Gimlin, D. (2007) ‘Accounting for Cosmetic Surgery in the USA and Great Britain: A Cross cultural Analysis of Women’s Narratives’, in Body and Society, 13 (1): 41-60.

[An article which makes a couple of interesting points: it examines the ways in which those who have had voluntary cosmetic surgery explained the decision to themselves and to others, and it looks at the ways in which typical explanations seem to be derived from a common vocabulary of health policy which differs between the USA and Great Britain].

This is a contribution to work on various ‘accounts’ – ‘efforts to explain questionable behaviour (even if only to one’s self) in order to neutralise its negative meanings’ (41).  Earlier work includes Sykes and Matza.  Accounting for decisions about the body have become increasingly important.

Voluntary cosmetic surgery is still treated with scepticism even though it is much more popular.  It is been seen as unethical, indulgent, implicated in sexual objectification.  It thus requires a particular kind of account.  Accounts are also ways of getting at the necessary experience of the practice.  Accounts seem to vary between Britain and the USA, probably because of differences in ‘cultural “toolkits”’ (42).

Accounts have been classified in terms of the excuses or justifications, concessions or refusals.  There are also ‘”metaphors of the ledger” (in which the speaker claims to have a sufficient supply of goods to his/her credit to permit wrongdoing without remorse’ (43).  Other researchers have examined narratives of resistance, which often involve ‘exemplars’ [a kind of denial of typicality], ‘continuums’ [I am not as bad as others], and ‘loopholes’ [which offer some reason for exemption].  [Note that these examples seem to be related to the reasons that fat people give for refusing a negative identity –discussed on page 43].  These refer to identities rather than actual behaviours.  Cosmetic surgery may involve different rationalisations compared to obesity though –obesity ‘is taken to be a controllable individual responsibility’, while cosmetic surgery patients ‘must engage to account for their behaviour and redefine the surgically altered body as an authentic representation of the self’ (43).

Social context will have an effect via cultural toolkits which offer characteristic ‘repertoires’ in different national communities [there are some interesting examples about American vs. French racism on page 44]. Discourses reflect and constitute major ways of allocating health care, although this is not always recognized.  The development of surgical technologies is particularly relevant.  In the USA, general values lead to healthcare based on ‘individual autonomy and choice, active intervention and procedural prowess’ (45) [the data provided to support American enthusiasm for surgical intervention includes the greater relative number of mastectomies].  In Britain, there is ‘greater conservatism and scepticism’ about surgery, among both patients and medics (45) [data provided here to support this is provided by prescription practices for controversial drugs, and the wishes of physicians themselves for treatment].  American consumers have been encouraged to seek treatment, as long as they can pay, while a more conservative concern to avoid excessive preoccupation with bodies has helped ration healthcare in Britain.

20 American and 40 British women were interviewed, compared for ethnic origin, age, employment and marital status.  It was a snowball sample to contact those who had had cosmetic surgery, which is admitted to being ‘not ideal’ (48).  Interviews were based on the main reasons for having cosmetic surgery.

There were variations between the two cultures.  Women in both countries felt they had to justify their decisions, and they offered accounts based on themes of entitlement, morality, need vs. desire, exclusion, autonomy and responsibility’ (48).

In the USA, women often talked about costs and investments.  Sometimes these were explicitly financial, but there were also non monetary items, such as the need to give up cigarettes.  This kind of discourse validated market orientations, but also the respondent’s ‘strength of character’ (49).  Themes of sacrifice for families were also common.  British women had a different version, claiming to have paid for surgery as a result of unexpected gifts of money, as a luxury, not as a routine consumer activity.  This approach justifies the respondent as someone who would only undergo surgery if it did not affect basic family income.  Other British women felt morally obliged to pay to avoid NHS costs [apparently, most cosmetic procedures in Britain are now funded privately, despite limited opportunity for NHS operations].

The women talked about their needs.  In Britain, sometimes these were medical needs to avoid further physical or emotional pain, such as unwanted attention, or even physical discomfort.  Medical consultants helped to legitimate this medical orientation.  Some women claimed to be excluded from normal social or intimate activities –‘the pre-surgical body as an obstacle to participating in mundane activities’ (52).  Some British women claimed psychological effects, including a overcoming the objectification resulting from childhood sexual abuse.

In the USA, a common theme was wanting to take control of the body, showing resolution in the face of ageing, or taking control over their own life, despite what their partners said.  Some admitted to vanity, but claimed to normalise it.  British women denied vanity, sometimes in contrast to other women, sometimes even in contrast to American women specifically.  Where they did admit to looking self indulgent, they tended to worry and feel ashamed, or remorseful at having spent lots of money.  Sometimes British women concealed surgery.  Sometimes they claimed to have been trying to please a particular man – here a justification is available, but only at the price of admitting the dominance of the male partner.  Overall, British women seem to have access to fewer justifications, which indicates the success of the cultural value which discourages preoccupations with bodies in Britain.

The conclusion attempts to trace the specific reasons given to the general discussion about accounts and how they work.  There is some evidence of justification, defence, using the metaphor of the ledger, refusing and denying.  There is a cultural difference in that the British respondents tended more towards concession and excuse.  By contrast, financial sacrifice and physical effort were more common with American accounts.  British women tended to stress medical or social need, while American women emphasized monetary value and financial sacrifice, individual choice and face in active medical intervention.

It is this attempt to trace these reasons back to more general work that Gimlin claims as original.  First, she is demonstrated the link between cultural context and individual reasons, instead of just blaming some general pressure towards being beautiful.  It offers a case study of working at self identity through bodies, and shows some of the complexities in cultural combinations of ‘facilitation and constraint…  The availability of resources for normalising one’s concern with and investment in the body simply harder to defend in some national settings’ (57).

NB the references to obesity and how obese people give an account of their condition – a key text appears to be Sobal, J and Maurer, D. (eds) (1999) Interpreting Weight: The Social Management of Fatness and Thinness, New York: Aldine de Gruyter.