1100 words essay

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The rhetorical limits of the "plastic body" John W. Jordan

Online Publication Date: 01 August 2004 To cite this Article: Jordan, John W. (2004) 'The rhetorical limits of the "plastic body"', Quarterly Journal of Speech, 90:3, 327 - 358 To link to this article: DOI: 10.1080/0033563042000255543 URL: http://dx.doi.org/10.1080/0033563042000255543

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Quarterly Journal of Speech Vol. 90, No. 3, August 2004, pp. 327–358

The Rhetorical Limits of the “Plastic Body” John W. Jordan

This essay analyzes the “plastic body” as it is produced in the discourse of plastic surgery. The contemporary industry has constructed a popular image of plastic surgery as a readily available and personally empowering means to resolve body image issues, on the presumption that any body can become a “better” body. The ideology underlying the industry emerges out of analysis of the rhetoric of surgeons and patients. The rhetorical efforts of amputee “wannabes,” who seek elective amputation and who use arguments similar to those of mainstream plastic surgery applicants, reveal the paradoxes and contradictions in decision-making about who has access to these procedures. The essay concludes that the concept of the plastic body is based less on medical technology and skill than on rhetorical power and suggests that this body of discourse has important implications for medical and technological advances that have enlarged the possibilities for body alteration practices.

Keywords: Plastic Surgery; Amputation “Wannabes”; Plastic Body; Body Image

The human body is arguably the most fluctuating signifier in the history of cultural expression, but the technological and commercial developments of the 20th and 21st centuries have given the material body nearly as much fluidity as its artistic representations. Varieties of cosmetic alteration, including piercings, tattoos, the corporeal refashionings of performance artists, and virtual body designing are an increasingly common part of society today and push the boundaries that constitute social understandings of the “natural” body.1 Current body modification techniques prompt new considerations of the human body, but also raise questions about the acceptable limits of human intervention in altering its appearance. These concerns are brought into focus by public messages that define humans as surgically malleable entities—“plastic bodies”—whose corporeal identity is always in a state of potential

John W. Jordan is an assistant professor in the Department of Communication at the University of Wisconsin-Milwaukee. Correspondence to: 210 Johnston Hall, University of Wisconsin-Milwaukee, Milwau- kee, WI 53211, U.S. Email: [email protected]. The author thanks the editor and anonymous reviewers for their help and Melissa Gilbert for access to her excellent documentary Whole.

ISSN 0033–5630 (print)/ISSN 1479-5779 (online) © 2004 National Communication Association DOI: 10.1080/0033563042000255543

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transition. This plastic body is a rhetorically contested substance, with a variety of social agents engaged in efforts to shape its public meaning and, by extension, its corporeal form. Their messages frame contemporary debates about the human body, its entelechies, and the means by which individuals seek out and justify their desire for a “better” body.

The most socially sanctioned and physically altering body alteration techniques are those belonging to plastic surgery.2 Although surgery and other medical techniques have for centuries been used to alter the human body, the dramatic and often controversial techniques involved in plastic surgery have brought it to the forefront of the public’s knowledge about body augmentation, leading some to describe the contemporary era as a “plastic surgery culture.”3 Once available only to a select few, plastic surgery is now touted as a democratic technology, “no longer restricted to the very wealthy or famous,” but “mundane and available to everyone.”4 Public accounts of plastic surgery imply that there is an augmentation for every body and for every part of the body, including some of the more idiosyncratic forms, such as having one’s toes shortened to fit designer shoes, “umbilicoplasty” or “designer bellybutton” surgery to create the perfect bellybutton shape, “laser vaginal rejuvenation” or “designer vagina” surgery to reshape a vagina to display a youthful appearance and increase sexual pleasure, and penis enlargements that boost a man’s sexual ego, if not sexual function.5 What may be obscured by the apparent ubiquity of plastic surgery is an understanding that realizing the body’s plastic potential is not a simple matter of personal desire. Because surgeons control the means to actualize body alteration desires, surgical applicants must confront the medical community’s ideological perspective on the healthy body and how this influences surgeons’ choices about which bodies and desires will receive surgical attention and which will be rejected as inappropriate.6 These choices put into perspective the ways in which the plastic body is limited symbolically and materially and the possible avenues for change opened up through rhetorical interaction.

In this essay, I explore three rhetorical phenomena that shape public understand- ing of the possibilities for and limitations on the body’s plasticity in a plastic surgery culture. The first phenomenon is that, over the course of the last century, plastic surgery advocates have engaged in a concerted, commercial effort to redefine the human body as a plastic, malleable substance which surgeons can alter and people should want to alter in order to realize their body image ideals. These messages convey to the public the apparent ease and wonder of plastic surgery and associate body augmentation with individual empowerment, making surgery a desirable solution for individuals with body image issues. The second phenomenon concerns the rhetorical work surgical applicants do to receive augmentation. Although plastic surgery is advertised as an almost universally accessible commodity, access to surgical alteration is predicated on applicants successfully aligning their desire for surgery with the medical community’s definition of a better body. This requires that applicants persuade surgeons of the “wrong”-ness of their bodies and their need for surgical “correction,” a rhetorical strategy that places applicants in embarrassing and contradictory situations. The third phenomenon includes challenges to the medical

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The “Plastic Body” 329

community’s definition of the better body produced through surgery. In particular, I focus on a group of surgical applicants known as amputee “wannabes,” who desire amputation of one of their healthy limbs in order to make their bodies “whole.”7

Wannabes are a compelling example for rhetorical analysis because they articulate their augmentation desires through statements that are nearly identical to main- stream plastic surgery applicants, but they are not granted the same legitimacy by the medical community, thereby bringing into focus the role that the body plays in arguments about its plastic potential.

The plastic body emerges as an influential, contested, and evolving configuration of meanings that circulate through the public sphere and are the impetus behind many body alteration desires. Public discourse about elective surgical alteration comprises rhetorical texts that shape public understanding about bodies as symbolic and material sites of expression.8 A rhetorical analysis of these texts yields important insights into the ways that the borders between technology, medicine, authority, and body image are managed through the production of plastic bodies.9 Statements regarding the “proper” uses of plastic surgery do not limit the body alterations surgeons can perform but the kinds they will perform, which in turn influences the kinds of bodies prospective patients should ask for. By exploring these rhetorical statements, this essay analyzes what counts as an authentic desire for plastic surgery on a plastic body and how authoritative definitions of a whole, healthy, and beautiful body are produced and maintained in public discourse. Ultimately, I conclude that, even in a time of astonishing biotechnology, the constitution of the human body depends on rhetorical invention as much as technological intervention.

A Brief Rhetorical History of Plastic Surgery

The “plastic” in plastic surgery comes from the Greek plastikos, “to shape or mold,” and relates to the techniques for shaping and the object that is to be shaped, meaning that plastic surgery presumes that the body is plastic.10 This presumption forms the basis on which popular and medical discourse, particularly in the 20th century, established the body’s plasticity to the degree that people today “perceive the malleability of the body as commonplace,” a perception “writ so deep in the collective unconscious that it is hard to speak of a ‘natural’ body.”11 In one sense, this perception is not entirely novel as medicine has always regarded the body as a plastic substance that could go from health to illness and back again based on how doctors diagnosed and treated their patients. Indeed, without the belief that medi- cine can transform bodies, medicine would seem to have little to offer.12 Bodies in plastic surgery, however, usually are not so much ill as they are “wrong,” and they are not healed so much as they are corrected or beautified. These distinctions kept plastic surgery at the fringes of medical knowledge until recently, when it emerged as a visible, desirable, and discussable part of everyday life.13 Augmentation now factors into definitions of better, healthier, and even happier bodies. In this section I discuss some of the events that changed attitudes toward plastic surgery and contemporary perspectives on the body’s surgical alterability.

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Plastic surgery’s origins have been traced back to ancient India, where techniques were developed to reattach or reconstruct noses lost through misfortune or punish- ment.14 These early procedures were painful and time-consuming but effective, leading to their adoption in other cultures across time. Advances in plastic surgery were slow, largely owing to a lack of technological innovation and to the perception that it was an unnatural and immoral science that meddled with nature and the social order and, therefore, was unworthy of serious medical study or public acceptance. Practitioners attempted to combat this attitude through justifications for plastic surgery that extolled the amazing results of their techniques, but their efforts did little to ease society’s concerns. In his 16th century manual for plastic surgery, De Curtorum Chirurgia per Insitionem, the surgeon Gaspare Tagliacozzi elevated plastic surgeons above nature, writing that, “We bring back, refashion and restore to wholeness the features which nature gave but chance destroyed, not that they may charm the eye but that they may be an advantage to the living soul.”15 Testimonials to the amazing transformations effected through plastic surgery would become an instrumental aspect of 20th century discourse, but in earlier centuries these claims were often viewed as heresies that confirmed plastic surgery’s reputation as an unnatural and dangerous enterprise.16

The history of plastic surgery contains numerous examples of almost comical juxtapositions of the medical skills of plastic surgeons and their ineptitude at gaining legitimacy. Plastic surgery in the 19th century was generally regarded as the province of quack doctors more interested in self-promotion than healing.17 They advertised experimental plastic surgery procedures (some of which ended tragically for their patients), boasted about celebrity clients (many of whom vehemently denied having surgery), and performed facelift operations on public stages in front of paying audiences.18 These stunts raised public awareness about the plastic potential of the body, but the carnivalesque atmosphere of these demonstrations did little to improve plastic surgery’s standing in the eyes of the traditional medical establishment. Medicinal practitioners of this era demonstrated a lack of empathy for quality of life issues beyond survival and did not see the merit in attending to a patient’s personal appearance, dismissing such concerns as mere vanity.19 As has been noted, “Research has shown that surgeons by nature tend to be more critical and less empathetic than most people.”20 Concerns about bodily appearance were not important aspects of surgeons’ decision-making or of their patients’ well-being and as such were not incorporated into the doctor’s “gaze” or perception of the body.21 Even those medical procedures that disfigured patients, such as radical mastectomies, were performed with little to no consideration of the patient’s body image. Doctors were more likely to tell women that they were lucky to be alive, and that should be enough.22

Somewhat ironically, the viciousness of war prompted medical professionals to expand their view of patient well-being to include aesthetic treatment. The First World War introduced new and improved ways of destroying bodies, but advances in medical and transportation technologies also meant that more injured soldiers could be treated and saved instead of being left to die on the battlefield. The

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problem, of course, was that many soldiers were left severely disfigured by their wounds and the emergency surgery that kept them alive. The confluence of numerous damaged bodies, the social disruption of war, and a community of doctors working toward a common goal set the stage for plastic surgery’s legitimiza- tion in the public and medical realms. “Never before had physicians been required to treat so many and such extensive facial and head injuries. Shattered jaws, blown-off noses and lips and gaping skull wounds caused by modern weapons required innovative restorative procedures.”23 The romanticized honor of being wounded in battle provided the necessary credibility to plastic surgery which, in this context, was neither vain, hubristic, nor corrupt medicine but a means to allow soldiers to return home as heroic rather than pitiable figures, thereby preserving the social order through diminishing the personal and social stigma of modern warfare.

The restorative work done on soldiers did much to legitimize plastic surgery as a healing science. “By the end of the war, these [plastic] surgeons had earned the respect of their colleagues and the public. No longer were questions raised about the morality of surgical reconstruction or, for that matter, about the social value of medical practice.”24 Plastic surgery’s legitimation was accompanied by a reinterpreta- tion of its medicinal utility as “techniques primarily evolved for hiding facial blemishes and correcting visible deformities were applied with immense success to the treatment of wounds in general.”25 As the medical gaze of surgeons shifted from blemishes to wounds, public perception of these techniques increased in value as did the status of its practitioners, who became seen as “expert advisers and helpful collaborators in a wide range of surgery.”26 Plastic surgery’s newfound medical and social legitimacy enabled it to rewrite its own troubled history, proudly announcing itself to the public as “one of the world’s oldest healing arts.”27 The plastic surgeon’s perspective on the body became an integral component of the medical gaze, transforming knowledge of the body and of the ways in which bodies could be transformed.

In the 20th century, particularly after the First World War, plastic surgery shifted from reconstructive to aesthetic applications.28 The Second World War provided additional opportunities for plastic surgeons to demonstrate their value, but by this time plastic surgery had expanded into more everyday uses.29 The restored bodies of soldiers were a kind of a fortiori argument in more peaceful times and reversed the earlier proscriptions against vanity surgery: if plastic surgery could work wonders on the horrible disfigurations of a wounded soldier, surely it could repair unsightly features on an otherwise healthy body. Plastic surgery’s acceptance as medicine enabled practitioners to seek out other “ill” bodies in need of their brand of healing, such as those suffering from psychological “wounds” brought about by bodily dissatisfaction. “Whereas plastic surgery was formerly aimed at repairing bodily deficiencies which made a person noticeably different from the rest of the world,” historians write, “it increasingly came to be seen as a normal intervention for essentially normal bodies.”30 An article from a 1939 magazine, Independent Woman, illustrates the way in which normal bodies could be rewritten as needing plastic surgery. “The defect may seem slight,” the author writes, “but its psychological

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consequences may be serious enough to undermine the patient’s mental health or economic security.”31 A more pervasive and permissive sensibility of the body’s plasticity was disseminated, fostering the belief that body alteration was an available, practical, and desirable application. “Throughout its history, aesthetic surgery has striven to join the mainstream of medicine by promising patients uniquely effective therapies for becoming happy, healthy, and whole.”32 Commentators have summed up this attitude by saying, “Not only can we change our identities … we do it all the time. And we ought to be glad, because this kind of plasticity is healthier, more honest, more apt to bring us happiness.”33

Plastic surgery became known as a way of combatting unfair circumstances, of triumphing over the hand dealt by nature or fate and of acquiring the body one ought to have.34 This is a persuasive idea in a culture that is wont to see the body as the canvas for the mind’s desires. The plasticity brought about by surgical augmentation enables a person to see the body as a mere starting point for corporeal identity. Plastic surgeons offer to remold flesh to fit fantasy and base this promise on an image of the body as potential awaiting form. As I demonstrate in the following sections, however, there is a significant disparity between the promise of a plastic body and its fulfillment, and the requirements imposed upon those seeking augmen- tation entail more than wishful thinking.

Plastic Bodies and Plastic Rhetoric

Plastic surgery’s efforts to redefine the natural body as a body-in-transition fit easily within “the cultural landscape of late modernity: consumer capitalism, technological development, liberal individualism, and the belief in the makeability [sic] of the human body,” the cumulative effect of which enabled plastic surgery to “emerge as an acceptable means for altering or improving the appearance of the body.”35 Such acceptance confirms that, “Not only has the body come to stand as a primary symbol of identity, but it is a symbol with an unlimited capacity for alteration and modification,” which is evident in the increasing demand for a variety of surgical enhancements.36 This combination of factors—the body’s presumed plasticity and individuals’ desire to remold their bodies—points to a strong sense of Cartesian dualism permeating the cultural understanding of body modification.37 As I argue below, the impetus to seek plastic surgery for many is the desire to have their bodies reflect an idealized mental image they have of themselves. Surgery is looked on as a means to “restor[e] order and mak[e] the psyche happy through the establishment of a unitary identity,” with alteration of the physical body as the means to this end.38

This “mind over matter” perspective permeates the plastic surgery industry’s public promotions, the justifications for surgery offered by patients, and the judgments made by plastic surgeons.

Plastic surgery’s mind/body dynamic has been addressed in several studies that seek to explain why Westerners are so concerned with using augmentation technolo- gies to improve body image. These analyses explore possible influences on individu- als, such as psychological issues like low-self esteem or cultural influences such as

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mass-mediated body images, which compel them to seek relief through the “scalpel psychiatry” of plastic surgery.39 Of equal importance are the ways that discourse constructs and disciplines the plastic body as a symbolic and material substance, and the way that the material body “binds discourse by setting limits.”40 Put more simply, the way that plastic surgery is discussed shapes the body, and the limitations of the physical body in turn shape the way that plastic surgery is discussed. Despite what their advertisements promise, transforming a physical body to fit a body image is not simply a matter of requesting plastic surgery; instead, such requests generate issues of desire, authority, and resistance. Accordingly, further attention is needed to the ways that the body and bodily desires are constructed rhetorically by physicians and patients as they strive to find ways to translate such desires into an “illness” that a surgeon can cure.41

A rhetorical analysis of plastic surgery discourse identifies several tensions—per- sonal desire and public promise, physical and imagined bodies, psychological need and professional ethics—that are in conflict in the production of a plastic body as a physical object and as an imagined construct. The plastic body is a contested subjectivity whose meaning shapes and is shaped by the ways that the body can be discussed, by whom, and toward what end, as well as the socio-political implications of people seeking to make their bodies conform to an idealized image. This perspective differs from the usual ways in which plastic surgery is discussed publicly, which is in terms of the end product—the visible, post-surgery body. Before a single incision is made, however, the plastic body as an object of discourse has been sculpted rhetorically to reflect the varied interests of patients, surgeons, and, in some instances, communities. Even in situations in which surgery is rejected, a new body is produced because the applicant’s body is redefined as unsuitable for surgery, which alters its rhetorical status. Approval of surgery is made on the assumption that the refurbished body will improve the individual patient and be a public statement affirming the benefits and appropriate uses of plastic surgery. Rhetoric, thus, is a vital component of the development of bodies in plastic surgery culture, and it influences individual decisions about and public knowledge of the human body.

The critical perspective I use to investigate the rhetorical construction of the plastic body stems from and contributes to theories about how “the body is alternately sustained and threatened through modes of address.”42 As critics remind us, “regarding the body as a discursive site is not new,” but engaging the body as a “mobilization of signs, images, and discourses for the articulation of identities, ideologies, consciousness, communities, publics, and cultures” is a more recent enterprise to which rhetorical analysis has made important contributions.43 Rhetoric as an analytical perspective is particularly well-suited to addressing such questions because it takes into account how ideas—and bodies—are produced and altered across time and in a variety of contexts. The human body is rhetorical in that it can be “a pivotal resource for the crucial practice of public argumentation” and the “site and substance of the argument itself.”44 Indeed, because the body is “incongruous” and a “site of incoherence,” it is necessarily rhetorical because it requires interpret- ation in order to be meaningful.45 As the body is interpreted, framed, and under-

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stood, it becomes a text that reflects the attitudes and values of the culture in which it is situated. A body’s meaning depends on rhetorical articulation; “there are no a priori bodies. Bodies are enmeshed in a turbulent stream of multiple and conflictual discourses that shape what they mean in particular contexts.”46 Any “understanding of the body,” critics argue, “whether by the general ‘lay’ person or the expert, must be constituted from language, images, and concepts that are culturally bound.”47

Without interpretation, the body ceases to be meaningful because, “absent context and significant symbols, the body’s declarations remain largely inchoate.”48 The innate incoherence of the body is the wellspring of its rhetorical power.

Although it was not written with plastic surgery in mind, an additional perspective on the material and discursive entwinements of plastic surgery emerges from taking literally Donald C. Bryant’s definition of rhetoric as “adjusting ideas to people and people to ideas.”49 At its core, plastic surgery is literally about adjusting an individual body to a bodily ideal while re-imagining that ideal based on a body’s material possibilities. Statements about plastic surgery can be understood as deliberative, “inherently future-oriented” rhetoric that instruct audiences “about overcoming obstacles through making [bodies] change,” with physical embodiment as the outcome of these deliberations.50 As in many other aspects of everyday life, plastic surgery uses rhetoric to “giv[e] form to the vague and disordered flow of human experience. Rhetoric gives shape to social reality and, in so doing, makes sense of it.”51 Plastic surgery embodies rhetoric metaphorically and literally, reflecting the idea that “one of the ways to connect the physical and the imagined is by invoking terms of identity that mutually constitute who we are with who we want to be.”52

How the human body is made meaningful through public discourse on plastic surgery has important ramifications for the choices people make regarding their health and the possibilities and obstacles they confront in pursuit of better bodies.

Viewed in this way, the physical body can be understood as an “epistemic force that articulates itself not through traditional rational argument but through a kind of corporeal performativity.”53 With respect to surgical alteration, the body’s mean- ing is in even greater need of explication because this epistemic force is spread across multiple, imagined bodies and generates multiple perspectives regarding its proper social function. The body in question is an amalgam of the pre-surgical body of the patient, the body desired, the body the surgeon sees through the disciplinary gaze of medicine, and the body produced by surgery or its refusal. Although plastic surgery seeks to unify the symbolic and corporeal, ultimately it cannot contain the symbolic expressiveness of the body in the public realm, giving rise to multiple and even conflicting interpretations of plastic surgery as an instrument for realizing a desired body image. Granting or refusing requests for surgical alteration does not eliminate the rhetorical plasticity of the body; instead, it adds layers to it.

This is a significant issue in the culture of plastic surgery and signifies the tensions involved in altering bodies: “If bodies are inscribed in particular ways, … then these kinds of inscriptions are capable of reinscription, of transformation, are capable of being lived and represented in quite different terms.”54 The post-surgery body is a living advertisement, which constrains the types of surgeries doctors are willing to

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perform because they do not want just any body to be an example of the effects of medical intervention. Those who challenge these restrictions, such as amputee wannabes, agree with the surgeons that the body is an important site of rhetorical signification, but argue that the limits surgeons place on acceptable body alterations are ill-conceived and too narrow. Wannabes view surgical amputation as a means to diversify social interpretations of the body and to admit and appreciate, rather than stigmatize, differences in bodily form. In essence, they debate two sides of the same coin: The body’s plasticity is either useful only when directed toward conforming to the social norm or when diversifying social body norms. Both sides define the body as plastic, but arrive at that definition through different logics. To observe better these rhetorical issues and their enactment in public discourse, I next examine examples of plastic body discourse in the public sphere.

Plastic Surgeons and Plastic Medicine

Physicians’ public statements about their surgical abilities are an important source of rhetoric about the plasticity of the body.55 As plastic surgery became safer, more popular, and more affordable during the last century, surgeons used self-promotion to attract new clients; some even hired marketing experts to develop ad campaigns for cosmetic services.56 These efforts raised public awareness and transformed “the practices of cosmetic surgery … into commodities,” and many surgeons became “celebrities in their own right.”57 The public persona of the surgeon is a carefully crafted aspect of plastic body discourse that also reveals surgeons’ attitudes toward their patients’ bodies. Pioneering plastic surgeon Adalbert Bettman, for example, writes in his classic essay that, “By the application of plastic surgery the deformities of nature, accident, disease and age are removed and the smooth, plump, rotundity of health and youth replace the wrinkled, hollow, drawn appearance of advancing years and illness.” In Bettman’s estimation, a body could be “changed to suit the esthetic taste of the owner” by “yield[ing] to the touch of the surgeon.”58

When speaking of their abilities, surgeons often resort to hyperbole bordering on hubris. One surgeon, for example, says, “Patients sometimes misunderstand the nature of cosmetic surgery. It’s not a shortcut for diet or exercise. It’s a way to override the genetic code.”59 In proclaiming their ability to relieve patients of their “genetic flaws” or “features that they could change through no other available means,” surgeons redefine the current era as one in which “the wonders of technology have put in the hands of physicians what used to be in the hands of fate.”60 For surgeons, plastic surgery is a way of combatting unfair circumstances, of triumphing over nature, and achieving the idealized body to which a person is entitled. This vantage enables surgeons to craft an image of themselves as “miracle workers” with the power “to make things right, to make faulty organs function most efficiently and to look as well as possible,” and explains why many people believe in their “promise to sculpt our bodies, to restore our youth, to create beauty out of what was ugly and ordinary.”61 “Whatever the problem,” applicants are assured, “deformity, ugliness, old age—you will be made anew. The end will be better than

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the beginning.”62 Plastic surgeons bring about transformations that patients could not effect on their own. Surgeons promote themselves as “purveyors of the mystical quality of beauty itself,” saying that, “What we do … is very powerful magic.”63 In more clinical terms, surgeons report: “The plastic surgeon today can help reconstruct a person’s asymmetries or deformities to conform to their peers, or even surpass the norm.”64 For those hoping to alter their bodies, these messages must sound like the answer to their body image dreams.

Plastic surgeons’ self-promotion creates an understanding of body alteration as a procedure that otherwise healthy individuals might want rather than an operation that only disfigured victims need. The message conveyed is that, “You would be crazy not to be operated on when doing so will change your life—you will be loved, you will be successful. You would be crazy to refuse all that.”65 Surgeons are enamored with their ability to effect changes that extend beyond the flesh. One researcher notes that “repeatedly what surgeons have told me they love about surgery is exactly the way these operations can turn around people’s lives.”66 Although they make a point of not raising applicants’ expectations during consultations, that surgery can reconstruct both bodies and lives comes across in surgeons’ statements regarding the personal empowerment of plastic surgery: “You must be convinced that it is your free and open right to make your individual choice about whether or not to have … any part of your body changed by surgery.”67

Counter-rhetoric is difficult to find. Images of plastic surgery circulating through popular discourse “[do] not apply any brakes to these fantasies of re-arrangement and self-transformation. Rather, we are constantly told that we can ‘choose’ our own bodies,” leading to “a construction of life as plastic possibility and weightless choice, undetermined by history, social location, or even individual biography.”68 Such statements reflect the image of plastic surgery as advertised in the public sphere, but closer inspection reveals obstacles to the realization of these plastic possibilities that are imposed by the same surgeons who speak of entitlement and limitless choice. Surgeons promote and police plastic surgery, offering the ideal to all but surgery only to those who pass intense scrutiny. The gatekeeping of plastic surgeons illustrates the strategic ambiguity in their public marketing and the ideological assumptions informing their decisions.

Plastic Surgeons as Gatekeepers

As publicized, plastic surgery is about open access and personal entitlement: “No patient should have to jump through hoops to benefit from plastic surgery.”69 Even in countries without socialized medicine, such as the United States, the popular perception is that the only obstacle to surgical alteration is price.70 This is a false impression because being able to afford elective surgery is the not the only or even the most significant hoop through which prospective patients must jump. The more substantial yet less discussed requirement for surgery is the ability to demonstrate psychological health. Medical researchers point out that, “The subject is allocated property rights over [his or her] looks[,] and the value of his [sic] property (and

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hence the need for repairs to it) is determined by a calculus based on his own assessments,” but “the exercise of property rights is dependent, however, upon the constitution of a ‘rational’ subject.”71 Accordingly, “the importance of evaluating the psychological motivations and outcomes of patients undergoing aesthetic surgery has been long recognized” by surgeons who scrutinize the ways in which applicants describe their bodies and their surgical desires for signs of mental instability.72 In this context, validation of one’s body alteration desires depends on the rhetorical performance of an appropriate surgical identity.

Gatekeeping is a common component of medical practice. Modern clinical medicine is founded on a physician’s ability to scrutinize patients through the abstract, dehumanizing gaze of medical knowledge to determine what, if any, intervention is needed.73 What distinguishes the gatekeeping of plastic surgeons is that, for elective surgery, the applicants bring their “illness” to the surgeon’s attention.74 “Someone with a problem seeks someone with a skill,” as one surgeon puts it.75 Prospective patients come to surgeons with complaints about their current body and ideas about how it could be improved. Many surgeons even advocate incorporating an applicant’s self-diagnosis into their pre-surgical consultations, advising colleagues to “emphasize that both [the doctor] and the patient share responsibility for the decision to proceed with surgery and for the surgical outcome itself…. Furthermore, a physician–patient relationship that is egalitarian, rather than authoritarian, must be developed. The surgeon thereby allows the patient to express his [sic] desires, fears, and expectations.”76

Despite such advice, egalitarian relationships between plastic surgeons and surgical applicants exist more in theory than discernible practice. When surgeons listen to someone’s complaints and desires, they do so to see how the patient reveals his or her psychological state more than as an earnest collaboration on medical diagnosis. Consultations favor the surgeon’s authority to the degree that they need not ponder the contradiction between the power they exert and the collaborative atmosphere they claim to provide. “Viewing themselves as ‘healers’ of cosmetic defects and emotional desperation,” observers explain, “plastic surgeons need not interrogate their own psychological necessity for intervening in the appearance of healthy bodies.”77 Ultimately, the burden falls on applicants to perform their roles as patients in a way that will win approval from the adjudicating surgeon. Surgeons continue to exert nearly absolute control over their patient’s surgical futures because they have “the power to deny procedures for which the surgeon believes them to be psycholog- ically or physically unfit.… [The] surgeon ultimately decides if she ‘deserves’ the procedure.”78 Applicants must craft rhetoric that simultaneously articulates a wrong body and a healthy mind.

The complexities of this rhetorical situation have led some to conclude that, “of the various forms of body work, plastic surgery is surely the hardest to justify.”79

Justifying a request for plastic surgery is particularly difficult because surgeons’ evaluations are not based on an agreed-upon standard of a beautiful or normal body. Surgeons attempt to develop a “presurgical baseline of a patient’s body image concerns,” but in terms of shaping the body toward an idealized image, surgeons’

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views of beauty are as subjective as any artist’s.80 Surgeons’ statements that “Beauty, attractiveness, good looks and symmetry are synonymous,” are quickly followed by acknowledgments that “beauty may be in the eye of the beholder.”81 In the context of plastic surgery, the eye of the beholder is the surgeon’s gaze, and the declaration of what counts as beauty, “like so much of plastic surgery, comes down to each surgeon’s personal aesthetic.”82 Despite the surgeon’s subjective interpretation of the body, applicants must find ways to articulate their augmentation desires against a subjective standard over which they have little, if any, influence.

Because of the importance placed on fostering identification with the surgeon’s aesthetic sensibilities, critics report that applicants “know, instinctively, that if in our requests for surgery we don’t act the part of the ‘normal patient,’ we might be turned away.”83 In actuality, there is very little that is instinctive about this knowledge. Instead, a century’s worth of discourse on plastic surgery has educated the public about how to perform the role of an applicant in ways that improve their chances of being granted surgery.84 One successful identification strategy that patients employ is a confessional rhetorical style that provides them with the symbolic resources to characterize themselves as dissatisfied enough with their bodies to desire surgery, but mentally stable enough not to appear obsessed or delusional about body alteration.85 Successfully performing this confessional per- sona is all the more important because surgeons are prone to attribute reports of post-operative dissatisfaction to the patient’s unrealistic expectations or an underly- ing psychosis.86 Surgeons may speak of creating egalitarian consultations, but they are most persuaded by applicants who kowtow to their authority. Adopting this confessional persona often causes embarrassment for applicants, whose willingness “to put themselves through such ordeals is an indication of how great their desire for cosmetic surgery [is].”87

Confession in the surgical context is entelechial, and “a failure to confess … is equated with a refusal of health; a preference for disease.”88 Confessional rhetoric is effective because it evokes sympathetic understandings of ill bodies and appeals to the surgeon’s skill in remolding the outer body into conformity with the inner being, thereby absolving patients of their body image crises.89 If a surgeon is convinced by the rhetorical performance that the patient needs rather than just wants surgery, he or she can consent to approve surgery because a patient is being cured, rather than a client being serviced. Confessing through the language of illness is often used to justify commercial enhancement technologies like plastic surgery, and offers applicants strategies for legitimizing their surgical desires as necessary rather than as spurious interventions into otherwise healthy bodies.90

The language of illness also redefines the surgical act from one of elective or spurious action to a restorative or healing function, which helps plastic surgeons justify their own medical authority. In order for this rhetorical schema to achieve the desired result, the applicant’s “illness” has to be expressed in a particular way. Applicants cannot exhibit the wrong kind of illness or express it in the wrong way or they will be rejected by surgeons who “suspect their patients of trying to solve emotional problems by altering their bodies” and warn their colleagues to reject

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applicants who appear too eager or too desperate.91 What may be gleaned from the intricacies of this situation is that the “illness” of a body in the context of plastic surgery is primarily a matter of an applicant’s rhetorical ability to express their “wrong” bodies in the “right” way.

Wrong Bodies and Right Rhetoric

Existent critical and professional studies, along with numerous popular culture examples, suggest that the most effective schema for prospective patients’ con- fessional rhetoric is to claim that their current bodies are wrong, cause them psychological distress, and require the healing powers of plastic surgery to make them right again.92 This argument for scalpel psychiatry expresses the underlying belief that mental anguish can be relieved surgically by altering the body, demon- strating identification between the applicant’s desires and advertisements that prom- ise “a more harmonic relationship between your self-perception and outer image.”93

Constructed in this way, the body is viewed as the scourge and salvation of the applicant’s overall well-being. Surgical applicants articulate their wrong body claims through descriptions of the “ways in which their physical features have kept them from living ordinary lives” because their bodies are misaligned with their imagined perfection.94 Conjoining notions of a wrong and plastic body is sufficient warrant for surgical intervention and delineates the way that the right body is developed through rhetorical interaction between applicants and surgeons.

Wrong body rhetoric follows the Cartesian juxtaposition of an outer body against an inner self, as well as the hierarchy that the body should follow the mind’s will. The goal for those seeking surgery is not to find a way to accept their bodies, but to make their bodies more acceptable. Applicants argue that although they are comfort- able with their inner self and psychologically stable, their outer body gives a false and harmful impression to others and threatens their emotional health. One surgical applicant described her/his problem by saying, “I look like someone who is always pigging out on cake, but I’m not.”95 A woman seeking a rhinoplasty felt her nose made her look “like a character in an old Italian movie,” and one man feared that his facial features resembled “one of those criminal types.”96 It is common for applicants to describe troublesome body parts as “pieces of flesh which had been imposed upon [them]—inanimate and yet acting against [them].”97 Some applicants speak in terms of the strangeness of their own bodies, such as the woman who claimed that her uneven breasts made her look “half man, half woman.”98 Before her breast reduction surgery, another applicant reported feeling that her large breasts “shouldn’t be there.”99 A participant on the television program Extreme Makeover framed her body as alien in declaring of her pre-operative body: “This is not my body. What’s under my clothes is not the person I know.”100

Wrong body rhetoric enables patients to externalize their complaints while demonstrating their mental competence, as though some outside circumstance were responsible for their bodies. The origins of their body’s wrongness include forces such as fate, time, accident, and lifestyle, but the general grievance is of having an

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unduly ravaged and inappropriate body. Applicants complain about aberrant fea- tures that “ruined the rest” of their body, and seek surgical help to acquire the body they would and should have but for the influence of these other forces.101 This reasoning is exemplified in a statement by Patricia Heaton, a successful television actor and mother of four, in her justification for having plastic surgery: “I had four C-sections and my stomach looked like the map of the world. My breasts were hanging down to here from breast-feeding those babies, and my nipples were like platters. I wanted to fit into the gowns that I finally got to wear.”102 Heaton’s statement adroitly makes use of wrong body tropes. She attributes her disfigurement to surgical scarring (the C-sections) and to maternal wear-and-tear (breast-feeding), both of which portray her as a considerate and sympathetic person deserving a better body. Heaton’s surgery seems reasonable because she has done everything right in her life and yet wound up with a body unable to reap the rewards of her success. To be sure, not everyone has the personal and professional successes of a Patricia Heaton to draw on when articulating what is wrong with their body, but her example is a more extreme form of the pattern developed by plastic surgery promotions and articulated by applicants: people deserve bodies that reflect rather than inhibit their inner selves. This concept of a hidden, right body is a prominent feature of wrong body rhetoric because it enables all bodies, regardless of their current condition, to be understood as wrong but with the inherent potential to become right. Through the rhetorical confession of a wrong body, “plastic surgery becomes … not an act of deception but an attempt to align body with self” and the means by which applicants’ surgical desires are realized.103 Plastic surgery is the cure one seeks for a body that “came out wrong.”104

Articulating the body as wrong coheres with “the idea of authenticity [which] drives much of the language that patients and clients use to describe their use of enhancement technologies.”105 Surgeons themselves decree that, “The best motiv- ation [for plastic surgery] is that of achieving an outer appearance that matches the inner spirit, thereby leading to improved self-esteem and surgical satisfaction.”106 In these terms, individuals who recognize and then confess their wrong bodies are promoting health and well-being, not succumbing to narcissism. Desiring to be healthy and beautiful is discussed as a natural impulse for wrong-bodied persons, and the surgeon’s skill is called upon to expose, not impose, health and beauty by “divining the truth of the [patient’s] body—to make visible [its] invisible depths.”107

Addressing the body as a wrong surface obscuring a natural rightness transforms surgery into a revelatory, almost passive transformation: “When [surgeons] put knife to skin, it is as though they are merely tracing the lines already etched in imagin- ation—following the arcs and angles of beauty that are dormant in the subject, until one day awakened and lifted to the surface by the plastic surgeon.”108 Nature may have made the body, but plastic surgery can make it right.

A century’s worth of published patient testimonials, medical journal articles, consumer guides, commercial advertisements, and television documentaries and docudramas about plastic surgery have shaped cultural knowledge of the body’s plasticity. The implied lesson for those seeking surgical body alteration is that a

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person who appropriately confesses to a wrong body should be able to receive surgical assistance to align their physical and idealized body images. Those who are refused are either psychologically imbalanced or rhetorically deficient. In the next section, I argue that this rhetoric is challenged by amputee wannabes, who articulate their surgical desires through the same discursive frames as mainstream plastic surgery applicants but are denied surgery. Wannabes’ rhetorical efforts and their rejection by the medical community reveal the ideological constraints on the body’s plasticity and the cultural disciplining of the material and imagined body.

Limiting Plasticity: Amputation, Authority, and Acceptance

The rhetoric of wrong bodies has “constructed a pragmatic, sensible, affordable image of cosmetic surgery … [I]n it we see reflected the promise of individual transformation.”109 This promise is manifested in surgeons’ declarations that “the sound conclusion must be that there is no valid reason why anyone should be denied the boon of corrective surgery, even though they are not the victims of disease, accidents, wars, and other disasters.”110 Yet the transformations surgeons promise are not available to all who desire them. Like mainstream plastic surgery applicants, wannabes employ wrong body rhetoric in support of their surgical requests but are far less successful in satisfying surgical gatekeepers. Surgeons make a distinction between the inherent plasticity of bodies and their willingness to alter them. The farther an applicant’s desires are from socially sanctioned body images, the more reluctant surgeons are to make those desires real. Because “it is, generally, not acceptable in our culture to be disabled, let alone have an unexplained desire and want for amputation or disability,” wannabes find themselves in the oppressive position of having to prove not only their surgical worthiness but also the validity of their body alteration desires.111 Their strategies for resolving this situation focus attention on the ways in which particular body images, even before their corporeal actualization, restrict individuals’ ability to speak persuasively about their need for surgical intervention.

The primary impediment for wannabes is to convince the medical community and the general public that the elective amputation of a healthy limb will produce a healthier body. This is a particularly difficult task in a culture that is quick to associate difference from the physical norm with tragic deformity.112 “If people with disabilities are considered anything,” critics contend, “they are or have been con- sidered creatures of disorder.”113 Many popular culture texts represent amputees as villains or morally ambiguous characters who must either be subdued or socially readjusted.114 Positive portrayals of amputees usually emphasize their ability to succeed despite their “handicap.”115 Given these generally negative connotations of amputation, when a person voluntarily amputates a healthy limb, the expectation is that dire circumstances forced them to do so, such as the spelunker who amputated his arm after it became pinned under a boulder.116 Under these circumstances, even suggesting that an amputated body would be preferable to a healthy, full-limbed body would seem to contradict every tenet of cultural body logic. The public and

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medical communities resist the wannabes’ desires precisely because they create disorder, calling into question the implied norm of a whole, healthy body as well as the sanctioned uses of surgical intervention.

Further hindering the wannabes’ rhetorical efforts are publicized accounts of the extremes to which some wannabes have gone in their pursuit of amputation when denied elective amputation by surgeons. Reports describe wannabes intentionally injuring themselves so as to compel surgical amputation, such as using a shotgun to blast off a leg, submerging a limb in dry ice, severing an arm with a homemade guillotine, and illegal, often fatal, back-alley surgeries.117 These accounts paint wannabes into a rhetorical corner. They aptly demonstrate the often suicidal desperation wannabes feel at not being able to receive surgical relief from their wrong bodies and make clear that, “for at least some people with the condition, the desire for amputation is not at all trivial … [but] is so intense and all-consuming that it is ruining their lives.”118 At the same time, these stories raise serious doubts about wannabes’ mental stability and make it easier for surgeons to claim that wannabes need psychiatric rather than surgical assistance. Combating this perspec- tive requires wannabes to engage in rhetorical counter-arguments regarding their public status as surgical candidates and their private desires for bodies that will make them feel whole.

Challenging the Wholeness of the Plastic Body

The public attention given to plastic surgery discourse has made available symbolic resources for wannabes to articulate their body modification desires. Like others desiring body alteration, wannabes buy whole-heartedly into the “surgical solution” and look to the medical community to make good on its promise that wrong bodies can be corrected. Wannabes adapt wrong body arguments to emphasize in even stronger terms the incongruities between their mental body image and their corpo- real reality. Similar to mainstream plastic surgery applicants’ descriptions of a right body lurking beneath the surface of their wrong body, wannabes describe their bodies in terms of superfluous corporeality that needs to be cut away. Wannabes “view their body in a distorted way, disoriented from the way they actually present themselves. They do not like what they have as a body and want to be missing a limb.”119 One wannabe considering a below-the-knee amputation expresses this viewpoint by saying, “This part is not my part…. It is not a part of my leg, not a part of my body.”120 Other wannabes declare, “I will never feel truly whole with legs,” and, “when I see myself as a four-limbed person, I don’t feel incomplete. It’s more a matter of feeling that my body doesn’t entirely belong to me.”121 Another wannabe describes her physical body in terms of superfluous parts: “My legs are extraneous. They shouldn’t be there … it doesn’t feel right that they extend beyond where I feel my body should end…. Legs in any form are not something that feel a part of me.”122 Others identify their rhetoric even more closely with medical discourse on plastic bodies. Baz, another below-the-knee amputee, refers to his surgery as “body correction” and strives for clinical rationality in describing his

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decision, saying, “I have effectively cut my leg off. And I have therefore, to your way of thinking, mutilated myself. But to my way of thinking, what I’ve done is I’ve corrected the body that is wrong.”123

Statements like Baz’s illustrate the ways that wannabes attempt to gain acceptance for their desires by broadening the boundaries of the plastic body. Baz conveys an understanding that his actions may be troubling to others by anticipating the argument that his desire for amputation is symptomatic of some other pathology or psychosis. Drawing from plastic body tropes, he defines his body as being in need of correction even though his leg was healthy. Baz’s rhetoric is echoed by other wannabes attempting to counter the public’s sense of incongruity over their actions. Kevin, one of only two wannabes to date to have received a medically sanctioned, elective amputation, acknowledges, “The paradox is that by taking a leg away, I’m actually made more complete; I’m actually more of a person than I was before.” He offers assurances that he feels satisfied with his decision and his new body: “I’m just normal now. Whatever normal happens to be, I’m probably it. Just relaxed, comfortable, at ease.”124 The baseline for normality is not an abstract understanding of what a healthy body should be, but a rational subject’s reporting of a satisfactory unification between the mind and body, which is what surgeons advertise as the benefits of body alteration procedures. By retaining the stated goal of surgical alteration but redefining the means through which it is evaluated, wannabes attempt to persuade the public and the medical community that their desire for surgical correction is earnest, rational, and legitimate.

Wannabes further parallel mainstream plastic surgery arguments by making use of the rhetorical juxtaposition between their physical and ideal selves to redefine their desire for amputation as a rational response to a pressing need rather than a fanciful whim or mental instability. Amputees insist that they “needed to become an amputee. It was not a wish. It was a need,” and that for them living in a wrong body is “worse than death.”125 By articulating their desire for amputation as a pressing need and the corporeal body as the source of their dissatisfaction, surgical ampu- tation becomes the necessary cure for their illness. As one wannabe points out, the problem does not go away without surgery: “Just knowing it’s peculiar and saying it’s weird doesn’t do away with the problem; it’s still there. You’ve got to deal with it somehow.”126 Wannabes argue that the desire for amputation is not “alien and unwanted” because an amputated body image is “part of who they are.”127 Indeed, part of their pressing need argument is that amputation would allow them to live in the bodies they were meant to have and, as one wannabe put it, “to be myself and live honourably.”128 Such distinctions bolster their claims of mental competence by emphasizing that although they feel oppressed by their bodies, they are not slaves to bodily compulsions.

Wannabes also distinguish their need to live in “their natural body form” from a fetish, sexual or otherwise, and make clear that they would be satisfied with a single operation on a specified body part and would not request additional or continual amputation.129 Wannabes are careful to point out that they do not hate their problematic appendages, nor do they “believe they have a defect in the limb or digit,

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for which they desire amputation.” Instead, wannabes define themselves as “persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves.”130 Specificity is an integral part of wannabes’ arguments for ration- ality in that they “don’t just want to become an amputee; it’s a particular limb, a particular location.”131 Although reluctant to admit it, specificity arguments bring wannabes into alignment with what plastic surgeons “recognize as the perfect surgical candidate. These patients know what they want.”132 Demonstrating a command of their body image desires helps wannabes argue that “a healthy limb amputation is simply an extreme example of persons exercising their right to control their bodies. Surgeons and hospitals are involved only because they are the best places to get safe and tidy amputations.”133 If understood in terms of body autonomy and sanitary alteration, wannabes’ desires are not pathological but responsible choices about reshaping their own bodies.

At the same time, the specificity of wannabes’ rhetoric has potential drawbacks. Although mainstream plastic surgery applicants and wannabes make an effort to distinguish themselves from “scalpel slaves” who continually desire surgical enhance- ments and are reviled by surgeons and the public alike, arguments based on body plasticity work best when the possibility of further modification is present.134

Botched plastic surgeries can be fixed or at least smoothed out, lending credence to the notion that the body’s plasticity can be employed productively. An amputation, however, cannot be reversed, and the finality of the operation creates another obstacle for wannabes because surgeons and the public are reluctant to sanction an irrevocable course of action. Wannabes who have undergone amputation address this concern through “after” statements offered as proof of their happier, regret-free, post-operative lives. George, whose leg was amputated after a self-inflicted shotgun injury, proclaims that his actions, although admittedly drastic, allowed him to “carr[y] out the contents of a lifelong obsession that my leg should be amputated.” After the amputation, he “felt as if transformed…. Because I have realized myself…. I have become whole.” Another amputee describes the feeling of peace resulting from his operation: “The relief, the relief from the fifty years of torment that I’d had, is undescribable [sic].” Others confirm these sentiments, saying, “I felt that a huge weight had been lifted…. That this problem, this weight, had just gone, just melted away.”135 These claims are supported by research on wannabes that reports that, “The few who had managed an amputation seemed … to have made peace with their desires,” and other studies indicating that wannabes respond well to their surgery.136

Because “it is quite feasible for plastic surgeons to mark physical appearances in highly imaginative ways to disconcert, shock, or even disgust others,” the question of whether surgically to alter a healthy body becomes one of rhetorical, rather than technological, efficacy.137 Wannabes’ rhetorical strategies focus on redefining the plastic body to include their notion of a whole body. By aligning their rhetoric with that of mainstream surgery applicants and by offering counter-arguments to the anticipated objections of physicians and the general public, wannabes attempt to gain sympathy and sanction for their body alteration desires. They acknowledge that their requests may appear unusual but argue that they are fundamentally similar to

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the surgeries that millions of other people undergo every year to satisfy similar body modification desires. If surgeons are willing and able to administer scalpel psychiatry in order to achieve cosmetic well-being, then surely it must be acceptable to use the same techniques to grant a tormented person a whole body. Wannabes’ bodies, both as discursive invention and post-amputation substance, are arguments for expanding the concept of the plastic body in which surgeons and society have already invested much of their hopes for personal fulfillment.

Reaction from the Medical Community

Ultimately, wannabes’ quest is to prompt surgeons and society to regard elective amputations as acceptable body alteration desires. During his interview in the documentary Whole, Baz states this goal by looking directly into the camera and saying,

I want you to accept that this condition exists, and that the only way that it can be sorted out is by surgery, by removing the part that that person believes should not be there. And only then can those people be given peace. And, if they’re anything like me, only then can they be given the opportunity to get on with life.138

These pleas have reached a few doctors who have begun to address wannabes sympathetically as legitimate surgical applicants. Dr. Michael First expresses this attitude when he characterizes wannabes as “regular people just like you and I, except they have this one thing going on, and that doesn’t make them crazy.” He goes on to say,

I’m very struck by the amount of suffering. I mean, the people who have it are really, really suffering. As a physician and a psychiatrist it’s my main goal in life to relieve suffering and this is certainly an area where there’s suffering and there’s virtually no answer for these people.139

If one grants that wannabes’ requests stem from an earnest body image complaint, then First’s statements may be understood as tentative acknowledgment of the effectiveness of their rhetorical strategies. He responds to wannabes as ill patients with wrong bodies in need of surgical relief, demonstrating at the very least that such an identification is possible, if not popular.

Doctors like First are a minority, however. Although physicians wish to help wannabes resolve body image issues, particularly without resorting to self-inflicted wounding, most are unconvinced that granting amputations on request is the best method for doing so and admittedly are “baffled by the desire for amputation.”140

Doctors are skeptical of wannabes’ claims and prefer to interpret their desires as symptoms of other psychological conditions, such as childhood neglect or sexual perversion.141 Displacing the origin of the wannabes’ distress from the body and onto the mind also enables surgeons to distance themselves and their medical specialty from these discussions, although this contradicts the Cartesian dualism underlying mainstream justifications for plastic surgery. In medical journals, surgeons advise each other that “amputee wannabes should be encouraged to seek help not from

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surgeons, but from psychiatrists and other mental health professionals.”142 Most surgeons express reluctance even to consider elective amputation until further study and evaluation of the condition has provided clear legal and medical guidelines for treatment.143 Some surgeons have reacted with hostility, chasing wannabes out of their offices upon hearing their amputation requests.144 The amount and type of public attention given to wannabes only adds to surgeons’ reluctance as some have begun to feel the weight of political pressure within their communities. Upon hearing of a surgeon who performed elective amputations on wannabes, a politician called for an official inquiry into the operations and surgical staff, saying, “I find it almost incredible that any reputable surgeon would amputate a perfectly healthy limb.”145 Wannabes’ expressions of their desires have marked them as dangerous and untouchable patients by surgeons and civic leaders alike.

Press reports describing two elective amputation surgeries also illustrate the ways that wannabes are positioned as risky patients who threaten a surgeon’s medical and public standing. The negative characterization of wannabes is evident from the opening summary of events: “A surgeon in Scotland amputated the legs of two psychologically disturbed men who had nothing physically wrong with them but felt a ‘desperate’ need to be amputees.”146 Although factually accurate, the manner in which the wannabes are framed casts doubt on the medical veracity of their illness. Pairing “psychologically disturbed” with “nothing physically wrong” diminishes the possibility of a rational connection between their bodies and their mental anguish. The key term, “desperate,” is set in quotation marks to mark it as a special, non-medical use of the term. This implies that the wannabes’ need is not a typical surgical need and calls into question the surgeon’s reasons for proceeding with the operations. By making it clear that the surgeon consented to amputate only after consulting with psychiatrists regarding the patients’ mental condition, the doctor’s reputation is saved, and he is portrayed as a mindful gatekeeper forced into a troubling decision by these patients.147 The surgeon is then defined nobly as “willing to risk international notoriety to put [each patient] out of his intense emotional pain,” implying that the patients are to be blamed should this surgeon fall into disrepute for having selflessly carried out his humanitarian duty.148 The surgeries are described as successful, but only because it is the surgeon, not the patients, who is satisfied with the outcome, reinforcing the surgeon’s authority over the body’s plasticity and hinting that the patients’ self-evaluations cannot be trusted. “At the end of the day,” the surgeon is quoted as saying, “I have no doubt that what I was doing was the correct thing for those patients.”149 Even though this particular surgeon is sympathetic to the wannabes, these accounts illustrate the rhetorical obstacles that other wannabes face in securing understanding from the medical community and the public, and are warnings to those within the medical com- munity that wannabes bring with them a host of risks in addition to the actual surgery and that a decision to operate will likely face intense public scrutiny.

The difficulty for surgeons, even those who may be sympathetic to the wannabes’ plight, is that elective amputation does not fit readily into traditional body improve- ment schemas, such as the “healthy beauty” achieved through plastic surgery, but

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instead directly contrasts with their understanding of the purpose of surgical correction. Given the strictures of medical ideology, it is difficult for surgeons to believe that amputating healthy limbs could produce a healthier body.150 Surgeons also lack medical precedent for this extreme procedure and are reluctant to set a new precedent with amputees. Even sex reassignment surgery, a once taboo subject that is now discussed in the medical community with relative openness and ease, and is mentioned frequently as a possible analogy for understanding wannabes’ desires, has had little influence on making surgeons more amenable to wannabes’ requests.151

Analogies between sex reassignment applicants and wannabes are dismissed by doctors who argue, “The notion that a [wannabe] is a ‘disabled person trapped in a nondisabled body’ is difficult to justify, there being no ‘naturally-occurring’ state of disability that would correspond to the two naturally-occurring genders.”152

According to this perspective, just as bodies are naturally inclined to be either male or female, bodies are also naturally inclined to be fully-abled, which in this context means having all of one’s limbs. To make the body less than whole is therefore an irrational objective, that jeopardizes the body’s natural disposition. In medical journals and press interviews, physicians inform the public and warn each other that granting elective amputations would place the body in a non-natural state and constitute an improper use of surgical skill.153 By basing their objections on an understanding of a perfect, healthy, natural body as the productive goal of any medical procedure, surgeons avoid speaking out against colleagues who perform mainstream plastic surgeries. They also avoid contradicting previous statements by surgeons about their abilities to triumph over nature because plastic surgery makes otherwise healthy bodies happier and whole, and receive tacit approval from politicians, the medical community, and mainstream body image consumers. For surgeons seeking direction on the issue, the choice between supporting or avoiding wannabes seems a foregone conclusion.

Although clearly not intended to do so, the negative and often unsympathetic reactions to wannabes by the medical community ultimately may reinforce wan- nabes’ belief that their cause would be aided by further rhetorical efforts that address their skeptics. The perception seems to be that, “If wannabes can convince the medical profession that … they suffer from a mental disorder appropriately reme- died by surgery[,] then the courts might consider healthy limb amputations to be legally permissible.”154 This belief has prompted wannabes to speak publicly about their condition and need for surgery, sparking debate and raising awareness of the issue, and emphasizing the importance of understanding the rhetorical underpin- nings of the plastic body in contemporary culture. Wannabes seem to draw inspiration from body rhetoric scholars who observe that, although “the body has thus far remained colonized through the discursive practices of the natural sciences, particularly the discourses of biology and medicine,” there are avenues for rhetorical redefinition and material change. “Although these may represent dominant models for understanding corporeality, they are not incontestable. They may be challenged and superseded by other conceptions.”155 When wannabes argue that amputation is not mutilation but the “correction of a ‘mutilation’—the conversion to what they

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regard as their correct body image,” they are seeking access to the already established and available surgical techniques that “would allow them to become their true selves.”156 This is a promise that surgeons offer to the general public in the form of socially sanctioned cosmetic augmentation. Wannabes are a reminder of the reality that only the chosen few are able to pass through the rhetorical gates of medical discretion based on their narrowly defined concept of a proper plastic body. At the same time, the rhetorical efforts of wannabes are reaching a few sympathetic ears within the medical community and the general public, which may encourage a reconsideration of what counts as a whole body and the role of surgery in helping persons to resolve their body image complaints in an era in which bodies are viewed as plastic.

Conclusion

This analysis sheds light on the role that rhetoric plays in defining and reshaping the human body in a plastic surgery culture. In analyzing plastic surgery discourse, it has not been my intent to argue against imposing any limits on technological, particu- larly surgical, alterations of the human body. Rather, my aim has been to listen empathetically to all aspects of this discursive nexus to discern the possibilities and contradictions involved in the different positions advocated.157 Listening empatheti- cally to the confessional rhetorics of surgical applicants, including wannabes, and to the official and commercial pronouncements of the medical community, makes visible the ways in which bodily plasticity is redefining personal identity and its corporeal performance. This discourse illustrates the ways that bodies are being produced by complex cultural ideologies in addition to technological evolution and conceptions of beauty rampant in popular culture, threatening to turn individuals into surgical automatons. Only when we understand the ways that plastic bodies are rhetorically produced and negotiated can we claim to understand their cultural functions and effects on individual lives and bodies.

“If bodies are objects or things, they are like no others,” critics contend, “for they are the centers of perspective, insight, reflection, desire, agency.”158 I have argued in this essay that the cultural definition of the plastic body is produced rhetorically through a contentious amalgamation of individual desire, cultural knowledge, and institutional disciplining. Although the fulfillment of body image desires is a much heralded and carefully constructed feature of plastic surgery discourse, including those messages coming from the medical community, this plasticity is available only to those who fit within a particular ideological perspective on what constitutes an appropriate body. If “[d]efinitions describe the world, but they do so prescriptively,” then we should expect to find examples of those who, by definition, violate these prescriptions.159 In the case of surgical enhancement, the ways in which the appli- cant’s body is defined give hope to many who feel their bodies are not as they should be, but also leave many others dissatisfied and frustrated when surrounded by messages about a possible cure that they cannot access. Those who challenge this definition of a healthy and whole body risk personal scrutiny, institutional marginal-

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ization, and, in many instances, public condemnation. This risk extends to appli- cants and physicians and illustrates the limitations placed on who can speak about body plasticity and how they can speak about it. What is revealed is that the body may be plastic, but the ideology informing its cultural production is less so.

The surgically modified body embodies cultural notions of physical health and beauty, ownership of the self, and physical appropriateness. For this reason surgeons are wary of granting atypical requests. The bodies on which they operate become medical testimony to the plasticity of bodies and their acceptable alterations. A surgeon’s decision to grant or refuse a request for surgical alteration necessarily becomes a public statement regarding the entelechy of the human form as well as a response to an individual applicant. Consequently, when wannabes challenge the scope of plasticity, they are arguing not only for their individual rights to their own bodies and psychological well-being, but they also are redefining how the body is known and understood in society. Wannabes argue that if the psychological goal of healing the mind through resculpting the body is the aim of plastic surgery, then that promise should hold for any image of the body, even those which fall outside the traditional aesthetic boundaries.

To be sure, not every request for surgical alteration should be granted. At the same time, a rhetorical analysis of the ways that the definition of a wrong body is constructed and maintained by the medical community raises the possibility that some who might benefit from surgery may never receive it. Even for those whose desires fit within the acceptable parameters of correcting a wrong body, the process of acquiring surgical enhancement can be an embarrassing ordeal that contradicts the picture of easy acquisition and personal empowerment portrayed through surgeons’ public statements. This is a troubling circumstance and suggests that current methods of surgical gatekeeping would benefit from rethinking, as would the ways in which plastic surgery is marketed as an uncomplicated solution to individual body image concerns. Furthermore, requiring surgical enhancement desires to be couched in terms of individual psychology is not only demeaning, but ultimately paradoxical. If psychological distress is the primary requirement for being granted surgical relief, then wannabes seemingly would have no trouble demonstrating their need for surgery. These individuals exhibit obvious psychological anguish stemming from a difficulty in resolving their mental and physical body images, but their requests, expressed in language nearly identical to mainstream plastic surgery patients, are rejected because the body they seek to produce does not accord with the current medical thinking about a healthy and whole body. Yet applicants desiring shorter toes or prettier belly-buttons are deemed to have the proper motivation. Psychological distress is not the primary requirement for plastic surgery; it is merely its public excuse.

Although it is important to understand how cultural standards of body image pressure individuals toward normative alterations, it is equally important to recog- nize that these cultural norms are shifting as a result of rhetorical, political, and technological influences. Recent developments in surgical body alteration, such as the Botox phenomenon and numerous designer cosmetic surgeries, suggest that

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plastic surgery’s rhetorical and corporeal visibility in the public sphere will only be enhanced, with the likely result that an increasing number of people will look to surgical alteration as the means to acquire the bodies they desire. Even if there is little horizontal expansion of the meaning of the plastic body and its appropriate surgical enhancement, the vertical extension of current definitions of the healthy body continues to push the boundaries of the “natural” body. Indications of such extension are expressed in the concerns of genetics scholars who point to logics stemming from plastic surgery’s advocacy of a better body as influencing arguments that genetic engineering might produce a better baby, and “scientists have already begun rewriting the genetic body-text through the manipulation of genes.”160 The argument is premised on the notion that if scalpel psychiatry is socially sanctioned for adults with body image issues, then it would be even better to genetically engineer a perfect baby who would never have to deal with these issues.161 Although a host of issues currently prevents this notion from becoming a reality, that it can be mentioned as a possibility demonstrates the extent to which body plasticity has permeated cultural thinking about the human body and is a call for further inquiry into ideologies informing the public’s knowledge of the human body and how this knowledge is articulated. It is likely that we will see more public arguments about the plasticity of the human body at all its life stages and the role medical science will play in its development. As researchers contend, “enhancement technologies, whatever their putative benefits and demonstrated risks, will have significant space in our future.”162

Notes

[1] See Margo Demello, Bodies of Inscription: A Cultural History of the Modern Tattoo Community (Durham, NC: Duke University Press, 2000); Armando R. Favazza, Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry (Baltimore, MD: Johns Hopkins University Press, 1996); Kim Hewitt, Mutilating the Body: Identity in Blood and Ink (Madison, WI: Popular Press, 1997); Victoria Pitts, In the Flesh: The Cultural Politics of Body Modification (New York: Palgrave Macmillan, 2003); Jennifer González, “The Appended Subject: Race and Identity as Digital Assemblage,” in Race in Cyberspace, eds. Beth E. Kolko, Lisa Nakamura, and Gilbert B. Rodman (New York: Routledge, 2000), 27–50; and John W. Jordan, “(Ad)Dressing the Body in Online Shopping Sites,” Critical Studies in Media Communication 20 (2003): 248–268.

[2] Surgical augmentation procedures are known by a variety of names: plastic surgery, cosmetic surgery, reconstructive surgery, aesthetic surgery, and others. Each describes non-vital surgical intervention primarily for aesthetic purposes. Throughout this essay, I use the term “plastic surgery” as a general descriptor of these augmentation procedures. I take my cue from the several medical, academic, and popular texts that use the term “plastic surgery” as an umbrella term for the other augmentation techniques. The American Society for Plastic Surgeons, for instance, places cosmetic and reconstructive surgeries under the heading of “plastic surgery,” and emphasized this usage when in 1999 the organization changed its official name from “The American Society of Plastic and Reconstructive Surgeons” to “The American Society of Plastic Surgeons.” See “History of Plastic Surgery, ASPS and PSEF,” http://www.plasticsurgery.org/History.cfm; Michael Ciaschini and Steven L. Bernard, “History of Plastic Surgery,” http://www.emedicine.com/plastic/topic433.htm;

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and Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore, MD: Johns Hopkins University Press, 1997), 4.

[3] Virginia L. Blum, Flesh Wounds: The Culture of Cosmetic Surgery (Berkeley, CA: University of California Press, 2003), 52. On the history of medical perspectives on the body’s malleability, see Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New York: Vintage, 1973/1994); Michel Foucault, Discipline and Punish: The Birth of the Prison (New York: Vintage, 1977/1979), 135–194; Tony Hunt, The Medieval Surgery (Rochester, NY: Boydell Press, 1999); and Barbara Maria Stafford, Body Criticism: Imaging the Unseen in Enlightenment Art and Medicine (Cambridge, MA: MIT Press, 1991), 47–129. Haiken’s Venus Envy is a history of corporeal malleability specific to U.S. plastic surgery.

[4] Carole Spitzack, “The Confession Mirror: Plastic Images for Surgery,” Canadian Journal of Political and Social Theory 13 (1988): 40.

[5] See Kate Kelly and Shelly Branch, “Agony of the Feet: If the Shoe Fits, What’s the Point?” Wall Street Journal, 8 August 2003, A1; Clive Thompson, “The Year in Ideas; Umbili- coplasty,” New York Times, 15 December 2002, 131; Lynda Gorov, “The Latest Fad from La-La Land: A ‘Designer Vagina’,” Boston Globe, 23 August 1999, C1; and Jon Stratton, The Desirable Body: Cultural Fetishism and the Erotics of Consumption (Urbana, IL: University of Illinois Press, 1996), 128–9.

[6] James Kavanagh defines ideology as “a social process that works on and through every social subject,” and shapes human understanding and meaning making; I use the terms “ideology” and “ideological” in that sense. As John M. Sloop explains, ideology “refers to the process by which knowledge of self and of the world is created, maintained, and assumed.” Different people, institutions, and communities can participate in and generate ideological perspectives on a given subject, and these perspectives often interact in the public sphere. Some rhetorical scholars, such as Trevor Parry-Giles and Shawn J. Parry-Giles, have written about “ideological rhetoric” that “helps shape and order the cultural meaning” of social institutions, concepts, and artifacts. In Trevor Parry-Giles and Shawn J. Parry-Giles, “The West Wing’s Prime-Time Presidentiality: Mimesis and Catharsis in a Postmodern Ro- mance,” Quarterly Journal of Speech 88 (2002): 209. See James H. Kavanagh, “Ideology,” in Critical Terms for Literary Study, ed. Frank Lentricchia and Thomas McLaughlin (Chicago, IL: University of Chicago Press, 1990), 311; and John M. Sloop, “Ideology,” in Unspun: Key Concepts for Understanding the World Wide Web, ed. Thomas Swiss (New York, NY: New York University Press, 2000), 88

[7] Josephine Johnston and Carl Elliot, “Healthy Limb Amputation: Ethical and Legal Aspects,” Clinical Medicine 2 (2002): 431.

[8] On the importance of textual assemblage to rhetorical criticism, see Raymie E. McKerrow, “Critical Rhetoric: Theory and Praxis,” Communication Monographs 56 (1989): 101.

[9] Rhetorical criticism is well-suited to discussing the ways in which symbolic and material borders influence public action. As Kent A. Ono and John M. Sloop argue, rhetoric shifts the ideological positions of borders, “changing what they mean publicly, influencing public policy, altering the ways borders affect people…. Rhetoric shapes understandings of how the border functions; taken further, because of its increasingly powerful role, rhetoric at times even determines where, and what, the border is.” See Kent A. Ono and John M. Sloop, Shifting Borders: Rhetoric, Immigration, and California’s Proposition 187 (Philadelphia, PA: Temple University Press, 2002), 5.

[10] Wallace H. J. Chang, “Plastic Surgery—A Brief Perspective,” in Fundamentals of Plastic and Reconstructive Surgery, ed. Wallace H. J. Chang (Baltimore, MD: Williams and Wilkins, 1980), 3. See also Haiken, Venus Envy, 5.

[11] Thomas C. Shevory, Body/Politics: Studies in Reproduction, Production, and (Re)Construction (Westport, CT: Praeger, 2000), 175; Marilyn Yalom, A History of the Breast (New York: Ballantine, 1997), 159.

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[12] As Thomas J. Darwin points out, “The way a body is articulated in a given paradigm of healing has direct entailments for the treatment of patients.… [A] paradigm of medicine or healing must ground itself in a coherent rhetoric of the body which explains how the body works, what the nature of disease is, and thus how best to care for the body.” Thomas J. Darwin, “Intelligent Cells and the Body as Conversation: The Democratic Rhetoric of Mindbody Medicine,” Argumentation and Advocacy 36 (1999): 35.

[13] Plastic surgery is a ubiquitious discursive phenomenon in contemporary culture, constitut- ing the primary topic of several television shows, books, and the lead stories of many popular press magazines. See Domeena C. Renshaw, “Body Dysmorphia, the Plastic Surgeon and the Psychiatrist,” Psychiatric Times (July 2003): 64.

[14] See Adalbert G. Bettman, “Plastic and Cosmetic Surgery of the Face,” Aesthetic Plastic Surgery 12 (1920/1988): 5; Jennifer Herendeen Brown, “The History of Plastic Surgery: From Ancient India to Modern America,” Bulletin of the American College of Surgeons 71 (1986): 21; and Ciaschini and Bernard, “History of Plastic Surgery.”

[15] Quoted in Deborah A. Sullivan, Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America (New Brunswick, NJ: Rutgers University Press, 2001), 35.

[16] Tagliacozzi’s exuberance was viewed by the Roman Catholic Church as heretical effrontery, and after his death his corpse was exhumed and reburied in unconsecrated ground as a sign of his disgrace. Brown, “The History of Plastic Surgery,” 22.

[17] One individual who confounds this narrative, mentioned in the American Society of Plastic Surgeon’s history, is Dr. John Peter Mettauer, who in 1827 performed the first cleft palate surgery in the United States, using surgical instruments he had made. He seems to have been isolated in his accomplishments, as the next moment discussed in the ASPS history is World War I, which is acknowledged as the moment when plastic surgery became legitimized. See “History of Plastic Surgery, ASPS and PSEF.”

[18] See Haiken, Venus Envy, 44–90. [19] Haiken, Venus Envy, 259. Gardner notes that some medical practitioners attempted to

develop means for restoring physical appearance, such as surgical repairs and specialized prosthetics, but their efforts were not widespread. See Kristen E. Gardner, “Hiding the Scars: History of Breast Prostheses after Mastectomy since 1945” in Beauty and Business: Commerce, Gender, and Culture in Modern America, ed. Philip Scranton (New York: Routledge, 2001), 310.

[20] Peter A. Adamson and Warren M. Kraus, “Management of Patient Dissatisfaction with Cosmetic Surgery,” Facial Plastic Surgery 11 (1995): 102.

[21] Foucault argues that the medical gaze is not reductive, ignoring elements of a subject until it finds an essential core; instead, it is a generative capacity that produces the body as a whole subject that admits to no other epistemological possibilities. It is the sole means by which patients’ bodies become visible, and therefore knowable, to medicine. In order for surgeons to see the body differently, their knowledge of the body itself must be changed. See Foucault, The Birth of the Clinic, xiv.

[22] See Robert M. Goldwyn, “Forward,” in Fundamentals of Plastic and Reconstructive Surgery, ed. Wallace H. J. Chang (Baltimore, MD: Williams and Wilkins, 1980), viii; and Haiken, Venus Envy, 259.

[23] “History of Plastic Surgery, ASPS and PSEF.” See also Haiken, Venus Envy, 15, 29–43; and Sheila M. Rothman and David J. Rothman, The Pursuit of Perfection: The Promise and Perils of Medical Enhancement (New York: Pantheon, 2003), 103-4.

[24] Sullivan, Cosmetic Surgery, 40. [25] Charles Illingworth, “Forward,” in Ian A. McGregor, Fundamental Techniques of Plastic

Surgery and Their Surgical Applications (Baltimore, MD: Williams and Wilkins, 1965), v. [26] Illingworth, “Forward,” v. As Gilman points out, disreputable knowledge often gains

legitimation by adopting a “more complex and ‘scientific’” rhetorical style. See Sander L. Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery (Princeton, NJ: Princeton University Press, 1999), 11.

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[27] The first line in the American Society of Plastic Surgeons’ “History of Plastic Surgery” states that “Mankind’s [sic] essential nature entails self-improvement.… Because human beings have always sought self-fulfillment through self-improvement, plastic surgery—improving and restoring form and function—may be one of the world’s oldest healing arts.” This history significantly omits references to outlaw surgeries in ancient India as well as the 19th century quack doctors, offering instead a linear narrative of enlightened scientific progress. See “History of Plastic Surgery, ASPS and PSEF.” An additional example demonstrates plastic surgery’s rhetorical legitimization within medicine. The same hubristic rhetoric that warranted Tagliacozzi’s desecration has been reframed as a progressive statement about individual entitlement and the plastic surgeon’s desire and capacity to do good works. The American Society of Plastic Surgeons displays Tagliacozzi’s (in)famous quotation, cited previously, as the introduction to their informational webpage on reconstructive surgery techniques. See “Reconstructive Surgery,” http://www.plasticsurgery.org/public education/ procedures/ReconstructiveSurgery.cfm.

[28] Kathy Davis, Reshaping the Female Body: The Dilemma of Cosmetic Surgery (New York: Routledge, 1995), 16.

[29] Sullivan, Cosmetic Surgery, 45. [30] Davis, Reshaping the Female Body, 18. [31] Lois Mattox Miller, “Surgery’s Cinderella,” Independent Woman (July 1939): 202. [32] Gilman, Making the Body Beautiful, 294. [33] Carl Elliot, Better than Well: American Medicine Meets the American Dream (New York: W.

W. Norton and Co., 2003), 47. [34] Shevory, Body/Politics, 171. [35] Davis, Reshaping the Female Body, 28–9. [36] Debra L. Gimlin, Body Work: Beauty and Self-Image in American Culture (Berkeley, CA:

University of California Press, 2002), 78. The American Society of Plastic Surgeons (ASPS) estimates that 6.6 million people underwent cosmetic enhancement procedures (both surgical and non-surgical) in 2002, and paid fees in excess of seven billion dollars. Although the majority of these procedures, 4.9 million, were non-surgical (such as Botox injections and chemical peels), 1.6 million people had surgical cosmetic procedures, an increase from 2001. The top five surgical procedures were nose reshaping, liposuction, breast augmen- tation, eyelid surgery, and facelift. The trend over the past decade shows a significant increase in the number of plastic surgeries performed. From 1992–2002, the number of people who had plastic surgery nearly tripled, the number of breast augmentation surgeries increased sevenfold, and liposuctions quadrupled. The ASPS tracks only those procedures performed by member plastic surgeons, making a comprehensive account of the total number of cosmetic surgical procedures virtually impossible to obtain. See American Society of Plastic Surgeons, “National Clearinghouse of Plastic Surgery Statistics,” http:// www.plasticsurgery.org/public education/statistical trends 92to01.cfm.

[37] Elizabeth Grosz defines Cartesian duality in the context of the body as “the assumption that there are two distinct, mutually exclusive and mutually exhaustive substances, mind and body, each of which inhabits its own self-contained sphere.” She also points out that this duality favors the mind as the superior partner that dominates the body. See Elizabeth Grosz, Volatile Bodies: Toward a Corporeal Feminism (Bloomington, IN: Indiana University Press, 1994), 6.

[38] Gilman, Making the Body Beautiful, 270. [39] See Anne Balsamo, “On the Cutting Edge: Cosmetic Surgery and the Technological

Production of the Gendered Body,” Camera Obscura 28 (1993): 207–37; Blum, Flesh Wounds; Susan Bordo, “‘Material Girl’: The Effacements of Postmodern Culture,” Michigan Quarterly Review 29 (1990): 653–77; Gimlin, Body Work; Kathryn Pauly Morgan, “Women and the Knife: Cosmetic Surgery and the Colonization of Women’s Bodies,” Hypatia 6 (1991): 25–53; Spitzack, “The Confession Mirror” and Naomi Wolf, The Beauty Myth: How Images of Beauty are Used Against Women (New York: William Morrow, 1991).

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[40] Nathan Stormer, “Embodied Humanism: Performative Argument for Natural Rights in ‘The Solitude of the Self’,” Argumentation and Advocacy 36 (1999): 51.

[41] On the difficulty of communicating bodily trauma as a source for rhetorical articulations of the body, see Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1985), 161–80.

[42] Judith Butler, Excitable Speech: A Politics of the Performative (New York: Routledge, 1997), 5.

[43] Gerard A. Hauser, “Incongruous Bodies: Arguments for Personal Sufficiency and Public Insufficiency,” Argumentation and Advocacy 36 (1999): 1; Kevin Michael DeLuca, “Unruly Arguments: The Body Rhetoric of Earth First!, Act Up, and Queer Nation,” Argumentation and Advocacy 36 (1999): 10. See also Davis W. Houck and Amos Kiewe, FDR’s Body Politics: The Rhetoric of Disability (College Station, TX: Texas A&M University Press, 2003), 4; and James C. Wilson and Cynthia Lewiecki-Wilson, “Disability, Rhetoric, and the Body” in Embodied Rhetorics: Disability in Language and Culture, ed. James C. Wilson and Cynthia Lewiecki-Wilson (Carbondale, IL: Southern Illinois University Press, 2001), 2–4.

[44] DeLuca, “Unruly Arguments,” 10. [45] Hauser, “Incongruous Bodies,” 2; DeLuca, “Unruly Arguments,” 20. [46] DeLuca, “Unruly Arguments,” 12. See also Donna Haraway, Simians, Cyborgs, and Women:

The Reinvention of Nature (New York: Routledge, 1991), 298. [47] Darwin, “Intelligent Cells,” 35. [48] Hauser, “Incongruous Bodies,” 5. [49] Donald C. Bryant, “Rhetoric: Its Functions and Its Scope,” Quarterly Journal of Speech 39

(1953): 413. [50] Blum, Flesh Wounds, 271. [51] Andrew Herman, The “Better Angels” of Capitalism: Rhetoric, Narrative, and Moral Identity

among Men of the American Upper Class (Boulder, CO: Westview Press, 1999), 6. [52] Vincent Mosco, “Webs of Myth and Power: Connectivity and the New Computer Technop-

olis,” in The World Wide Web and Contemporary Cultural Theory, ed. Andrew Herman and Thomas Swiss (New York: Routledge, 2000), 42.

[53] Christine L. Harold, “Tracking Heroin Chic: The Abject Body Reconfigures the Rational Argument,” Argumentation and Advocacy 36 (1999): 66.

[54] Grosz, Volatile Bodies, xiii. [55] As my concern is the public representations of plastic body rhetoric, my sources for

statements from surgeons, patients, and other members of the discursive community are taken from published or publicly available texts.

[56] See Sullivan, Cosmetic Surgery, 131–54. [57] Balsamo, “On the Cutting Edge,” 216; Blum, Flesh Wounds, 83. [58] Adalbert G. Bettman, “Plastic and Cosmetic Surgery of the Face,” Aesthetic Plastic Surgery

12 (1920/1988): 5, 7. [59] Quoted in Morgan, “Women and the Knife,” 31. [60] Gimlin, Body Work, 74; Mary Ruth Wright, “The Elective Surgeon’s Reaction to Change and

Conflict” in Plastic and Reconstructive Surgery of the Head and Neck, Vol. 1: Aesthetic Surgery, ed. Paul H. Ward and Walter E. Berman (St. Louis, MO: C. V. Mosby Co., 1984), 525.

[61] James W. Smith and Samm Sinclair Baker, “Doctor, Make Me Beautiful!” (New York: David McKay Co., 1973), 16, 3; Morgan, “Women and the Knife,” 32.

[62] Blum, Flesh Wounds, 272. [63] Blum, Flesh Wounds, 52; quoted in Blum, 4. [64] Renshaw, “Body Dysmorphia,” 64. [65] Blum, Flesh Wounds, 275. [66] Blum, Flesh Wounds, 106. [67] Smith and Baker, “Doctor, Make Me Beautiful!”, 14.

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[68] Bordo, “Material Girl,” 656, 657. [69] Goldwyn, “Forward,” vii. [70] Renshaw, “Body Dysmorphia,” 64. [71] David Silverman. Communication and Medical Practice: Social Relations in the Clinic

(London: Sage, 1987), 162. [72] Michael A. Bolton, Thomas Pruzinsky, Thomas F. Cash, and John A. Persing, “Measuring

Outcomes in Plastic Surgery: Body Image and Quality of Life in Abdominoplasty Patients,” Plastic and Reconstructive Surgery, 112 (2003): 619.

[73] Foucault, The Birth of the Clinic, 8. [74] Davis, Reshaping the Female Body, 2. [75] Goldwyn, “Forward,” vii. [76] Adamson and Kraus, “Management of Patient Dissatisfaction with Cosmetic Surgery,” 99. [77] Blum, Flesh Wounds, 13. [78] Gimlin, Body Work, 11. See also Balsamo, “On the Cutting Edge,” 209; and Blum, Flesh

Wounds, 275. [79] Gimlin, Body Work, 78. [80] Bolton et al., “Measuring Outcomes in Plastic Surgery,” 619. [81] Renshaw, “Body Dysmorphia,” 64. [82] Blum, Flesh Wounds, 291. [83] Blum, Flesh Wounds, 274. [84] One role science plays in society is that of educator, using rhetorical communication not

only to translate science into everyday language but also to communicate scientific values about how the world ought to be and how people should comport themselves. See Thomas Lessl, “The Priestly Voice,” Quarterly Journal of Speech 75 (1989): 183–97.

[85] See Spitzack, “The Confession Mirror.” [86] See Bolton et al., “Measuring Outcomes in Plastic Surgery.” [87] Davis, Reshaping the Female Body, 72. [88] Spitzack, “The Confession Mirror,” 39. [89] Elliot, Better than Well, 13. [90] See Balsamo, “On the Cutting Edge,” 216; and Haiken, Venus Envy, 6. [91] Gimlin, Body Work, 81. See also S. Anthony Wolf, John W. Devine, Jr., and D. Ralph

Millard, Jr., “Cosmetic Surgery,” in Fundamentals of Plastic and Reconstructive Surgery, ed. Wallace H. J. Chang (Baltimore, MD: Williams and Wilkins, 1980), 262. Foucault also notes that medicine historically has used psychiatric considerations as a means to police “public hygiene.” Michel Foucault, Abnormal (New York: Picador, 2003), 199. These warnings, although medically and legally prudent, contradict surgeons’ self-proclaimed egalitarianism and reassert their own authority over an applicant’s body.

[92] Sullivan, Cosmetic Surgery, 64. [93] Quoted in Blum, Flesh Wounds, 72. [94] Gimlin, Body Work, 97. [95] Quoted in Davis, Reshaping the Female Body, 71. [96] Quoted in Sanjay Gupta, “Ethnic Makeovers,” Time (6 October 2003): 88; quoted in Davis,

Reshaping the Female Body, 71. [97] Davis, Reshaping the Female Body, 74. [98] Quoted in Davis, Reshaping the Female Body, 77. [99] Quoted in Davis, Reshaping the Female Body, 77.

[100] Quoted in Extreme Makeover, ABC Television, September 18, 2003. Chuck Bangert, Lou Gorfain, and Howard Schultz, producers.

[101] Davis, Reshaping the Female Body, 76. [102] Quoted in “Nipped, Tucked, Talking,” People (1 September 2003): 102. See also Patricia

Heaton, Motherhood and Hollywood: How to Get a Job Like Mine (New York: Villard, 2002), 157–158.

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[103] Gimlin, Body Work, 95. [104] Blum, Flesh Wounds, 2. [105] Elliot, Better than Well, 30. [106] Adamson and Kraus, “Management of Patient Dissatisfaction with Plastic Surgery,” 100. [107] Balsamo, “On the Cutting Edge,” 209. [108] Blum, Flesh Wounds, 38. For some surgeons, the yearning to resculpt seems almost

compulsory. During an interview, one surgeon suggested that the researcher should have plastic surgery because “the skin you were meant to have is buried underneath the surface and unfortunately people cannot see it.” See Spitzack, “The Confession Mirror,” 47.

[109] Haiken, Venus Envy, 300. [110] Smith and Baker, “Doctor, Make Me Beautiful!”, 17. [111] Gregg M. Furth and Robert Smith, Amputee Identity Disorder: Information, Questions,

Answers, and Recommendations about Self-Demand Amputation (Bloomington, IN: 1st Books, 2002), 66. I draw my use of the notion of “oppression” from Butler’s argument that “discourse becomes oppressive when it requires that the speaking subject, in order to speak, participate in the very terms of that oppression—that is, take for granted the speaking subject’s own impossibility or unintelligibility.” See Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990), 116.

[112] See Renshaw, “Body Dysmorphia,” 64; and Sarah S. Jain, “The Prosthetic Imagination: Enabling and Disabling the Prosthesis Trope,” Science, Technology, and Human Values 24 (1999): 31–54.

[113] Lennard J. Davis, Enforcing Normalcy: Disability, Deafness, and the Body (New York: Verso, 1995), 143.

[114] See Paul K. Longmore, “Screening Stereotypes: Images of Disabled People in Television and Motion Pictures,” in Images of the Disabled, Disabling Images, ed. Alan Gartner and Tom Joe (New York: Praeger, 1987), 66–72.

[115] See Bruce Feldman, “Amputee Parry Makes Historic Return,” ABCNews.com, http://abc- news.go.com/sections/sports/DailyNews/ESPNFeature1.html?0919855; and Katherine M. Skiba, “Optimism Sustains Local Soldier Who Lost Legs,” JSOnline.com, http:// www.jsonline.com/news/state/sep03/167076.asp.

[116] See “Lessons Learned,” ABCNews.com, http://abcnews.go.com/sections/GMA/US/ climber 030608.html.

[117] See Whole, produced and directed by Melody Gilbert, Frozen Feet Productions, 2003. James H. Burnett III, “South Side Man Uses Homemade Guillotine to Sever Arm,” Milwaukee Journal Sentinel, 7 October 1999, 3; and Jennifer Trueland, “Investigation After Limbs Amputated on Demand,” The Scotsman, 31 January 2000, 1.

[118] Johnston and Elliot, “Healthy Limb Amputation,” 432. See also Cherry Norton, “Disturbed Patients Have Healthy Limbs Amputated,” The Independent, 1 February 2000, 13; and Furth and Smith, Amputee Identity Disorder, 6.

[119] Furth and Smith, Amputee Identity Disorder, 29. See also Richard L. Bruno, “Devotees, Pretenders and Wannabes,” Sexuality and Disability 15 (1997): 257.

[120] Quoted in Whole. All quotations from the documentary Whole were obtained from a transcription made by the author from a videotape copy of the original film.

[121] Quoted in Elliot, Better than Well, 213; quoted in Whole. [122] Quoted in “Complete Obsession,” BBCi, http://www.bbc.co.uk/science/horizon/1999/obses-

sion script.shtml. [123] Quoted in Whole. [124] Quoted in Whole. [125] Quoted in Whole; Furth and Smith, Amputee Identity Disorder, 44. [126] Quoted in Whole. [127] Johnston and Elliot, “Healthy Limb Amputation,” 432.

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[128] Quoted in John Money, “Paraphilia in Females: Fixation on Amputation and Lameness; Two Personal Accounts,” Journal of Psychology and Human Sexuality 3 (1990): 167.

[129] Furth and Smith, Amputee Identity Disorder, 68. See also Richard L. Bruno, “Devotees, Pretenders and Wannabes: Two Cases of Factitious Disability Disorder,” Sexuality and Disability, 15 (1997): 257.

[130] Furth and Smith, Amputee Identity Disorder, 5. [131] Quoted in Whole. [132] Blum, Flesh Wounds, 280. [133] Johnston and Elliot, “Healthy Limb Amputation,” 433. [134] See Balsamo, “On the Cutting Edge,” 220–1; Bordo, “Material Girl,” 656; Davis, Reshaping

the Female Body, 5; and Sullivan, Cosmetic Surgery, 65. [135] Quoted in Whole. [136] Elliot, Better than Well, 216. See also Furth and Smith, Amputee Identity Disorder, 30–35;

and Johnston and Elliot, “Healthy Limb Amputation,” 431. [137] Shevory, Body/Politics, 194. [138] Quoted in Whole. [139] Quoted in Whole. [140] Elliot, Better than Well, 209; see also Furth and Smith, Amputee Identity Disorder, 74. [141] The condition is frequently referred to by medical specialists as either “body dysmorphic

disorder,” which is a harmful psychological fixation on a particular body part that the person feels is defective or deformed, or “apotemnophilia,” which describes individuals who desire to have a body part amputated, although usually for reasons of sexual gratification. See Furth and Smith, Amputee Identity Disorder, 5; Elliot, Better than Well, 209–10. Those who have studied the phenomenon argue that neither term is particularly apt as a descriptor for the wannabes’ condition. Similarly, the use of the term “apotemnophile,” although common in the literature, has been criticized because of its connotations of sexual disorder or fixation, such as its closely related term “acrotomophilia,” which is used to describe those who have a sexual attraction to amputees. See Elliot, Better than Well, 210; Johnston and Elliot, “Healthy Limb Amputation,” 431; and John Money, Russell Jobaris, and Gregg Furth, “Apotemnophilia: Two Cases of Self-Demand Amputation as a Paraphilia,” Journal of Sex Research 13 (1977): 115–25. Popular press accounts often conflate the two without discussing the possibility of desiring amputation for non-sexual reasons. See Tracey Lawson, “Therapist Praises Doctor’s ‘Bravery’,” The Scotsman, 1 February 2000, 11. Because of these associations, some have offered alternative terms to describe the phenomenon, such as “body integrity identity disorder” and “amputee identity disorder.” In the existent literature, however, the more accepted linguistic path has been a redefinition of apotemnophilia to describe “a syndrome in which individuals believe they belong in a body that is missing a limb or a digit, or, in other words, a body different from their four normal limbs.” See Furth and Smith, Amputee Identity Disorder, v, 29.

[142] Johnston and Elliot, “Healthy Limb Amputation,” 434. [143] See Johnston and Elliot, “Healthy Limb Amputation,” 432; Pennie Taylor, “’My Left Foot

Was Not Part of Me’,” The Observer, 6 February 2000, 14. [144] Furth and Smith, Amputee Identity Disorder, 43. [145] Quoted in Norton, “Disturbed Patients have Healthy Limbs Amputated,” 13. [146] Clare Dyer, “Surgeon Amputated Healthy Legs,” British Medical Journal 320 (5 February

2000): 332. [147] See Taylor, “ ‘My Left Foot Was Not Part of Me’,” 14; Trueland, “Investigation After Limbs

Amputated on Demand,” 1. [148] Taylor, “My Left Foot Was Not Part of Me’,” 14. [149] Dyer, “Surgeon Amputated Healthy Legs,” 332. [150] See Furth and Smith, Amputee Identity Disorder, 10.

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[151] See Furth and Smith, Amputee Identity Disorder, 6, 10; Elliot, Better than Well, 221; Johnston and Elliot, “Healthy Limb Amputation,” 433–4; Suzanne J. Kessler, “The Medical Construc- tion of Gender: Case Management of Intersexed Infants,” Signs: Journal of Women in Culture and Society 16 (1990): 3–26; and John M. Sloop, “‘A Van with a Bar and a Bed’: Ritualized Gender Norms in the John/Joan Case,” Text and Performance Quarterly 20 (2000): 130–49.

[152] Bruno, 251. [153] Bruno, 257–259; Furth and Smith, 70; Elliot, 230; and Johnston and Elliot, 432–434. [154] Johnston and Elliot, “Healthy Limb Amputation,” 432. [155] Grosz, Volatile Bodies, x. [156] Furth and Smith, Amputee Identity Disorder, 30; Johnston and Elliot, “Healthy Limb

Amputation,” 432. [157] On empathy as a critical rhetorical lens, see Celeste M. Condit, “The Critic as Empath:

Moving Away from Totalizing Theory,” Western Journal of Communication 57 (1993), 178–90.

[158] Grosz, Volatile Bodies, xi. [159] Edward Schiappa, Defining Reality: Definitions and the Politics of Meaning (Carbondale, IL:

Southern Illinois University Press, 2003), 169. [160] Wilson and Lewiecki-Wilson, “Disability, Rhetoric, and the Body,” 17. [161] See Glenn McGee, The Perfect Baby: A Pragmatic Approach to Genetics (Lanham, MD:

Rowman and Littlefield Publishers Inc., 1997), 118; and Rothman and Rothman, The Pursuit of Perfection, 208–12.

[162] Rothman and Rothman, Pursuit of Perfection, 207.

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