving the problem of moral epistemology which has eluded philosophers for all these millennia’; and (2) that ‘I think that if you’re “uneasy” about someone else’s actions, you should probably keep it to yourself unless you have strong reason to believe that you (or perhaps a third party) are actually harmed by those actions’, which is itself a strong, controversial claim of moral knowledge. Why is harm to others the only salient issue? How do you know that it is? Is ‘harm’ any more susceptible to precise definition than the terms I’m using?

Ajay made a good point upthread, that at least some of my criticisms would also apply to obsessive body-builders. That suggests that I should take John’s point that one’s views about CS and other body-modifications ought to be symmetrical, and just add that something which is fine if you do a little of it could be a vice if pursued to excess.

Specifically, to be honest, that kind of criticism sounds a little like something one of my old schoolteachers might say. So another question for the second paragraph above is: How do you prevent annoying rigidity when all the criticisms made from the point of view “above” society amount to something incoherent or outright impossible?