Int J Ment Health Addiction (2008) 6:619–630

DOI 10.1007/s11469-008-9164-2

Addiction to Cosmetic Surgery: Representations

and Medicalization of the Body

Amnon Jacob Suissa

Received: 18 April 2008 / Accepted: 16 May 2008 /

Published online: 19 June 2008
# Springer Science + Business Media, LLC 2008

Abstract Contemporary social transformations of the body are essentially mediated by

medical discourse. With the body conceived of as “soft and modifiable,” we are witnessing
an unprecedented rise in recourse to medicine in order to validate primarily social
conditions. In this context, plastic surgery functions as a modality of social control and
management, not only of the physical body as such, but at the social level as well. Physical,
because plastic surgery allows one to modify the external and visible organs (face, breasts,
legs, nose, etc.), and social, because it proposes a social model of the ideal body that goes
beyond the one inherited from the biological parents. If the past sheds light on the present,
one might wonder whether there are any representations of the body in history that can help
us understand better the contemporary phenomenon of cosmetic surgery. What do we mean
by the medicalization of bodies? How does a psychosocial condition change from having a
social status to a medical one? How can we explain the extraordinary popularity of plastic
surgery as a socially acceptable, and desirable, behavior? To answer these questions, based
on a review of the literature, this article analyzes the social trend towards the medicalization
of bodies via plastic surgery. To that end, four main aspects will be examined: (1) a brief
overview of the body’s representation throughout history; (2) a reminder that medicalization
is a mode of social control; (3) psychosocial factors that influence the recourse to plastic
surgery; (4) cultural examples that demonstrate how important cultural values are in
shaping the different trajectories regarding plastic surgery. In conclusion, the author
suggests considering social ties as a major component in the social intervention process.

Keywords Addiction . Cosmetic surgery . Medicalization

Introduction

In recent years, we have witnessed an unprecedented fascination with the recourse to

cosmetic surgery as a means of meeting the increasingly socialized, and increasingly

A. J. Suissa (*)
School of Social Work, University of Quebec in Montreal, UQÀM, Montreal, QC, Canada
e-mail: suissa.amnon@uqam.ca
620 Int J Ment Health Addiction (2008) 6:619–630

standardized, criteria of beauty. Although the body is a priori a physical object, one must
also speak of the social body, since the social gaze on the body is a determining factor in
the process of judging what is acceptable and what is less so. The medicalization of
behavior via plastic surgery highlights the importance of the social standardization and
normalization of the criteria for beauty (Blum 2003). Dissatisfaction with one’s body has
now been diagnosed by the DSM-IV as a disorder (body dysmorphic disorder), and the
increasingly widespread use of plastic surgery to manage this image and body problem
reflects one of the real discontents of civilization (Freud 1929).
It is a malady of civilization because we have moved beyond the social and medical
control of persons considered to be dangerous or deviant to modalities of control that cover
the very existence of life itself. Where Foucault (1975) spoke of locking away pathological
or “abnormal” people, today we can speak of the medicalization of all stages of life from a
temporal point of view. Indeed, one of the new issues in the process of medicalization of the
body is mastery over time (Moreau and Vinit 2007). By mastery, we mean the control of
biological time by medicalizing the milestones of existence and supervising all the stages of
life from birth to death. Moreau and Vinit do not hesitate to speak of a paradigm shift in the
understanding of life as a natural process. Thus, the birth process today, for example, gives
people access to reproduction without sexual relations (embryo freezing), and clearly shows
that the time of reproduction can be altered. Along the same lines, the therapeutic extension
of life in seriously ill people, the use of assisted reproductive technologies at birth, the
interruption of pregnancies, and the pharmacologization of menopause through hormone
therapy (Fabre and Lévy 2007), are good illustrations of processes that increasingly tend to
be managed in the course of this biotechnological revolution. Such phenomena are what the
epistemologist Atlan has referred to as a new mastery over life (Atlan 1999: 37).
Gori and Volgo (2005) reflect on this ongoing change with their analysis of this current
trend as stemming from a pathologization of existence. In this regard, Di Vittorio (2005)
reminds us of the history of medicine and its central role in the medicalization of behaviors,
demonstrating that the professionalization of physicians took place within the framework of
public health policy at a time when a need was seen for a technical apparatus to manage the
social body. In a remarkable essay on Foucault’s work, Di Vittorio shows that, in the name
of public health, a body of “medical-administrative” knowledge within medicine developed
to manage social danger as a pathological risk. Insofar as the discourse was centered on
danger, this science of social danger became the springboard for medicalization or, as
Castel (1983) would put it, the social control of undesirable behaviors.

The Body and Its Representations: A Historical Outline

Gunther Von Hagens’ international exhibit of plastinated bodies, that is, cadavers that have
undergone a new process that preserves the soft tissues of the body (muscles, organs, lungs,
nerves, etc.), has given us an opportunity to expand our knowledge of the body (Von
Hagens and Whalley 2005). First exhibited in 1998 at the Museum of Technology and
Labor in Mannheim, Germany, and recently in Montreal in the summer of 2007, this new
display has been a resounding success around the world. Its success is largely explained by
the fact that the exhibit plays with the taboo of death in our society, in which thoughts of
death are generally repressed, or even rejected. It is in this context that we can best
understand the unceasing attempts, throughout the ages and in all societies, to slow down
the aging process and give human beings access to the idea of the “eternal man.” The
phenomenon of ageism and the extraordinary boom in plastic surgery are directly related to
Int J Ment Health Addiction (2008) 6:619–630 621

this point of view, in which the body becomes the object of a variety of interventions. In
this exercise, which is intended to meet the criteria of beauty and aesthetics by striving for
“perfect” bodies, medicine plays an important mediating role.
Historically and philosophically, it is useful to remember that body/mind dualism, which
was strongly integrated into the values of Christianity by members of the Roman Catholic
Church, made it possible to dissect the body and thereby advance the knowledge of anatomy.
The body is often viewed as a “divine machine,” and all cultures and religions have
interpreted it not only as a physical object but also as a creation of the soul and the spirit.
According to Von Hagens and Whalley (2005: 9), although the first known anatomist
was Aristotle (384–322 B.C.), the first people to take an interest in human anatomy were
probably cannibals. They were followed by “more civilized” cultures, which developed
techniques designed to immortalize the bodies of the deceased, or at least of certain
important people. The mummification of the pharaohs in Egypt is an apt example. In the
fifteenth century A.D., the paintings and sculptures of the Renaissance started to show the
outer beauty of the body to a greater extent, but not until the sixteenth century did the
human body take its place at the center of artistic preoccupations. Sculptures and portraits
then elevated the human body to the highest aesthetic level: a new kind of immortality.
Aspiring to ascertain perfection, sculptors and painters of the day watched anatomists and
adopted a more aesthetic approach to bodies understood to be free from defect.
Today, Von Hagens’ exhibition of the world of the body is the target of criticisms and
debates on the part of some religious, medical, ethical and legal authorities, which reject,
either in part or in whole, this kind of transformation of the human body. Thus,
representatives of the church expressed themselves extremely critically, using arguments
from moral theology, while representatives of the world of medicine expressed scientific
reservations concerning the fact that the anatomical plastinations were made accessible to a
lay public (Lantermann 2005). From this perspective, one might think that, depending on
the position one occupies in the hierarchy of power and the cultural or religious values of a
particular society, the transformation of the body may trigger major social debate and a
highly variable range of reactions.
At the cultural level, although critics in Germany stirred up fiery debates, the exhibitions
in Japan and elsewhere in Asia, for example, hardly generated any polemics at all. In
examining how the perception of the body can differ even within a single country, one
might consider the example of Sudan, where residents of the northern part of the country,
which is more Islamic, favor the chador, keeping all parts of the body invisible, while
people in the southern regions are more liberal, even appearing completely naked. Thus, the
taboo against nudity does not depend only on the act of being naked, it also—in fact above
all—depends on social reaction to the act of being naked in a given social and cultural
context, based on what is acceptable and what is not. This cultural example highlights the
differential perception of the body and explains the deeply negative social reaction by
authorities and religious values in the case of Islam. The exhibition of the internal organs of
bodies by means of plastination fits into this attempt to reconcile the external and internal
aspects of bodies, in which plastination and narcissism could find a certain balance and a
more universal meaning. Contrary to the position of physicians, who denounce the
“popularization” of these bodies to laypeople, is there not a broader issue related to the
democratization of anatomy and access to information about the body?
Although death is still the great equalizer among human beings, technological progress
in the field of medicine now offers us a new way of understanding the human body and
artificially manipulating data that used to be inaccessible: magnetic resonance, 3D
ultrasound, tomodensitometry (TDM), digital image processing, among others.
622 Int J Ment Health Addiction (2008) 6:619–630

Medicalization as a Mode of Social Control: An Expansion of Medical Categories

In attempting to define medicalization, let us consider the view of Zola (1983: 295), who
defines the concept as “a process whereby more and more aspects of daily life have come
under the control, the influence and the supervision of medicine. Other researchers describe
medicalization as a process whereby one defines and treats primarily social problems as
medical, and even pathological, problems (Beaulieu 2005; Saint-Germain 2005; Saint-Onge
2005; Cohen and Breggin 1999; Conrad 1995). According to these researchers, certain
contextual factors have favored the rise of medicalization as a means of managing social
problems. These include a certain decline in religion, an unshakable belief in science,
increasing individualism, the weakening of social ties, rationality and progress and, finally,
the increased power and prestige of the medical profession.
If medicine, through medicalization, is managing more and more of our daily life, the
medicalization of social groups with less power in society is also evident. We have only to
think of “happy pills” as a means of social control of the elderly, who consume an average
of more than six prescription drugs per day (Pérodeau et al. 2005), or of adolescents
prescribed Ritalin (Lloyd et al. 2006) to recognize this phenomenon.
The medicalization of children and adolescents constitutes a striking instance of the
medicalization of social conditions (Conrad and Potter 2000). It represents a major issue for
the future of our society insofar as psychotropic drugs, in most cases psychostimulants,
have become very popular for treating children with attention, mood or behavioral issues.
With the arrival of new classes of psychotropic drugs, especially SSRIs (selective serotonin
reuptake inhibitors), almost 4% of children in Canada, or more than 300,000 young people,
are now on the list of customer groups to be medicalized (Kluger 2004). In England,
prescriptions for attention deficit hyperactivity disorder (ADHD) among young people rose
from 6,000 in 1994 to 458,200 in 2004, the greatest increase ever recorded in the world
(Government Statistical Service 2005). And a study reveals that the prescription of
medication for insomnia in children aged 10 to 19 years old has climbed by more than 85%,
in some cases, to counteract the side effects of Ritalin (Macdonald 2006).
When we consider the cycle of adolescence, we might wonder about the dramatic
increase in Ritalin prescriptions for so-called hyperactive children, with or without a deficit.
According to Guay (2006), an expert in this field, the medical evaluation of ADHD can be
very fast and the same criteria are applied to a child of 5 and a teenager of 14. In addition,
certain behaviors attributed to ADHD are often related to other problems such as anxiety or
dyslexia. Some psychiatrists and researchers question the abusive prescription of
psychotropic drugs for young people and emphasize that these practices have outstripped
our real knowledge; they wonder whether we are in fact testing these substances on our
children (Lloyd et al. 2006; Breggin 2002).
Medicalization is closely related to the concept of “medicamentation,” namely the
recourse to medication in managing social problems. But it is important to distinguish
between the two concepts (Collin and Suissa 2007). Medication can undeniably constitute
an appropriate solution to physical and mental health problems, depending on the
etiological definition of the problems in question, which is largely dependent on the social
contexts in which they emerge. Recourse to medication constitutes a major element of
medicalization, defined as the process of extending the medical to the social. It represents
more than just a biotechnology in our western societies and fits in with logical frameworks
that go far beyond the medical alone (Collin et al. 2006).
Researchers who have drawn attention to the phenomenon of medicalization as a form of
social control include Parsons (1951, 1975), Friedson (1970) and Zola (1972, 1983).
Int J Ment Health Addiction (2008) 6:619–630 623

According to Conrad and Schneider (1980) and Conrad (1995, 2005), we must avoid
limiting medicalization to the application of a single level of control since the process
affects three levels: conceptual, institutional and interactive.
1. Conceptual in the form of a discourse and the adoption of an ideology that strengthens
its social acceptance
2. Institutional at the level of physicians’ role in organizations and the management of
psychosocial problems
3. Interactive at the level of the medicalization of the more private relationship between
doctor and patient
To these three levels must be added the social construction of new clinical entities that
are intimately related to the development and marketing of pharmacological treatments
(Fabre and Lévy 2007). This trend towards the pharmacologization of the body is
confirmed by Conrad and Leiter (2004), although it also involves actors outside the
pharmaceutical industry (researchers, government regulators, physicians and consumers).
Understood in this way, the process of medicalization is seen to be largely impelled by the
pharmaco-industrial complex and advances in pharmacogenomics, as well as through
actions taken by the medical profession to extend its jurisdiction (Conrad 2005). The
emergence in the biomedical field of technological innovations, which are commercialized
by big marketing campaigns, appears to be changing the organization of medical practice,
but also of medical science, by transforming representations of the living.
Another explanatory factor that may shed some light on the recourse to medicalization as
a mode of social control is the accentuation of individualism in our postmodern society. In
an article entitled “Dilemmes de l’individualisme: un contexte sociétaire de l’usage de
drogues” (Dilemmas of individualism: A social context for drug use), Van Caloen (2004)
clearly demonstrates how the use of psychotropic drugs fits directly into the integration
process for people seeking support to equip them to meet requirements for performance. In
other words, if one sets aside the structural context that gives rise to the social conditions in
which people live (for example, unemployment in certain regions), one will tend to use
medicalization/medicamentation as a mode of control in managing the social distance that
is likely to arise between the ‘normal’ performers who have jobs and the ‘non-performers’
who are unemployed. The side effects include a social viewpoint that individualizes the
problem and often marginalizes by means of medicalization (depression, anxiety, insomnia,
etc.). At that point, we often see medicamentation accompanied by a more private,
individual withdrawal from society. In connection with the ‘mad rush towards economic
globalization’, Gori and Volgo (2005) remind us that hyper-consumerism actually
contributes to the fact that a failure to be is transformed into a failure to have.
In an article entitled “Souffrir sans disparaître” (Suffering without disappearing), Furtos
(2005) clearly demonstrates how psychological and psychosocial problems prevent the
normal development of social bonds by making the ‘affected’ person suffer from ‘self-
exclusion syndrome’. Similarly, Fainzag’s work on the exercise of medical power in the
physician–patient relationship also constitutes a valuable landmark in the comprehension of
the individualizing dynamics associated with the process of medicalization (Fainzag 2005).
In light of these observations, one can say that two important fields constitute
preferential targets in the process of medicalization. The first is what one might call the
medicalized social control of the normal events of life: birth, adolescence, infertility,
menopause, menstruation, death, etc. The second is related to the management of certain
behaviors or problems considered to be deviant, including the aesthetic transformations of
the body.
624 Int J Ment Health Addiction (2008) 6:619–630

The Increasing Popularity of Cosmetic Surgery: An Example of Medicalization

of the Body

According to Von Hagens and Whalley (2005: 269), our sensitivity to the beauty of the
body’s outward appearance is part of our evolutionary heritage in the West. The physical
attributes that are accepted as criteria of beauty and signs of health and vitality are generally
related to bodily symmetry, muscle volume, smooth skin, etc. Thus, plastic surgery seems
to constitute a response to these criteria that fits into this mode of control and management
of physical and social bodies.
In the view of Moreau and Vinit (2007), the increase in knowledge of the body, coupled with
the increase in technical and surgical possibilities, has created the image of a “soft body,” as
postulated by Darmon and Détrez (2004: 5). Plastic surgery, which represents hybridization of
the body and medical techniques, is becoming more and more widely practiced in contemporary
medicine, thereby permitting people to change the bodies they inherited biologically. In an
analytic article on this subject, Saint-Hilaire (2006: 112) introduces the notion of plasticity of the
subject, whereby people can enhance their bodies to make them more faithful to their own
images of themselves. This author asserts that plastic surgery generates certain contradictory
claims. On one hand, there is the version in which women are victimized by an invasion of the
body by a medical discourse that allows the socialization of aesthetic and social norms of the
body; in this case, they are seen as victims. From this perspective, Naomi Wolf (2007), in her
book on ‘the beauty myth’, explains how the discourse of beauty focused on the image is a
device to dispossess women of their power by confining them to the role of object.
On the other hand, there is the thesis that, paradoxically, women who decide to have
plastic surgery are taking ownership of their bodies and affirming themselves precisely by
exercising control over their bodies; thus, they are not victims. According to Davis (1995,
cited in Saint-Hilaire 2006: 113), cosmetic surgery is not about beauty as such, but about
identity. Given that the person is coming to terms with and renegotiating her identity by
transforming her body, her face, and her external appearance, this author asserts that this is
an exercise of power that is primarily related to identity. Again according to this author,
having plastic surgery serves to reproduce the normal, the better than normal, and the best,
and most women who have had surgery say they are “better accepted” socially. To return to
Saint-Hilaire’s questions, insofar as cosmetic surgery contributes to changing “natural”
bodies into “less authentic” bodies, it raises the question of the meaning of becoming
oneself and how one does so. Up to what point does changing a facial feature, for example,
modify the subject’s interior/exterior identity?
Etcoff (2002) states that our perception/representation of beauty derives from biology
and not from learned behavior. This Darwinian version of the transformation of the body is
part of an explanation in which the battle for survival within a given social environment
allows a person not only to access beauty as such, but also to acquire important secondary
benefits, such as finding the ideal partner or spouse.

Plastic Surgery: Cultural Aspects

In Venezuela and Argentina, for example, where there is an extraordinary cult of physical
appearance and plastic surgery, having surgery is not only socially acceptable, it is
institutionalized and even normalized. The service is free and is generally available to
young girls once they obtain authorization from a professional (psychologist, psychiatrist or
physician).
Int J Ment Health Addiction (2008) 6:619–630 625

In Iran, a country that seems as secret as the private lives of its female citizens, women
still use plastic surgery as a means of escaping from the oppressive nature of male–female
relationships within a theocratic environment in which all external expression of the body is
forbidden. The body parts available to them as personalized outer signs, in an inadequate
form, are the face and the hands. Since the private space available in the public space is
forbidden territory (because of the chador and the morality police), plastic surgery becomes
an act of deviance, even delinquency. Unlike in Venezuela and Argentina, in Iran social
class becomes a central factor in explaining who is able to undergo cosmetic surgery.
In South Korea, the prevalence of plastic surgery among women in their twenties peaks
at close to 50% (Scanlon 2005). Two factors explain this extraordinary popularity. The first
is related to the intense social pressures on women of marriageable age to fit into commonly
accepted standards of beauty. The values conveyed in South Korean culture assert that
cosmetic surgery will ensure access to wealthier husbands, so it is understood as an
investment to enhance one’s social and economic status. In a highly competitive context, it
is not enough to simply correct one body part or another; rather, one needs to stand out
from the herd of eligible young women as being exceptional.
The second explanatory factor is that the cosmetic surgery industry is not regulated in
any way, which gives surgeons more scope. Although there are only 1,200 registered plastic
surgeons in the country, thousands of others carry out surgery without the recommended
qualifications. Needless to say, this has negative consequences, since hundreds of women
have found themselves with permanent damage to their faces, because their operations were
undertaken by radiologists or psychiatrists without any specific training in this area.
These different cultural conceptions of the body and the role of cosmetic surgery
demonstrate that the conception of this condition is a multifactorial phenomenon.
Depending on the time and the social and cultural values in question, the body may be
represented differently and will trigger a social reaction specific to the sociocultural values
underlying the particular society.
In the USA, for example, 2% of people experience severe distress related to their self-
image, which is most likely to be expressed during adolescence (Gorbis 2004). Diagnosed
by the DSM-IV as a bodily disorder (BDD, body dysmorphic disorder), the concerns seen
in this disorder are closely related to anorexia or even obsessive–compulsive disorder
(OCD). According to Lorenc and Hall (2005), 50% of American college students are
anxious about at least one aspect of their physical appearance. Although the media puts
more emphasis on women, the US studies analyzed by Gorbis (2004) show that BDD
affects men as much as women, albeit to different degrees and for different reasons.
Historically, American women have been more subject to changes, indeed transformations, in
their body image. According to Riordan (2004), as early as 1858 American women would use a
metal device about ten centimeters across to enhance the appearance of their bosoms. From
1850 to 1950, most of the technological products available for breast augmentation were
intended primarily for women. The use of these devices arose essentially out of a desire for
male attention and the reinvention of the body by transforming one woman into several women.
By “several women,” we mean that the use of different characteristics and strategies for physical
beauty allows the male gaze to be displaced to the greatest possible number of body parts.
As for men, the trend is to make use of non-psychiatric treatments, primarily
dermatological services. Men are more likely to experience a bodily disorder focusing on
muscles (muscle dysmorphia) or to be obsessed with their hair, skin, face or penis size. In
fact, penis enlargement is the most widespread practice (Luciano 2001).
That being the case, plastic surgery may not prove beneficial in the medium term for some
people since it is never seen as being good enough. Thus, patients continue to be obsessed with
626 Int J Ment Health Addiction (2008) 6:619–630

other body parts that must be changed and transformed. In this context, one can even speak of a
disorder affecting the psychosocial image of the self, namely addiction to plastic surgery. This is
addiction in the sense described by Le Breton, is “a way of filling a void or stifling a fear by
means of a product or an action that procures temporary relief and response” (Le Breton 2004).
As an illustration, let us consider the case of Hope Donahue, a young woman of 30 who
exemplifies this kind of addiction (Donahue 2005). Her first plastic surgery operation was
at age 22, when she had what she viewed as a problem with her nose corrected; at 23, she
had a facelift; and by age 27, she had undergone seven surgeries. To pay for them, she used
all her available credit cards, stole money from her parents and her friends and posed naked,
all to alleviate her suffering and attempt to satisfy her addiction. However, Donahue was a
beautiful young woman, who came from a well-off family and had an enviable social status.
As an only child who was educated in the best private schools, Donahue gradually found
herself pursuing physical perfection to escape from family tensions and temporarily
enhance her poor self-esteem.
When considering how recourse to surgery can constitute an addiction, it is useful to
remember that Peele and Brodsky (1975) were among the pioneering researchers, if not the
very first, to apply the term “addiction” not only to the abuse of mind-altering substances
but also to other behaviors such as addiction to love, gambling, money, etc. Applied to
plastic surgery, the concept of addiction refers primarily to a search outside oneself for
something that is lacking on the inside. The book by Garcia (2003) entitled The Truth about
Beauty: Transform Your Looks and Your Life from the Inside Out examines at some length
this aspect of the inside–outside relationship and its relation to addiction.
In other words, although we may all be candidates for developing addictions, it takes
specific psychosocial conditions to trigger the cycle of addiction. As with mind-altering
substances, gambling or money, addiction to surgery is part of the relationship to one’s own
body and the reaction to personal suffering, on one hand, and to contextual social demands,
on the other. It is therefore this relationship between the individual and the substance/
activity/idealized image of the body within a social context that leads to this dynamic of the
cycle of addiction (Gorbis 2004; Suissa 2005, 2007). Among the other social factors that
influence addiction to cosmetic surgery, Lorenc and Hall (2005) mention at least three:
1. Exposure to television, special programming, Hollywood spokespersons, artistic
representations, and fashion;
2. The huge technological strides in medical procedures, such that patients require less
anesthetic and postoperative recovery is much faster;
3. The socialization process that increases the acceptability and desirability of surgery in a
society that has become more and more tolerant of the idea.
More than eight million Americans have Botox injections every 6 ; many have wrinkle-
reducing surgery every 3 to 6 years, or liposuction every 5 to 10 years. In other words,
these procedures are becoming common practice in certain social classes. Two-thirds of
patients who have plastic surgery have already had such operations in the past. According
to Lorenc and Hall (2005), many individuals admit that they have developed an addiction to
surgery, leading them to deviant or even delinquent actions. In order to deal with their
addiction to a certain self-image, some women will resort to prostitution, theft, posing for
pornographic magazines, or taking out bank loans that they cannot repay. Aged between 25
and 50 years old, some of them have had between 20 to 35 surgeries since their teen years
and have withdrawal symptoms similar to those of drug addicts if they do not have at least
two surgeries a year. This primarily female trend is now spreading to the male population as
well (Luciano 2001).
Int J Ment Health Addiction (2008) 6:619–630 627

Conclusion and Prospects

The issue of the medicalization of behaviors in general and cosmetic surgery in particular
sheds light on the importance of the standardization and social normalization of the criteria
of beauty (Blum 2003). Someone who is dependent on an image of herself and vulnerable
to ageism uses surgery as a means to anesthetize her emotions and her poor self-esteem, as
well as to respond to social criteria and norms. Although having cosmetic surgery to repair
damage (an accident, facial burns, facial paralysis, jaw cancer, etc.) is more than legitimate,
surgical operations, often obsessive, for purely aesthetic reasons reveal that the answer lies
not in surgery but in one’s relationship with oneself and with the world—or social ties.
In the face of this growing image problem, Weil (1983, 2007) reminds us of the
importance of integrating the physical, mental and spiritual aspects of our lives in order to
build a barrier against the invasion of disease in general, as well as inappropriate behaviors
such as the growing use of cosmetic surgery. The Harvard-educated Weil, who for some
30 years has been a spokesperson for integrative medicine, achieved a masterstroke in
opposing the positivist, mechanistic vision of the body by developing a discourse that
focuses on people’s hidden competencies. From the point of view of re-appropriation of
power, he has contributed significantly to the fact that 15% of medical schools in the USA
now include contents that come from outside the realm of so-called conventional medicine.
Thus, he has denounced the health care system, calling it the disease care system, along the
same lines as Peele (1989) in The Diseasing of America. Although most cases of recovery
in the world occur as a result of spontaneous healing, this “diseasing” of physical and social
bodies still constitutes the core of the medical model and its ideology.
The phenomenon of medicalization, or over-medicalization, constitutes a preferred
choice for managing social problems including those related to ageism or image problems.
The perverse effects of this discourse of medicalization include the elimination of any
reference to psychosocial and cultural factors and an attempt to prove that addiction to a
certain utopian image is an impersonal, individual and non-discriminatory reality. In this
regard, Soulet reminds us that there is no such thing as vulnerability per se, but only
creatures who are vulnerable in certain circumstances and conditions: “any production of
meaning can only be social despite the outward appearance of individualization” (Soulet
2004: 189).
In a well-documented article, Maddux (2002) gives a masterly demonstration of how the
discipline of psychology, for example, has historically backed up the social construction of
the ideology of disease and the individualization of social problems. In managing “diseases
of the soul,” Maddux suggests that we turn towards a so-called positive psychology, where
the emphasis is placed on strengths and skills rather than on shortcomings and deficits. In
the face of the expansion of medicalization as a form of social control, the issue of social
ties is, and remains, central, since it spearheads the modes of control and measures to be
favored (Horwitz 1990, 2002). Thus, social problems that are viewed as individual, rather
than collective, raise the question of citizen participation in decision-making bodies and of
obtaining the most objective possible information.
Insofar as we tend to be “obsessed” with our health—indeed, it is the primary
preoccupation of people around the world—one might wonder whether the highest form of
beauty should not reside in originality and in becoming a more authentic psychosocial self,
rather than in conformity and social pressure.
A Canadian study on breast implants carried out with 24,600 women by two researchers
at the faculty of medicine at Université Laval in collaboration with colleagues in Ontario
revealed that, although having breast implants does not increase the risk of mortality, the
628 Int J Ment Health Addiction (2008) 6:619–630

suicide rate for women with implants is 73% higher than in the general population
(Villeneuve et al. 2006). This team of researchers compiled data on 17,400 Quebec women
and 7,200 Ontarians who had received breast implants between 1974 and 1989. These
women, who had been operated on at a mean age of 32, were followed up on for some
15 years.
To sum up, the researchers emphasize that, in order to undergo breast augmentation, a
woman must first be in good health, and two factors seem to be key. The first is that the
women who receive breast implants are generally in better health than the average
population; the second is that women who have plastic surgery tend to have a higher-than-
average socioeconomic status. Finally, these researchers issue some warnings concerning
medical practices in this field and encourage surgeons to consider the reasons for the
surgery. They point out that numerous scientific studies report that women who undergo
breast augmentation tend to have a psychological profile characterized by low self-esteem,
a lack of self-confidence and more frequent mental health problems, especially depression.
In this regard, Garcia (2003) suggests that it is important to work first on one’s inner life, in
order to achieve as much balance as possible between one’s own self-image, the
psychosocial ideal to be achieved and the concrete social reality of self-acceptance.
The debate over cosmetic surgery has only just started and is far from being over. When
one considers the new sex design surgeries—vaginal rejuvenation, labiaplasty, reconstruc-
tion of the hymen, augmentation of the perineum—one can only view the medicalization of
women’s bodies as a worrying trend (Collard 2006; Galipeau 2006). Are women not in the
process of erasing their femininity in the name of productivity and social efficiency? What
will these people do when they inevitably start to grow older? Will they continue with this
kind of practice, which can become an addiction? Will we soon see the formation of self-
help groups based on the twelve-step philosophy?
The future of discourses on the medicalization of bodies is not yet clear, however, what
is clear is the need for further research into these alarming trends.

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