26.02.2004

Unkindest cut of all

Though TV programmes and womens' magazines normalise plastic surgery, it is a form of self-harm, argues Zoà« Simon

The essence of adolescence is the crushing realisation that your internal reality has no bearing on your external reality. Why don’t the most difficult and the darkest emotions burst out of us, mark us, maim us, mark the world? There is no answer to this question other than they just don’t. We know that they don’t - experience has taught us that.

The aching sense of this contradiction continues into adulthood, and the creative mind frequently draws on it: Munch’s The Scream and Rothko’s split canvasses have become its epitome.

Adolescence remains the fulcrum - the point at which these difficult feelings explode. There are, as always, statistics. Self-harm leads to about 15,000 attendances in accident and emergency units each year, while an estimated 25,000 adolescents end up in hospital after self-harming. A survey commissioned in 2003 reported that 66% of hospital staff considered adolescent self-harm to be on the rise; one in 10 teenagers have deliberately harmed themselves …

I reiterate that the discrepancy between realities continues into adulthood. How do adults reconcile themselves to it? Some continue to self-harm; some - like Munch - fill the world with images of their internal reality; some make their bodies their own canvas - they resort to plastic surgery. Perhaps you find the link tenuous? You may claim that plastic surgery is designed to make people look better, and if you have ever had sight of a deliberate cut or burn on the body of your child, sibling or friend, you may argue that a spliced lip or breast is a lot less upsetting, and a lot more appealing. I argue that the two things have the same root, and that is the square root of pain.

Those who undergo plastic surgery have such a deep-rooted, internal sense of their body’s wrongness that they will undergo painful procedures - cutting, splicing, stretching, scraping - in order to realise their internal self. Society’s reaction? Some treatments are available on the NHS, and, if you can afford it, at luxurious private clinics. Whether we travel economy or business, shame isn’t on the in-flight menu. By contrast, a self-harmer will arrive at A&E in severe pain to be accused of time-wasting. Serial self-harmers report being told that they are wasting bed space, of waiting hours for treatment, and of having strips put on wounds rather than stitches. A particularly distressing anecdote tells of a young man being made to wait in a room full of razor blades.

Did the hospital staff imagine that the individuals concerned felt good about what they had done? Clearly they do and it is a widespread misconception - the media labelling it a ‘cutting craze’, and its young participants ‘wannabes’ eager to join the ranks of the disappeared Richey Edwards and Garbage’s glamorous front woman, Shirley Manson.

In reality self-harm is accompanied by huge feelings of guilt, and fear at what you have done to yourself. What I want is not society’s labelling of a self-inflicted cut or burn as an acceptable aesthetique. I am not hankering after the lurid society as depicted in Ballard’s Crash. That, after all, wouldn’t lead to tolerance: rather fetishisation of injury. I want a recognition that the desire to have plastic surgery, and the desire to self-harm come from the same place - a place of pain and depression.

Most depressives describe a loss of contact with reality, a constant battle to achieve the sense that they are ‘still here’. Self-harmers say that seeing blood or a burn is proof that they still exist. I don’t doubt that anyone desperate enough to have plastic surgery has any less of a fragmented sense of their own identity. That they feel unrealised by their outer appearance to the extent that they are willing to alter it permanently. And society not only supports these changes: it prescribes a set of acceptable changes.

Sociologists have begun to document the homogenisation of the female face through surgery - a prominent upper lip or ‘trout pout’ being one of the sought after looks. When I was at school, a friend was absent for a week owing to a nose job. When I asked what it looked like I was told she had had a “number 8”. I’m still reeling from the late Paula Yates’s tale about choosing a pair of silicone breasts - she was ushered into a room walled with breasts, and asked to point out the ones she wanted.

It seems to me the worst form of bullying. Society not only caters for people’s insecurities, but also makes money out of them. A spliced lip is just as indicative of a psyche in crisis as a self-inflicted wound. And, what is more, we are familiar with the idea of self-harm through drug and alcohol abuse, and eating disorders. We know that people risk inflicting long-term harm upon themselves for the short-term benefit of relief. So why make self-harmers the pariahs?

As communists, and as human beings, we have the sense that reality doesn’t always come up to scratch. It is the tragic essence of the human condition. As a society it’s high time we stopped allocating people a MacDonald’s menu of how to deal with it.