This is a significant and timely book. Since 2005, more than 40 face transplants have taken place globally, and each has brought medical, ethical, emotional and sociological challenges. Pearl offers an important contextualisation to debates about the surgical challenges, seeing social discomfort around the procedure as part of a broader and more fundamental bias about facial identity. Building on Pearl’s previous work into the history of physiognomy, a pseudoscience that read personality and aptitudes from the collection of features one is born with, she identifies the ‘face as a form of “index”’: a relationship between the face and character that prejudices against those with any form of perceived disfigurement or deformity (and who is not depressingly familiar with the cultural presumption that beauty = good and ugliness = evil?).1 Sharing stories of those who have literally lost (and gained) their face, Pearl writes beautifully and polemically, with a genuine passion for her subject, in particular for the ‘humanity of the faceless,who through disfigurement or transplantation may be denied respect by, and engagement with, human society; snubbed, rejected, humiliated or “left for dead”’ (p. 3). In challenging the indexical relationship between the face and the character of a person, Pearl situates the face transplant in the context of cosmetic surgery and raises questions about the nature of medical ‘need’. Although need and desire are regarded as binary opposites in the history of surgery, they are often one and the same, as Pearl observes. It is, moreover, important to note that the medical construction of need has its own history; in the case of the first breast implant recipients, for instance, small breasted-ness needed to be identified as a physical ‘problem’ with negative psychological consequences before a solution (surgical intervention) was deemed an appropriate response.2 Social pressure on the facially disfigured produces similar effects, with ideals of beauty and acceptable appearance compounding the psychological and physical impact of disfigurement. Surgery to ‘improve’ the face of the disfigured is presented as the most appropriate solution. The individual is posed against society in these discussions, with the stakes being an acceptable or unacceptable version of the embodied human. The collective, often shocking social response to face transplants (as demonstrated by the media treatment of Isabelle Dinoire, the world’s first partial face transplant recipient), is also manifested in a range of cultural spaces, including film. Pearl is adept in her handling of visual culture, and in accounts of face transplants she notes the similarities across cinematic narratives regardless of language or location. The tropes of surgical intervention—good or bad doctors, the search for individual, post-war identity, social and familial abandonment, death—are dominant throughout the ‘sci-fi/horror canon’ in which face transplants can, somewhat uncomfortably, be situated (p. 51). Pearl also provides a nuanced interpretation of the ways in which media reports of radical, transformative surgery like face transplants connect with other aspects of visual and digital culture, including voyeuristic modern ideals of medical ‘celebrity’ and reality TV (p. 123). Faces matter. The ways in which we perceive difference and disfigurement also matter, for they underpin many forms of prejudice and social exclusion. Pearl’s book is an important reminder that humanity is far more than skin deep. Of course, she cannot solve the problem of othering, as she acknowledges in her conclusion. But she can and does offer a thoughtful and compassionate interpretation of how the ‘indexicality of appearance’ (p. 179) thrives as an outdated, unethical way of dealing with our fellow human beings, as well as the multiple challenges in overcoming this narrative. Drawing on the diverse interpretations of the French philosopher Emmanuel Levinas and the American gender theorist Judith Butler, Pearl concludes that ‘there is no one way to have a face’ (p. 180). By deconstructing the indexicality of appearance, Pearl ultimately argues the need for an ethical, accountable way to look for different, more equitable ways of valuing humanity. What that might look like (how ubiquitous is the language of the visual), remains open to question. Pearl’s approach is ambitious, insightful and heart-warming. It offers new ways of exploring the relationships between identity, appearance and selfhood. Yet as the history of emotions and facial expressions suggest, the social function of the face depends on more than its appearance and perceived character; Jonathan Cole’s work on Moebius Syndrome, for instance, a condition that makes emotional communication through the face impossible, shows how much we depend on the face as a lexical as well as an indexical construct.3 This is not a criticism of Pearl’s work, but an acknowledgement of how much remains to be done in studying the mutating meanings of face transplants, from the evolution of surgical skills and pharmaceuticals to the framing of the procedure as part of the histories of emotion, transplantation and selfhood. Footnotes 1 Umberto Eco, trans. Alistair McEwan, On Beauty (London: Maclehose Press, 2010). 2 Fay Bound Alberti, This Mortal Coil: The Human Body in History and Culture (Oxford: Oxford University Press, 2016). 3 Jonathan Cole with Henrietta Spalding, The Invisible Smile: Living without Facial Expression (Oxford: Oxford University Press, 2009). © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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