Face/On

Face/On Face Transplants and the Ethics of the Other

by Sharrona Pearl

University of Chicago Press, 2017
Cloth: 978-0-226-46122-9 | Paper: 978-0-226-46136-6 | Electronic: 978-0-226-46153-3
DOI: 10.7208/chicago/9780226461533.001.0001

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ABOUT THIS BOOKAUTHOR BIOGRAPHYREVIEWSTABLE OF CONTENTS

ABOUT THIS BOOK

Are our identities attached to our faces? If so, what happens when the face connected to the self is gone forever—or replaced? In Face/On, Sharrona Pearl investigates the stakes for changing the face–and the changing stakes for the face—in both contemporary society and the sciences.

The first comprehensive cultural study of face transplant surgery, Face/On reveals our true relationships to faces and facelessness, explains the significance we place on facial manipulation, and decodes how we understand loss, reconstruction, and transplantation of the face. To achieve this, Pearl draws on a vast array of sources: bioethical and medical reports, newspaper and television coverage, performances by pop culture icons, hospital records, personal interviews, films, and military files. She argues that we are on the cusp of a new ethics, in an opportune moment for reframing essentialist ideas about appearance in favor of a more expansive form of interpersonal interaction. Accessibly written and respectfully illustrated, Face/On offers a new perspective on face transplant surgery as a way to consider the self and its representation as constantly present and evolving. Highly interdisciplinary, this study will appeal to anyone wishing to know more about critical interventions into recent medicine, makeover culture, and the beauty industry.

AUTHOR BIOGRAPHY

Sharrona Pearl is assistant professor of communication at the Annenberg School for Communication at the University of Pennsylvania. She is the author of About Faces: Physiognomy in Nineteenth-Century Britain and editor of Images, Ethics, Technology.

REVIEWS

“Written in a voice that is punchy, personal, ruminative, probing, and always crystal clear, Face/On shows how face transplants raise some of the oldest mysteries of identity and embodiment. Not only an inquiry into medical and media ethics, it is also a philosophical consideration of identity, a cultural study of popular discourse, an exploration of intractable questions about health and beauty, and a consideration of what it means to be an enfleshed being. Always poignant and funny, Face/On is illuminating.”

— John Durham Peters, Yale University

“In this thoughtful and engaging exploration of medical, cinematic, popular, and literary representations of the face transplant, Pearl deftly shows what is at stake when faces are surgically changed as well as how these stakes have changed over the past century. Face/On powerfully confronts the societal abnegation of the faceless, the disfigured, and the visually different, compelling us all to rethink how we imagine humanity.”

— Kathy Davis, author of Reshaping the Female Body

“Pearl has provided us with a new chapter in the history of modern identity. Beautifully written, Face/On offers both a history of medical transplants and an account of philosophical and theoretical investigations of the relations between face and self.”

— Jack Halberstam, author of The Queer Art of Failure

"Although only about 30 face transplants have been performed, Sharrona Pearl believes that the procedure – and the ways it has been represented in films and television – touches on crucial 'questions of the self, the relationship between mind and body [and] cultural negotiations of self-presentation and manipulation'. It may also lead us to think again about the design of digital avatars and how 'faces in advertising and other media [are manipulated] to elicit behaviour from viewers'. This book charts the strange territory that has been opened up by the advent of face transplants and claims it may be 'time to come up with a new ethics of the face'."

— Times Higher Education

"Sharrona Pearl‘s new book is an absolute pleasure to read. Face/On looks closely at facial allotransplantations (FAT), commonly known as face transplants, in order to offer a careful and fascinating study of the stakes for changing the face, and the changing stakes for the face.... [S]parklingly written and well worth a read!"

— Carla Nappi, New Books Network

"An expert on physiognomy, Pearl delves into the multiple ethical and social dimensions of face transplants touching on questions of self-identity, and peer and social identification....This book is an interesting read for everyone and closes the gap between science fiction and the realities of modern medicine. Sharrona Pearl raises socially relevant questions and issues in modern medicine, psychology, philosophy and science, and makes the reader think not only about the faces of other people, but how we look and judge others and how we look at ourselves."

— American Journal of Transplantation

"This is a significant and timely book. Since 2005, more than 40 face transplants have taken place globally, and each has brought medical, ethical, emotional and sociological challenges. Pearl offers an important contextualisation to debates about the surgical challenges, seeing social discomfort around the procedure as part of a broader and more fundamental bias about facial identity.... Sharing stories of those who have literally lost (and gained) their face, Pearl writes beautifully and polemically, with a genuine passion for her subject, in particular for the ‘humanity of the faceless,who through disfigurement or transplantation may be denied respect by, and engagement with, human society; snubbed, rejected, humiliated or “left for dead”’."

— Fay Bound Alberti, Social History of Medicine

"Face/On looks at the cultural representations of face transplants. It is a fascinating account of media discourses particularly concerning the issue in the United States. In a refreshing writing style that keeps her own voice strong, Pearl promises not only to reveal the mechanisms of institutional normativity by discussing the media discourses about face transplants but also to use the chance 'to reimagine what the face means'. . . . As with many topics Pearl touches, she inspires curiosity to look further."

— Andrea Zittlau, H-Net

1. Introduction: Effacing - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0001
[face transplant;facelessness;ethics;indexical;disability;relationality]
This introductory chapter frames the book as a whole through the stakes for changing the face, and the changing stakes for the face. It argues that face-transplant surgery is the most dramatic manifestation of face manipulation to date, situating the surgery as the ideal way to explore public representations of the self as always changing. The face transplant is discussed through the indexical relationship between the face and character. The face transplant vexes the index in the most extreme of ways, by substituting not just another face, but the face of another. What does that tell us about both the face and the condition of facelessness? The book lays out the answers to these questions, starting with the assertion that the index of the face has always been unreliable.The face and the self have always been always changing. The face transplant brings that unreliability to the fore, as our reliance on the index itself is undermined. As it should be. We should encounter the faceless just as we encounter the face. Faces are not the index to humanity, no more so than facelessness. We owe the faceless the face- to- face encounter as well, and the ethical obligations incurred therein. (pages 1 - 9)
This chapter is available at:
https://academic.oup.com/chica...

2. Mind/Medicine - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0002
[identity transfer;cellular memory;bioethics;cosmetic surgery;organ transplants;face reattachments;cinema studies;science fiction;immunosuppressants;Sandeep Kaur]
This chapter explores the history of cosmetic surgery and its intersections with transplants, showing how FAT is both and neither and something else entirely. Through a deep dive into the literature of cosmetic surgery, the chapter maps the discursive terrain on which face transplants have been charted, discussing the rhetoric of facial manipulation in the context of FAT. If the lack of a face is a debilitating medical condition for which a transplant is the cure, what is the difference between that and a more cosmetic intervention—is it a difference ofdegree or kind? The narrative differentiating the former from the latter, this chapter shows,is one of risk: the risk of the operation and especially ofthe lifetime on immunosuppressants while living with a new face. Butrisk is just an excuse that obscures the true source of our objections. After a discussion of the first transplants and their relationship to the birth of bioethics as a field, the chapter explores the first facial reattachment and reactions to it. It moves to fears of identity transfer and cellular memory, tracking the literary and cultural manifestations of these phenomena, thinking about how these concerns impact conceptions of transplant surgeries more broadly. (pages 10 - 48)
This chapter is available at:
https://academic.oup.com/chica...

3 Losing Face on Film - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0003
[Eyes Without a Face;Seconds;The Face of Another;post war;gender;surgery;medical power;self-transofrmation;cinema;international]
This chapter explores cinematic representationsof face transplants and the fears and concerns they reveal in three filmsfrom the 1960s, The Face of Another, Eyes without a Face, andSeconds. These films, all shot post– World War II, investigate the varying cultural considerations around losing face in Japan, France, and the United States, respectively. In each film acts of radical self- transformation are punished, even if they represent an escape from the liminal state of facelessness, a state between life and death. The chapter analyzes common themes in all the films, thinking about the role of medicine and the evil doctor, the dismantling of the family, the stakes for self- transformation, the adherence to gender roles, individual and collective obligation and punishment, and the liminal space of life without a face. The journeys in these films all end up going nowhere, but there is great violence along the way, and that violence ramifies. Those seeking to alter their faces do not mourn, or heal, their conditions. They attempt to eradicate them. It doesn’t work. Not for people, not for countries, not for history. The lesson of these films is that replacement and revision don’t work. (pages 49 - 87)
This chapter is available at:
https://academic.oup.com/chica...

4. Decoding the Face-Transplant Debates - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0004
[Isabelle Dinoire;bioethics;journalism;frame analysis;medical literature;France;Jean-Michel Dubernard;transplants]
This chapter introduces a case study, exploring the popular, medical, and bioethical debates following the first partial face transplant of Isabelle Dinoire in 2005. It concentrates on the technical aspects of the surgery, as well as the way that it was framed by surgeons and bioethicists in the medical literature during early attempts to get ethical approval for the FAT. The chapter argues that there was space in the initial journalistic coverage of the surgery to imagine it as something other than strictly cosmetic and strictly self- serving, imagining and taking seriously the therapeutic possibilities of facial interventions. The earliest news narratives were cautiously positive, celebrating the practical advantages of the procedure for (recipient) Isabelle Dinoire and future patients. It then looks at how and why that space constricted as Isabelle Dinoire and her doctors were put on journalistic trial for attempting to win what newspapers around the world dubbed “the face race”. While broad bioethical concerns provided the ostensible framework for these challenges, the underlying narrative rested on a discomfort with Dinoire’s own right to the procedure, which occupied an ambiguous space between medically necessary reconstruction and elective aesthetic surgery. Ultimately coverage was highly critical and negative. (pages 88 - 122)
This chapter is available at:
https://academic.oup.com/chica...

5. A Very Special Makeover: Face Transplants on Television - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0005
[makeover television;medical documentary;television studies;military funding;Carmen Tarleton;Charla Nash;Richard Norris;James Maki;Dallas Weins;Mitch Hunter]
This chapter looks at the continuation of the face transplant through its mediatization. It focuses on television representations of subsequent face- transplant recipients in the United States, reflecting on the highly conservative, deeply normalizing stories these representations tell. These television representations are mapped onto both the medical- documentary and makeover formats. This analysis shows the rhetoric of the big reveal of the conforming external self, earned by trauma and the work of self- improvement. There is a specific national context to this study, as the United States is the only country for which recipients of the surgery needed a private source of funding. There’s also a gendered story: women make better (makeover) television, a significant advantage in raising needed funds and awareness for the procedure. I consider the role that television portrayals play in making the surgery palatable and acceptable, a trajectory heightened by military involvement in, and funding of, the surgeries and their associated research. The chapter argues that military rhetoric frames the surgery as the solution to the social problem of the injured vet. Except ultimately, the index between the face and theself remains fundamentally vexed, asking us to rethink what we imagine faces can tell us. (pages 123 - 155)
This chapter is available at:
https://academic.oup.com/chica...

6. Conclusion: Face Transplants and the Ethics of the Other - Sharrona Pearl
DOI: 10.7208/chicago/9780226461533.003.0006
[ethics;Emmanuel Levinas;Orlan;Michael Jackson;Genesis P-Orridge;Joan Rivers;the other;online identity;bodily determination;digital bodies]
This concluding chapter examins public performances offacial and bodily manipulation by Orlan, Genesis P- Orridge, Michael Jackson, and Joan Rivers thinking about how these bodily canvases open up arenas for new ways of thinking about the body, the face, and the self. It considers what physical identity means in the online arena, and how new possibilities of face and body mutability might create space for a radical reorganization of relationships. Drawing on a number of theorists of the face including Emmanuel Levinas, Judith Butler, Deleuze and Guttari the chapter argues that it’s time to come up with a new ethics of the face, a newconception of what faces mean and what we mean when we look at faces. The face, manipulated by transplant, by other surgery, by accident, by time, changes in multiple ways. And these manipulations may be called cosmetic or reconstructive, and these two may not be all that different. We have to understand, and also ensure, that the loss of face does not mean losing face. If we take all that seriously, we won’t put the faceless on trial. Only then, may the full radical potential of the surgery, of hybridity, be unleashed. (pages 156 - 180)
This chapter is available at:
https://academic.oup.com/chica...