On the Intersection of Vanity, Beauty, and Aging
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Have you ever had your medical concerns or symptoms dismissed? Ever apologized to your doctor for asking too many questions? Are there things about your health you feel too embarrassed to discuss? Or worse, offered treatments, and even surgeries, you don’t need? Dr. Elizabeth Comen, a medical oncologist specializing in treating breast cancer, is passionate about the history of women’s health and how it intertwines with religion, culture, and politics. In her debut book, All in Her Head: Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today, she traces the insidious roots that seed women’s experiences in our current health care system. She walks us through women’s bodies by organ system (the same way doctor’s learn about the body), as well as our shared medical history. She aims to heal our complex medical past and explain why narratives about our bodies continue to haunt us today and impact how we feel about them, what medical research is conducted, and what care is available to us all. Read an an exclusive excerpt, below.
The integumentary system is the body’s largest: its surface. Skin, hair, teeth, fingernails: all form a barrier between your vulnerable organs and the harsh, dangerous world, a system whose sole purpose is to protect what’s inside from the outside. As a result, integumentary medicine has a uniquely superficial component, comprising not only the treatment of rashes, lesions, and other malignancies, but also the cosmetic, the aesthetic. Doctors primarily preoccupied with beauty are free, if they wish, to focus more on style more than substance, on nipping and tucking and taking apart perfectly healthy bodies in the hopes that nature itself might be improved upon.
Unlike other chapters in this book, this is not a history of women’s health issues going overlooked, ignored, or misdiagnosed for lack of interest. Indeed, it’s a physician’s preoccupation with women’s bodies, women’s beauty, that has driven many of the advancements in the field—and sometimes without much concern for what the women themselves think about it. In the field’s infancy, male doctors found themselves empowered to act as both enablers and enforcers of women’s beauty, putting the stamp of medical legitimacy on the social pressure to be pretty. Today, the practice of cosmetic medicine is one that walks the line between empowering women to control their bodies and trapping them in a gilded cage of punishing beauty standards.
Despite its posh present-day connotations as a leisure activity for upper-class women, plastic surgery has its roots on the battlefield, and among men. The early patients were soldiers, and the field’s first and most dramatic advancements began as a quest to address the facial injuries resulting from trench warfare. The weaponry of the era—grenades, mortars, and machine guns—was unprecedented in its impact on a human body, both capable of inflicting massive injuries and more likely to blow up in a man’s face, literally. Many survivors were brutally disfigured, with missing eyes, shattered jaws, skin and bone sheared away, leaving a gaping black hole where a nose and cheek used to be. The legitimization of plastic surgery as a medical field coincides almost exactly with the return to society of injured veterans from the First World War. The American Association of Plastic Surgeons was founded in 1921, the American Society of Plastic and Reconstructive Surgeons in 1931, and the American Board of Plastic Surgery in 1937. That latter institution signified a breakthrough: the following year, in 1938, the American Board of Plastic Surgery was officially recognized as a subsidiary of the American Board of Surgery.
All in Her Head by Elizabeth Comen
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At the same time, the advent of modern anesthesiology completely changed the nature of surgery itself as well as the patients who arrived in search of it. Before general anesthesia, the only way to have surgery was fully conscious (or, at best, in a stupor brought on by the use of alcohol or opium as a painkiller), and patients were strapped or held down so that they couldn’t flinch away when the cutting began. The notion of elective surgery was inconceivable; given the pain and horror involved, few people went under the knife unless absolutely necessary, and doctors confined themselves to operations that aimed at restoring normal function—chewing, swallowing, breathing—rather than physical appearance. But now, doctors could operate on pliant, unconscious patients who neither flinched, wriggled, nor screamed, and the promise of being able to sleep through the worst of the operation enticed an entirely new sort of person to the plastic surgeon’s office. The possibility of surgery as self-improvement emerged.
As the field evolved, surgeons began to divide into two camps: those who did reconstructive surgeries on damaged faces and bodies, and those who performed cosmetic procedures on otherwise healthy people. And here, the line between medical and moral authority began to blur. Doctors, long valued for their expertise in matters of health and healing, were now the arbiters of aesthetics, too. Beauty, as always, was in the eye of the beholder—but now, the beholder was holding a scalpel.
From the book ALL IN HER HEAD by Elizabeth Comen, MD. Published on Feb. 13, 2024 by Harper Wave, an imprint of HarperCollins Publishers. Reprinted with permission.
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