The Surgical Age took over from the institutionalization of female “mental illness,” which had in turn overtaken the institutionalization of nineteenth-century hysteria, each phase of medical coercion consistently finding new ways to determine that what is female is sick. As English and Ehrenreich put it: “Medicine’s prime contribution to sexist ideology has been to describe women as sick, and as potentially sickening to men.” The “vital lie” that equates femaleness with disease has benefited doctors in each of these three phases of medical history, guaranteeing them “sick” and profitable patients wherever middle-class women can be found. The old edifice of medical coercion of women, temporarily weakened when women entered medical schools in significant numbers, has gained reinforcements from the beauty doctors of the Surgical Age.
The parallels between the two systems are remarkable. Both arose to answer the need for an ideology that could debilitate and discredit middle-class women whose education, leisure, and freedom from material constraints might lead them too far into a dangerous emancipation and participation in public life. From 1848 until the enfranchisement of Western women in the first decades of the twentieth century was a time of feminist agitation of unsurpassed intensity, and the “Woman Question” was a continuing social crisis: in backlash, a new ideal of the “separate sphere” of total domesticity arose. That ideal came, like the beauty myth in a parallel backlash against women’s advancement, with its socially useful price: the cult of female invalidism, initiated by “a constriction in the field of vision which led doctors to focus, with obsessive concern, on women as organs of reproduction . . . a distortion of perception which, by placing primary emphasis on the sexual organs, enabled men to view women as a creature apart.” Showalter also notes that
during the decades from 1870 to 1910, middle-class women were beginning to organize in behalf of higher education, entrance to the professions, and political rights. Simultaneously, the female nervous disorders of anorexia nervosa, hysteria, and neurasthenia became epidemic; and the Darwinian “nerve specialist” arose to dictate proper feminine behavior outside the asylum as well as in . . . and to oppose women’s efforts to change the conditions of their lives.
The Victorian woman became her ovaries, as today’s woman has become her “beauty.” Her reproductive value, as the “aesthetic” value of her face and body today, “came to be seen as a sacred trust, one that she must constantly guard in the interest of her race.”
Where Victorian doctors helped support a culture that needed to view women through ovarian determinism, modern cosmetic surgeons do the same for society by creating a system of beauty determinism. In the last century, notes Showalter, “women were the primary patients in surgical clinics, water-cure establishments, and rest-cure homes; they flocked to the new specialists in the ‘female illnesses’ of hysteria and neurasthenia, as well as marginal therapies, i.e., ‘mesmeric healing,’” just as women are the primary patients of “beauty therapies” in the current backlash. These attitudes, in both ideologies, allow doctors to act as a vanguard in imposing upon women what society needs from them.
Health
Both the Victorian and the modern medical systems reclassify aspects of healthy femaleness into grotesque abnormality. Victorian medicine “treated pregnancy and menopause as diseases, menstruation as a chronic disorder, childbirth as a surgical event.” A menstruating woman was treated with purgatives, forced medicines, hip baths, and leeches. The regulation of menstruation was pursued obsessively, just as the regulation of women’s fat is today: “The proper establishment of the menstrual function was viewed as essential to female mental health, not only for the adolescent years but for the woman’s entire life-span. Menarche was”—as the weight gain of puberty is now considered to be—“the first stage of mortal danger.” Maintaining reproduction, like the maintenance of “beauty,” was seen as the all-important female function threatened by the woman’s moral laxness and mental chaos: Just as they do today, doctors then helped the Victorian woman maintain her “stability in the face of almost overwhelming physical odds,” and enforced in her “those qualities of self-government and industriousness that would help a woman resist the stresses of her body and the weakness of her female nature.”
With the advent of the Victorian women’s doctor, the earlier religious rationale for calling women morally sick was changed into a biomedical one. That in turn has changed into an “aesthetic” one, bringing us full circle. Our rationale is even more subjective than the “vital lie” of the Victorians. While their medical terminology had at least to gesture at “objectivity,” today’s aesthetic judgments about who is sick and who is well are as impossible to prove, as easy to manipulate, as a belief about the stain on a woman’s soul. And the modern reclassification makes more money: A woman who thought she was sick with femaleness couldn’t buy an ultimate cure for her gender. But a woman who thinks she is sick with female ugliness is now being persuaded that she can.
The nineteenth-century version of medical coercion looks quaint to us: How could women have been made to believe that menstruation, masturbation, pregnancy, and menopause were diseases? But as modern women are being asked to believe that parts of our normal, healthy bodies are diseased, we have entered a new phase of medical coercion that is so horrific that no one wants to look at it at all.
The reclassification of well and beautiful women as sick and ugly women is taking place without hindrance. Since the nineteenth century, society has tacitly supported efforts of the medical profession to confine women’s lives through versions of this reclassification. Since it is socially necessary work, now as in the last century, fewer reality checks apply to this than are applied to medical practices in general; the media is tolerant or supportive; and the main functionaries, whose work benefits the social order, are unusually highly compensated.
The purpose of the Victorian cult of female invalidism was social control. It too was a double symbol, like “beauty”: Subjectively, women invalids exerted through it the little power they had, escaped onerous sexual demands and dangerous childbirth, and received attention from responsive doctors. But for the establishment, it was a political solution as useful as the Iron Maiden. As French writer Catherine Clément puts it: “Hysteria [was] tolerated because in fact it has no power to effect cultural change; it is much safer for the patriarchal order to encourage and allow discontented women to express their wrongs through psychosomatic illness than to have them agitating for economic and legal rights.” Social pressure demanded that leisured, educated, middle-class women preempt trouble by being sick, and the enforced hypochondria felt to the sufferer like real illness. For similar reasons today, social pressure requires that women preempt the implications of our recent claim to our bodies by feeling ugly, and that forcibly lowered self-esteem looks to the sufferer like real “ugliness.”
The surgeons are taking the feminist redefinition of health as beauty and perverting it into a notion of “beauty” as health; and, thus, of whatever they are selling as health: hunger as health, pain and bloodshed as health. Anguish and illness have been “beauty” before: In the nineteenth century, the tubercular woman—with her glittering eyes, pearly skin, and fevered lips—was the ideal. Gender and Stress describes the media’s idealization of anorexics; the iconography of the Victorians idealized “beautiful” hysterics fainting in front of male doctors, asylum doctors dwelt lasciviously on the wasted bodies of anorexics in their care, and later psychiatric handbooks ask doctors to admire the “calm and beautiful face” of the anesthetized woman who has undergone electroshock therapy. Like current coverage by women’s journalism of the surgical ideal, Victorian journalism aimed at women waxed lyrical on the sentimental attractiveness of feminine debility, invalidism, and death.
A century ago, normal female activity, especially the kind that would lead women into power, was classified as ugly and sick. If a woman read too much, her uterus would “atrophy.” If she kept on reading, her reproductive system would collapse a
nd, according to the medical commentary of the day, “we should have before us a repulsive and useless hybrid.” Menopause was depicted as a terminal blow, “the death of the woman in the woman”: “The end of a woman’s reproductive life was as profound a mental upheaval as the beginning,” producing, like the modern waning of “beauty,” “a distinct shock to the brain.” Then as now, though with a different rationalization, menopause was represented as causing the feeling that “the world . . . is turned upside down, that everything is changed, or that some very dreadful but undefined calamity has happened or is about to happen.”
Participation in modernity, education, and employment was portrayed as making Victorian women ill: “warm apartments, coal-fires, gas-lights, late hours, rich food,” turned them into invalids, as today, as the skin cream copy puts it, “central heating, air pollution, fluorescent lights, etc.” make us “ugly.” Victorians protested women’s higher education by fervidly imagining the damage it would do to their reproductive organs; Friedrich Engels claimed that “protracted work frequently causes deformities of the pelvis,” and it was taken for granted that “the education of women would sterilize them” and make them sexually unattractive: “When a woman displays scientific interest, then there is something out of order in her sexuality.” The Victorians insisted that freedom from the “separate sphere” impaired womanhood, just as we are asked to believe that freedom from the beauty myth impairs beauty.
Vital lies are resilient. Contraception, for example, is defined by the medical profession, depending on the social mood, as making women ill or “beautiful”: Victorian doctors claimed that any contraception caused “galloping cancer, sterility and nymphomania in women; . . . the practise was likely to produce mania leading to suicide.” Until the 1920s, it was considered “distinctly dangerous to health,” sterility and “mental degeneration in subsequent offspring” being among its supposed effects. But when society needed sexually available women, although questions about safety and side effects arose at once, women’s magazines nonetheless ran enthusiastic stories suggesting that the Pill would keep women young, and make them more “sexy.”
In the same way, surgeons—and women’s magazines, increasingly dependent on the editorial copy and ad revenue the surgeons provide—are recasting freedom from the beauty myth as disease. Advertisements for holy oils initiated this new definition by imitating medical journalism’s photographs of “disease” and “cure.” They drew on the worst medical fears of the age, postnuclear cancers and AIDS. “Crow’s feet” sounds insignificant compared with the suggestions the ads made of radiation sickness and carcinogenic lesions, cellular chaos and lowered immune systems. Elizabeth Arden’s is “the most advanced treatment system of the century,” as if aging required chemotherapy. Estée Lauder’s “science-proven” Night Repair is applied with a medical syringe and rubber balloon, like a blood transfusion or a liquid drug. Vichy lets your skin “recuperate.” Clarins talks of “relapse.” Elancyl speaks of fat as a “condition” that “disfigures.” Doctors give prescriptions, Clarins a “Beauty Prescription,” and Clinique, “Prescriptives.” Cancer specialists speak of the “regression” of the illness; so does Clinique: “Stay with your treatment—the temporary ‘regression’ will stop.” Ultima II makes Megadose.
In 1985, Eugenia Chandris in The Venus Syndrome called big hips and thighs “a medical problem”; looking at the Paleolithic fertility figures, she committed the solecism of saying that “the problem has troubled women ever since.” “The problem,” of course, has only troubled women since it has been called a problem—that is, within living memory. Female fat is characterized as if it were not only dead, but carcinogenic: “proliferating cells,” breeding more death. The Victorians defined all reproductive activity as illness; today’s beauty surgeons define as illness all evidence on the body of its reproductive activity—stretch marks, sagging breasts, breasts that have nursed, and the postpartum weight that accumulates, in every culture, at about ten pounds per pregnancy. Education, of course, never affected a woman’s ovaries, just as maternal breasts lose no feeling; nursing is erotic. Nor are they dysfunctional; to the contrary, they have fulfilled a primary function of the breast, lactation. But cosmetic surgeons describe postpartum breasts, as the Victorians described educated ovaries, as “atrophied,” a term that healing doctors use to describe the wasted, dysfunctional muscles of paralysis. They reclassify healthy adult female flesh as “cellulite,” an invented “condition” that was imported into the United States by Vogue only in 1973; they refer to this texture as “disfiguring,” “unsightly,” “polluted with toxins.” Before 1973, it was normal female flesh.
Health makes good propaganda. “‘Proof’ that women’s activities outside the home are detrimental to the health and welfare of themselves, their families and the country as a whole” lent impetus, writes Ann Oakley, to the nineteenth-century cult of domesticity. The ovaries were seen as collective property rather than the woman’s own business, as the face and the body outline are seen today. Who can argue with health?
Institutionalized Reclassification
Respected institutions are participating, as they did in the last century, in this cultural policing of women through reclassification: In 1978, the American Medical Association made the claim that preoccupation with beauty was the same as preoccupation with health. Dr. Arthur K. Balin, president of the American Aging Association, declared to The New York Times that “it would benefit physicians to look upon ugliness not as a cosmetic issue but a disease.” In professional plastic surgery journals, it is impossible to see where the surgeons differentiate between the cutting open of the cancerous and the healthy breast. Dr. Daniel C. Tostesen of Harvard Medical School, who has accepted $85 million from Shiseido for research, is earning his salary on its behalf: There is, he asserts, a “subtle and continuous gradation” between health and medical interests on the one hand, and “beauty and well-being” on the other. Such dicta affect women more than men, as they are meant to; it is women who are the main surgical patient pool and the buyers of Shiseido products (no mention is made of the physical appeal, or lack of it, of Drs. Balin and Tostesen). When the surgeons convene conferences to discuss “the deformities of the aging face,” the profile on the announcement is invariably female.
A man is “deformed” if a limb or feature is missing or severely skewed from the human phenotype. Where women do not fit the Iron Maiden, we are now being called monstrous, and the Iron Maiden is exactly that which no woman fits, or fits forever. A woman is being asked to feel like a monster now though she is whole and fully physically functional. The surgeons are playing on the myth’s double standard for the function of the body. A man’s thigh is for walking, but a woman’s is for walking and looking “beautiful.” If women can walk but believe our limbs look wrong, we feel that their bodies cannot do what they are meant to do; we feel as genuinely deformed and disabled as the unwilling Victorian hypochondriac felt ill.
The tragedy of this reclassification is that for most of our history, women have indeed suffered from illness—prolapsed uteri, early death from ovarian cysts, untreatable venereal diseases and vaginal infections; poor hygiene, ignorance, shame, and compulsory yearly pregnancy took their toll. Compared with that, women are now miraculously, unprecedentedly well—but the myth denies us the experience of our wellness. Only a generation after the physical dis-ease of femaleness had ended, the new possibility of ease in the female body was ruined for women by the beauty myth.
Recycled rhetoric about female disease insults women’s healthy bodies: When a modern woman is blessed with a body that can move, run, dance, play, and bring her to orgasm; with breasts free of cancer, a healthy uterus, a life twice as long as that of the average Victorian woman, long enough to let her express her character on her face; with enough to eat and a metabolism that protects her by laying down flesh where and when she needs it; now that hers is the gift of health and well-being beyond that which any generation of women could have hoped
for before—the Age of Surgery undoes her immense good fortune. It breaks down into defective components the gift of her sentient, vital body and the individuality of her face, teaching her to experience her lifelong blessing as a lifelong curse.
As a result, fully able women may now be less satisfied with their bodies than are disabled people: “Physically handicapped people,” reports a recent study quoted in The New York Times, “generally express an overall satisfaction about their bodies”—while able-bodied women, we saw, do not. One San Francisco Bay area woman in four would undergo cosmetic surgery given the chance. The word “deformed” is no longer used in polite discourse, except to describe bodies and faces of healthy normal women, where cosmetic surgeons’ language constructs out of us the new freak show.
Is “Health” Healthful?
How healthy is the Surgical Age? Smoking is on the decline in all groups but young women; 39 percent of all women who smoke say they smoke to maintain their weight; one quarter of those will die of disease caused by cigarette smoking—though, to be fair, the dead women’s corpses will weigh on average four pounds less than will the bodies of the living nonsmokers. Capri cigarettes are advertised as “the slimmest slim.” The late Rose Cipollone, whose husband sued the tobacco industry for her death from lung cancer, started smoking as a teenager because “I thought I was going to be glamorous or beautiful.”