Beauty is bought by judgement of the eye?

Isn’t it interesting how differently we look at things? How the same bridge crossed by ten people becomes ten bridges? How beauty is so subjective? So ephemeral? Just think of how Shakespeare opened his second sonnet: When forty winters shall besiege thy brow and dig deep trenches in thy beauty’s field, thy youth’s proud livery, so gazed on now, will be a tattered weed, of small worth held.

And yet to some, beauty -however evanescent- seems a prize worth having, no matter the sacrifice. It seems unfair that it should have been doled out to some, but not to others. There are cultures where the inequity of this disparity is taken seriously; there are countries where beauty is felt to be a right to which all should be entitled no matter their social strata.

So accustomed am I to my own cultural mask, I have to admit that I had not realized that Brazil was such a place until I came across an article in the Conversation that addressed the issue. It was written by Alvaro Jarrin, an Assistant Professor of Anthropology, at the College of the Holy Cross in Massachusetts. https://theconversation.com/in-brazil-patients-risk-everything-for-the-right-to-beauty-94159 ‘Brazil considers health to be a basic human right and provides free health care to all its citizens. […] In Brazil […] patients are thought of as having the “right to beauty.” In public hospitals, plastic surgeries are free or low-cost.’ But, ‘public hospitals remain severely underfunded, and most middle-class and upper-class Brazilians prefer to use private medical services.’

Jarrin feels there is a darker side to this medical largesse however, in that the surgeries are frequently performed by more junior surgeons, just learning their techniques (albeit likely under the supervision of more experienced surgeons as is frequently the case even in the USA).

He goes on to say, ‘Yet these patients, most of whom were women, also told me that living without beauty in Brazil was to take an even bigger risk. Beauty is perceived as being so central for the job market, so crucial for finding a spouse and so essential for any chances at upward mobility that many can’t say no to these surgeries.’

‘Plastic surgery is considered an essential service largely due to the efforts of a surgeon named Ivo Pitanguy. In the late 1950s, Pitanguy […] convinced President Juscelino Kubitschek that the “right to beauty” was as basic as any other health need. Pitanguy made the case that ugliness caused so much psychological suffering in Brazil that the medical class could not turn its back on this humanitarian issue. In 1960, he opened the first institute that offered plastic surgery to the poor, one that doubled as a medical school to train new surgeons. It was so successful that it became the educational model followed by most other plastic surgery residencies around the country. In return for free or low-cost surgeries, working-class patients would help surgeons learn and practice their trade.’

The author seems to feel that the reconstructive aspects of plastic surgery -techniques for the treatment of burn victims and those with congenital deformities, etc.- have taken a back seat to techniques geared to aesthetic enhancement, however. ‘Since most of the surgeries in public hospitals are carried out by medical residents who are still training to be plastic surgeons, they have a vested interest in learning aesthetic procedures – skills that they’ll be able to later market as they open private practices. But they have very little interest in learning the reconstructive procedures that actually improve a bodily function or reduce physical pain. Additionally, most of Brazil’s surgical innovations are first tested by plastic surgeons in public hospitals, exposing those patients to more risks than wealthier patients.’

As a retired (gynaecological) surgeon myself, I have to say that I take issue with the naive view Jarrin seems to have about the training of the resident surgeons he reports. After all, clearly it would be better for the young surgeon to learn techniques under the careful guidance of an experienced mentor, than to suddenly be expected to possess the required expertise once she has passed her exams. Indeed, a selection bias is perhaps equally applicable to the anecdotes Jarrin quotes to demonstrate his contention. But, in fairness, I may be guilty of an insidiously perverted form of cultural relativism myself: I see my own world even when it’s not…

Cultural relativism, first popularized in the early twentieth century, attempts to understand and judge other cultures not by our own standards, but by theirs. It is a contextually rooted approach that can be devilishly difficult to achieve. We are all inherently cultural solipsists; we learn customs from the cradle and mistrust or actively disavow any deviations from those to which we have become habituated.

Even beauty itself is fraught. What is beautiful? Surely it is an ill-defined shadow on a rather large spectrum, its position tentative and arbitrary, depending as it must, on time and measurement. Shakespeare knew that. We all know that… Or do we? Are there unequivocal, objective criteria that must be met, or are they entirely subjectively defined? Culturally allotted? Surgically assigned?

No one has defined beauty more bewitchingly, in my opinion, than the poet, Kahlil Gibran, a Lebanese-American writer and artist in The Prophet. When the prophet is asked about beauty, he replies:

… beauty is not a need but an ecstasy.
It is not a mouth thirsting nor an empty hand stretched forth,
But rather a heart enflamed and a soul enchanted.

It is not the image you would see nor the song you would hear,
But rather an image you see though you close your eyes and a song you hear though you shut your ears.
It is not the sap within the furrowed bark, nor a wing attached to a claw,
But rather a garden for ever in bloom and a flock of angels for ever in flight.

… beauty is life when life unveils her holy face.
But you are life and you are the veil.
Beauty is eternity gazing at itself in a mirror.
But you are eternity and you are the mirror.

I cannot criticize the cultural ethos of Brazil, or its need for beauty; I can only wonder whether they will ever find what they are so desperately seeking. Who can touch a rainbow just by reaching?

 

 

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This Thing of Darkness

We all walk the earth in egg-shell armour at the whim of Nature. There is little of any of us that will not break if chaos strikes, or heal without a scar. You’d think that, given our fragility, we would opt for conciliation or compromise, and yet more often we challenge those who are not us, and seek to conquer those we cannot otherwise convince to join. It has become a point of honour not to yield, and so we glorify those who suffer grievous injury for causes dear to us, and our stories magnify their deeds, and exploit their hardships. We call them heroes…

But not all who suffer are our heroes, even though they may also have demonstrated equal courage for their positions, or found themselves inadvertently damaged in the crossfire of our wrath. We call them victims -if we notice them at all -and often deny guilt, even if we do.

Despite Steven Pinker’s contention in his The Better Angels of Our Nature that violence has been diminishing ‘over long stretches of time’ and that ‘today we may be living in the most peaceable era in our species’ existence’, I am still troubled by the violence that continues around us. Of course he may be correct in pointing out a lack of current, or at least, local internecine wars that would affect our daily lives, and suggesting that our improved communication systems highlight and magnify our knowledge of more distant conflicts without our having to experience the trauma ourselves. So, is it our arguably decreasing experience of violence that makes something like domestic cruelty stand out? At any rate, when this form of abuse seems all too apparent around us, it is impossible to ignore. Immoral to accept.

And often hidden beneath the more obvious traumatic injuries are the long-term effects. Of course we have all read about the ramifications of continuing abuse, and about how difficult it is to know whether the injuries are purposefully inflicted or the accidents they are often claimed to be, but what about the often more subtle and cumulative effects of traumatic brain injury?

Two articles caught my eye when I was trying to learn more about the subject. The first was an op-ed in the Los Angeles Times of a few years ago: http://www.latimes.com/opinion/op-ed/la-oe-1012-garayserratos-tbi-domestic-abuse-20151012-story.html ‘In recent years, medical science has uncovered the high risk and devastating effects of traumatic brain injury, or TBI, among U.S. combat soldiers and athletes, especially football and hockey players. What if a vastly greater population were also suffering these effects: women and children living with the consequences of domestic violence?’

At that time, ‘There [were] few empirical studies on the prevalence of TBI among women and children affected by domestic violence. But evidence so far strongly indicates a silent epidemic, with major public health ramifications. A 2001 study found that 67% of women seeking emergency medical support for injuries stemming from domestic violence had symptoms related to TBI, and 30% reported loss of consciousness.’

A more recent article, with links to this op-ed was in the online Conversation: https://theconversation.com/traumatic-brain-injury-the-unseen-impact-of-domestic-violence-92730 ‘The statistics are terrifying: In Canada, one woman is killed every week by her partner, globally, one third of women will suffer violence at the hands of someone they love in their lifetime.’

The article was written by Paul van Donkelaar, a professor in the Faculty of Health and Social Development and a neuroscientist at the University of British Columbia. He goes on to ask, ‘But what if survivors […] are also dealing with the effects of a traumatic brain injury along with the fear and trauma of finally having escaped a long-term abusive relationship? […] the impacts of this injury can be devastating — ranging from headaches, double vision and nausea to difficulty concentrating, remembering things and completing simple tasks. It’s also clear the effects tend to be worse when the trauma occurs repeatedly over time, with symptoms lasting for months to years.’

And, ‘Unlike athletes who have suffered a sport-related concussion, survivors of intimate partner violence also quite often experience emotional difficulties such as post-traumatic stress disorder (PTSD), depression and anxiety.’

‘[…]the U.S. Centers for Disease Control and Prevention, reports each year, 2.3 per cent of women over the age of 18 experience severe physical violence including “being slammed against something” or “being hit with a fist or something hard.” Furthermore, up to 90 percent of survivors of intimate partner violence report head, neck and face injuries at least once and typically on multiple occasions.’

Although I’d like to hope that we live in somewhat different conditions from our neighbours to the south, ‘Assuming similar percentages in Canada, this translates into approximately 276,000 women per year who will suffer a traumatic brain injury as a result of intimate partner violence.’

One of the many disturbing things about this trauma is the possibility of subsequent cognitive deficits -some of which may be severe, and because they may have occurred years before, difficult to remedy, let alone reliably assign attribution. As the author of that op-ed in the L. A. Times, Maria Garay-Serratos, wrote of her mother: ‘For as long as I can remember, my mother took aspirin every day, complaining of unbearable headaches. Sometimes she locked herself in the bedroom with the lights off, asking me to take my siblings outside because she couldn’t tolerate the noise. As she got older, her naps grew longer and her sensitivity to light and noise intensified. By her 50s, her memory had begun to fail.

‘On the day she finally asked me to take her away from my father, I found her in a worse state than I had ever seen her. She could barely stand. She was crawling from room to room while my father ignored her. […] When all the tests were finished, the neurologist told us my mother was suffering from moderate to severe Alzheimer’s disease. The head trauma had been so great and so consistent that there was little they could do.’

Unfortunately, it’s all too easy to focus on simply treating the physical symptoms -and, of course, rescuing the victim from further harm. This is obviously important, and yet woefully insufficient; there is also a need to be alert to problems that seem temporally unrelated. The link to head trauma may be more evident with events like automobile and athletic or combat injuries, but less so in a woman who escaped from an abusive relationship years ago.

Maybe Pinker really has spotted an inexorable trend towards less violence in our society. In the meantime, however, I think ongoing surveillance and counselling for the effects of head trauma might help the abused victims to live a better life while we await an actual treatment for what we now call CTE (Chronic Traumatic Encephalopathy). Oh, and an effective prevention strategy, too -in case those better angels lose their jobs…