Foreword: Reconstructing Myself
Upon being asked what I am doing for conference work, I instantly clam up. My mind races: how am I going to concisely explain what I’m writing about without launching into an intellectually-fueled ten minute discussion? And indeed, this is usually what happens. Truth be told, I have wanted to write this paper for some years now, but never had the chance. I established the thesis almost accidentally three years ago; while writing a paper on psychosomatic illness and the placebo effect for a psychology course, I skimmed over a section delving into gynecological surgeries of the late 19th century. It was then that I made the mental connection linking this obscure chapter of surgical history to the ever-present quandary of cosmetic surgery. However, throughout the span of this course, Surgically and Pharmacologically Shaping Selves, I’ve had to reevaluate my previous attitudes on cosmetic surgery — something, I confess, I was very ignorant about. Many times I was forced to expand my paradigms by being plunged into first-person accounts of ‘being born in the wrong body’ and the subsequent path to reclamation of the body and self through surgical or pharmacological means. This veritable “quest” on the road to authenticity is not endured only by transsexuals, by those seeking to alter their appearance via cosmetic surgery, or by those who undergo extreme body modification, but by each and every one of us in this individualistic world. We all struggle and come to terms with our own respective identities sooner or later, no matter what means or experiences it takes us to get there. And so, by way of this course, I have been able to reconstruct my own attitudes on surgical and pharmacological interventions by being able to embrace the various facets of each side of the arguments for and against them.
Introduction: Modern Times
In our modern society, it has become a commonplace occurrence for womento “go under the knife” and receive breast augmentation surgery.1 Popular women’s magazines contain advertisements which tout the better life — the life that could be — awaiting those who finally decide to take the operative plunge. Their glossy pages are splashed with picture upon picture of fashionable celebrities, who oftentimes endorse and undergo cosmetic surgery themselves, as they are undeniable social pillars of beauty and image. Not surprisingly, nearly three quarters of a million American women will undergo some cosmetic surgical procedure this year, with nearly 300,000 for breast implants alone.2 In her book Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Kathy Davis states that through cosmetic surgery women are “[provided] an avenue toward becoming an embodied subject rather than an objectified body.”3 Davis listens to many women reveal personal testimonies of both life pre-operation, and life post-operation, and in doing so lends a voice to these women that are so often muted. By way of these accounts, she suggests that women who endure cosmetic surgery are able to reestablish their identities, becoming more of the woman that they have always wanted to be and therefore more functional members of society. Although I do not directly refute this viewpoint, I believe there is much to be concerned about in these staggering figures and statistics. Why do more and more women feel the need to surgically enhance themselves?
Perhaps what is most frightening about the escalation of cosmetic surgery is how it echoes a virtually unknown chapter in gynecological history. In the latter part of 19th century America, it was common for women afflicted with hysterical symptoms to have their ovaries surgically removed, in a procedure formally known as “Battey’s operation.”4 Superficially, it seems as though these two separate circumstances hold no relation at all. After all, breast enhancement is a cosmetic procedure, one that is administered solely to affect the external appearance of the recipient, whereas Battey’s operation initially seems to have been administered specifically to improve the physical health of the patient. However, before we can delve deep into the similarities and differences of these situations, it is necessary to examine the social climate that pervaded in the age of Battey’s operation.
Uterine Considerations in the 19th Century: “It is Almost a Pity That Woman Has a Womb.”
Before sophisticated knowledge of female anatomy, the uterus was believed to be not a regular bodily organ, but a live animal.5 With the onset of the medical age, and the formal crystallization of the fields gynecology and obstetrics, came more refined explanations. Between 1850 and 1900, reflex theory became one of the dominant medical models of nervous disease. Reflex theory held that nervous connections running via the spine regulated all bodily organs quite independently of human will.6 In a decidedly unscientific and even obsessive manor, a direct reflex arc was established from the uterus and other reproductive appendages to the brain. Reflex theory thus represented a conjunction of medical theories that reduced women to the status of automata regulated by their uteri, and the cultural prejudices of the time saw women as womb-centered and more passive than men. Aptly, upon addressing a medical society in 1870, Hubbard, a professor from New Haven, remarked that it seemed “as if the Almighty, in creating the female sex, had taken the uterus and built up a woman around it.”7 And so the uterus and associated reproductive organs, so essential to womankind, were apparently highly perilous possessions to bear. In 1860 William Byford, a prominent professor of gynecology at the University of Chicago, was moved to publicly announce, “ It is almost a pity that woman has a womb.”8
Consequently, it is easy to recognize how an entire school of psychiatrists (known as alienists at the time) and gynecologists would argue that the reproductive organs were the direct cause of hysteria and insanity in women. It would only be a matter of time before an operative “cure” would be fashioned. In one of the most audacious leaps taken in nineteenth century medicine, gynecologists would begin operating on their patients to cure hysteria and insanity in an era that knew no antibiotic drugs against infection and that took cursory precautions with surgical cleanliness.9 On August 17, 1872, Robert Battey10 of Rome, Georgia, performed the world’s first “normal ovariotomy”11 — the removal of healthy ovaries — on a patient who had exhibited hysterical symptoms: “epileptiform convulsions, semi-coma, pulmonary congestion, acute articular rheumatism.”, etc.12 After recovering from the surgery, all nervous phenomena had vanished from the patient.13 Initially, Battey took pains to point out that the ovaries excised were often “diseased” and thus their extirpation justifiable. However, the indications for castrating the patients were undoubtedly psychological and, as Battey said, were “long protracted physical and mental suffering, dependent upon monthly nervous and vascular perturbation.”14 Repeatedly, he rearranged these indications to include “neuro-psychiatric (insanity and epilepsy) and sexuologic (nymphomania) disorders, amenorrhea ‘without discoverable disease of the ovaries’, and even ‘certain incurable inflexions of the uterus.”15 Indeed, the procedure became run-of-the-mill not only by both the nation’s gynecological elite and small-town surgeons, but also in asylums for the insane. Asked in 1900 whether they agreed that “malformations and traumatisms of the female genital apparatus [are] the causes of insanity,” all but one of the American asylum superintendents polled answered in accordance.16
Had they not been so widespread, these operations might have remained a mere footnote in the larger scheme of surgical history. However, Battey’s operation was a prevalent and frequently performed procedure in America. In fact, gynecological surgeries had become so widespread in this timeframe that in October 1866 an anonymous physician wrote to the medical press: “To such an extent [have these] operations been preformed that it will soon be somewhat rare to meet with a woman whose sexual organs are entire.”17 Just how many Battey’s operations were carried out in the United States? In the absence of an official registry, it is difficult to speculate the total number of operations performed, but a considerable amount occured. Statistically, in the 1889 edition of the Index-Catalogue of the Library of the Surgeon-General’s Office, United States Army, 51 percent of all articles concerning oophorectomies were based on mental and nervous disorders alone, and 42 percent of those recorded in the 1907 edition.18 By the 1890’s, Battey’s operation had reached proportions of a “panacea”, an “epidemic rage”, a “thriving industry”, and continued to be employed in spite of the backlash that had begun.19 Undoubtedly, to a great extent it was the flagrant abuse of the procedure and its performance for questionable indications that soon led to its loss of favor, doubled with further knowledge of the female reproductive system and the gradual realization that ovaries are precious organs after all.20
Linking Excised Ovaries to Augmented Breasts: The Desire for an Operation
A direct consequence of the widespread use of Battey’s operation was that the procedure garnered much exposure. Subsequently, urban as well as rural physicians employed the operation. Forums of gynecologists, such as the Chicago Gynecological and New York Obstetrical Societies, recorded cases and discussed their indications and merits. Social class distinctions played an obvious role in who received the operation. Most of the patients were from the middle and upper class and were “rich enough to afford a gynecologist, and all seem to have been non-workers, home-bodies… and quite a few were bed-ridden.”21 Some reports included gleaming testimonials from patients to boost recommendation of the procedure. For instance, the observation of one patient:
No pen can write the sufferings I endured in the five years previous to my operation. At times I became almost desperate enough to take my life and end my sufferings… My life now seems a new one, and I am getting along splendidly… I am now a well, happy, and cheerful girl, and do not feel like the same person at all.22
In contrast, many reports appeared to be more cautionary. In particular, one doctor who had three patients die following the procedure noted the mortality rate —33% of all cases reported — and the fact that only another third seemed to be improved significantly.
Regardless of the content, it was these reports and case studies that were circulated in medical journals, and likewise circulated orally to women far and wide. The mainline publication of American gynecologists and obstetricians, The American Journal of Obstetrics, from its founding in 1869 up to World War I, was filled with numerous articles praising and reporting gynecological surgeries.23 As a result, women with the means to do so began scheduling appointments with gynecologists and demanding that, no matter what the price, they perform the “life changing” operation on them at once. This became such a prevalent practice that there exist many documented cases of gynecologists cautioning their colleagues about operation-seeking women. For example, Carl Backhaus, a Leipzig gynecologist, warned in 1901 at a professional meeting that “we have learned that women –– and this applies absolutely to hysterical ones –– are psychically heavily influenced by the news that something is not quite right with the genitals. Such women tend to drift from one gynecologist to the next [and] are ready for every operation.”24 By seeking out the ‘surgical fix’, women patients coalesced the various ill-defined sensations that plagued them into a fixed diagnosis and sought out surgical help on the basis of these self-diagnoses. This desire to seek out this surgical intervention seems to stem directly from the grip of reflex theory, and the subsequent smorgasbord of pelvic operations on women administered in the name of it. Battey’s operation had become a fashionable procedure that only the most well to do could afford.
Many parallelisms can be drawn from both situations. The first lies in the nature of the surgical procedures themselves: they both involve altering a specific, highly feminine body part in response to some problem of a psychogenic origin. By “psychogenic origin,” I am implying that both respective procedures involve a deep psychological suffering relating to a physiological problem. This is not to say that hysterical symptoms and the suffering a woman goes through pre-breast surgery are exactly the same, but that there is a resemblance between the two. Take, for instance, the testimony of Elizabeth, a thirty-six year old woman deliberating breast augmentation surgery:
You’re dissatisfied with your life and so of course you keep sinking deeper and deeper into this hole… When it came to being too thin, I could always tell myself not to make a fuss: “Quit complaining!” But this –– it’s something you’re confronted with every day. If you are already feeling depressed, it just takes so much longer to pull yourself out of it.25
Compare that to the recorded testimony (via a gynecologist’s case-study) of a forty-year-old mother of three in 1885:
A lady friend… she calmly and deliberately made up her mind to have her offending organs removed. I demurred, and begged her to stand it for five years longer, until nature would come to her rescue in change of life. She replied that she had stood it just as long as she could, and that, unless she obtained relief, she would be in her grave or an insane asylum in less than a year.26
Within both accounts there is an unmistakable degree of suffering that each woman endured pre-operatively. Rudolph Schindler, a German physician, best describes this situation in 1925:
These are the unhappiest individuals, trapped in a horrifying milieu, their lives filled with burdens, torment, and lack of appreciation –– and therefore mainly women. They see, unconsciously of course, in an operation the only possibility of finding rest, maybe even sympathy and respect.27
This was in response to the plight of women who displayed mania operatoria passiva –– the German term for the fervent need to be operated on, but can easily be applied to the contemporary woman who seeks numerous cosmetic surgery procedures. It is interesting to note, however, that the forms and origins of pain are different in each case. For the woman of the late 19th century demanding gynecological surgery, she first has a psychological disruption, and subsequently manifests this in somatic, physical symptoms whereas a modern woman demanding breast augmentation surgery first develops a problem with a physical aspect of herself (her breasts), then manifests this psychologically. Nevertheless, the deemed mode of allaying the attested pain of both patients was through surgical means. Essentially, both patients are seeking an operation that will “fix” their respective problems.
Both ordeals exhibit the reconstruction and medicalization of the American female body, from one context to another. In order to fully pick apart this statement and make additional comparisons, a further understanding of the respective social contexts that encompass both episodes is crucial.
Women and Hysteria
Nineteenth-century America is a very intriguing period in history. It was during this time frame that hysteria moved to center stage. Hysteria, that elusive malady, came to be seen as the Pandora’s box to impenetrable riddles of existence.28 Topping them all, of course, was the mystery of women. The medical profession’s reaction to the hysterical woman was ambivalent at best. As the eminent gynecologist Samuel Ashwell wrote in 1833: “Few practitioners desire the management of hysterics. Its symptoms are so varied and obscure, so contradictory and changeable, and if by chance several of them, or even a single one be relieved, numerous others almost immediately spring into existence.”29 This resentment seems rooted in two factors: first, the baffling nature of hysteria itself, and second, the relation that existed in the physicians’ minds between their categorizing hysteria as a disease and the role women were expected to play in society.30 The nineteenth century provided one socially respectable, nondeviant role for women: that of loving wife and mother. Therefore women, who presumably came in various psychological and intellectual shapes and sizes, had to settle in one prescribed social role, one that demanded continual self-abnegation and a desire to please others.31 Who can doubt that, in an age where sex and childbirth involved very real threats to the health and life that some women would use the pretext of being “delicate” as a way not only of escaping household labor, but of also evading bedroom duties? Indeed, poor health in women had become positively fashionable and was exploited by its victims and practitioners as an “advertisement of genteel sensibility and an escape from the too pressing demands of bedroom and kitchen.”32 Popular journals and literature from 1840-1900 consistently emphasize that a large number, even the majority, of middle-class American women were in some sense ill. In an 1866 book titled Letters to the People on Health and Happiness, Catherine Beecher, a pioneer in women’s education and hygiene, not only stressed that many American women in the middle and upper ranks were sick, but also implied that they were ill precisely because they were women. Most ailments were regarded as symptoms of “female complaints” — nervous disorders thought to be linked with the malfunctioning of feminine sexual organs.33
As a result, women most often related their nervous illnesses to their female bodies. This set off a virtual ball-and-chain in the interaction between the patient and the doctor of the nineteenth century. General practitioners and specialists had to account for women’s reproductive organs within their theories of insanity and nervous disease because women themselves related their emotional problems to reproductive dysfunction. Before sophisticated diagnostic techniques, women patients’ self-reported symptoms and perceptions of causes formed the primary data of medical theorizing.34 Thus, a cultural norm was established through this patient-physician discourse. If a woman was experiencing any nervous disorder, her reproductive organs were clearly to blame; subsequently, the cure to these ailments resided in the surgical alteration (or as we have encountered, the surgical excision) of these offending organs. The expression of hysterical symptoms was decidedly unfeminine: these women patients did not function as expected. Hysterical and insane women were described as antimaternal, selfish, willful, violent, erotic –– all of these unacceptable in terms of nineteenth century definitions of womanhood.35 Therefore, it was the urgent surgical intervention that was required to become a more authentic woman, and the necessity to once again fill the accepted social role. The great exposure and availability of Battey’s operation only facilitated and ultimately aided in the establishment of its status as a societal norm, and a ‘fashionable’ cure that was to be sought out at any expense –– be it fiscal or mortal.
Breasted Experience
For many, if not all, American women, breasts are an integral component of the body and self-image; a woman may love them or loathe them, but rarely is she indifferent. Breasts are a prominent and highly visible sign of a woman’s femininity, and function as a virtual indicator of sexuality. It is no wonder that women often feel judged and evaluated according to their size and contours: much more than a man’s, a woman’s chest is in question in this society and has not escaped the condition of being problematic.36 It is therefore easy to see how breast augmentation surgery could flourish solely in response to this predicament. In fact, many women choose to undergo this procedure simply because they feel they don’t “measure-up.” Take, for example, Abbey’s account:
I guess I just wanted to feel that I was attractive to other people –– men. Because I always saw other girls walking down the beach, and saw a man looking at her, and thought, ‘Well, no one’s going to look at me because I’m flat as a board.” And I wanted to try on clothes and not have to worry about if the top part fit right… I just wanted to look like a person who did grow breasts.37
The primary, resonant, motive on the desire to endure cosmetic surgery throughout the testimonies of women is that the breasts belie the self within the body. There are other reasons women give for making the decision for surgery, which include the representation of one’s self accurately, and to increase social opportunities in the workplace.38 Even so, women commit themselves to these surgeries to achieve a level of normalcy based on their perceptions of who they are as well as what others expect from women in general. This is perhaps where Davis’ individual-oriented viewpoint falls short the most. By way of the agency required to select a doctor and undergoing the operative procedure, a woman clearly is constructing an embodied self, liberating herself from the former, less than satisfactory self. However, anyone who makes any bodily alteration ––whether wearing makeup, dying hair, dieting, exercising, getting pierced or tattooed, or having cosmetic surgery –– is invariably influenced by the wider society in which one lives.39
As the statistics prove, an ever-increasing number of women are resorting to breast augmentation surgery. These surgical interventions are not a mere stroll in the park; they can result in infection, bleeding, unfavorable scar formation, bodily rejection of the implant, and excruciating pain derived from the body’s encasing and hardening the implant –– many of these adverse aftereffects can leave the body in much worse physical condition, and can in some cases, result in death.40 Outside of individuals’ personal motives for receiving cosmetic surgery, there are many important questions that need to be raised. Where do these women get their ideas of what breasts should look like? What factors influenced them in their desire for cosmetic surgery? Where did they get the idea to have breast augmentation to achieve the bodies they desire? What factors influenced them as they made their decisions to have the surgery performed? The clear-cut answers to these questions lie within the enveloping social climate. Social forces, such as the media and the fashion industry, bombard women on a daily basis, and therefore establish societal beauty norms –– the need to be thin, the need to be tall, or in this case, the need to have larger breasts. Just as in the case with hysteria in the nineteenth-century, the more women who undergo breast augmentation surgery, the more that the surgical fix becomes, in itself, a societal norm, almost to the extent that “women who contemplate not using cosmetic surgery will increasingly be stigmatized and seen as deviant…”41
In Conclusion: The Love of Knives
Both examples of surgical interventions for women chiefly involve the medicalization of the female body. First, a woman approaches a doctor, explicitly with the demand of an operation, and a self-diagnosis of a principal problem that jeopardizes her feminine nature. In the ensuing patient-doctor discourse, a discrete pathology of the female body is established (defective sexual organs/small, unsightly breasts) based on the doctor’s compliance, and agreement to the surgery. If the respective surgeries are not fraught with complication, and are successful, then the woman has effectively cured her problem and become a much more authentic woman in her respective social context.42 Perhaps the largest difference amongst the two episodes is that one has effectively become extinct, while the other is thriving. In light of this distinction, should we think of breast augmentation and cosmetic surgery in general as the new Battey’s operation? No, not necessarily. Throughout time, women have become quite acquainted with ‘healing’ knives.43 Given the current set of social beauty norms, women are going to continue to seek surgical intervention as long as they can spare the fiscal and physical expense. Societal norms would have to completely shift for these practices to ever be considered wholly “unfavorable” by the masses. This does, however, leave room for much concern. In the words of George Bernard Shaw, Irish playwright, in 1911:
There are men and women whom the operating table seems to fascinate: half-alive people who through vanity… or the craving to be the constant objects of anxious attention or whatnot, lose such feeble sense as they ever had of the value of their own organs and limbs. There is in the classes who can afford to pay for fashionable operations a sprinkling of persons so incapable of appreciating the relative importance of preserving their bodily integrity… that they tempt surgeons to operate on them not only with huge fees, but with personal solicitation.44
These almost prophetic words hold firm to this very day.
Notes
1 This is not to say that men do not also undergo any sort of elective cosmetic surgery, because they certainly do. I, however, will be focusing on women in this paper.
2 Nowalk 2006.
3 Davis, 114.
4 There are a slew of other gynecological operations being performed in this timeframe as well. Other female reproductive organs, such as the uterus and clitoris, were also excised, but were most often done in adjunct with Battey’s operation.
5 Shorter (1992), 52.
6 Shorter (1992), 40.
7 Wood, 29.
8 Wood, 32.
9 Shorter(1992), 73.
10 At the time, Battey was considered one of the foremost surgeons in the south. He later would hold chair of professor of obstetrics at the Atlanta Medical College, and was a founding member of the American Gynecological Society—- a group of the most prestigious gynecological surgeons in the United States at the time. Longo, 246.
11 It was Battey’s colleague, James Marion Sims, the founder of gynecology in America, who in 1877 proposed that the procedure be called “Battey’s operation”. Shorter, 75.
12 Theiry,4.
13 Note: It is intriguing to read all of the operations that were relatively “successful”. This phenomenon alludes to the psychosomatic nature of hysteria in women in this time frame—- the patients believed the operation had “cured” them. Shorter (1992), 75.
14 Longo, 250.
15 Thiery, 5.
16 Shorter, 80.
17 Shorter, 84.
18 Shorter, 78.
19 Indeed, records of Battey’s operations exist up until 1921. Barker-Benfield, 60.
20 Longo, 260.
21 Barker-Benfield, 62.
22 It is shocking how much this resembles a positive testimony of the current post-opt recipient of breast augmentation. Longo, 256.
fn23.
24 Shorter,
25 Davis, 75.
26 Shorter, 88.
27 Shorter, 90.
fn28 Hysteria can be classified as what Carl Elliot would refer to as a “transient mental illness”: a mental illness that resides within a specific “ecological niche”. Clearly the social climate of the nineteenth-century was ripe for hysteria to flourish. for more see Better Than Well, pgs 227-230.
29 Smith-Rosenberg, 203.
30 Smith-Rosenberg, 202.
31 Smith-Rosenberg, 213.
32 Wood, 27.
33 Wood, 28.
34 Theriot, 23.
35 Theriot, 17.
36 Young, 152.
37 Gagné & McGaughey, 823.
38 Davis, 73-91.
39 Gagné & McGaughey, 827.
40 Morgan, 165.
41 Morgan, 165.
42 Ironically, in both scenarios it would seem the other way around: The hysteric is castrated and can no longer bear children, and the contemporary woman receives two inorganic bags of goop where healthy breasts once were…
43 Morgan, 165.
44 Shorter, 90.
Works Cited
Barker-Benfield, Ben. “The Spermatic Economy: A Nineteenth Century View of Sexuality.” Feminist Studies, Vol. 1, No. 1. Summer 1972, pp. 45-74.
Davis, Kathy. Reshaping the Female Body: The Dilemma of Cosmetic Surgery. Routledge: New York & London. 1995.
Elliot, Carl. Better Than Well: American Medicine Meets the American Dream. W.W. Norton Co., NY& London. 2003.
Gagne, Patricia; McGaughey, Deanna. “Designing Women: Cultural Hegemony and the Exercise of Power Among Women who have Undergone Elective Mammoplasty.” Gender and Society, Vol.16, No.6, December, 2002. Pp. 814-838.
Longo, Lawrence D. “The Rise and Fall of Battey’s Operation: A Fashion in Surgery.” Bulletin of the History of Medicine, Vol. 2, No. 53. Summer 1979, pp 244-267.
Morgan, Kathryn Pauly. “Women and the Knife: Cosmetic Surgery and the Colonization Of Women’s Bodies.” In The Politics of Women’s Bodies: Sexuality, Appearance, & Behavior. Second Edition. Ed. Rose Weitz. Oxford University Press: New York, Oxford. 2003. Pp 164-183.
Nowalk, Rachel. Cosmetic Surgery Special: When Looks Can Kill. 19 October, 2006.
Shorter, Edward. From Paralysis to Fatigue: A History of Psychosomatic Illness In the Modern Era. The Free Press: NY,NY. 1992.
Smith-Rosenburg, Carrol. Disorderly Conduct: Visions of Gender in Victorian America. Alfred A. Knoph Inc.: New York, 1985.
Theriot, Nancy M. “Women’s Voices in Nineteenth-Century Medical Discourses: A Step Toward Deconstructing Science.” Signs. Vol. 19, No. 1, Autumn 1993. pp 1-33.
Thiery, Michel. “Battey’s Operation: An Exercise in Surgical Frustration.” European Journal of Obstetrics and Gynecology and Reproductive Biology. Vol. 81, No. 2, 1 December 1998. pp 243-246.
Wood, Ann Douglas. “‘The Fashionable Diseases’: Women’s Complaints and Their Treatment in Nineteenth-Century America.” Journal of Interdisciplinary History, Vol. 4, No.1, The Historian and the Arts; Summer 1973, pp 25-52.
Young, Iris Marion. “Breasted Experience: The Look and the Feeling.” In The Politics of Women’s Bodies: Sexuality, Appearance, & Behavior. Second Edition. Ed. Rose Weitz. Oxford University Press: New York, Oxford. 2003. Pp 152-163.