Body by Daddy
When I
was 13 years old, as if overnight, a
mole appeared on my right cheek, diagonal to the upper corner of my mouth. This
seemed like a forbidding omen, though I did not yet know it was the beginning
of the end. I had been put on attention-bending stimulants at the tender age of
8, and my baby fat had melted off in inverse proportion to my sudden increased
ability to spend hours at the piano practicing Air on the G String. I spent my
latency period seraphic, a tawny lanugo coating my long legs and arms. The
geriatric greeters at Walmart smiled behind their support our troops buttons,
complimenting my mother on her beautiful children. In the heat of the car ride
home, my mother would rebuke me for vanity, but I didn’t experience my body as
beautiful or unbeautiful. I was — and I cannot emphasize this enough — fucking
high for the entire opening act of the millennium. But the mole was sudden and
felt ugly, portending worse transformations to come.
I caught
my father in the master bathroom one night shortly after the mark appeared. He
was still in his blue scrubs, returning late from another complicated hospital
birth. We both took in my face, not looking directly at each other but at our
reflections in the large mirror over the sink. He told me it was like the
beauty mark gracing Cindy Crawford, whom he called, within earshot of my mother
in the adjacent bedroom, “the most beautiful woman in the world.” My father,
the evangelical obstetrician-gynecologist, was for once on the same page as the
puberty enchiridion published by American Girl, which I would read in the
coming months crouched between the magazine racks in the public library, poring
over cartoon diagrams of the vagina: You Are Beautiful the Way You Are. I was
beautiful the way I was then, but it wouldn’t stay that way.
In the
years to come, as my face grew pocked and twisted with the precipitous growth
spurt of my upper jaw, as my father became ashamed of my awkward body suddenly
veiled in a chastity garment of ill-laid fat, I held this moment — my father
and I regarding each other quietly in the mirror — as incorruptible. For years,
I planned to tell this story at his funeral.
Things
fell apart. I left home. Years later, I returned. My father had not exactly
divorced my mother, but he had a new ultra-beige apartment and was sporting a
puka-shell necklace procured as a memento of the most recent of his new
indulgences, Caribbean cruises. I started telling friends, “My father is in his
Gauguin phase.” His Gauguin phase, it turned out, was financed by a specialty
dermatology clinic catering to women targeted by skin-care advertising terms
like firming and tightening. After a long career birthing the lily-white
evangelical children of our Lollardy southern town, my father’s gimlet eye lit
upon the new needs of his aging clientele. He was determined to be a better man
than his deadbeat Canadian father, and had spent the heady first months of Bush
II’s sequel term devouring an investing-for-beginners book and tape series
titled Rich Dad Poor Dad, which promised insight into the secrets of the
wealthy, and possibly — secondarily — fatherhood. After a series of opaque
real-estate deals tanked in the 2008 crash, Rich Dad returned his gaze to the
oldest moneymaker, the female body.
There
are treatments that needle the entire face so that the body, mistaking itself
as under violent attack, pumps blood to the epithelium. There are threads you
can attach to the inside of the temple and pull up through the hairline,
tightening the sagging skin. All this under local anesthetic, if any. The
business in injectables alone — Restylane Lyft, Juvéderm Voluma, Bellafill — is
brisk and easy money, at around $800 per syringe, with each multi-syringe
procedure requiring an apotropaic annual repetition. “Almost everyone you know
is having it done,” my father told me. After a few years at it, he’d developed
a kind of craftsman’s appreciation for techne: inability to detect the art was
the measure of excellence. Casting his diagnostic eye on the public and
discreetly remarking “what she’d had done” — this woman at Chick-fil-A, that
celebrity in the supermarket checkout tabloids — became one of his standard and
most entertaining bits.
Almost
everyone you know is having it done. The market for cosmetic surgery in the US
climbed rapidly between 1992 and 2005, increasing by 725 percent, with over $10
billion spent in 2005 alone. The same period saw so-called noninvasive
procedures, like peels and soft-tissue fillers, increase by 3,158 percent, as a
raft of new products came to market. Over the next decade the injectables
market outperformed even the most optimistic predictions of the American
Society of Plastic Surgeons, hitting 9.92 million procedures annually in the US
if you include Botox. The global market for facial injectables in 2016 was
valued at $6.5 billion and is projected to reach $17.2 billion by 2025. (For
comparison, the global statin market was valued at $19.2 billion in 2017.) The
main cause behind these ever-increasing numbers is the rise of noninvasive
procedures, purveyed by clinics that can book you last minute and have you back
at your desk the same day. A new, younger demographic of people in their
twenties and thirties is flocking to plastic surgeons and dermatologists, lured
by the pied pipers of Instagram. “Invest in your skin,” one campaign reads,
beside an image of a woman with radiant cheeks and bee-stung lips. “It’s going
to be with you a long time.”
For my
father, the lateral move into the medicalized beauty market was a “Meet the new
hysteric, same as the old hysteric” sort of situation. My father’s approach to
the female body was, by and large, that of a sanguine auto mechanic dealing
with a clientele he benevolently regarded as clueless. He was the first
physician in our southern state to perform surgeries with the laparoscopic
wonder dubbed the da Vinci system, a suite of high-tech gadgets the university
hospital network introduced in the melee for patient-customers in the early
2000s. The system allows the surgeon to perform procedures via tiny incisions
in the skin. A robot that looks like a praying mantis is inserted into the body
cavity, its movements tracked by a camera, the whole thing leaving only a
whisper of a scar.
As if to
provide encyclopedic dispatches of the gore machine my prepubescent body was
poised to become, my father shed magazine-size, high-def color photographs of
innumerable uteri gleaned from his robotic labors into the maw of his new
Miata’s passenger seat. This purchase my mother had greeted darkly with a
tight-lipped quotation from Ecclesiastes, “All is vanity and vexation of the
soul,” notwithstanding the fact that he had bought it secondhand, and that it
was constantly sputtering what seemed to be its final protest. With Leonardine
optimism, my father would coax it to continued efforts, prostrate under its
body or hunched under its hood. As I helped him clean out the car during one
such session, carrying armfuls of vivid glossies of women’s guts to dump in
piles on his desk, from under the car came my father’s voice: “You wanna know
what it’s like doing a vaginal hysterectomy? It’s like changing the engine
through the exhaust pipe.”
“El da
Vinci” was not the only innovation pioneered by my father in the wild early
Aughts. After leaving a group practice of seven ob-gyns, my father struck out
on his own, an American utopianist all the more American for being a Canadian
refugee fleeing the penurious margins of socialized medicine. He was a man who
believed in being smart so you could make money, so you could use that money to
engineer solutions to problems caused by the sad fact that everyone in the
world was a fucking moron. He was a man whose fight against the man turned out
to involve, to his great regret, day-jobbing as the man. He had migrated south
in search of a B-I-N-G-O of warmer climes, a privatized health-care system, and
a community of believers who would honor the Holy Ghost while otherwise leaving
him the hell alone. His late-career embrace of the out-of-pocket beauty
industry was simply an extension of this earlier logic. After a series of
weekend courses in the subtle arts of the needle, he was ready to set up shop.
Under the golden sun of American capitalism, taking out a uterus was a mere
shade of difference away from cool-sculpting the drooping fat of the upper arm,
microblasting the depredations of fine webbing around the eye, hypodermically
finessing the turgid lip into a sinuous, artisanal pout.
And so,
although he was not a man eager to acknowledge his shortcomings, my father
offered amenities as if in tacit recognition that there had been faults
meriting redress. Mistakes may have been made. When I met him for dinner over
Christmas break after my first semester of graduate school, my father had his
business partner in tow, a nurse practitioner my boyfriend at the time would
later describe admiringly as “stacked.” She was more than stunning, the sort of
woman you could imagine, if you didn’t know any better, feeling Beautiful the
Way She Are. She beamed at me with a Pre-Raphaelite glow while fawning on his
arm: “Your daddy did my lips.” Over the following years, my aunts would have
their wrinkles blasted, their cheeks and lips plumped, their underarms
de-flabbed, all gratis. My mother found it a dark business, and anyway it had
been curtains for her. As we kissed goodbye after dinner, my father paused in
the restaurant’s foyer light. Peering at the right side of my face, he noticed
the mole as if for the first time. “You know, I could get rid of that mole real
easily.” For free, he said, as a gift.
He had
forgotten, of course. A pang of fondness shot through me. I didn’t remind him.
I knew he was just trying to help. Several nights later, we drove to the dark
clinic, where I lay on the tissue paper–covered dais as he burned off the mole
with workmanlike detachment. Pressing gauze to my face in the car on the way
home, I thought, You Are Not Beautiful the Way You Are, But with Some Smart
Investment, You Could Be Okay. By my early twenties, having seen the direct
correlation of opportunities both social and professional with being hot, I was
not not desperate. Most women are, if you ask me. Vanity and vexation of the
soul. To be a woman is to engage in constant revision of our horrific, obdurate
bodies. It often involves surgeries.
The Bad
Feature
In the
years after the mole, I came to the realization of the Bad Feature. The Bad
Feature waxed and waned in my mind on its own mysterious cycles, eclipsing my
ability to think and then receding. Under its moon I became a monster, a
lunatic. By the end of the worst year, the Bad Feature had ballooned
cancerously to the size of a white whale. It was a year in which I could not
stay sober from the intoxication of its shame, months on end in which my mind
was occupied by it — not like a handicraft, but like a foreign army. It had
become first hard, then impossible, to leave the house without white-knuckling
my way through a handful of juiceless CBT routines. That this misery enveloped
me so entirely was only an added mark in my own bad book. Wasn’t the political
situation getting worse and more worthy of my attentions? I was shallow,
stupid, bad, evil, hideous, vain. The language of shame has always been my
natural grammar, but by the end any tensegrity of my mind had collapsed; I was
speaking fully, ecstatically, in tongues. It sounds like a joke to say that for
several years I seriously contemplated suicide in a pattern of reasoning that
fastened to the unlivability of a life in which, in addition to everything
else, I was grotesque; it sounds even more like a joke to say that I don’t
anymore. The Bad Feature is the only changed variable.
To be
clear, I’m not complaining. Even in the worst phases of a dysmorphia too
mortifying to describe any further, I knew, rationally, that it was a
politically conditioned tic of the mind, inseparable — like everything
else — from its political-economic-historical conditions, but not inherently
politically valorous for being so. Two months before my consultation with the
surgeon, I had run the numbers. Surgery was cheaper than therapy, assuming as I
did that it would take at least two years to get to the bottom of things by way
of the couch. I didn’t want to stop wanting what I wanted. What I wanted was to
be wanted in the way that I wanted. I wanted to change my appearance, not how I
related to my own visibility. I was making a targeted strike.
I had
found the practice of a doctor I’ll call William Fabriole through a website
that advertised him with unsettling modesty as the best cosmetic surgeon in the
“greater metropolitan area” of a midsize town. During the night car ride to my
father’s clinic years earlier, swatting at the silence that seemed to be
radioactively emanating from the mole, I’d asked him if his new profession had
caused him to view his own face differently, as something with the potential to
be improved. Had he ever been tempted to get high on his own supply? My father
had eluded giving a straight answer, but Dr. William Fabriole was not a man who
left you in any doubt on the question. It was hard to find what art historians
call the “detail” in his face, which caused it to look like something that
would melt if left in a hot car, but by the time we met for my surgical
consult, I’d already decided that any change would be better than continuing as
I had. And anyway, the consultation fee was nonrefundable.
Perhaps
I’d been half hoping that in the harsh light of the medical clinic, the
professional gaze would size me up and tell me I was insane to think I needed
any surgical help. Fabriole eyed my head like a secondhand purchase, turning it
this way and that by the chin, and asked me to discuss my “concerns about my
face.” I spoke in clipped sentences, as if describing troubles with a piece of
machinery. “I definitely see what you mean,” he said, while in the background a
nurse nodded silent amens. As in every instance of ritual humiliation, I felt
myself to be in a state of grace. I left with a bill for the $4,000 I had
scraped together and a surgery date, on which morning I arrived alone, was put
under, awoke bedazed by painkillers, called a cab, and recovered in solitude in
an Airbnb for several days. I told no one save my two closest friends where I
was or what I was doing, considering this one of my weirder experiments,
certainly no one else’s business politically or otherwise. The first rule of
feminine labor is that you don’t talk about your feminine labor.
During
my battle with the bad feature, a significant piece about gendered
body-modification surgery caught my attention. In an op-ed in the New York
Times titled “My New Vagina Won’t Make Me Happy,” the author, a transgender
woman on the eve of bottom surgery, argued that the question of whether or not
someone should be able to get trans surgery should be decided simply by whether
or not they want it, end of story.1
On its
own terms, this holds water. If I could opt to have my Bad Feature addressed as
I willed it, why not Andrea Long Chu or anyone else? As things stand, trans
surgery is ghettoized within a bureaucratic hedge of medical ethics and
specialist evaluation that arrogates to itself the power to decide whether a
procedure will be “good for the patient.” Chu argues that this medicalization
of trans surgery in the name of “patient outcomes” is rank paternalism
masquerading as ethics. As I read Chu’s piece, laid up post-op through a veil
of bandages, it did not escape me that it was possible that this was the
dumbest thing I had ever done. I hadn’t asked anyone for advice because I
hadn’t wanted any. Even including the sizing-up my Airbnb host’s lumpen
boyfriend gave me as I staggered in from the cab, my face swollen as a bitten
tongue, the only thing that could have made the process more humiliating would
have been a state-licensed high inquisitor of my sanity asking me if I was sure
I really needed what I wanted. My Airbnb host was a perfectly lovely woman
dating a man who, as far as I could tell, spent most of his time playing a
cacophonous video game involving dragons, and occasionally screaming invectives
at the postal worker, and I was in a pink haze of Vicodin facing the reality
that I had disfigured myself permanently; nobody was checking in on us to make
sure “we knew best for ourselves.” Why start asking if women are sure they know
what they want only when they get to the consultation chair for trans surgery?
At first
blush, what’s so persuasive about Chu’s reasoning is that the decisionism
vested in the physician in trans surgery is exceptional, one of the few
remaining holdouts of a physician sovereignty that has by now become largely
antique. In every genre of gendered body modification other than trans surgery,
all that was solid in the physician’s little kingdom has melted into air. Chu’s
demand is that the same standard of patient choice apply in trans procedures.
Yet what’s missing from this political program is a sense of how the dethroning
of the physician — whose completion Chu calls for — was achieved and how it
ended with the recurring triumph of commoditized medicine and the great failed
experiment of the current American health-care system.
Following
World War II, the vast expenditure of the American military state on applied
sciences like medicine suggested that the state could replace the market and
provide its citizens with universal health care. Spooked by the threat of
national health plans in the style of Britain’s new National Health Service,
American capitalists and the state struck a deal: the state would invest in
health care, but health care would remain a commodity. Throughout the 1950s and
1960s, the US federal government invested dizzying amounts in medical science
to sponsor research and fund hospitals. By the mid-’60s, medicine was reeling
into what would be called the biological revolution, as cutting-edge
technologies from genetic engineering to cardiac pacemakers sprang to life,
nourished by federal funding aimed at maintaining the nation’s cold-war edge.
But the
rapid pace of technological change throughout the 1950s and 1960s introduced an
ever-widening knowledge gap between physicians and their patients. Soon
patients began to grow suspicious of doctors’ unchecked power, and several
radical civil rights and liberation movements coalesced to demand patients’
rights. The antipsychiatry movement railed against psychiatry’s medicalized
imposition of social normativity, often implemented through underfunded state
institutions that confined rather than treated patients. Simultaneously, the
women’s health movement revolted against the lack of autonomy available for
women in making decisions about their bodies, particularly reproductive
decisions, while demands for medical justice were likewise key features of
antiracist liberation movements, animating the Black Panthers’ campaigns for
free health care and against medical experimentation in prisons, for example,
and the Young Lords’ free medical clinics.
At the
same time that patients were seeking greater autonomy over their medical care,
a crisis of unevenly distributed medical capacity was underway. Following the
defeat of Harry Truman’s 1950 proposal for a national health plan, which left
it to employers to provide health care to their employees, huge portions of
rural, often agricultural populations were without coverage or care, and the
majority of even the employed population had only inadequate
fee-for-service — or nonexistent — benefits. (By 1960, three in four American
workers were nonunion and thus lacked the ability to wrangle a strong
contract.) The Lyndon Johnson Administration’s creation of Medicare and
Medicaid in 1965 likewise did not succeed in resolving the health system’s
central contradiction: that the most technologically advanced nation failed to
deliver the benefits of its medical advances to the estimated fifty million
Americans too poor to afford any type of medical care. The bitter irony of the
situation was that by introducing a system of generous direct subsidies to
hospitals and physicians without introducing effective price controls, Medicare
and Medicaid only contributed to the runaway spiraling of health-care costs
throughout the late 1960s, as hospitals and physicians jacked up their fees.
Conservatives could have hardly asked for a better example of an alleged
failure of central-government planning with which to argue that the solution to
the health-care crisis could only be mediated by the information-processing
functions of the market.
By the
mid-1960s, as the health-care system began to buckle into permanent crisis,
patient suspicion toward doctors began to be normalized. Even the average
citizen was skeptical of the kind of scientific “expertise” that authorized the
Tuskegee scandal and human experiments in Nazi death camps and US prisons
alike. The push to topple the dictatorship of the white coat was increasingly
articulated not as a subsidiary of the civil, feminist, or environmental rights
movements, where it had originated, but of the burgeoning consumer rights
movement, whose assault on corporate power was by then propulsive enough to
have procured Kennedy’s 1962 Consumer Bill of Rights. Reframing the problem of
medical care as an issue of protecting buyers from unfair business practices
gave everyone a partial victory: the patient would be empowered, but with the
power of the consumer.
Milton
Friedman’s 1962 Capitalism and Freedom argued that professional medicine was a
licensed guild that should be exposed to market forces. Instead of the
state-backed profession limiting consumers’ choices by professional and ethical
restrictions, Friedman argued that the consumer should be trusted to choose
among any medical service offered for purchase — including from “crackpots” and
experimentalists lacking good standing in the medical profession. The only
consideration restricting what types of treatment and body modification are
available to a patient should be whether party A is willing to sell it and
party B is willing to buy. Friedman’s argument was an edgelord version of what
was rapidly becoming common sense. The lesson seemed clear: the failure of
federal planning demonstrated that only the market could discipline prices to
calibrate demand and value.
The
result was that across the political spectrum, opinions converged in agreement
that the proper role of the government was not to provide or subsidize
services, but to guarantee that each individual was equipped with accurate
information as they navigated the health-care market. The consumer’s discretion
among services came with the condition that the patient shoulder moral
responsibility for their choices. As John Knowles’s influential 1977 essay “The
Responsibility of the Individual” argued, the consumer’s increased discretion
correlated to a deeper responsibility for their own decisions: “The idea of a
‘right’ to health should be replaced by the idea of an individual moral
obligation to preserve one’s own health — a public duty if you will.”
The
marketization of medicine was also attracting increased financial investment
throughout the 1970s and early 1980s. In the wake of the Reaganite
triumph — which spelled a clear end to any threat of a national health
plan — Wall Street plunged into a health-care bonanza. Investors staked out
markets in hospitals, commercial laboratories, and long-term care facilities
while a suite of new biotech companies held IPOs. With health care launched
through the financialized looking glass, the everyday decisions of patient care
were increasingly governed not by sovereign physicians, but according to the
terms worked out between for-profit health-care giants and insurance companies.
This
effectively describes our situation now, the result of a political bait and
switch. The patient has been empowered, sure, but only because she is paying.
Getting our heads around how the present state of affairs came about means
grasping that capitalism is the sine qua non of modern American medicine’s
historical development. The logic of the market was grafted into its DNA, and
its essential character is that of a commodity, not a juridical right.
Chu’s
case for the sovereign right of the individual to modify their body in accord
with their desires is the clear-sighted and internally consistent extension of
the logic that has come to govern health care in the United States. On these
terms, Chu’s reasoning is not just persuasive, but the ineluctable extension of
a dialectic in which the radical critique of the patriarchal institution of
medicine was coopted by the neoliberal transformation of medical science into a
marketplace. If medical care is a purchasable commodity, and if the consumer is
not harming other people, then what right does the physician have to interfere
in the workings of the market?
Of
course, not all body modification procedures are privatized. In the US,
twenty-one states plus Washington DC provide Medicaid coverage for transition
therapies. Only eighteen states have Medicaid programs that explicitly include
hormone replacement therapy and both genital and chest modification. Of these,
six states provide coverage for hair removal, and three provide surgery for
facial feminization or masculinization. The long legal struggle to secure these
provisions relied on establishing transition as “medically necessary,” a
technical term that hinges on qualifying the mental anguish trans individuals
often suffer because of gender dysphoria as a kind of sickness. In consequence,
procedures that would be cosmetic for someone cisgendered are medically
necessary to mitigate intense psychological distress. As the World Professional
Association for Transgender Health argues, “Although it may be much easier to
see a phalloplasty or a vaginoplasty as an intervention to end lifelong
suffering, for certain patients an intervention like a reduction rhinoplasty [a
nose job] can have a radical and permanent effect on their quality of life, and
therefore is much more medically necessary than for somebody without gender
dysphoria.” The case for the state’s coverage of trans surgery is predicated on
the medicalization of dysphoria as being different in kind from everyday
cosmetic dysmorphia. By this logic, the role of the physician in rationing
state resources is to sort the cosmetic from the medically necessary, the
aesthetic from the political.
Which
brings us to the paradox of trying to hold Chu’s position while also imagining
socialized medicine: you can either demand sovereignty over the body as a
customer investing in your human capital, or you can make the case for the
state rationing resources to provide medical care. What you can’t do is try to
have it both ways, both appealing to professionalized medicine to underwrite
the legitimacy of desires for bodily transformation as “medically necessary”
while stripping the physician of precisely the authority your claim annexes.
But of
course, when you really want something, contradictions matter less. Everyone
knows that. As many trans people have argued, acceding to the medical narrative
that being trans is a sickness is simply making a deal with the devil. That’s
one thing I’ve learned about desire: it can feel so much like sickness that you
agree to suspend the quotation marks around “sick” if it will get you the
“cure.” That’s what it means to want something.
Desire
doesn’t say yes or no; it holds two irreconcilables and says “and yet . . .”
I’ve learned to call this a dialectic: I want to want to not want to be
beautiful, and yet I want to be beautiful; I am a woman, and yet I am not
really a woman; I don’t believe plastic surgery is or should be necessary, yet
I needed plastic surgery. For some time now I have kept my whole story a
secret, thinking I could never survive the humiliation of anyone knowing, and
yet there’s something I can’t stop myself from telling you. Desire is the Bad
Feature.
Plastic
Desire
It’s
become a fashionable gesture to call things ‘’Neoliberal’’, a gambit raised to
a coup d’éclat if the speaker’s target has pretensions to liberatory politics,
preferably feminism. That’s not what I’m up to here. Neoliberalism is not
something to be revealed by scanning the zeitgeist and picking off X but not Y
cultural phenomenon (Hillary Clinton but not tenant organizing, Instagram but
not blood donation). It doesn’t work that way; neoliberalism is a historically
specific infrastructure — of central banks, software, language, policing,
kinship, and so on — that conditions contemporary social reality, infusing its
logic into the most intimate zones of everyday life. What I am describing is
the development of a historical condition: the rise of medicalized body
modifications aimed at making gender performances “better,” undertaken within
the subsumption of health care into neoliberalism’s ontology of the market.
Is being
trans in 2020 conditioned by neoliberalism? Understood historically, yes. So is
being a nurse, taking an evening course in graphic design, signing up for food
stamps, quitting Instagram and then signing back up for it, apologizing to Dad
so he’ll sign your FAFSA, going another year without seeing the dentist — in
short, so is everything we do within the political horizons and ordinary
calculus of everyday life.
This
doesn’t mean there is no outside to neoliberalism, but that — like
neoliberalism itself — the outside is nowhere in particular. To find the
outside you have to look at people who think they’re disagreeing, then follow
the logic of both parties to its terminus of secret agreement: the shared
paradigms, language, values, and logic forming the consensus required for them
to understand what they’re disagreeing about in the first place. That’s where
neoliberalism lives, in the secret back laboratory of politics, the place where
the molecular units of common sense are concocted.
In this
secret laboratory, neoliberalism breeds its synthetic life-form, a parasitic
hybrid of Homo economicus and financialized postindustrial capitalism that
Foucault called the entrepreneur of the self. After centuries of interminable
struggle between labor and capital, the parasite got wise: she sees that the
body of the host organism — its health, intellect, physical attractiveness,
knowledge — is itself a form of capital whose value must be maximized through
investment. Once the parasite has hacked the organism, activities that used to
look like very different sorts of things — namely, production (or labor) and
consumption — are now a single genre: all activity becomes investment in the
human body the parasite has taken over in order to maximize returns on its
human capital.
Monetary
returns are only one potential form that dividends might assume. “Not all
investment in human capital is for future earnings alone,” Theodore Schultz, an
early theorist of human capital, explained in 1962. “Some of it is for future
well-being in forms that are not captured in the earnings stream of the
individual in whom the investments are made.” Seen this way, incels who fail to
compete in the Darwinian sexual marketplace can invest in “chad surgery” to
generate returns on their “sexual capital,” and the enormous global market for
cosmetics becomes a rational ramification of women’s savvy investment in what
economists by 1997 were calling “beauty capital,” the advantage bestowed by
good looks.
This is
to say, nature is a sentimentality the parasite cannot afford, though the
illusion of it can lend value as superadded artifice. As proprietor of its
host’s body, the parasite takes a cool, ecumenical approach to augmenting and
optimizing the organism and has no qualms about becoming cyborg, provided the
likelihood for return on investment is there. It manages the body as a
privatized investment property, responsible to no one for its life and, it
follows, imbued with the right to do whatever it likes to that body.
The
equivocal status of the cyborg as private investment property has prompted some
contemporary feminists to wonder what became of the political potential of
biotechnology heralded by feminists at the end of the biological revolution in
the 1970s. In a recent essay, Jia Tolentino sketches the imperative for
feminized self-valorization under postindustrial capital — barre class,
orthorexia sponsored by Sweetgreen, dermal-injectable-plumped features — before
homing in on the early works of Donna Haraway, the paladin of an earlier
generation’s techno-optimist feminist school. In the 1980s, Haraway sized up
the hippified romanticization of the natural among feminist
second-wavers — think Gaia, menstrual cups, and trans exclusion — and concluded
that liberation would not ramify out of continued enthrallment to the idea of
an unreconstructed nature. Instead, in her 1985 “A Cyborg Manifesto,” the
most-likely-to-be-abused essay in critical theory since Marx’s “Fragment on
Machines,” Haraway argued that because the construct “woman” is already constitutively
artificial, feminist politics shouldn’t be afraid of abandoning nature. There
is no natural essence of woman to be faithful to in the first place. Since
woman is already cyborg, feminists could torque technology toward liberation,
even if the technological marvels of the day were the offspring of the US
military-industrial complex and the consumerization of medicine.
But
while in 1985 Haraway thought that by 2020 women would be using technology to
biohack their way out of oppression, the feminine cyborg these days seems to
use technology only to get a leg up within the game patriarchal capitalism has
set up for her. Visions of radical gestational engineering to free women from
the division of labor chaining them to the home have given way to global
commercial surrogacy markets that keep Mommy’s tummy flat. Cyberspace is less a
zone of radical freedom from political hierarchy than a panopticon that
relentlessly quantifies and transacts social capital. Woman is born cyborg, yet
she is everywhere Instagramming.
In a
further weird turn of the dialectical screw, the cyborgification of women’s
bodies seems to tend toward a virtuosic augmented performance of the natural.
The contemporary fashioning of woman is notable not for the embrace of the
artificial that marked Haraway’s Eighties woman — the camp-artificial
silhouette of jutting shoulder pads and the no-holds-barred conspicuous
makeup — but for its recommitment to “the natural.” We get injections now so we
can meet beauty ideals without seeming to wear any makeup at all. Now, we not
only have to look hot but to conceal the artificiality of hotness, to veil the
labor required to achieve the effect. Under this politics of reenchanted
nature, the entire political spectrum agrees that women should not spend a lot
of time or money looking hot — or if they must, they should be discreet about
it, because making your complicity in your own oppression obvious is in bad
taste. Camp is dead, or at least kind of gross. If you want to be a woman now,
you had better mean it without the quotation marks, regardless of your genitals
at birth. For someone who had been resistant to doing either for years, I found
it less personally or politically embarrassing in polite left-liberal society
to come out as queer than to admit to having had plastic surgery. The
supposedly liberatory insouciance of the woman who “woke up like this” is the
structural isomorph of the queer who was “born this way,” two claims that only
function, like the commodity fetish, by occluding the conditions of their
production.
Why has
the cyborg collapsed as a political figure? If the Harawayan project was to use
technology to facilitate nonnormative desires, why does the expression of those
desires look like a relentless drive toward self-optimization? It is as if
desire is itself a kind of hybrid, both plastic and organic. It is as if the
desires for transformation that enlist technology are formed in the conditions
of technocapitalism. The cyborg, it turns out, was easily colonized: it has no
desires, and the parasite does.
This is
the problem with the politics of desire. The parasite is already within us, and
our desires are not our own. It’s not that a “real” self has been colonized by
the infrastructures of desire, but that the very thing that we call “self” is
composed of that colonization; the self does not exist without it. The politics
of desire that undergird both the private transformation I pursued and Chu’s
argument hinge on an idea of “rights” without referent to the constructions of
both subjectivity and social collectivities as the transparent outcome of
nature. With their framing of desires as natural rather than artificial — an
expression of essence rather than the historical contingencies of power — the
politics of desire end up reanimating the very carcass of romanticized nature
that Haraway attacked. As in so many post-’68 political impulses that unwittingly
reinscribe the politics of natural law that they claim to revolt against, here
desire comes to stand in as nature, in the sense both of “that which could not
be otherwise” and “that from which our politics must be deduced.”
Extracting
political projects from this naturalized desire — as if it were impossible to
want anything other than what we want — plays the same card as any other
naturalization of politics: from the neofascists, it looks like blood-and-soil
racism linking arms with evolutionary biological notions of gender; from the
center, the idea that political constructs like queerness or “mental health”
can be found in the folds of the cerebellum or the gene. The entire ideological
project of neoliberal governance hinges on this gambit’s success: Will we buy
into the illusion that the desires of the parasite are inevitable? This is what
Foucault meant by saying that the entrepreneur of the self is “eminently
governable”: the apparatus of power doesn’t have to resort so much to open
coercion or violence. It is already on the inside, pulling the levers of the
individual’s desires with an invisible hand.
The
Ethical Body
Some
pricate medical insurance will cover bottom surgery, mostly after putting the
applicant through a grotesque bureaucratic stations of the cross, but balks at
covering anything beyond getting the genitals or chest to make the quantum leap
onto the other side of the gendered binary opposition. Aetna’s policy language
on coverage for transitioning is a litany of denials: blepharoplasty, body
contouring (liposuction of the waist), breast enlargement procedures such as
augmentation mammoplasty and implants, face-lifting, facial bone reduction,
feminization of torso, hair removal, lip enhancement, reduction thyroid
chondroplasty, rhinoplasty, skin resurfacing (dermabrasion, chemical peel), and
voice modification surgery, which have all been used in feminization, are
considered “cosmetic.” The same goes for the tools of masculinization, whether
chin implants, lip reduction, breast reduction, or nose implants. In other
words, after bottom surgery, for the rest of the long slog toward woman- or
manhood, you’re on your own, fighting your fat hips or square jaw like the rest
of us.
In terms
of achieving acceptance as your identified gender, it’s arguable that so-called
cosmetic procedures are a priority on par with genital surgery. After all, most
people won’t be looking below the belt. The tragedy of public violent attacks
and discrimination against trans people would conceivably be better addressed
by cosmetic surgery that facilitates “passing,” not to mention the payoffs of
the “beauty premium” that pays dividends in social, monetary, and sexual
capital. Improving the normative performance of gender is an effective strategy
in the arsenal of human capital’s self-valorization. As a 2017 Columbia Law
Review article noted, both hair removal and facial transformation procedures
can offer significant benefit to transgender patients, and it seems arbitrary
to offer coverage of certain gender-affirming procedures yet deem others to be
cosmetic. But by insurance companies’ logic, reductive gender biopolitics are
what keep them from going belly-up. If insurers started covering the myriad
forms of bodily modification beyond those of the genitals, the infinite
optimizations that make one’s gender performance more “real,” who wouldn’t take
out a policy?
With the
world that we have, Chu is right to demand that trans surgery be treated as all
other forms of bodily modification, as nobody’s business but the patient’s. But
it’s telling that exactly the loss of such autonomy is held up as a bête noir
by conservatives and neoliberals alike in the face of demands for socialized
medicine, from the specter of “death panels” to the ability to “see your
doctor.” It’s not for nothing that opponents of single-payer programs reach for
the plastic surgery market first as an example in their arguments against
universal coverage. Because costs in the plastic surgery market are borne
directly by the customer-patient, they argue, cosmetic surgery markets have
been immune to the ballooning costs otherwise prevalent in health care.
Demanding the extension of the regnant logic of privatized medicine only punts
on the question of what bodily modification and its medicalization would look
like under the conditions of collective, socialized medicine.
The
socialization of medicine is not simply a process of installing a government
payer to pick up the tab for a system that remains otherwise intact, but a
transformation of the ethical relationship between the individual body and a
collectivity. The ethical premise of the welfare state is that statistical risk
to the individual should be borne by the body politic as a whole. In return for
insurance against the risk of accident or injury, the citizen’s body is not her
own; her body is sponsored by a collectivity whose lives are bound up in each
other’s. In many senses, the story of the late 1970s is the story of how social
institutions were dismantled in the name of freeing the individual to fulfill
their desires: in place of the institutions of collectivity, the libertarian
imagination promised infinite freedom from the repressive mores of the welfare
state. But if neoliberalism is found not in one specific entity or phenomenon
but in the fabric of a way of life, the way out is the disintegration of the
paradigm that provides the individual with absolute sovereignty over the body
in the name of private property and the freedom to invest in her own human
capital. Decommodifying health care requires decommodifying the human being.
What
this means is that there is a fundamental anachronism in attempting to transact
the political projects of the neoliberal subject within the framework of the
welfare state. The welfare state disciplines the individual into the political
imagination of a collectivity as the price of its care for her life. By
contrast, the politics of the sovereign consumer in the era of neoliberal medicine
are predicated on taking one’s own desire so seriously that it forms the core
of a political project that is coterminous with investment in the self. The
marketplace seems to be the supervenient structure that conditions all possible
realities in which bodies relate to each other and transform. If the rallying
phrase “My body, my choice” originated as a call for women’s liberation, its
cooptation by astroturfed protesters calling for the post-Covid economy to be
flung back open is no surprise: the rights of the individual over her body
reach a limit in the ethical relation of the individual to a political body.
The medicalized aesthetic projects of the body can make us hot; they can aid in
chasing the asymptote of becoming woman, no scare quotes; but they cannot get
us out of the fundamental paradigm of the neoliberal subject: the ownership of
the self as private property to self-optimize. It’s every woman for herself out
here under the unforgiving glint of the needle, the scalpel, the credit card
chip.
If we
conjure the political will to create socialized medicine under the argument
that health care is a human right, what forms of becoming gendered will be
covered? To say that only bottom surgery would qualify is to reinscribe
precisely our enemies’ reductive biopolitics of genital obsession. But what if
becoming woman is a process not simply of jumping across a gendered binary, but
one constantly occurring within gender itself? Do we then lean into or out of
the medicalization of the gendered body? Do we have a right to be hot? Why
should the socialist state cover one woman’s acquisition of breasts and not
another’s augmentation of them? What is the space of nonequivalence between
these two visions of “rights,” the right to purchase a commoditized medical
service and the rights of an individual within a sociopolitical collectivity?
If the welfare state is staked on the ethical wager that the plastic body is
sponsored by the collectivity to help realize a collective vision of the good,
what is the relation between rights and desires? And if the body is not private
property to be managed as an investment, then how do we relate to it?
Epilogue
If you ‘re
wondering whether my surgery worked, the answer is yes and no. Yes, in that I
am no longer tortured, and no in the sense that I don’t look particularly
different from how I did before, certainly not hotter. Truth be told, I was
disappointed in the surgical results, and sank into a brief state of
nigh-psychotic despair, arriving at my one-month follow-up appointment ready to
wage war. Like all the most dangerous lunatics, I was cunning. “I think it’s
important for us to have honesty in the surgeon-patient relationship,” I said,
citing the highest principle I reckoned I could force Dr. Fabriole to pretend
to agree to. “And if I’m speaking honestly, I feel that we” — a lesson from
Rich Dad, when negotiating always use we — “haven’t achieved the results I was
hoping we would.”
He
understood my gambit perfectly and adapted without a downbeat. “Sure, OK,” he
concurred, hauling out his phone from the back pocket of his scrubs and holding
it at a farsighted arm’s length as we inspected the pre- and post-op photos,
side by side. “And if we’re being honest, your befores aren’t so hot either.”
Point and counterpoint. There was nothing to say to this but to revert to the
first principle of negotiating, Dwell on Common Ground, in this case that we
both agreed on that. In the following weeks, our therapeutic relationship fell
apart precipitously in the course of an email thread whose critical juncture
was my suggestion that “Just keep hoping and praying for the best” was not
confidence-inspiring medical advice. By the end, he suggested that if I wasn’t
happy, I was free to take my cash to a new physician, or pay him four thousand
more dollars, preferably the former, as far as he was concerned. That’s how the
marketplace works.
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