BODIES OF VALUE: TRANSNATIONAL DISCOURSES AND PRACTICES OF PLASTIC SURGERY By ANDREW HOMER SPONAUGLE MAZZASCHI A Dissertation submitted to the Graduate School-New Brunswick Rutgers, The State University of New Jersey in partial fulfillment of the requirements for the degree of Doctor of Philosophy Graduate Program in Women’s and Gender Studies written under the direction of Jasbir K. Puar and approved by ___________________________ ___________________________ ___________________________ ___________________________ New Brunswick, New Jersey May, 2014 ABSTRACT OF THE DISSERTATION Bodies of Value: Transnational Discourses and Practices of Plastic Surgery by ANDREW HOMER SPONAUGLE MAZZASCHI Dissertation Director: Jasbir K. Puar Proceeding through case studies of actors involved in transnational instantiations of plastic surgery practice or discourse, this dissertation demonstrates that a transnational lens illuminates new dimensions of plastic surgery’s history and its contemporary manifestations. Examining plastic surgeons’ development efforts after WWII, the transnational charity Operation Smile, and cosmetic surgery tourism to Johannesburg, South Africa, the dissertation examine how surgeons’ and patients’ involvement in transnational work affects their understandings race, gender, and health. I argue that, in all three cases, the demarcation between reconstructive and cosmetic surgery is racialized: On the one hand, cosmetic patients understood as paradigmatically white and from the “developed world,” enacting forms of self-investment through medical markets. On the other hand, recipients of reconstructive surgery, associated with particular geographical areas and racialized as nonwhite, are understood as objects of external investment. I show that the concept of race operative in transnational surgical contexts is not, first and foremost, an anatomical one; rather surgeons produce a nonbiological but ii still embodied conception of race that is linked to cultural and economic difference. Finally, I show that plastic surgery’s expansive conception of health—incorporating bodily, psychic, and social dimensions—is precisely what allows it to engage in the forms of racialization I describe and what enables the specialty to incorporate itsef into a variety of economic rationalities. iii Acknowledgements The debts I have incurred in the course of writing are many. I was lucky to have an assembly of scholars of staggering intellectual acuity and generosity on my committee. Jasbir Puar’s guidance has been invaluable, and the breadth and depth of her knowledge, and her ability to draw together seemingly disparate threads, is inspiring, and her feedback and creative though have been crucial to this project. Ed Cohen’s historical and theoretical knowledge continues to astound me, and his thinking and teaching have shaped this project immensely. Julie Livingston stepped in at a crucial moment, and I was honored to have a scholar of her caliber engage with my work. And Aren Aizura was a generous and supportive outside reader, and his innovative work has provided key interventions into my own thinking. The broader community of feminist scholars at Rutgers has shaped this project in many ways. Mary Hawkesworth has been a wonderful mentor and has provided me with support and professional opportunities for which I will be forever grateful. She is a model of a feminist scholar and without her I am not sure that I could have seen this project through. I could not have asked for a better friend that Laura Lovin. She has supported me though many crises, kept me sane, and provided perspective and insights that have gotten me through this process. EunSung Lee has also been a wonderful friend, and the writing group that she formed, along with Stephanie Clare and Stephanie Jenkins, was critical to moving forward with the project. Ari Rotramel, Agatha Beins, Danielle Phillips, Magda Grabowska, Bahia Munem, Kelly Coogan-Gehr, and Rama Lohani- Chase were all excellent friends, colleagues, and interlocutors. iv I am privileged to work with an amazing group of colleagues at Signs. Miranda Outman-Kramer, Anne Keefe, and Amari Verastegui have been wonderful to work with. Miranda and Karen Alexander have both taught me so much, and Karen has provided me with opportunities for professional development that I greatly appreciate. I had the opportunity to participate in two interdisciplinary seminars during my time at Rutgers. The Institute for Research on Women’s “Health and Bodies” seminar was an excellent and supportive environment in which to present my work, thanks in large part to the direction of Nancy Hewitt and Beth Hutchison. Beth has continued to provide me with support and eminently pragmatic advice, and I am grateful to have met Susan Sidlauskas through my participation in this seminar. The Rutgers Center for Historical Analysis’s “Body and Soul/Mind,” under the directorship of Julie Livingston and Indrani Chatterjee was a mind-opening experience from which I benefited greatly. I also benefited from comments, especially from Kathy Davis, at a writing workshop at Linköping University. I’m grateful for the many conversations and forms of support that Barbara Balliet and Kayo Denda offered me in my time at Rutgers. I’m lucky to have had such a positive and encouraging graduate director in Yana Rogers as I was finishing. Suzy Kiefer’s administrative support and friendship have also been crucial, as were Joanne Givand’s. Monique Gregory, Barbara Sirman, and Alex Bachman have also been incredibly helpful. Finally, words cannot express how much the love and support of my family has meant to me. This dissertation is dedicated to my parents and to my partner, Luke, for unconditionally sticking with me throughout my time in graduate school. v A highly curtailed and much earlier version of chapter 4 was published in Signs: Journal of Women in Culture and Society (vol. 36, no. 2 [2011]: 303-12) as “Surgeon and Safari: Producing Valuable Bodies in Johannesburg.” vi Table of Contents Abstract ii Acknowledgements iv List of Illustrations viii Introduction 1 Chapter 1: Theory and Method 16 Chapter 2: Liberal Visions and the Traveling Surgeon: Race and the Value of Surgery to Development 55 Chapter 3: Healing Faces, Healing the World? Operation Smile, the Humanitarian Mission, and the Address to Human Dignity 128 Chapter 4: Surgeon and Safari: Medicine, Superfluity, and the Production of Valuable Bodies in Neoliberal Johannesburg 169 Conclusion 221 Bibliography 231 vii List of Illustrations Figure 1, Walled home in Bryanston 199 Figure 2, Carstenhof Clinic 214 viii 1 Introduction The statistics regarding the contemporary global trends in cosmetic surgery, while providing an impressive sense of the scale of the cosmetic surgery industry and its expansive global reach, they tend to conceal as much as they reveal. According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2011, there were over 1 million cosmetic surgery procedures performed in the United States, 900,000 in Brazil, 415,000 in China, 372,000 in Japan, 299,000 in Mexico, and so on. The Daily Mail (Bates 2011) notes that the ISAPS statistics, when analyzed on a per capita basis, demonstrate that South Koreans undergo more cosmetic surgery than any other nationality, followed by Greeks, Italians, and Americans. In discussions of these statistics, surgeons and media commentators alike are apt to mention the plastic surgery “industry” and discuss the changes in the amount of money spent within particular national contexts. For instance, in a story titled “Economy, Boob Jobs Grow,” ABC News notes that the 2010 figures are the first “uptick in cosmetic procedures … since the recession began” (Conley 2011). The story quotes a surgeon explaining, "The market has recovered, so people are feeling a little more comfortable to spend money." Similarly, CNN notes in a headline, “$10 billion spent on cosmetic procedures despite recession” (Cafferty 2010). But I’d like to pause at the outset to interrogate the assumptions underlying those statistics as a way of introducing the themes that organize this dissertation. What are the conditions that make possible their emergence, and what does that show us? First, the prevalence of monetary figures and references to the economy highlights the 2 entwinement of plastic surgery with capitalism. This entwinement is significant for several reasons, but the one most central to my argument is that the study of plastic surgery practice and discourse provides unique insights into medicine’s integration with capitalist formations. In fact, cosmetic surgery has become paradigmatic of the commodification of medicine within the contemporary era (e.g., Frank 2004). What these statistics show, in my estimation, is that people are literally investing capital into their bodies and transforming them through that investment. The specific forms of investment and its effects on the micropolitics of bodies are what form the basis for the argument I advance in this dissertation. Second, these statistics highlight the imbrication of plastic surgery with nation and the transnational; the aggregations take place through demarcating nation. They demonstrate that surgery is a transnational phenomenon situated within national contexts and economies. The organization of plastic surgery through the category of nation is again an obvious point, but it forms another important part of the argument developed here—that plastic surgery cannot be understood as a practice of capitalism’s