Learning to Love Yourself: Esthetics, Health, and Therapeutics in Brazilian Plastic Surgery

Abstract

Brazilian plastic surgeons have successfully promoted a psychotherapeutic rationale for cosmetic surgery. This article critically engages with this ‘philosophy’ of health, analyzing how it is deployed in busy teaching hospitals. I show how a tradition of intimate hierarchy and class dynamics in medical institutions informs the experimental ethos of clinical practice as patients internalize a psychotherapeutic notion of health and management regimes of female reproduction and sexuality that are becoming normalized among upper social strata. In the process, cosmetic and healing rationales become blurred as patients pursue an expansive, qualitatively defined state of well-being that I call ‘esthetic health’.

Keywords:

• Plastic surgery
• Brazil
• esthetic health
• female reproduction and sexuality
• social class
• enhancement technologies

Acknowledgments

The Social Science Research Council and Princeton University provided research support. I would also like to thank the research participants, and my research assistant, Olivia van der Weid, as well as João Biehl, Kirsten Bell, Mirian Goldenberg, Peter Fry, Chris Huston, Rachel Newcomb, Pál Nyíri, Sarah Pinto, Kalpana Ram, Kirsten Scheid, Tom Strong, Hermano Vianna, Lisa Wynn, and the Ethnos reviewers and editors for their very helpful comments.

Notes

The people (in Portuguese, o povo, or povão, ‘common people’) is often used in Brazil to refer to the masses, or those too poor to be included within the middle classes (often estimated to comprise less than 20% of the population) (Levine 1997:33). Many elites used such terms to refer to patients at public hospitals as well as to poorer patients who have surgeries at cheaper private clinics with credit plans.

A newer trend for silicone breast implants, ostensibly following their adoption by celebrities in the 1999 Carnival, was seen to threaten such a traditional ideal, and sparked debate in national media about ‘cultural imperialism’ (there was though little discussion of health risks). Minor breast reductions continue to be popular surgeries.

He seems to be echoing here a central theme in Brazilian identity that underlies diverse social forms, from the jogo de cintura, ‘waist game’ (making do), to the ‘beautiful game’ of soccer. In a kind of negative nationalism, ‘messiness’ is turned on its head to become creativity and resourcefulness.

Following Canguilhem's (1989) distinction, these conditions enable medicine to become morally authorized to heal rather than only technically to cure a particular kind of suffering.

I borrow the distinction between ‘digital’ and ‘analogical’ from Sedgwick's (1995) discussion of affect.