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Civilization Watch
First appeared in print in The Rhinoceros Times, Greensboro, NC
By Orson Scott Card May 16, 2004

Messing Around with Our Bodies

When Clark Gable took off his shirt in It Happened One Night and revealed that he was wearing no undershirt, the American public followed his example: Undershirt sales plummeted.

So it's no surprise that as Hollywood facelifts and botoxes its way to eternal beauty, we common ordinary nonstars do likewise.

Except there's one key difference. Clark Gable looked really good without his shirt on.

Why would anyone in their right mind want to look like the puffed-up botox-injected monsters we see at award ceremonies?

Why would anyone want to emulate facelift shipwrecks like Mary Tyler Moore or Goldie Hawn?

Above all, why would anyone want to subject themselves to surgery, with all the pain and danger that entails, in order to have themselves abused on television, first as "ugly ducklings," and then as competitors in a dog-eat-dog "reality show" like The Swan?

Cosmetic Surgeons Work Miracles

Some of the procedures surgeons use now are astonishing.

Breast augmentation or reduction is now being done by state-of-the-art surgeons without any visible scar -- because the body is entered through the navel.

That's right. A breast implant through the navel.

The empty plastic bag is rolled up and inserted under the skin. When it has been pushed into place, it is then filled with fluid and sealed.

Then there's the combination facelift and hair replacement. The bald scalp is removed. Then flaps of skin from the side and back of the head, where the hair is still growing normally, are jigsawed into place so that the whole head is covered with hair growing in its natural, original pattern. None of the orchard look that comes with plugs.

And because the same surface is being covered with half the skin, it's all nicely tightened up. The results are permanent -- and they look great.

The question is: What's wrong with baldness? What's wrong with having small breasts? Just because the surgery is clever and effective doesn't mean it's necessary.

When Surgery Is Needed

There are many cases where cosmetic or reconstructive surgery is absolutely called for.

Victims of fires and traffic accidents who need to be rebuilt are beyond dispute. So are children born with cleft palates and other correctable abnormalities.

Our brains are hardwired to notice people whose appearance is widely divergent from the norm, and to exclude them -- even torment them.

Civilized behavior includes learning to treat people with such abnormalities decently -- but it takes a long period of exposure before we become fully accustomed to any particular deformity. And each new abnormality we encounter requires that we go through the process all over again.

Children are the least able to behave in a civilized way toward the physically abnormal -- for the obvious reason that children are barbarians until we civilize them.

So when someone -- particularly a child -- has been deformed by nature or disaster, to correct their appearance is to bring them closer to having a normal human life.

It's as valid to repair a hare-lip as to repair a broken limb, to separate webbed fingers or remove a sixth digit as to inoculate against diphtheria.

Human beings are social animals, and if our appearance would cause us to be shunned or tormented by our tribe, it can ruin our lives -- especially if the deformity happens in childhood, when we are learning how to be human in the first place.

But where do you draw the line?

Surgery Is Never Safe

There is no such thing as absolutely safe surgery. So in deciding on a cosmetic procedure, the risks must be weighed against the benefits.

Most plastic surgeons are deft, talented, and fully trained, so the risks are few.

Some, however, are not so well trained in the procedures they're carrying out. And even those who are not quacks or dabblers can make mistakes.

After all, every surgeon has to do his first operation of a particular kind; every surgeon will encounter a surprising situation for the first time. Nobody wants to be that first one.

Most mistakes merely cause pain or leave ugly scars or fail to correct the problem. But some can kill you.

There's also the problem of anesthesia. People respond differently to different drugs. Some can attack your body and damage organs, sometimes fatally. The most common risk, though, is that you suffer brain damage or simply don't wake up.

Then there's the fact that anesthetics actually serve three functions, and pain-killing is the least important.

The most important function of the drugs is to immobilize you, so you won't so much as twitch during the operation. As long as this drug works, the operation can go forward. Because even if you're feeling excruciating pain, as long as you don't move, you're not in danger of causing your own death by making the surgeon cut the wrong thing.

The second function of the drugs is to make you forget everything that happened. Even if you feel every moment of terrible pain during the operation, if you don't remember it, then you won't sue for malpractice, will you?

I've known people who woke up during an operation and felt everything, but were immobilized and couldn't signal the doctors that they were screaming inside from the shattering pain. When they told the surgeon afterward, the reaction was the same: "You're not supposed to remember! I mean, you aren't supposed to feel anything!"

Things don't always go according to plan. There is no such thing as a "routine procedure" when it involves cutting into your body or drugging your brain.

It's a Personal Decision

A large nose may be a minor irritant to one person, hardly worth considering rhinoplasty, while the same nose might make another person so miserable that the risks of surgery seem trivial.

The trouble is that the risks always seem remote. If only a tiny percentage of people suffer lasting damage or die under the knife, it's easy to think -- beforehand -- that of course you'll be part of the vast majority that comes out all right.

But if you're the one whose heart stops on the operating table, it can change your point of view. Or at least the point of view of the loved ones who come to your funeral and want to scream at you: You didn't need that operation! You looked fine! And now you're gone!

Those tragedies happen, and regrets can go on for many years after wrong choices were made.

But there are risks to everything in life -- as every driver knows. Because it's also true to say that there's no such thing as a routine car trip. Just because you're "only running to the store for a couple of things" doesn't mean that you can't get hit by a drunk and killed.

So the decision should be up to the patient and the doctor, with a full awareness of the risks. Except for strict regulation of the standards of entry into the medical profession, the government has no useful role in that decision. Please don't imagine that I'm calling for regulations beyond those we already have!

Instead I'm calling for common sense.

Because some operations and procedures are so unnecessary, so pointless, so dumb, that it hurts us all when they lead to disaster. Especially when they're followed by malpractice suits that raise the cost of medical care and insurance for everybody.

Sometimes, when a lawsuit is brought against a surgeon because something went wrong, the first question the court ought to ask is, Why in the world were you having the operation in the first place?

Weight-loss by Surgery

Most cosmetic surgery does not penetrate the abdomen or thorax. But there are operations designed to change your appearance by altering the capacity of your stomach, so you will eat less and lose weight.

I've known several people who've had the operation. There are some important things you should know.

First, sometimes it can save a life. One friend of mine was dying from obesity. He was suffering from near-suicidal depression -- only the "suicide" was taking place very slowly, as he ate his way toward death by despair. He was so unhealthy he couldn't exercise, unless you count hauling around an oxygen tank.

The surgery served him as the trigger that brought him to a point where he could begin to live normally again. It was worth the risk, because without the surgery he was surely going to die.

Second, one of the people I know never got the results he wanted, because he died during the operation. And the sad thing is, he wasn't that heavy. He had simply bought into the hype that (a) he needed to be really thin to have value as a person and (b) a stomach operation was an "easy" fix.

Third, those who have lived through the operation report that willpower is still involved. Because if you are really determined to eat, you can still gain weight even with your stomach reduced to the size of a thimble. All it takes is to eat tiny amounts of high-calory foods ... constantly.

And since you're hungry all the time, the temptation to eat is there.

Nor does stomach-reduction surgery work for everyone. There are many people who are heavy because of glands that aren't working right. Their bodies are constantly signaled to store fat no matter how much they eat. Dieting doesn't work for them, because their body adapts. It will get rid of muscle -- including the heart -- before it will significantly reduce fat. To such people, stomach reduction works no better than any radical diet: some weight loss at first, then weight gain as the body's fat-no-matter-what mechanism kicks in.

These cases aside, however, most people who have a doctor cut into their abdominal wall in order to shrink their stomach are risking death in order to accomplish something that they could do without surgery.

You want the same results as that surgery, without the risk? Eat only what you can fit into a half-cup measuring cup, and do that no more than five times a day. You'll lose weight, and nobody will have cut up your organs.

I speak as a person who has bounced around during my adult years between 180 and 310 pounds. For me, there would be no excuse for surgery at all. When I exercise and eat with reasonable caution, my weight balances very comfortably at a healthy level. When I'm heavy, it's because I either got physically lazy or ate carelessly for a long period of time. There's no shortage of people in my category.

However, there are other body types. Most people who are quite thin are that way because that's what their body insists on. No matter what they eat, excess seems to burn away. They're always lean and mean and ready to run.

Other people, though, have bodies designed to carry a certain amount of fat. These permanent fat deposits are usually in the buttocks and thighs -- the "pear-shaped body" that seems to be able to be heavy without causing much risk of heart failure or other diseases of obesity.

Let's Stop Killing Each Other for Fashion

Wouldn't it be nice, then, if we could simply accept the fact that evolution likes having human bodies that use different strategies for survival. Some bodies are designed to be light and lithe, ready to flee from danger at any time. Other bodies are designed to store fat, so long periods of famine -- like, for instance, winter -- won't kill them. Other bodies -- like mine -- are designed to do both: We lose weight whenever we get a lot of exercise, then pack it on when there's lots of food and we don't move around much.

Each strategy has its place in the natural history of humankind, and there's no reason for one to be preferred over another.

No reason except fashion.

You can be beautiful at any weight, as long as you're happy. There's nothing more futile, I think, than thing people who look pinched and miserable and approach every meal as if it were a fight to the death.

All so they can buy clothes off the rack that have a certain size number attached to them.

The fact is that even fat people are living far longer today than they ever did before. So what if you're carrying ten or twenty or thirty extra pounds? You look great, you feel great, and you aren't hungry all the time, so go ahead and be happy.

Except how can you, when society -- not just advertisers, but regular people around you -- are constantly pounding you with the message that because of those extra pounds, you are not acceptable.

The cruelty is most open in school, as cruel nicknames like "thunder thighs" are applied to women whose only crime is to have a body that thinks it's living in the stone age and needs to store fat for a low-calory winter that never comes.

But it's obvious in the adult world, too. Comedians who no longer make ethnic jokes still rail at fat people as if their condition were always their own fault.

Even if a person is heavy because of his own choices, why does that give anybody else a reason to abuse them? And those who do torment fat people never know which ones are unable to change their condition. It's as cruel as if you made fun of someone for being retarded. (Of course, there are people who do that, but we know they're barbarians.)

After all, if someone is heavy because their response to depression is to eat, how is that worse than responding to depression by killing yourself? People who would never dream of condemning someone driven to suicide by depression have no qualms about sneering at someone who is driven to overeating by the same psychological burden.

If we stopped torturing heavy people and left the decision about whether they need to lose weight up to them and their doctor, maybe there wouldn't be so many people who think dangerous surgery is their only option.

Yet we've spent the past few years bombarded with articles and shows about celebs who lost vast amounts of weight through surgery.

Well, good for them. But they shouldn't be held up as role models.

Or else for every success story, the magazines and news shows ought to run the same number of pictures of people who died under the knife. Keep these things in perspective!

Known When to Say When

If you think you want a facelift, it's none of my business to say no.

But do remember that it's only the first facelift that makes you look younger.

The second facelift makes you look tight and starts limiting your facial expressions.

The third facelift makes you look as if you're perpetually in a wind tunnel. Or in the seat of a spaceship accelerating at five gees.

In other words, folks, those of you who are trying to conceal your age, why bother? It only works for a little while; when you keep going back to the plastic surgery well, eventually it comes up dry.

Too much plastic surgery, and you become a freak. I see them whenever I go to LA, the sad little old ladies dressed like teenagers with bad tasted, their faces so lifted they can't pronounce the letter O, their wigs ludicrously luxuriant as they perch above their dried-up faces.

It's ok to be old. It's great to have wrinkles. It means you've lived long enough that you might actually know something.

You don't become a beautiful old person by trying to use plastic surgery so you can pass for twenty years younger.

You become a beautiful old person by being kind and cheerful and not thinking every moment of your life about yourself and how you look and how people are thinking of you.

I think of one of the most beautiful women ever in film -- Julie Christie -- and how she looked in the movie Troy.

Maybe there was a facelift somewhere in her past, maybe not. The point is, even if she ever had cosmetic surgery, she knew when to stop and accept the face that age had given her.

She was gorgeous.

We Can Help

When plastic surgery is needed for someone to lead a normal life, then let none of us criticize the decision.

And even when it's not needed, the solution isn't to ridicule the plastic surgery junkies (no, not even Michael Jackson) but rather to live our own lives with a conscious effort to avoid causing other people to resort to surgery in order to avoid our "clever" remarks.

We should even avoid disparaging ourselves. "Oh, I'm so fat" is really not a good thing to say -- especially when it isn't true. Even if you are fat, to deplore it aloud is to tell others who have weight problems that they, too, should loathe themselves. If they suffer from depression, you're really not helping.

At the same time, it would be a good thing if Greensboro actually installed sidewalks everywhere, so people could exercise without walking in the gutter -- or in the path of speeding cars.

Oh, and one more thing. Don't watch trainwreck shows like The Swan. Surgery is far too serious to be entertainment.

Copyright © 2004 by Orson Scott Card.


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