The first comprehensive cultural study of face transplant surgery, Face/On reveals our true relationships to faces and facelessness, explains the significance we place on facial manipulation, and decodes how we understand loss, reconstruction, and transplantation of the face. To achieve this, Pearl draws on a vast array of sources: bioethical and medical reports, newspaper and television coverage, performances by pop culture icons, hospital records, personal interviews, films, and military files. She argues that we are on the cusp of a new ethics, in an opportune moment for reframing essentialist ideas about appearance in favor of a more expansive form of interpersonal interaction. Accessibly written and respectfully illustrated, Face/On offers a new perspective on face transplant surgery as a way to consider the self and its representation as constantly present and evolving. Highly interdisciplinary, this study will appeal to anyone wishing to know more about critical interventions into recent medicine, makeover culture, and the beauty industry.
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Face Transplants and the Ethics of the Other
By Sharrona Pearl
The University of Chicago PressCopyright © 2017 The University of Chicago
All rights reserved.
In David Lodge's wonderful academic satire Changing Places, we are introduced to the game Humiliation. The point of the game is for participants to reveal which classics of literature they have not read; the winner is the one whose gap is most humiliating. In the book, the winner (the loser) is a literature professor who has never read Hamlet. He wins the game, and he loses his job. (The game has become rather popular in certain circles. You may wish to try it; I leave that time-suck to you.) Here's my own personal version of Humiliation: I've never seen John Woo's 1997 film Face/Off in one sitting. Appalling, I know. But in my defense (and leaving aside evaluations of the movie itself, which ... I'll leave aside), the face transplant(s) that take place in the movie are fundamentally different from those I explore in this book in ways that are deeply significant. In the film, John Travolta's character switches faces with the terrorist portrayed by Nicolas Cage as part of a heroic quest to save lives. He doesn't want to do it, but he quells his misgivings and conducts this major personal sacrifice in service of the greater good. The face transplant at the heart of the film is done for the benefit of others despite the individual cost. It's a heroic masculine journey that will end when the world is saved. It's reversible. John Travolta will get his old face back. And while his experiences posing as a terrorist criminal mastermind may change him (and they do — spoiler alert), in the end, he gets his life back. He gets himself back.
Facial allotransplantations (FAT), commonly known as face transplants, are not reversible. While their effects may be temporary (faces, like all other transplanted material, can be rejected and lost), the old faces are, by definition, gone forever. The old selves attached to the old faces are perhaps gone forever. (But isn't that true of us all? Isn't every moment that passes a moment of our lives and our selves gone? And aren't we now different as a result?) And while face-transplant recipients may on some level undergo the surgery for others, to shield the world from their faceless condition, they are, in the end, doing it for themselves, for their own ease of life and ability to navigate the world. They may do it for their relationships with others, for their ability to develop relationships with others or deepen ones that had been compromised by facelessness and the trauma that led to it, but the surgery is ultimately not a heroic project, not in the save-the-world kind of way. Even though, as we'll see, it is sometimes painted as one. But its personal nature is often presented by bioethicists and journalists as cosmetic, and maybe even selfish, and maybe even cheating. The face transplant, in these terms, is an indulgence rather than a medical necessity, and we'll explore how these are two very different categories of intervention. Except, as I show, when they are not.
These two distinctions, the nonreversibility and the highly personal nature of the face transplant, matter deeply in the way that the surgery and its recipients are understood, presented, discussed, and debated. At stake here are the reasons that people get face transplants and the risks — both medical and psychological — that recipients undertake with the surgery. At stake here is the way that a new face may bring with it a new identity. At stake here is the very meaning of faces themselves. And the meaning of facelessness. That matters too.
This is not (simply, or even at all) a book about the historical stakes for the face. That topic is too, too big. People have thought about it, and written about it, well and in depth. Though I bring some of these theorists of the face to bear at the end of this book (Lévinas, first and foremost, and Deleuze and Guattari, Goffman, Sennett, and Butler), I don't wish to reproduce their work. Also I can't; the long history of the face surpasses the modesty of my intentions here. Well, sort of. This is a book about the stakes for changing the face, and the changing stakes for the face. This begs the question of the meaning of the face, and I think about it with the help of these scholars, and carefully offer my own speculative theories. But rather than looking backward, I push forward, using the face and the most dramatic manifestation of its manipulations to date, the face-transplant surgery, as a way to think about the self, and its always-public representation, as always changing. As always becoming.
I approach the face transplant through the framework of the index, the indexical relationship between the face and character. When that index is vexed, when the context for the correlation has changed, what do our reactions tell us about the meaning (for us) of the face, and the flexibility of its symbolic features? And what about when that index is vexed in the most extreme way, by substituting not just another face, but the face of another? What does that tell us about both the face and the condition of facelessness? That's my question. My answers are in the book that follows, but I'll give you some hints: the index of the face has always been unreliable. The face and the self are always changing and have always been always changing. The face transplant brings that unreliability to the fore, as our reliance on the index itself is being undermined. As it should be. We should encounter the faceless just as we encounter the face. Faces are not the index to humanity, no more so than facelessness. We owe the faceless the face-to-face encounter as well, and the ethical obligations incurred therein. We don't always live up to these obligations to the faceless; we don't always extend to them our acknowledgment of their basic humanity. That might be changing; it certainly ought to.
So how should we (re)conceptualize the face while still taking very seriously the importance of embodied experience? That's what, in part, this book tries to figure out. Like all processes, it's a journey. Writing this book, I've gone on a journey. It started in the nineteenth century, in Britain, with a graduate-school project on faces and their relationship to character. It became a book, and I became an academic. And that book thinks about the face as an index, ultimately arguing that our reactions to the faces of others tell us more about ourselves than the people around us. It also thinks about how people self-consciously fashioned their faces and appearance to play to the index. Maybe to manipulate it.
I took those ideas and assumptions to this book, also about faces. (It turns out — and I truly didn't know this before — that I'm a little obsessed with faces. With the face-to-face.) But what I knew about faces in the nineteenth century turns out to be wrong in the twenty-first. It turns out that while some important things stay the same — bodies matter, faces matter, our relationships to our own faces and to the faces of others matter so very much — other things have changed. And at the end of this book, I outline not only how the face and its status have changed but also how my own thinking around the face and the interlocutors of the face has changed. As I hope you'll see, this is a very personal project in addition to an academic and professional one. It's a project of fighting for the voices and the humanity of the faceless and disfigured, the visually different and disabled, and thinking about why they need fighting for. Thinking about why we have denied the humanity of the faceless or, rather, why we imagine humanity to be vested in the face, and what happens when that assumption is shown to be false. In the conception of the face as index, the faceless are left out. They are, in a way, left for dead.
The faceless are not dead. But at the same time, their new faces bring with them new possibilities, new ways of imaging what bodily change (which we all undergo, though not to this extent) might mean.
This is a project of reframing how we think about minds in relation to bodies, and how we think about interventions on the body with respect to the mind. I hope to unsettle the division between mind and body by showing that treatments to the body treat the mind, or can; minds are deeply individual things. And (like all acts of writing, maybe) this is a project of passion and a project of love. This book about faces is me at my most intimate and me at my most public. I defer some of my own voice throughout the book in favor of my evidence and interlocutors, but at the end I chart what I've learned about the change in faces, and how my own thinking has changed.
The face was always going to be a deeply personal project. What can be more intimate, more inviting, more vulnerable, than sharing our faces? But at the same time, what could be more performative, more produced and manufactured, more public, than the faces we present to the world?
There is no contradiction here. The face is relational. That's one of the major themes at the heart of this book: the face is always public. Manipulations to the face are an act of publicity, one that we think is final. It isn't. We think of the face as fixed. It isn't. Not only because we can manipulate it, operate on it, transplant it, without necessarily rewriting history or transplanting ourselves. But also because we are all always in the act of becoming. As are our faces: they too are always changing. They too have multiple manifestations.
There are many different kinds of faces. But that doesn't mean we should lose sight of the centrality of the actual face, which lies at the heart of my book. Metaphor is important, but so is flesh and blood. In what follows, I use the face-transplant surgery as a way to explore the supposed indexical nature of the face by examining when the index is vexed. Face transplants are a particular case of facial manipulation because they not only change the face, they change it into the face of another. A random other. The story of the face transplant is not the story of changing the exterior to (finally) match the interior, a narrative that corrects faults in the index rather than challenging the index itself. Rather, it's the story of fundamental disruption. At least, it could be. It could be the story of radical hybridity, a new way of thinking about the body and our relationship to it, a new version of the power and limit of self-fashioning and representational judgment. It could be that story, but it isn't: instead, as I show, it's the story of neutralization, of making even this most disruptive of interventions into yet another makeover big reveal conforming to standard gender narratives and bodily norms.
But the face transplant isn't — exactly — cosmetic surgery. It also isn't — exactly — a whole-organ transplant. It's maybe a little of both, and versions of the story have been told to support both formulations, but I think that in the resistance of the surgery to categorization lies an opportunity. We can now trace the shape of a third thing that is a new way of conceptualizing the body and its interventions. It's a way to unsettle the distinction made between bodily interventions and psychological changes. It's a chance to reimagine what the face means without eradicating or ignoring its representational power, its links to identity, and its archiving of history. But we're not there yet, as this book shows. And much of what follows is the chronicle of us not being there yet, as I trace narratives of the face transplant as its resistance to categorization is negotiated and neutralized. I track this potentially radical and certainly pathbreaking surgery from its initial representation as a dangerous and shallow cosmetic procedure through its normalization as a technology of self-actualization and personal growth. I look at the various pieces that contribute to its (sort of) changing public presentation, including early fears of dramatic self-transformation and monstrosity, journalistic framing practices, rhetorics of medical fixing, military involvement and rehabilitation, and makeover narratives. I then imagine, alongside other dissenting voices in this history, another way for face-transplant surgery to be understood.
I'm playful with my sources, moving from medical literature and surgical history to bioethical debates, journalistic reports, reality- and news-television programming, and highly theoretical treatises on the meaning of the face. I dive into cultural manifestations of facial manipulation and substitution, looking in particular at transplant films and the fears they both represent and produce. Undergirding it all is an engagement with the literatures and theories of difference and disfigurement, around disability, around gender, around monstrosity. I think about hybridity and the possibilities and dangers therein.
Face transplants seem to be the realization of medicalized mixing and melding, unsettling stabilities and creating liminal and collective spaces, bodies, stories, and institutions. The lack of fixed points in what is a highly detailed and tremendously complicated surgical intervention makes us very uncomfortable. In a story about identity, we can't quite tell who the main players are because they themselves are not discrete. Or, to put it another way, it is not about the difference between the cyborg and the monster but the difference between the cyborg and the goddess. At the moment, there isn't a real difference between these two transformed productions. But, as the face transplant and other examples that I chronicle show, there could be.
The before-and-after, the big reveal, is a well-known moment in all makeover contexts, televisual and otherwise. In the case of facial-allograft surgery, the big reveal is ongoing with the possibility that the new face may disappear ever-present. (Now that would be a reality moment.) The trauma is always on display; the scars are always visible. What is so shocking about these particular transformations is the normalization of that trauma. These deeply scarred people start to look like everyone else. The transformations by which they earn the right to their new selves lie in precisely the banalization of their pain; when they say they would not go back to the time before their face loss, when they say they have changed, improved, become too different for that, only then can their facelessness disappear. It's a highly conservative narrative, and one that serves to neutralize the radical possibilities of this kind of hybridity. It makes this kind of transformation, like the reality narratives it echoes, almost inevitable. With the right kind of personal labor.
Onscreen for everyone to see.
No other surgery has been archived so richly and in such a wide variety of highly sophisticated media. This is partly because it is so recent, and its documentarians have access to the most advanced technology. It is also partly because of the nature of the procedure itself; visually awe inspiring, the surgery is at its core about giving someone a new appearance and, in so doing, a new or often renewed life. But while many makeovers are ostensibly transformative and may even change people into a new version of themselves, most do not go so far as to turn their subjects into actual other already-existing people. We are left with the question of what the face transplant actually transplants, and who the new person actually is. So much of our identity seems to revolve around our faces; does the face of another bring with it the identity of another?
I use this question as a way to think about how the self has always been in process, always changing, and always mediated. The self has always been a set of choices, and this book discusses what we don't and can't always choose, namely the reactions of others and how they relate to us, and what we can choose, namely how we imagine we ought to relate to others. And that imaginry, thanks partly to the face transplant and its associated technology, and thanks partly to the multiple representations of self in the digital environment, is changing.
More concretely, in chapter 2, "Mind/Medicine," I turn to the history of cosmetic surgery and its intersections with transplants to start the story, showing how FAT is both and neither and something else all together. Through a deep dive into the literature of cosmetic surgery, I map the discursive terrain on which face transplants have been charted, thinking about the rhetoric of facial manipulation in the context of FAT. If the lack of a face is a debilitating medical condition for which a transplant is the cure, what is the difference between that and a more purely cosmetic intervention — is it a difference of degree or kind? The narrative differentiating the former from the latter, as we see in this chapter, is one of risk: the risk of the operation and especially of the lifetime on immunosuppressants while living with a new face. But maybe risk is just an excuse that obscures the true source of our objections. I focus on fears of of identity transfer and cellular memory, tracking the literary and cultural manifestations of this phenomenon, and think about how these impact conceptions of transplant surgeries more broadly.
Excerpted from Face/On by Sharrona Pearl. Copyright © 2017 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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Table of Contents1 Introduction: Effacing
3 Losing Face on Film
4 Decoding the Face-Transplant Debates
5 A Very Special Makeover: Face Transplants on Television
6 Conclusion: Face Transplants and the Ethics of the Other
Appendix: Face Transplant Recipients