The Resurrection of the Body

By

Flesh Wounds:The Culture of Cosmetic Surgery

By Virginia L. Blum

(University of California Press, 356 pp., $29.95)

Click here to purchase the book.The Pursuit of Perfection: The Promises and Perils of Medical
Enhancement

By Sheila M. Rothman and David J. Rothman

(Pantheon Books, 292 pp., $25)

Click here to purchase the book.

Our Own Devices: The Past and Future of Body Technology

By Edward Tenner

(Alfred A. Knopf, 314 pp., $26)

Click here to purchase the book.

I.

Once upon a time, the life of the mind required the renunciation of
the body. Professors, like their monkish predecessors, were assumed
to inhabit a world of bloodless abstraction, remote from the messy
animality of muscle, flesh, and bone. This was the
cloud-cuckoo-land that Jonathan Swift satirized as Laputa in
Gulliver's Travels. For two centuries to come, novelists populated
their work with spectral scholars, from Casaubon in Middlemarch to
the Shakespearean pedants in Ulysses. Professors were pallid
figures, it seemed, inert to the rhythms of bodily experience and
"dead from the waist down," in Robert Browning's withering phrase.

How times have changed. While libidinous academics have become
familiar characters in fiction and in film, professors themselves
have discovered that "the discourse of the body" is central to the
discourse of the humanities. Intellectuals, for so long assumed to
be indifferent to their bodies, now seem able to talk of little
else. For centuries the body had to be content with bit parts and
supporting roles in the drama of cultural history, a victim of
Cartesian prejudice; but in the past two decades it has taken the
lead as a locus of meaning where struggles are constantly fought
out. Hundreds of articles and monographs dissect the body's
significance as an arena for social performance, a site for the
assertion of personal identity.

In part, this preoccupation is a sign of the times. Scholarly
fashions parallel popular obsessions, and seldom has the body been
loaded with so much cultural freight as in the contemporary United
States. Ordinary Americans may be grayer and flabbier than ever,
but they are also surrounded by more images of conventional
perfection, which is made all the more attainable (or so it seems)
by plastic surgery, hormone replacement therapy, and other
"enhancement technologies." A recent issue of Newsweek presented
"The Perfect Face," presumably embodied by the stunning but robotic
cover girl, "supermodel Saira Mohan," who is "part Indian, part
French, and part Irish." Inside we learn "How a Global Standard of
Beauty Is Emerging and What People Are Doing to Get It." The people
in question turn out to be Asian women, who are undergoing multiple
plastic surgeries to lengthen their faces and make their cheeks more
angular. Though the obligatory reference to Mohan's multicultural
ancestry blends exoticism and political correctness, the "global
standard" turns out to be once again culturally coercive, and once
again Western.

Tarted up in the latest fashions and harnessed to the latest
technologies, the pursuit of physical perfection is, of course, not
new. On both sides of the Atlantic, tabloid media have been
trotting out perfect faces and bodies for more than a century, from
the "professional beauties" of the Edwardian stage to the
live-action Barbies of the current modeling scene. But body worship
has an especially complex history in American culture. From the
earliest colonial times, the Protestants who shaped our mainstream
morality shared a deep distrust of surface effects. Beauty was
proverbially "only skin deep," and true perfection was an inward
state--one that the godly aspired to but only fitfully attained.
Officially, the perfectionist project locked the individual in
combat with his baser impulses, in the sight of God alone. But even
the most fervent Protestants could not help but suspect that a
successful inner struggle might reveal itself to human observers.
Under the gaze of the righteous community, the pursuit of
perfection became a public performance--not a theatrical
performance, since that would have conjured the specter of
insincerity, but a performance of hard and highly visible work. The
Protestant ethic created lives of constant self-correction,
pervaded by a preoccupation with will, choice, and moral
responsibility.

By the early nineteenth century, the perfectionist project began to
encompass flesh as well as spirit. In a secularizing commercial
society, the Calvinist heritage of self-distrust became focused on
the body as well as the soul. The body was not only a timeless
temple of the soul, a spiritual subject, but an object, too--a
thing to be tinkered with, maintained, and improved. Patent
medicine advertisers urged their customers to worry as much about
the state of their bowels as the state of their souls, and to long
for physical as well as moral regeneration. The rise of a modern
market society, pervaded by anonymous transactions and dominated by
large corporations, made a conventionally pleasing physical
appearance ever more essential to success.

The advertising industry has reinforced this imperative. Since the
early twentieth century, advertisers have encouraged Americans to
fear the fateful effluvia of a badly managed body--bad breath and
body odor, flatulence and five o'clock shadow. The reward for good
management was perpetual adolescence-- personified now for nearly
half a century by beach-bound boys and girls swilling Pepsi and
slipping into dangerous transports of ecstasy. In the terminally
hip world of global capitalism, even youth culture is old hat; but
the ritualized exuberance obscures persistent anxiety. In the social
universe created by advertising and mass media, as in the righteous
communities of old, the individual is under constant surveillance;
self-scrutiny complements the appraising gaze of others. The
pursuit of physical perfection is charged with moral meaning, and,
as in Puritan times, the pilgrim's work is never done.

So bodies have carried meaning for a long time, in America as
elsewhere. Why intellectuals have only recently noticed this is an
interesting question. Certainly the body's symbolic importance
intensified as other sites of significance slipped away. Though
Americans have been lamenting the decline of community ever since
William Bradford set foot on Plymouth Rock, there is no doubt that
social ties loosened with the resurgence of laissez-faire
individualism in the last several decades. Workplaces, families,
churches, neighborhoods--the places where meanings are made--became
more difficult for many Americans to find or to sustain. Amid
increasing mobility and anonymity, the body was left to take on
heavier cultural burdens.

But there was also a political dimension to the discourse of the
body, especially on the academic left. The outpouring of
scholarship on the body reflected the shrinkage of social hope and
the rise of identity politics. These developments contained a
fundamental contradiction. Scholars of cultural studies
deconstructed the natural, arguing that such allegedly immutable
categories as race and sex were socially constructed, not
biologically given. Yet even while blackness or femaleness was
exposed as a mere construction, the experience of being black or
female was promoted to the core of one's moral and intellectual
authority. In a typical graduate seminar, one could find students
both denying and insisting on the significance of bodily markers
such as sex organs and skin color. Sometimes these were the same
students. The body was at once an all-important source of identity
and a curiously phantasmic ideological creation.

The triumph of the discourse of the body marked the ascendancy of
Foucault as the chief theorist of power for what remained of the
left. In many ways this was a great leap forward from liberationist
simplifications. Like Tocqueville and the Frankfurt School
Marxists, Foucault saw the instruments of social discipline amid
the din of democracy--the capacity of elites to depoliticize
dissent by persuading the populace that they wanted to do what they
had to do anyway. He recognized that the rhetoric of liberation
concealed subtle forms of coercion, which could shape social
relations in the most apparently private settings. From Foucault's
view, the rise of "sexual science" at the turn of the last century
displaced the supposed darkness of ages past with sharper divisions
between normality and pathology, as coercive in their claims to
scientific neutrality as God-centered moralism had been. The key to
the success of this new "regime of truth" was the manipulability of
language: under the aegis of Enlightenment, compulsion nearly
always masqueraded as choice.

In Foucault's world, there was a multitude of sites where the
powerful defined reality and their subordinates accepted (or
contested) that definition: hospitals, prisons, workplaces,
marriages. But the bedrock was the human body, which was the
primary object of re-education, readjustment, rehabilitation, and
enhancement--all the clinical proddings of the therapeutic
mega-state. Like Weber, Foucault was haunted by the thought that
Enlightenment bred enslavement; his most memorable model of modern
society was the Panopticon, Jeremy Bentham's design for a prison of
total surveillance. But it was not always clear, given Foucault's
stress on the constitutive powers of discourse, whether his
Panopticon was a structure of concrete and steel or a prisonhouse of
language.

The political problems with Foucaultian thought became immediately
apparent. Neither he nor his American followers took much account
of any middle ground between his bleak vision of society under
surveillance and his Nietzschean ideal of an untrammeled self. He
allowed no space for politics or resistance, short of an
unimaginably open-ended immunity from all norms and values. He set
the bar for liberation so high that only a few polymorphous
sadomasochists could clamber over it. The effect of this
pessimistic perspective was to discredit any form of meliorism,
anything short of anarchic individualism, as a snare and a
delusion--and, worse, a fraud. No wonder the postmodern left
lurched between fantasies of free-floating selfhood and the fear
that resistance was futile.

During the 1980s and 1990s, Foucault's lefter-than-thou
individualism converged with the free-market fundamentalism of the
deregulated marketplace. The spawn of their awkward embrace was a
distinctly postmodern creed: laissez- faire with a Nietzschean
flair. This outlook united corporate gurus and hip academics in a
celebration of restless discontent and a disdain for limits.
Indeed, from this perspective the very idea of limits, natural or
otherwise, was a creation of puritanical killjoys who were probably
un-American besides.

Yet at about the same time, biological determinism was making a
comeback, having been revived by evolutionary psychologists for a
credulous popular audience. The result was a resurgence of the
dualism that has characterized the nature-versus-culture debate
from the beginning. Outside the postmodern academy, pop-Darwinian
theories of behavior acquired renewed authority, especially with
respect to gender differences: men were from Mars, women were from
Venus, et cetera ad nauseam. Inside the postmodern academy, even
cautious biological explanations were forbidden under pain of
excommunication, and the body remained sicklied o'er with the pale
cast of thought--a site of "discursive practice" rather than
physical experience.

Fortunately, serious efforts are under way to restore some
complexity to the nature/culture debate--to resurrect the body in
all its fleshly actuality while continuing to explore its symbolic
meanings. Or so at least these three books suggest. All of them
take for granted the modern status of the body as a thing, a
project for tinkering. All try to renegotiate the relationship
between technology and the body, and to reclaim some middle ground
between determinism and freedom. But this turns out to be a tricky
business, given the confusions in our public discourse.

The fundamental problem is the difficulty of distinguishing between
compulsion and choice, as Foucault and his predecessors understood.
One of those predecessors was Orwell, whose notion of Newspeak not
only characterizes totalitarian propaganda but also captures the
self-canceling rhetoric of consumerist democracy. The key Orwellian
word is "we." While it allows the speaker to merge his own
interests and worldview with those of "most Americans, " it also
blurs the boundaries between liberation and coercion. In our
current cultural climate, this is only to be expected. A "can do"
society in the grip of revived entrepreneurial fervor and imperial
delusions has little time to notice helplessness. What we want--or
at least what we get, in idioms from cultural theory to tabloid
journalism--are tales of triumphant will. Yet this faith in human
striving coincides with an equally strong conviction that we are
all in the grip of a deterministic process--called progress or
providence or globalization or evolution--that we can hardly
influence and certainly cannot control. If we have never been
freer, it's a good thing, too, because there is no way out. The
yoking of these contradictory assumptions allows everyone from Jean
Baudrillard to Bill Gates to reach a common conclusion: we are all
autonomously deciding to do what we are fated to do anyway.

Each of these books helps to clarify this muddle without escaping
from it altogether. Virginia L. Blum's Flesh Wounds explores the
interplay of desire and desperation in the subculture of plastic
surgery, revealing that patients are more than victims and less
than free agents. Sheila M. and David J. Rothman's The Pursuit of
Perfection begins by deploying the language of consumer choice,
describing hormone replacement therapies as a response to popular
demand; but their evidence shows how doctors and drug companies
have collaborated in feeding popular fantasies of rejuvenation,
creating consumers who were anything but well-informed. Edward
Tenner's Our Own Devices escapes the claustrophobic atmosphere of
the clinic to an open-air world where bodies and technologies
interact on equal terms, but he acknowledges that the
"technological treadmill" can force us to adapt to its rhythms
whether we want to or not. None of these interpretations can fully
resolve the paradox of compulsion and choice. Yet, taken together,
they suggest new and more capacious ways of writing the history of
the body. By orchestrating the interplay of human desires and
values alongside biological limits, capital investments, and
technological blunders or breakthroughs, they reveal that the
marriage of freedom and fate is not quite as cozy, or as fated, as
it seems.; In Flesh Wounds, Virginia L. Blum resorts often to the
obfuscation...

II.

In Flesh Wounds, Virginia L. Blum resorts often to the obfuscation
of the first-person plural: "our" longings to look like movie
stars, "our" equation of personal identity with surface appearance.
But at its best the book burrows deeper. Blum is very plain about
its origins in her personal life. She was a middle-class Jewish
girl growing up in Southern California; her mother had had a nose
job and was determined that her eighteen-year-old daughter would
have one, too (even though the daughter was perfectly satisfied
with her face). This has been one of the classic American uses of
plastic surgery--as a ethnic rite of assimilation into the WASP
mainstream, epitomized (especially in Southern California) by the
airbrushed perfection of "the stars." The plastic surgeon showed
young Virginia a picture of a famous model. "This is what you can
look like," he said. Suddenly her head was filled with fantasies of
self- transformation. She agreed to the operation, and he botched
it. Years later she had her nose fixed by another surgeon. She
knows what surgery can and cannot accomplish, and she still feels
the seductive pull of the scalpel, still dreams the dream of the
perfect makeover. She wants to know why. So the book is partly a
journey of self-discovery--an often thoughtful one at that. It is
also a shrewd analysis of the subculture of plastic surgery.

But problems arise when Blum leaps from that subculture to society
as a whole. Without question, in recent years the profession of
plastic surgery has multiplied its practitioners, expanded its
constituency, and diversified its techniques. Its cultural meanings
have become more complicated: crude racial valences are out
(despite the persistent WASP hegemony in facial structure), the
narcissism of minor differences is in. Plastic surgeons are
inventing an infinity of imperfections for a fragmented consumerist
culture. Doubtless the spread of plastic surgery suggests that
people of both sexes have become more preoccupied with how they
look--sometimes pathologically so. But surely it does not mean that
"little by little, we are all becoming movie stars--internally
framed by a camera eye," as Blum writes.

Little by little, Blum and her friends begin to constitute a
universal norm. Like other intellectuals in the postmodern academy,
they are determined to flaunt their fascination with the cheesiest
mass entertainment. They read The National Enquirer, keep up with
soap operas, gossip about which stars have most recently been
"done." "We not only like makeover stories," she writes, "we also
believe them." For her, "our fascination with cosmetic surgery" is
of a piece with "our ongoing and evidently insatiable desire for
more information" about celebrities (particularly "surgical"
celebrities): both impulses express "our" status as subjects in a
two-dimensional empire of images.

This is the postmodern version of the Orwellian "we." We are all the
beneficiaries of fluid identities, endlessly reinventing ourselves
(or our companies), cavorting in the proliferation of mass-marketed
images. Not all is well in this world, but even if we wanted to
complain, we would have no business doing so, because we inhale the
same cultural atmosphere. So we have no objective standpoint from
which to criticize the culture we inhabit. To pretend that we did
would resurrect the delusion that there is a "view from nowhere"
(in Thomas Nagel's influential phrase) and the even more damaging
assumption that we (intellectuals) know more about culture than the
readers of People magazine.

In short, resistance is futile. The image empire is omnipresent. Do
not be misled into thinking that you can protect your children from
its effects, and do not try to depend on the old romantic ideals of
authenticity. There is no "real" body struggling beneath the
ceaseless assaults of imagery. "When identity itself is fashioned
(and incessantly refashioned) in relation to these transient
cultural images, how can we speak of any kind of premedia,
premeditated body? What authentic body is left to preserve or
liberate?" And don't assume that heavier, less pretty, less perfect
images will help. "From a Foucauldian perspective," Blum quotes a
cultural studies scholar, "the 'resistant' body ... is no less a
product of cultural discipline than the dominated body, the body of
'gender normalization.'" Finally, "the subjects who 'submit' to
images are the selfsame subjects who create them," so the old
vocabulary of domination and subordination does not work anymore.
"We" are all powerful and we are all powerless.

From this exquisitely confused perspective, why not play by the
rules of a body-obsessed society and win for a change? Plastic
surgery, says another authority in cultural studies, is "a form of
agency for women in an obdurately appearance-centered culture."
Besides, nothing is really real anymore, not even one's own flesh.
Or so Blum implies when she writes that "people who have been
raised to idealize and identify with two-dimensional images are
well-prepared to become surgical. It's easy for us to go under the
knife, because it doesn't really seem like a knife after all." This
bizarre line of thought, if one can call it that, is consistent
with certain postmodern theorists, notably Baudrillard. Blum cites
him frequently on "the triumph of the simulacra," summarizing his
view succinctly: "As the three-dimensional landscape takes orders
from screen images, movie stars and their cinematic lives can seem
more primordially authentic than one's own life and one's own
body." Tempting as it is to dismiss this hyperbole outright, it is
worth acknowledging that Baudrillard has a point. For decades, mass
entertainment has provided vicariously intense experiences to
modern people mired in boredom and futility. But to grant this
"hyper-reality" an ontological status is to leap into the void of
postmodern metaphysics.

Still, even as we back away from the precipice, we are entitled to
ask how we got here. Even if only some of us inhabit a
dematerialized, two-dimensional universe, the obsession with
manipulable surfaces has a history. When Blum attends to it,
however speculatively, her argument gets interesting. Both plastic
surgery and post-Freudian psychoanalysis, she suggests, arose to
heal the wounds of an individualist culture--one in which the price
for a separate self is "an ongoing but manageable experience of
object loss." The body becomes a site of mourning for lost love
objects, and plastic surgery a means of reclaiming an estranged
mother, a straying spouse, or one's own youthful beauty. The
project has become more urgent, she argues, as Americans have
become detached from social sources of identity--family, church,
neighborhood.

This familiar sociological theme captures something important
(though not unprecedented) about recent American history. For many
contemporary Americans, hoping to belong and to succeed, the
endless refashioning of the body may be all that is left to fall
back on. "Does this body take over for family ties? Does it become
our home?" Blum asks. The sad answer, in many cases, is yes.
Plastic surgery is a form of home renovation.

But the job is never done. Blum's recognition of this is rooted in
her own self-knowledge, as well as her interviews with patients and
surgeons. Admitting that plastic surgery sometimes makes people
happier, she nevertheless captures the pathos of the endless losing
battle against imperfection, the desperate compulsion to repeat and
to refine procedures that are bound to result in disappointment.
Despite her preoccupation with two-dimensional images, she
acknowledges that the knives and the pain are real, and that plastic
surgery may be "like any other practice that has us offering up our
bodies to the psychical intensities that angrily grip us." Blum
also realizes how silly the idiom of consumer choice is when
applied to physical appearance. "What I 'want' for my appearance is
inscribed in the culture that shows me, everywhere I turn, what is
supposed to be my ideal image ... drastically underweight
twenty-year- olds with enormous hardened silicone breast implants
... a comic-strip heroine made flesh."

What we have here is the ideal of a reincarnated righteous
community, surveying the pursuit of physical perfection with the
same unyielding scrutiny that Protestants once applied to the quest
for salvation. Success demands a systematic exercise of will, a
self-discipline with moral implications, a constant itch for
self-correction. Internal commitments are reinforced by external
surveillance. The struggle takes place under the eyes of others.
Plastic surgeons, mostly male, construct "a particular kind of
reality populated with bodies requiring correction." Women are
surveillant, too--as capable as men of the withering observation
and the glib appraisal. It may be a little melodramatic to call
this claustrophobic social climate "a narcissistic hell of
unresolved rivalry with ideal counterparts." But it is also astute.

III.

Sheila and David Rothman are less inclined to recognize the role of
the oppressive, surveillant others. The Pursuit of Perfection
begins by asserting that since hormone replacement therapy is what
the people want, it would be anti-democratic as well as pointless
to resist their relentless desires for revitalization. Fortunately,
the Rothmans are scrupulous historians, and their book tells a
story more persuasive than the triumph of popular choice. It
skillfully documents the convergence of careerism, capital
investment, and compliant regulatory policy in the promotion of
untested drugs among an unsuspecting populace. Like Blum (and
Foucault), the Rothmans understand that physicians and drug
companies have a certain power over patients and purchasers: the
power of superior knowledge about the procedure or product in
question. In medicine (even more flagrantly than in other economic
transactions), the concept of a sovereign consumer is a dangerous
fiction.

The Rothmans insist that the drive to enhancement is so deeply
rooted in our science and our culture that no social, political, or
religious objections will withstand it. The heart of the matter is
"the futility of trying to separate cure from enhancement" at this
point in our history. For the last hundred years, the catalogue of
conditions that require a doctor's intervention has expanded
hugely. Is short stature a disease? Muscular weakness in
seventy-five-year- olds? Crooked noses? Bulging thighs? Or are they
simply conditions that make us unhappy? It doesn't matter, as the
Rothmans observe, because "twentieth-century medicine is
comfortable taking happiness as its province."

Bracketing any discussion of psychiatry and psychoactive drugs, the
Rothmans leave a key question unasked: who gets to define
happiness? Their implicit answer is "we." The first-person plural
is rarely spoken in their book, but it is essential to their
interpretation. They attribute the spread of medical enhancement to
the "heightened individualism" of late twentieth-century American
culture, but they fail to observe that what looks like
individualism can be dictated by a drive to meet standardized
fantasies of perfection. Like Blum, they conflate their own norms
with those of the larger society. Consider this statement: "Novel
technologies may be able to improve memory and promote desired
personal characteristics--such as risk-taking and sociability.
Perfected bodies will be taller, leaner, quicker, and will require
less sleep-- no longer needing to go off line eight hours a day."
Among which subculture are risk-taking and sociability most
"desired"? And who wants to be "on line" twenty-four hours a day?
These are not universal values and desires--they tend to
characterize successful professionals like the Rothmans themselves
(not to mention corporate executives, high-octane entrepreneurs,
and other contemporary models of "peak performance"). A similar
provincialism surfaces in their sympathetic response to the
geneticist J.B.S. Haldane, who predicted that technology would
allow "'any two persons on earth ... to be completely present to
one another in not more than 1/24 of a second.' (The Internet
foreseen?)" Anyone who thinks that the Internet allows us to be
"completely present" to one another has been staring into
cyberspace too long.

In the Rothmans' account, assimilation to the managerial performance
ethic is implicitly equated with "heightened individualism."
Conformity and choice are conflated. Perhaps this confusion is only
a symptom of the individualist faith that the Rothmans find
everywhere--even in pseudo-feminist defenses of eating disorders,
which claim that "what appears to be pathological is really
independent behavior. 'Anorexia,' [the cultural studies scholar]
Noelle Casky maintains, 'is the cultivation of a specific image as
an image--it is a purely artificial creation and that is why it is
so admired. Will alone produces it and maintains it against
considerable odds.'" This fatuous and appalling statement deserves
scrutiny. The determination to reduce compulsive behavior to "will
alone" reflects the Orwellian anti-logic that pervades our public
talk. The sanctification of will inverts the clichs of the
therapeutic ethos: recoiling from victimhood, the devotees of
choice create a creed of absolute autonomy. Does this official
fantasy signify a sense of helplessness? Is the owl of Minerva
flying at dusk?

The Rothmans do not bother with such speculations, but once they get
down to actual cases, the rhetoric of consumer choice fades quickly
and a fascinating chapter in the history of twentieth-century
medicine unfolds. It begins with the heady optimism of the early
days of hormone research in the 1920s. The discovery of insulin
transformed diabetes from a life-threatening disease into a chronic
condition. Endocrinology was born, and with it the reductionist
belief that "you are your hormones." Hormones were the genes of the
1920s, the master keys to manipulating the self. "They shape our
skulls and shape our souls," said the Harvard geneticist R.G.
Haskins. Small wonder these mysterious entities were freighted with
utopian hopes.

Great expectations bred commercial opportunities. The Rothmans
expertly chart the growing symbiosis between pharmaceutical
companies and physicans. The Pure Food and Drug Act of 1906 had
exempted drugmakers from labeling requirements if the drug was
prescribed by a physician. Doctors became patients' purchasing
agents, at least for the "ethical" drugs that required a
prescription. Manufacturers of prescription drugs shed their
snake-oil past (even though many of them were still making patent
medicines, too); public suspicion of them ebbed. So did physicians'
suspicions, as "detail men" from the drug companies began routinely
stopping by the doctor's office, promoting the company line without
taking orders directly. The relationship seemed cleansed of
commercialism. By the 1940s, however, advertisements in medical
journals were giving the game away. Especially with respect to
estrogen-based drugs, they offered the same promises of
rejuvenation that one could find in the advertisements for the
burgeoning beauty industry. The medical profession and mass culture
had converged. As the Rothmans write, "It was as if Johns Hopkins
joined Hollywood to teach women how to use compounds, clothing, and
cosmetics."

Nowhere was this collaboration clearer than in the history of
estrogen replacement therapy (ERT). At first the discovery of
estrogen seemed to promise female emancipation. It posed a
challenge to the nineteenth-century assumption that women were
ruled by their anatomy. As part of a broader move from anatomy to
physiology, endocrinology shifted attention from the static uterus
to the fluid ovaries. The emphasis on hormones opened for women the
possibility of self-transformation--indeed, of a more subtle
conception of sex differences generally, as endocrinologists in
search of estrogen discovered huge quantities of it in stallions as
well as in mares. The idea that sex traits were manipulable
haltingly took hold.

Male doctors and their allies in the pharmaceutical industry did
most of the manipulating. Economic interest melded with scientific
hubris. For many medical researchers, the latter motive was
stronger. Endocrinologists were characterized from the outset by
excessive zeal. They medicalized menstruation, making sharper
distinctions between normality and pathology, even advocating
estrogen treatments to prevent sterility in young menstruating
women. The absence of data rarely bothered them.

From the outset, ERT was as much a treatment for unhappiness as for
sterility. It promoted uterine bleeding in patients who were not
menstruating, but it did not stimulate their ovaries. Yet this
bleeding made them feel more "womanly"--or so the researchers
claimed. ERT enthusiasts argued that pseudo- menstruation sustained
dreams of rejuvenation among aging women. As the gynecologist
Robert Wilson wrote in Feminine Forever in 1966, ERT "beats nature
at her own game," restoring sexuality, mental vigor, and a sense of
mastery to women who might once have been dismissed as dried-out
old biddies. Whether the women would have dismissed themselves was
another question, but the mass media were convinced that Premarin
and similar drugs were "Pills to Keep Women Young."

Like all treatments that promote cell growth, ERT carried a risk of
cancer. Researchers noted the possible link as early as 1937, but
it was not openly discussed until the 1970s, no doubt partly in
response to feminist critiques of male medicine. But the use of ERT
continued to rise, as did the gathering of data about it. The
inertia of grantsmanship and the desire for academic promotion
meant that many researchers remained professionally invested in
ERT. The link between hormone replacement and cardiac health was
discredited when, in July, 2002, the National Institutes of Health
stopped a clinical trial of estrogen supplements because it was too
dangerous to the participants to allow it to continue. The Rothmans
wonder: will women view the rise and fall of ERT as a cautionary
tale with implications for other forms of enhancement, such as
plastic surgery or liposuction? Their own evidence (and Blum's)
suggests: don't bet on it.

Testosterone replacement never became the male equivalent of ERT.
Men do not experience menopause, nor do they go to the doctor as
often as women. And the medical profession never embraced
testosterone with the enthusiasm doctors extended to estrogen. In a
revealing expression of gender stereotypes, the American Medical
Association worried openly during the 1940s about randy old men
demanding too much from their aging spouses (and maybe from
themselves) and spilling their seed recklessly about the social
landscape. But by the 1990s, hormone replacement had been
assimilated to the male performance agenda. Prescriptions of
testosterone to healthy older men increased dramatically-- without
convincing clinical evidence of its effectiveness or even safety,
but with the pharmaceutical companies' fervent support.

The 1990s also marked the growing popularity of growth hormone,
primarily for children who were "too short." In this case the
distinction between cure and enhancement threatened to disappear
altogether. In 1993 the NIH convened a panel on growth hormone
research, producing a therapeutic policy statement that uncannily
recalled the sociological jurisprudence of the Brown v. Board of
Education decision four decades before. Shortness, like the
segregation of black students, created psychic pain and social
disadvantage. These combined effects constituted the disease of low
self-esteem, which was treatable with growth hormones. This
conclusion cheered drug manufacturers. As the Rothmans point out,
"No one had a greater stake in blurring the distinction between
cure and enhancement than the pharmaceutical companies." One of
them, Genentech, set up the Human Growth Foundation in 1965 to
provide the promotion of growth hormone with a spuriously
scientific legitimacy, which the "foundation" has done for decades.
A year after the NIH conference, the U.S. Attorney's Office
indicted a Genentech subsidiary for paying kickbacks to a Minnesota
physician named David Brown, who had received more than $1.1
million for prescribing the company's product, Protropin.
Meanwhile, the benefits of growth hormone remain problematic and
the side effects uncertain, but the promise of enhanced self-
esteem keeps consumers coming back for more.

It is easy to dismiss drug-industry apologetics that substitute
therapeutic clichs for serious thought, but it is harder to write
off the pain of failing to fit in. Parents and their "too short"
children confront a physiologically perfectionist society, as
coercive in its demands as the old righteous communities had
been--but without the Christian hope of forgiveness and redemption.
The Rothmans ignore the subtle power of this perfectionist
consensus. They conclude that Aldous Huxley's nightmare of genetic
engineering as social control has given way to a more benign
individualist vision: "technologies that we once feared as coercive
are now being viewed as liberating." The passive voice is telling.
Who has come to view these technologies as "liberating"? And how
has this change occurred? One suspects, yet again, that the dream
of the body triumphant is a fantasy designed to feed on popular
feelings of impotence, and to make a few people very rich.; Still,
bodies interact with technology in a variety of venues....

IV.

Still, bodies interact with technology in a variety of venues. If
one ventures outside the clinical setting to places where the
relation between the provider and the user of technology is less
hierarchical, it is easier to make a case for the individual as an
active agent. This is Edward Tenner's approach in Our Own Devices.
"Arise, and walk," he says in effect to the patient etherized upon
a table. Escape the clinician's gaze through a bracing encounter
with the actual, material world. Within the discourse of the body,
Tenner is Dr. Johnson, refuting Bishop Berkeley's solipsism by
kicking a stone in the street.

He is also an American original, a historian of technology with an
unparalleled fund of knowledge about ordinary things--from baby
bottles to Barcaloungers--and how they work (or do not work) in
everyday life. His first book, Why Things Bite Back, which appeared
in 1996, explored the unintended "revenge effects" of technological
innovation--the fire ants that flourished when pesticides intended
to eradicate them killed their natural enemies; the long-distance
pollution that resulted when Midwestern utility companies built
higher smokestacks to meet local environmental laws. The drive to
control catastrophe has succeeded in many ways (fewer fatal
diseases and industrial accidents, for example), but in its very
success, Tenner argued, it has created new and subtler problems of
managing chronic conditions. Better emergency care, for example,
has enabled more people to survive serious brain injuries, but they
need constant attention. Few historians have a better grasp of the
ironies of technological progress, or of the capacity of the
material world to resist human manipulation, than Tenner.

Our Own Devices is a worthy complement to Why Things Bite Back.
While the earlier book stressed things' capacity to thwart their
makers' intentions, the new one emphasizes the makers' ability to
learn from their mistakes and make better things. The devices in
question are all designed to be extensions of the human body. But
it is a body quite different from the one that pervades most
academic discourse. It is not being tinkered with; it is doing the
tinkering. Our Own Devices is a celebration of what used to be
called Yankee ingenuity, the refusal to rest content with existing
methods. For Tenner, innovation is a life force, even if its
necessity is not immediately apparent. Acoustic pianos have
remained unchanged for centuries, resisting a variety of
improvement schemes and risking ascent into "glorious anachronism";
but "fortunately," Tenner writes, "there are always a few men and
women who refuse to be intimidated by stability," and they are
designing more responsive pianos that need less frequent tuning.

Seldom has one encountered a more straightforward application of
that much- misunderstood intellectual tradition known as American
pragmatism. Tenner's method restores pragmatism's original meaning
as an ethos rather than a doctrine, less a philosophy than a means
of doing without one--a skepticism toward a priori assumptions, an
openness to experiment, a willingness to evaluate ideas with
respect to their consequences in everyday life. By reconstructing
the pragmatic methods of inventors and designers, Tenner captures
the dialectical interplay between body technology and body
technique. Each calls the other into being: how people use office
chairs determines what changes they demand or resist, and those
changes in turn shape new uses and new demands. The picture is a
little too pure, a little too thoroughly cleansed of the vagaries
of fashion and the passion for profit--but it does perform the
essential task of restoring some creative tension between the body
and the technology meant to serve it. The perfectionist project
seems looser, more open to unforeseen possibility when it turns
from the body to the wider world.

For all his emphasis on choice, though, even Tenner evokes the
specter of compulsion. Occasionally he alludes to "a technological
treadmill, from which it is difficult to step down." Once humans
step on it, by simply sitting in chairs or wearing shoes, they
embark on a process of constant adjustment to ever-quickening
technological change. The treadmill metaphor implies that choices
are sometimes severely limited, especially for ordinary users of
technology outside specialized communities of designers and
inventors. Tenner rarely acknowledges the role of corporate capital
in promoting innovations for no purpose greater than profit--the
proliferation of new software programs and the planned obsolescence
of many still perfectly serviceable ones, to take a particularly
egregious pair of examples. It is difficult for nonspecialists to
see through the haze of mystification surrounding many
technological developments, much of it generated by the advertising
industry. In contrast, Tenner's model of technological change
depends on pristine clarity--on what Habermas calls an "ideal
speech situation," a community of equality and transparency in
communication. It is a beautiful idea, and it may even exist from
time to time among the designers, the inventors, and the engineers
Tenner described. But it is an idea that is usually shaped and
modified by larger institutional interests.

Tenner tends to neglect those interests. More palpable objects
arrest his gaze. "My goal," he writes, "is to promote new ways of
looking at the commonplace. For I agree with Oscar Wilde that the
true mystery of the world is not the invisible but the visible."
Tenner is trying to revive interest in the mysteries of materiality
in our postmodern culture--a culture supposedly saturated in
two-dimensional images and drunk on ephemera. Who better to enlist
in the cause than Wilde, the postmodern aesthete par excellence?

But Tenner's real heroes are not aesthetes, they are artisans.
Indeed, his whole account of technological change places a striking
stress on the freelance inventor, the maverick designer, the
creative individual over the anonymous organization. "Those who
create things, whether door knobs or glass pipes, can only begin to
imagine how they will be used." Fortuitous circumstance nurtures
creative innovation. Ideas can come from anywhere: the central
control room at Fermilab, a major neutrino research center near
Chicago, was inspired by the round subterranean den of the
Teletubbies. (Many parents and grandparents at Fermilab were fans.)
The key to design improvement is adaptability and openness to
unpredictability. As Tenner writes, "Almost anything can be made
better by user experimentation." This is the "benign and positive
side to the unintended.. .. In other species, natural selection and
social selection shape the appearance of the animal. In humanity,
technology helps shape identity. Our material culture changes by an
unpredictable, dialectical flux of instrument and performance,
weapon and tactic"--the co-evolution of body technique and body
technology.

Sometimes technology appears to destroy technique. We still have the
phrase "smooth operator," but we no longer have telegraph
operators. So what? says Tenner. "Designers--often rightly--aim to
make some skills obsolete. What virtue was there in trimming a
wick, cranking an automobile, tuning a crystal radio set, or even
(for casual amateurs) focusing a camera manually?" He is determined
not to enlist on the side of the Luddites, or anyone else
protesting the end of an artisanal way of life: the destruction of
craft skills, he says at various times, is either trivial or a
mirage. Manual skills have migrated from work to sports and
hobbies, or from using a stick shift to installing an infant car
seat (apparently a pretty tricky business these days). As Tenner
observes, technological innovation does not simply destroy old
techniques, it also demands new ones by "making inherently
dangerous things easy to use." Nine- millimeter pistols have been
made easy to use but hard to use safely. Something similar is true
of the anti-lock braking system--or at least the hype surrounding
it--which encourages risky driving in snow and ice. Anyone who has
ever seen a sport utility vehicle careening toward him at a
stoplight on an icy road knows what Tenner is talking about.

The heart of Tenner's book is his discussion of the "devices"
themselves: baby bottles and formula, sandals and running shoes,
sitting and reclining chairs, musical and text keyboards,
eyeglasses and helmets. As in all of Tenner's work, we discover a
fascinating variety of arcane details about how nature and culture
interacted to shape the body's presentation of itself to the world.
We find that French convent girls were taught to walk with clenched
fists, that Franklin Roosevelt kept his chin up for the decidedly
unheroic purpose of preventing his pince-nez from falling off his
nose, and that cockatoos can learn to roller skate. The facts come
thick and fast.

Still, there are patterns. Their particular form depends on power
relations. When innovations come from the top down, technology
dominates technique. This is clearest in the case of
bottle-feeding, which began with the British medical profession's
effort to lower malnutrition and infant mortality among the London
poor--a noble intention, but one that was ideologically charged with
Victorian tendencies to equate health with conformity to bourgeois
norms. Tenner acknowledges these class blinders but de-emphasizes
them. The medicalization of child-rearing was not social control,
he believes, but a response to lay enthusiasm for "scientific
motherhood." The nature of this enthusiasm deserves closer
scrutiny: consumer demand is limited and problematic when framed by
the authority of experts. The dialectic is not as democratic as it
seems.

The rise of bottle-feeding may have depended on popular support, but
it owed most to scientist-entrepreneurs such as the German chemist
Baron Justus von Liebig, who built a transatlantic business during
the mid-nineteenth century by selling a canned facsimile of breast
milk. Commerce and technology intertwined from the outset,
sometimes with calamitous consequences. "Bottle-feeding may exact a
high price in medical costs," Tenner concludes, "but as long as
medicines exist to treat the illnesses it increases, the
technological treadmill will roll on." At this point one wonders
whether the treadmill is entirely technological, or whether the
flow of capital investment might be powering it as well.

But Tenner's democratic account of technological change is more
persuasive when he turns to other topics--shoes, for instance. He
ignores the tired but inevitable questions regarding fashion. (Are
high heels a patriarchal punishment or a freely chosen
sadomasochistic fetish? And does anyone care?) Instead he focuses
on the triumph of sandals and sneakers over the stiff "corrective"
shoes of the early and mid-twentieth century. Here the hierarchs
have met their match: "The dream of molding ideal feet through
stiffly engineered shoes is as dated as the idea of the superiority
of formula to mother's milk." Demands for flexible and responsive
footwear have been even more influential in shaping the design of
athletic shoes. Since the 1930s, Tenner argues, there has been a
growing awareness of the relationship between athletes' specific
needs and the construction of their shoes. Some of the most
important design innovations arose from the experience of the
designers themselves. The Italian mountain climber Vitale Bramani
developed Vibram, a new sole material that combined strength and
grip, after six of his companions died in a storm in their
slippery, lightweight boots. The American yachtsman Paul Sperry
invented the Sperry Topsider, a deck shoe with a superior grip,
after he nearly drowned in a sailing accident. Though both of these
innovations made big money for the innovators, they nevertheless
epitomize the pragmatic, vernacular process of technological change
that Tenner rightly values. But when he discusses the extraordinary
rise of Nike, he is less eager to dwell on the more sordid aspects
of "the global footwear market that emerged in the 1970s," such as
the irresistible economic appeal (to executives and stockholders) of
Third World suppliers whose sweatshop operations mean minuscule
labor costs. To ponder the plight of running-shoe fabricators is to
acknowledge that their bodies, too, are part of this tangle of
flesh and muscle, rubber and steel.

The export of jobs brought the death of essential skills, such as
last- making and pattern-cutting. The emergence of
computer-assisted design and manufacturing (CAD/CAM) meant that
"industrial designers without shoe experience could work with
software models of lasts." Tenner is undisturbed by this
de-materialization of design; indeed, it illustrates his argument
that craftsmanship is never destroyed, only relocated. So we can
hope. Yet the aesthetic consequences of computerization were
profound: with the coming of CAD/ CAM, transparency and
functionality--those core principles of modernist industrial
design--were out and surface was everything. "The outside of the
shoe no longer had to reflect the interior," Tenner observes. "It
was open to fashion." This suggests just the sort of
"two-dimensionality" that is supposed to pervade our image-addled
society, but Tenner traces it to precise developments within a
particular industry--he does not claim that "we" are all imprisoned
by it.

Yet Tenner realizes that there is a fundamental trade-off embedded
in our relationship with material progress. While any pop
sociologist worth his salt knows that the triumph of the automobile
has come at a fearful price, Tenner's genius is to find that
trade-off in the most banal and taken-for-granted objects of
everyday life. Even the humble chair, he shrewdly observes, "is a
machine for producing dependency on itself." (Think of the other
technologies, beginning with cars and computers, that this
formulation illuminates.) The side effect of chair-sitting is a
weakening of the back muscles. Much of the world still squats; the
complex cultures of Asia, Tenner reminds us, were conducted at
floor level. There is nothing inherently natural about sitting in a
chair.

As the world urbanizes, however, more and more rural people who are
unused to sitting will learn to sit in a "task chair" while they do
their work. (In my daughter's kindergarten in the Washington, D.C.
suburbs during the 1980s, rote academic exercises were called "seat
work"--something every child had to learn to tolerate if she were
to join the white-collar salariat.) Sitting in a chair, like
conforming to clock time, has become an essential part of
assimilation to modern adulthood. What Tenner finally shows,
though, is that even if chairs are culture-bound objects, designers
(working mostly for American companies) have been deucedly clever
about making them more mobile, flexible, and comfortable. From the
rocking chair to the La-Z-Boy and contemporary ergonomic office
designs, the Americanization of posture has meant the introduction
of a standard more fluid than "sitting up straight."

In capturing these contributions, Tenner reveals his characteristic
curiosity and hope. He concludes by rejecting both utopian and
apocalyptic fantasies of a posthuman future. The body itself, he
believes, remains a surprisingly and reassuringly conservative
influence, a drag on cyborg fantasies. Yet our relation to our own
devices is still problematic. Augmenting our powers, these things
also increase their power over us. Standardization constantly
threatens creativity. What is to be done? Tenner's remedy is to
return to the classic collaborations between makers and users, the
kind that produced the American fire fighter's helmet or the QWERTY
keyboard. He believes in participatory design, user-friendly but
also user-challenging; he rejects the "one best way" of Taylorite
managerial theory in favor of shop-floor- workers' active
engagement in product development.

He finds hope for this democratic vision in the human hand itself--
specifically, in the shift of the hand's power base from index
finger to thumb. The proliferation of cell phones, Palm Pilots,
video games, and the like has begun to have a pronounced biological
impact: "thumbs all around the world are becoming stronger and more
skillful." Does this matter? Tenner thinks so. The index finger, he
says, has long been an instrument of authoritarian virtue; it is
the finger that the moralist wags in the miscreant's face, or that
the pedagogue uses to proscribe behavior. But the thumb is
associated with practical knowledge (rules of thumb) or tacit
understanding of how to do things (a green thumb). "Most of all,"
he concludes, "when extended in the almost lost art of hitchhiking,
the thumb shows the right attitude toward the future, open and
co-operative but with a firm sense of direction."

This is Tenner at his best, evoking a Whitmanesque sense of
possibility. But the thrum of the treadmill can still be heard, and
the hitchhiking metaphor is profoundly at odds with it. The
hitchhiker knows where he is going (even if he does not know how he
is getting there), but the treadmill is going nowhere--it is simply
locked in its own self-replicating system of repetitive movement.
The contrast between the hitchhiker and the treadmill raises
questions about the larger context of technological change. Why,
after all, is hitchhiking "almost a lost art"? One can muster all
sorts of formulaic answers about atomization and anonymity (and
crime or the fear of it). The truth, though, is that hitchhiking on
the interstate highway system, which carries most longdistance car
traffic, could land you in jail (it is illegal) or kill you.
Whitman's open road is filled with SUVs doing 80 miles per
hour--not a very enticing place to explore the universe. That
concrete network of high-speed, heavy-volume, limited-access
highways is an institutional constraint on the vernacular
improvisation that Tenner prizes. And sometimes, especially at rush
hour, it can feel like a treadmill.

So we are left to wrestle with the dilemmas of choice and
compulsion: how to sustain a sense of surprise in a society
saturated with system; how to create idiosyncratic possibilities in
a culture committed to conventionalized models of perfection. The
hitchhiker and the treadmill remind us that the paradoxes of
modernity and postmodernity are, after all, the same. Despite the
recent resurrection of the body, the supposedly free-floating self
is still troubled by the prospect of imprisonment and tempted by
the dream of escape.

By Jackson Lears

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