Wednesday, March 20, 2019

Part I

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Surgery for the sake of selfies? What a recent trend in cosmetic surgery tells us about our self-absorbed culture

We are surrounded by all kinds of new developments and challenges that do not change human nature but certainly bring human nature to a new light and facing new challenges the human beings have not experienced or faced before. Consider a headline that recently ran in The Washington Post. It’s by a cosmetic surgeon in Washington D.C.’s metro area. The headline, “What do my cosmetic surgery patients want? The headline answers, “To look better in selfies.” The subhead, “Younger patients self-diagnose ‘flaws,’” flaws put in quotation marks, “that often aren’t flaws at all.” Daria Hamrah is the plastic surgeon who is part of a practice in McLean Virginia. He writes, “Ten years ago a typical patient at my plastic surgery practice was 47 or 48. She, about 80 percent are women, generally wanted to look like a younger version of herself or else she wanted the best version of her basic appearance.”

Before we go further let’s just consider that one sentence. We are told that in times past, until very recently, we are told that the average patient looking for cosmetic surgery, 80 percent were women, were seeking one of two realities, one of two results. They either wanted to return to a younger version of themselves or they wanted a more idealized version of their own basic appearance. Now that’s before, this is the way it was in the past. Those two rationales are understandable to us. Someone would want to return to a younger version of themselves, reversing or resisting the pattern of age or they would want an idealized version of their basic appearance.

But if that’s the first sentence it is a setup for telling us that something has fundamentally changed. This plastic surgeon tells us that in the old days patients might come in looking for a face or a neck lift, eyelid lifts, a brow lift, skin resurfacing procedures or Botox injections. The typical patient back then would ask, “What do you recommend?” The doctor then said, “This is the kind of work I got into my profession expecting to do. And these are the consultations I expected to be giving.” But that was then and this is now. What’s changed? He writes this, “Today my average patient according to the records we keep in my office is 38 or 39.” We’ll stop there and say that’s almost a full decade younger than in times past. “She’ll come in fixated on a specific ‘flaw’.” Again the word flaw is put in quotation marks, “and often knows exactly what procedure she wants. Her nose is crooked she’s sure or her chin is too small or large or her eyebrows appear droopy. ‘I need a tip-plasty’, she will say, that’s rhinoplasty for the end of the nose. And these patients,” he writes, “are much less realistic about what I can achieve. They will ask for Kim Kardashian’s nose even if their facial structure looks nothing like hers.”

But all of that is just a setup for the thesis statement of the doctor’s piece which is a single sentence paragraph of just a few words, and these are the words. “There is a reason for this rapid and radical change, selfies.” Now let’s just ponder that for a moment. The very existence of something that is called a selfie. Given all the moral warnings about self-centeredness that are throughout human history, of course Christians know, grounded in scripture. But beyond that just about every civilization has found some way to say that selfishness and self-centeredness is wrong. But now we live in the age of selfies. We not only have something we call a selfie but we’re evidently not embarrassed to call them selfies. That’s a big change in human experience. It’s actually a big change in human moral reality.

But this doctor points specifically to the photographs, of course we call selfies, without apparent embarrassment. And he says that they are changing the way younger people look at themselves. He writes, “The self-taken photograph is warping the confidence of many younger people in unsettling ways. They come to my offices, show me selfies and point to say an asymmetry on their lips. A totally normal variation,” he says. “Often they will have already searched online until they found someone with a similar ‘issue,’” again put in quotes, “who fixed it with surgery.” “In one informal consultation,” he writes on realselfdot.com, a site that lets people ask questions of plastic surgeons, “A woman asked me if plastic surgery could give her cat’s eyes, rounded feline eyes of the sort that some photo filters can add to selfies.” The doctor says, “I told her that wasn’t a sensible goal.” “Once,” he says, “a 20-year-old having studied countless images herself said she needed a facelift.” The doctor then responds, “No 20-year-old needs a facelift.”

But even after reading that far your instinct might be to say, “Well that’s just one plastic surgeon in one practice. That might not be an accurate generalization to the entire culture.” But anticipating no doubt that response the doctor writes, “A survey of members of the American Society of Plastic Surgeons last year found that social media was driving more plastic surgery requests than any other social influence, more than TV, movies or magazine photography, which were the influences the surgeon says I used to hear about from my patients.” “People,” he continues, “are simply spending more time looking at themselves in an online environment where invidious comparisons are inevitable. “But selfies,” he continues, “also mislead people about how they look. Smartphone cameras get better each year but photos taken at arm’s length or closer often produce a fisheye effect. Whatever is at the center of the photo is bigger and things on the periphery are smaller.”

The doctor then cites a study published in The Journal of the American Medical Association’s facial plastic surgery. It was published last year and it found that selfies make noses look 30 percent larger than they are. Now this math might give us some comfort, even quantifying the distortion that results from photographs taken at such a short length. But as you’re looking at this you also come to understand that there’s a far deeper moral issue at stake here. And that was true of the past, not just to the present. “Even going back to the past,” this plastic surgeon describes, “we come to understand from a Christian worldview perspective that something is deeply wrong here.” “You have people who in the past,” he tells us, “were coming because they wanted idealized versions of themselves or they wanted to reverse age or they were comparing themselves with images they saw more glamorous, they saw them on television or movies or in magazine photography.”

But wait just a minute. An informed careful honest observer here would understand that even those images, maybe even especially those images, are themselves distorted. No one looks actually like they look on an airbrushed orchestrated magazine cover. That’s not real. Behind those orchestrated photographs are hours and hours of preparation. The photograph itself may have been chosen from thousands, certainly hundreds. You’re looking at the fact that there may have been hours of makeup. There was all kinds of lighting. There were fans blowing making the hair look like the individual was standing at the beach. All of this is then furthermore in the digital age, manipulated. It’s not reality. It’s bad enough however that that external reality used to be a big problem in comparison but now the point is this doctor is telling us that much of the dissatisfaction driving many people to plastic surgeons isn’t even looking at the orchestrated and manipulated representations of others. It’s looking at themselves. It is the curse of the selfie.

Documentation is provided in the article. He points to one study that included 268 college age students. They found that the more people use social media sites, the more they ruminate, he says, “about their own supposed shortcomings.” There’s no real surprise there. We then would ask the question what exactly is this doctor doing about this problem? What’s his response to the curse of the selfie? Interestingly he tells us that one of his first responses is to require patients to undergo photography, an accurate photographic representation of themselves. He says that that often makes the entire misrepresentation or misunderstanding go away. People looking at an accurate photograph rather than that fisheye effect of distortion by a photograph taken at arm’s length. Well it turns out that that makes a lot of people more satisfied with how they truly appear.

Dr. Hamrah also writes about the fact that there is mixed evidence about whether or not there has been an explosion in total plastic surgery procedures in recent years. But he also points to the fact that the number’s amazing. 1,800,000 surgical procedures that were in 2018 recorded. That’s 1,800,000 plastic surgery procedures. He lists them in their detail which I am not going to list. He says that it is a 1 percent increase since 2017 but it’s down when compared to a five year comparison. So what’s the big story here? The big story is long term not short term. And he says the long term picture is an increased attention to plastic surgery, an increased demand for plastic surgery that is driven by social media and the selfies. He says that even comes down to many the procedures that are now being requested.

But another interesting phenomenon has been remarked on elsewhere in the literature about plastic surgery. A lot of older Americans have already had plastic surgery. Several of them, many of them, have had repeated efforts at plastic surgery, repeated procedures. And now the big thing is the rise of younger patients, younger patients coming in for cosmetic and aesthetic surgery. We’re not talking about reconstruction here. We’re talking about that which is merely cosmetic, merely aesthetic and is driven by their self-perception which is driven by the selfie.

In concluding paragraphs in the article he says that he and many of his colleagues turn down more patients than they accept simply because they don’t think there’s any legitimate reason even for cosmetic or aesthetic surgery. But he concludes with these words, “The truth is that selfies provide an accurate feedback about how we look and they’re generally making people feel bad about themselves.” “That’s nothing, he concludes, “a plastic surgeon should cheer.”

Well even from a secular perspective we see huge problems here. We see the problem of human comparison. We see the problem of self-perception. In a sinful world even self-perception is corrupted. Here you have secular evidence of that. A plastic surgeon writing in a secular newspaper telling us that the selfie culture has produced misperceptions about the self. We also know a great deal more about the dangers of social media. In this case we know and it’s even documented in this article, in cited academic research, that college students who post selfies of themselves on social media, when they then engage in comparison they do not raise their self-esteem. They end up lowering their self-esteem. The issue here is twofold. It is the selfie understood simply as the presentation of the self. Inevitably that’s going to lead to some kind of concern for an idealized presentation of the self. And the other is the insidious reality of comparison. If we are posting in social media there’s always the danger that we will allow ourselves to compare how we look compared to how others look which oddly enough can come down to our selfie as compared to someone else’s selfie. Selfie versus selfie.

I’m not saying that there is never moral justification for cosmetic or aesthetic surgery. And especially looking at reconstructive and plastic surgeries, these are often indicated after an accident or in the aftermath of some kind of problem. But when we go to the moral concern of this article written by a plastic surgeon concerned about this phenomenon we recognize that the issue here is not legitimate surgery but rather his legitimate concern about the younger people who are now coming to him wanting plastic surgery and the reasons they are wanting it. And even secondary and tertiary to that, the kinds of procedures they’re wanting. All of this extremely revealing. All of it very concerning. But Christians have to step back for a moment and understand that normal in this case when we come to aesthetic values is something that covers a huge range of human experience and human appearance.

And this is where Christians also understand that the Christian worldview is based upon the unity of the good, the beautiful and the true. That is the fact that if something’s beautiful, it’s good and it’s true. If it’s true, it’s good and it’s beautiful. If it is good, it’s beautiful and true. Trying to separate the good, the beautiful and the true leads not only to endless frustration but it is fundamentally trying to pry apart what is unified in the very existence of God, the self-existent God who speaks in Scripture. When we understand the Christian Biblical worldview it doesn’t tell us that beauty doesn’t exist. It does tell us that beauty, physical beauty, in human beings can be misleading. It is when it’s found a reflection of the glory of God and it never lasts. It can’t last.

Perhaps the saddest recognition when you read this article is understanding how profoundly unsatisfying all of these surgical procedures are going to be. Even when they might temporarily achieve the improvement to the selfie that is sought, it won’t last. It will turn into yet another form of obsession with the self. It will turn into another concern with representation or misrepresentation. It will turn into an even deeper dive into the selfie culture from which there’s no rescue. We cannot rescue ourselves. No one else can, save Christ.

But I guess we really shouldn’t be surprised if we’re honest that a species who comes up with something called a selfie is dissatisfied with what it turns out to be.

Part II

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Examining the worldview of parenthood-indecision therapists: Is the decision whether or not to have children so trivial that the color of ink can help you decide?

Next, yesterday on The Briefing we talked about the fact that there are some who are warning that given the reality that is claimed about weather change and climate change we should not be having more babies or at least that young people should ask whether or not climate change is an adequate justification for not bringing babies into the world. But in thinking about all of this consider a headline that recently ran in The Washington Post. It’s by Caitlin Gibson with the headline “Deciding Whether to Have Kids has Never Been More Complex. Enter Parenthood Indecision Therapists.” I am so glad I saw this article. I was honestly a bit undecided about whether or not to talk about it on The Briefing right after the issue yesterday but there was no indecision therapist to whom I could turn. So here I am talking about the indecision therapy industry today.

Gibson writes, “They arrive anxious for an answer or maybe finally a sense of peace. They arrive because they haven’t been able to resolve the biggest question of their lives, ‘Do I want to be a parent?'”. And “So,” she says, “they come to the California Therapy Practice of Ann Davidman. By plane, by car, by phone. In the hope that the self-titled Motherhood Clarity Mentor might deliver an epiphany.” No ladies and gentlemen, I am not making this up. This is the Washington Post. Gibson then reports, “Next comes a simple instruction. Write down every fear, every loaded question, every disapproving comment and every panic inducing headline that has coalesced into a stranglehold of indecision. Will my mom be disappointed if I don’t give her a grandchild? What kind of world will my kid grow up in? Will I regret if I don’t have a baby? Will I regret if I do have a baby?” Davidman then tells those who come to her for advice, “You put them all away in an envelope. These are really important issues but we just don’t want to talk about them right now. When you’re considering all these external factors prematurely without knowing what you want and why you want it they just get in the way.”

It’s hard to come up with an article that brings together so much nonsense coalesced and concentrated into just a few words. This is an article that accomplishes all that and more. We are told about a burgeoning new industry of indecision therapists. We are told that they are now trying to help individuals and couples who can’t make up their mind about whether they even want to have a child or not. This has been this therapist’s area of expertise we are told since 1991.

And then Gibson writes, “For members of this cohort, meaning the millennials, and the younger of Generation X, the decision might feel especially daunting. Studies and stereotypes have frequently branded them as burned out, beset by decision fatigue, prone to scrupulous self-examination. They struggle with analysis paralysis in their careers and with FOBO,” F-O-B-O, “fear of better options in their personal lives. They’re waiting longer to get married and so are more likely to confront a narrowing fertility window.”

Now indeed we’re going to be talking about that more in coming days on The Briefing. The tie between that narrowing window and the nation’s falling birth rate but that will have to wait. For now we’re undecided about going forward with the story about indecision. Davidman continues later in the article, “Until fairly recently the question at hand do you want to become a parent wasn’t really a question so much as a pervasive social expectation.” When Merle Bombardieri, a clinical social worker who specializes in parenting decision making we’re told, she’s also the author of the book The Baby Decision, How to Make the Most Important Choice of your Life. When she held her first therapy workshop on parental indecision in Nashville in 1978, yeah that’s right, Nashville in 1978, the attendees “were deeply uneasy discussing their doubts.” “All that’s changed now,” says Bombardieri. “Nobody in these first few years of workshops actually knew anybody who had chosen to be child free but now I think more people are willing to admit that they’re not certain about whether they want to have children.”

I’m skipping way down in the article where one of the therapists says, “The big issue now is anxiety. It’s in, it’s cool. It’s au courant. Anxiety is huge now. That’s increased tremendously in just the last couple of years.” Gibson then writes, “Family dynamics, relationship fears and fertility have long factored into the equation for Davidman and Bombardieri clientele, a majority of whom are women, but the therapist also counseled clients across the gender spectrum, as well as couples. But these days Davidman sometimes hears people bring up concerns about the political climate and the prevalence of gun violence. Bombardieri’s clients have voiced worries about climate change. Both therapists have heard would be parents bemoan the tremendous cost of raising a child especially for millennials whose financial stability was dealt a lasting blow we are reminded in the 2008 recession. One woman who sought the advice said, “The state of the world just couldn’t be overlooked. It’s scary to have a kid right now especially where we live.” In what dangerous place does she live? Well she says later it’s California.

So what kind of exercises do these parental indecision therapists recommend? I love this one. “There’s one particular exercise from Davidman’s class that this one woman still uses whenever she struggles to make a decision.” I’m reading from the article. “She had us live in the “Yes” for a week and then live in the “No” for a week and write about everything that came up. “I was so used to going back and forth in my head a million times a day,” said the woman, “and never just sat with one answer. And it was so powerful.”

Another was told to keep a diary or a journal and the adviser said, “When you have a feeling of excitement about being a parent write that down in one color, and when you’re leaning toward ‘this is a reason I don’t want to have kids’ write that down in another color. After a while I realized that I was about 75 percent of the time using the color of the pen that symbolized not wanting to have a child.” And then the article tells us that she ultimately did choose to be child free. Choosing we are told by color, color of ink, color of the pen she was using.

It’s important to look at one section of the article where we are told, “The most important thing according to Davidman is for a couple to understand what they want before they decide what they’re going to do.” The adviser, the parental indecision therapist, said, quote, “It’s more about having clarity than choosing one path over another. This process is not for the faint of heart and is not simple. It requires people to possibly face some very uncomfortable feelings.” Yes, she actually said that. She said it’s more about having clarity than the actual decision. I’ll just offer that from a Christian worldview perspective, that is nonsense. It’s really about the decision. Being clear within yourself is hardly the great goal of human existence. And once again this comes on the heels of a report telling us that a member of Congress reflecting a larger cultural movement we discussed yesterday on The Briefing is suggesting that young people maybe shouldn’t have babies or at least should ask whether they should have babies because of the danger of bringing a baby into this world. And now you have The Washington Post of all things, the most influential newspaper in this nation’s capital city, telling us that there is a new specialized profession of parental indecision therapists. And then we are taken into their world, a world of colored pens and personal self-clarification.

And then as we come to a close, just when you think it can’t become more disappointing, oh yes it does. At the end of the article we have one of these therapists saying that sometimes after the parental indecision therapy process is concluded she’ll get an answer when she is sent a photograph on a cell phone. “Sometimes a year later I’ll get a picture of their dog or I’ll get a picture of their baby.” There you have the confusion of the secular worldview in just a few words. A picture of a dog, a picture of a baby. It’s just a decision. So long as you’re clear in yourself it’s all that matters. A dog or a baby. Both called parenting. End of story.