Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery (review)

Sander L. Gilman. Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery. Durham, N.C.: Duke University Press, 1998. xii + 179 pp. $21.95.

This intriguing book charts a number of themes within the history of the ideology of aesthetic surgery by connecting that ideology to the psychoanalytic goal of enhancing personal well-being. The Hippocratic oath required for entry into the medical profession forbids surgery on healthy patients; thus, from the founding of their specialty in 1887, aesthetic surgeons justified their procedures on psychological rather than medical grounds. By doing so, according to Sander Gilman, they established a close bond between their specialty and psychotherapy, which Freud invented not long after.

Gilman's argument about the correspondence between aesthetic surgery and psychotherapy is novel, if debatable. Early in Freud's career, after his disastrous operation on Emma Eckstein's nose, he abandoned surgical intervention. The personnel and procedures of aesthetic surgery and psychotherapy have remained distinct throughout the twentieth century, aside from the surgeons' wholesale adoption in the 1920s of Alfred Adler's "inferiority complex" to justify their procedures. One might posit an alliance between physicians and psychologists in the latter's pursuit of drugs as therapy, or in their experimentation with surgical techniques, such as prefrontal lobotomies, but Gilman does not pursue these possibilities. Rather, he seems to have spun a historical argument out of a present reality: as liposuction and breast implants become as common as straightening teeth or bobbing noses, it may be that body reconstruction is joining psychotherapy as a standard part of our modern therapeutic culture.

Gilman is most convincing when he explores the underlying rationales for certain types of aesthetic surgery, especially those involving the nose. This was the first body part on which aesthetic surgeons operated--partly because of the destruction to the nose caused by syphilis, which was epidemic in the late nineteenth century, and partly because anti-Semites denigrated large noses as typically Jewish. Gilman explores many variations on this theme. Western culture long connected the nose to the penis as a symbol of sexuality; thus Jews were vilified for a perverse sexuality because of their presumably large noses--and, conversely, for a lack of sexuality because they underwent circumcision, popularly viewed as castration. Gilman's Jew, however, is male. Given Freud's original operation on Emma Eckstein, one wishes that Gilman had added gender as a category of analysis in addition to his focus on ethnicity.

This book is neither a history of aesthetic surgery nor a definitive work on the issue of body types idealized by aesthetic surgeons. Yet, like so much of Gilman's writing, it is a stimulating--if idiosyncratic--reading of certain themes in the histories of the body, race and ethnicity, and medicine.

Lois W. Banner
University of Southern California

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