Cultural Influences
The public is assaulted continually with a barrage of articles in newspapers, fashion magazines, and self-improvement books about plastic surgery and the “miracles” that can be achieved by the physical reworking of one's body. Health columnists in community and national newspapers publicize any new procedure possible on faces, hips, and breasts—no matter how incremental or untested. Advertisements for colored contact lenses, permanent eyeliner, collagen injections, leg veins, and liposuction fill the back pages of Sunday newspaper magazine sections. While one may shake his or her head ruefully and dismiss all of this as postmodern folly, we cannot ignore the antiquity and ubiquitous nature of invasive procedures done for personal beautification.
The art of body enhancement by making physical change is described in most primitive groups and essentially all of the higher cultures. Tribesmen in Brazil wear disks and plugs as jewelry in perforated and progressively stretched lips and earlobes. Scarification of the skin as a method of beautification or a mark of distinction is commonplace in African tribes. In ancient Athens, women bound their chests tightly to produce atrophy of the breasts since the small, firm breast was associated with poise and grace. In Chaucer's day, the voluptuous breast was found only on peasants, and women of the upper class resorted to continuous chest binding to produce breast wasting. From this small sampling of hundreds of instances of manipulation of the appearance, it becomes clear that not only are people prepared to embark on physical interventions but also this is not done to meet an objective standard of beauty. Beauty is in the eye of the beholder, and man's concept of ideal beauty seems to be relative and heavily influenced by his cultural environment.
In addition to varying from culture to culture, and from society to society, concepts of beauty are dynamic and change over time. In America, the idealized female face has changed form the soft, round, baby-doll features of the 1930's to the more angular and strong face we see in today's attractive woman. The idealized male face has gone from the chiseled-looking, pencil-mustached matinee-idol regularity of Tyrone Power or Clark Gable to the far-from-classic unkempt looks of Brad Pitt or Johnny Depp. And even as society at large changes its perceptions of its “ideal” or most attractive members, so do the individual members adjust the context in which they see themselves.
Defining Body Image
For each of us, our own appearance becomes part of a complex psychological abstraction called body image. To explain why changing the external appearance affects personality and behavior, we need to define body image and review the complex psychological reactions that occur after an operation that alters the size or shape of a body part. 3
Body image has been defined as the mind-body relationship; the subjective perception of the body as seen through the mind's eye; or the psychological effects of what a person looks like. In 1935, Schilder, the first major student of body image, described it as a tridimensional scheme of one's own body involving interpersonal, environmental, and temporal factors. He talked about the influences that contribute to body image development. These include what our bodies look like. They also include what people say about how we look, our reactions to these inputs, where and how we grew up, and when certain key events happened. As an example, consider a young woman with a large, prominent nose. If she is a Jewish or Armenian girl from a close-knit, positive thinking, ethnically proud family, her feelings about her nose may be quite different from those of a Swedish girl of the same age who is the only female in her family not to have an attractive, refined, feminine nose. Or consider that within a certain family, certain characteristics may be valued or despised. Being told that you look just like your grandmother is an image booster if your grandmother was a legendary favorite known for her warmth and charm. Your feelings might be quite different if she was a wretched, ill-tempered woman disliked and avoided by her children. People's reactions to having familial, ethnically normative, or even a celebrity's features are colored in this way by feelings about the individual in question. Because of this, body image is, by definition, subjective. We cannot know how someone else feels about his or her body based on an evaluation of his or her objective appearance. Similarly, changes in appearance are “improvements” only if a patient evaluates them as such.