Making sense of both the popularity and the problems of the surgical fix requires situating cosmetic surgery in the cultural and social context from which it emerged. Cosmetic Surgery belongs to the cultural landscape of late modernity; consumer capitalism, technological development, liberal individualism, and the belief in the makeability of the human body. (Davis, 1995, p.28-29)
Cosmetic surgery is a procedure that has infiltrated the popular media in the past few decades. Simply turn on the television, and you will find portrayals of “transformation stories” of individuals who have undergone plastic surgery to fix perceived flaws. Enter a subway car, and you will be confronted with advertisements depicting before and after representations of cosmetic surgical enhancements to women’s faces, stomachs, breasts and thighs. Today, it is virtually impossible to not take notice of the effect that cosmetic surgery has had on our contemporary society. According to the American Society of Plastic Surgeons, over 1.3 million cosmetic surgery procedures were completed by ASPS surgeons in 2000; an increase of 198% since 1992. (ASPS trends, 2001). While individuals (mostly women) continue to alter their appearance surgically, debate regarding the ethical and social acceptability of this practice carries on.
In an attempt to understand the handling of cosmetic surgery in social science research, I have chosen three disciplines in which to explore cosmetic surgery; psychology, sociology, and history. Psychology is defined as the scientific study of human and animal behavior, concerned with the social, mental and biological processes influencing behavior (Herron, 2002, p.347). In exploring this discipline, I hoped to better understand the role of individuals’ thoughts and behaviors regarding cosmetic surgery, as well as any clinical findings related to this practice. Sociology focuses on the social nature of the individual, and is commonly regarded as simply the study of society. My goal in studying sociology was to see how researchers have addressed cosmetic surgery as a product of contemporary society and culture, and the relationship of the individual in society to this process. History, broadly defined, is the study of the past. When viewed as a social science, history includes the study of how events in the past have been shaped by or are currently viewed by social and cultural thought. My aim in exploring history was to see how cosmetic surgery has been viewed through the ages, and how cosmetic surgery’s past relates to its present state in society.
For each of the three disciplines, I have used two resources - one electronic, one print – to get a general overview of the treatment of cosmetic surgery. The electronic resources I chose were indexing and abstracting services, and the print resources were dictionaries or encyclopedias. The indexing resources have value in their timeliness and provision of highly specific research, while the print resources have value in their broad overviews of topics. Taken together, these print and electronic resources illuminate each discipline’s discourse on cosmetic surgery.
The first three sections of this paper are devoted to each individual discipline. Within each section is a review of the resources used, including a general overview, its search capabilities and entry points, and the method by which I conducted my search on cosmetic surgery. Following the resource reviews in each section is an analysis of the search results (for the indexes) and an appraisal of the dictionary or encyclopedia entries (for print). The paper concludes with a section that compares the resources and their content across each discipline.
Published by the American Psychological Association, PsycINFO is considered the premier indexing and abstracting database for psychology and its related fields. PsycINFO is the online counterpart to Psychological Abstracts, which indexes and abstracts journal entries from about 1300 journals annually. PsycINFO also includes dissertations, monographs and foreign language material. Although PsycINFO does not include full-text documents, it remains the most comprehensive indexing service in the discipline, containing over one and a half million citations. PsycINFO covers material from 1872 to the present and is updated on a weekly basis. It is available from a number of different vendors; Drexel University’s access to the database is via Ovid.
When accessing PsycINFO via Ovid at Drexel, one has three coverage periods to chose from: 1974 to current week, 2000 to current week, and 1872-1973. Once a coverage period is chosen, the user has a number of search options available. Author, title and journal searches can be conducted by selecting their icons from the toolbar heading the search page. Also located in the toolbar are helpful search aids that allow the user to search specific fields of a citation, and combine or limit searches. Additionally, a search history field located beneath the toolbar saves searches during each login session. The most helpful search function for those looking for citations based on subject is the Keyword search, which is the default search function when users first sign on. When searching a keyword or keyword phrase, PsycINFO automatically maps the entered term to APA Subject Headings listed in the Thesaurus. It then allows the user to select subject headings to search by, explode the headings (allowing the user to search using the heading and all of its more specific terms), or focus (allowing the user to limit the search to documents in which the chosen subject heading is considered the main heading of the work). Scope notes are also available for some terms, which provide the date the term was entered and information about the use of the term as a subject heading in the database.
When I conducted a keyword search using the phrase “cosmetic surgery”, this phrase was mapped to fifteen subject headings:
I could see a strong connection between cosmetic surgery and some of these terms (i.e. Cosmetic Techniques, Body Dysmorphic Disorder), while other terms (i.e. Symptoms, Motivation) were so broad that they could apply to topics far removed from cosmetic surgery. Clearly, Plastic Surgery was the subject heading that was the most appropriate synonym for cosmetic surgery. After selecting this heading, I was brought to a page where Plastic Surgery was mapped alphabetically in the Thesaurus with its broader term of Surgery and related term of Cosmetic Techniques. Since Surgery was far too broad of a heading, and Cosmetic Techniques not related enough to my liking, I chose to view only the citations with the subject heading Plastic Surgery. This search resulted in 169 citations. Using the citation manager, I selected all citations in this set and sorted by publication year and publication type, finding that citations regarding plastic surgery began in 1974 (I had selected the PsycINFO coverage of 1974-current week) and ended with the most recent publication in November 2003. In total PsycINFO retrieved citations for five books (three authored, two edited), 21 book chapters, 23 dissertations, and 108 journal articles related to plastic surgery.
The Dictionary of Psychology
This single volume reference source contains more than three times the number of entries of any other dictionary of psychology printed in English (Corsini, 1999, xiii). The scope of The Dictionary of Psychology is wide as its content is based on analysis of other dictionaries in psychology, psychiatry and counseling, textbook glossaries, articles in encyclopedias and other reference sources, articles in professional journals, and interviews with psychologists. While The Dictionary of Psychology is comprehensive, including some slang and foreign terms, its definitions are quite short. Like most dictionaries, the only point of access is the alphabetical listing of defined terms; no index is available. Included in this resource are appendices covering such items as the Greek alphabet, DSM-IV terms and psychological measurement tests.
In order to understand the treatment of cosmetic surgery in the indexed literature of psychology, I imposed limits on my PsycINFO results to try to determine some trends. I first limited my results to find how many related to studies. I selected the “content type” limits of “empirical study”, “case study”, “clinical case report”, “follow-up study”, “longitudinal study”, “prospective study”, “retrospective study”, and “treatment outcome study”, and found that these terms applied to 90 out of 169, or about 53% of the results. I then chose to limit these 90 results by male and female subject population groups, however, these limits did not work as smoothly as I had expected. 18 results were listed for males as subjects and 44 for females. this left 28 studies with neither as subjects. However, it is possible that these remaining studies were indexed with the general “human” subject population; it would be impossible to know without individually reviewing each citation. Further hindering my quest to find trends was that those results listed with males as a population group did not reference males in particular, but included them with women. The last limit I imposed on the study results that were studies was that of “empirical population”, the age grouping of human subjects. I found 8 results dealing with children, 3 with adolescents, and 80 with adults. As these numbers total 91, it must be that some studies included more than one empirical group.
* see text for explanation
Although the results of my search limits did not provide the facile arrival at trends that I had hoped for, one can still see some underlying currents in the literature. First, a little over half of the literature is devoted to studies. Second, females dominate the study populations, and it is unknown, without reading the articles, how many studies used only males as their participants. Finally, adults make up the greatest empirical age group, with children and adolescents making up a very small amount of participants.
In a further attempt to understand the discipline’s treatment of this topic, I chose to conduct a very crude analysis of the PsycINFO results based on the content of the document titles. Of course, an analysis based on abstract contents would have provided a much more thorough and informative view of how cosmetic surgery is treated in the PsycINFO results; however, time constraints did not allow for such research. The reader is advised that this was in no means a scientific endeavor, and some results are highly subjective. This being said, I do feel that this analysis could aid one’s understanding of how psychology researchers and practitioners treat this topic, and that it is a better method for gaining understanding than analyzing a random sample of abstracts. In conducting my analysis, I entered into a spreadsheet the type of surgery mentioned in the title (if any), clinical terms mentioned (if any), and what I considered to be the main thrust of the article – clinical or psychosocial (provided that the title was not too vague). Nine titles were discounted due to their being errata reports or duplicate entries, leaving a total of 160 titles analyzed.
Roughly half (85 out of 160) of the titles found in PsycINFO indicated that the content of the entry related to a specific type of plastic surgery, be it aesthetic or reconstructive, while the remaining 75 dealt with plastic surgery in general. Table 2 gives a breakdown of the specific types of surgery noted in the 85 titles.
|25.9||22||Breast augmentation or reduction, non-reconstructive|
|20||17||Reconstructive, general or other (i.e. burns, hip, knee)|
|18.8||16||Reconstructive, breast, post-mastectomy|
|17.6||15||Facial, non-reconstructive (i.e. rhinoplasty, face lift)|
|16.5||14||Craniofacial, Down Syndrome related|
Roughly 39% of the surgeries mentioned were reconstructive in nature, about half of which related to post-mastectomy breast reconstruction. The remaining 61% of surgeries mentioned were aesthetic in nature, 42% of which related to breast augmentation or reduction, 29% facial, 27% craniofacial relating to individuals with Down Syndrome, and less than .5% percent liposuction. It is interesting to note how many titles dealt with specific types of surgery; this may be an indication of how much quantitative analysis is valued in the discipline, since research results may be viewed as more valid if the sample studied has had experience with the same type of surgery v. a sample that may have different views/experiences of different surgeries. That 42% of aesthetic surgeries were related to the breast was not surprising, as such surgery is common and increasingly societally acceptable; it is probably not a difficult task for researchers to find study samples of women who have experienced this type of surgery. It is curious, however, to note the lack of titles mentioning liposuction, since this type of surgery is one that we frequently hear about in our culture.
The titles also evidenced a rather even split in regards to clinical v. psychosocial research. Those citations dealing with the clinical aspects of psychology often related to the role of the psychologist or psychiatrist in the consultation process prior to surgery, of psychological or psychiatric counseling in general, or of specific pathologies. Those titles relating to the psychosocial aspects dealt with identity, body image relative to cultural expectations, aging, and moral considerations regarding cosmetic surgery. Two abstracts representative of each type of result follow, with key terms and concepts highlighted.
Accession Number Peer Reviewed Journal: Author Renshaw, Domeena C. Title Body dysmorphia, the plastic surgeon, and the counselor. Source Family Journal: Counseling & Therapy for Couples & Families. Vol 11(3) Jul 2003, 264-267. Sage Publications, US Abstract Trauma repair, deformity, and unsightly blemishes may cause social embarrassment and take thousands of individuals to plastic surgeons. A few persons have endless preoccupation with a slight, real, or perceived appearance defect. Some of either gender age 10 to 80 seek cosmetic surgeons for aesthetic correction. However a minority continues to have intense obsessive preoccupation with an imagined body defect. Their concern is excessive and causes significant distress in social, work, or study functions not due to another clinical condition such as anorexia nervosa, in which subjects reject their body as obese. Misperceived ugliness is called body dysmorphia or dysmorphophobia, often only diagnosed after several discontented return visits to the surgeon who refers the patient for counseling--rarely welcome referrals by the patient when they are convinced the problem is physical and not psychological. Careful listening and patient acceptance are essentials in management. (PsycINFO Database Record (c) 2003 APA, all rights reserved)
Accession Number Journal Article: 2001-01764-010. Author Simis, Kuni J; Verhulst, Frank C; Koot, Hans M. Title Body image, psychosocial functioning, and personality: How different are adolescents and young adults applying for plastic surgery? Source Journal of Child Psychology & Psychiatry & Allied Disciplines. Vol 42(5) Jul 2001, 669-678. Blackwell Publishers, United Kingdom Abstract This study addressed 3 questions: (1) Do adolescents undergoing plastic surgery have a realistic view of their body? (2) How urgent is the psychosocial need of adolescents to undergo plastic surgery? (3) Which relations exist between bodily attitudes and psychosocial functioning and personality? From 1995 to 1997, 184 plastic surgical patients aged 12-22 yrs, and a comparison group of 684 adolescents and young adults from the general population aged 12-22 yrs, and their parents, were interviewed and completed questionnaires and standardised rating scales. Adolescents accepted for plastic surgery had realistic appearance attitudes and were psychologically healthy overall. Patients were equally satisfied with their overall appearance as the comparison group, but more dissatisfied with the specific body parts concerned for operation, especially when undergoing corrective operations. Patients had measurable appearance-related psychosocial problems . Patient boys reported less self-confidence on social areas than all other groups. There were very few patient-comparison group differences in correlations between bodily and psychosocial variables, indicating that bodily attitudes and satisfaction are not differentially related to psychosocial functioning and self-perception in patients than in peers. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
The first abstract is representative of an article with clinical focus. The author describes dysmorphia or dysmorphophobia, the “intense obsessive preoccupation with an imagined body defect”, as a condition of some persons undergoing cosmetic surgery; a condition unlike other psychiatric disorders such as anorexia nervosa. The author further indicates the need for counselors to be accepting of such patients in the clinical setting. The second abstract represents an article with psychosocial focus. The author describes a study using qualitative and quantitative measures regarding young adults’ body image, psychosocial functioning and personality. Appearance related psychosocial problems, self-confidence, body attitude and self-perception are addressed. The split in clinical and psychosocial citations may be indicative of the division in the discipline between the “hard” and “soft” aspects of psychology.
Additionally, 16 of the 160 titles, or 10%, referenced specific psychiatric or medical conditions and their relationship to cosmetic surgery. The vast majority of these (69%) referenced Body Dysmorphic Disorder (also known as Dysmorphophobia or Dysmorphia, noted in the preceding paragraph), 4 referenced eating disorders, and 1 referenced depression. It should be noted that in addition to these 16 titles, 14 related specifically to the developmental disorder of Down Syndrome – though not a psychiatric condition, it is worth noting that a good amount of research has been conducted relating to craniofacial surgery of those with this disorder, in effort to make the individual appear more “normal”. It is important to note that many of the pathology-oriented citations include psychosocial considerations, as shown in the following abstract:
Accession Number Journal Article: 1998-12046-004. Author Guthrie, Elsepeth; Bradbury, Eileen; Davenport, Peter; Faria, Frederick Souza. Title Psychosocial status of women requesting breast reduction surgery as compared with a control group of large-breasted women. Source Journal of Psychosomatic Research. Vol 45(4) Oct 1998, 331-339. Elsevier Science, US Abstract Investigated whether there are psychological differences between large-breasted women who seek breast reduction surgery and women with similar-sized breasts who do not seek surgical reduction. The study compared 33 patients (mean age 32.4 yrs) on a waiting list with 22 large-breasted controls, using a semistructured questionnaire and well-validated instruments. Patients experienced greater physical and psychological difficulties but similar social difficulties as compared with the control group. Patients were also more anxious and depressed and had poorer self-esteem, body image, interpersonal functioning, and health status. This study confirms the high psychological morbidity of patients seeking breast reduction. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Here we see the pathology of anxiety and depression related to interpersonal functioning, body image, and self-esteem. Works such as this highlight the social science nature of the discipline of psychology; although many works are narrowly clinical in nature, many have a more broad view which includes social relevance.
Unfortunately, few references to cosmetic surgery are to be found in the print reference literature; an issue discussed later in this paper. The only reference I could find to plastic or cosmetic surgery in the psychology reference literature was found in the Dictionary of Psychology. The following short entry was found in this resource:
Plastic surgery A branch of surgery that specializes in the removal, transfer, and repair of damaged or diseased tissue so that a body area can be restored to a normal or near-normal form. From the point of view of psychology, people who have either inherited conditions, such as hemangioma (port-wine stains) on the face, or developmental abnormalities, such as cleft-palate, are socially handicapped by their appearance and plastic surgery may help them to establish a better self-image as well as other-image. See BODY-DYSMORPHIC DISORDER, DISFIGUREMENT. (Corsini, 1999, p.732)
It is notable that this entry does not address the purely aesthetic/non-reconstructive application of cosmetic surgery. The entry also fails to address the negative psychological aspects of cosmetic surgery; although it references Body Dysmorphic Disorder, no pathology is indicated within the entry itself.
Figure 1 provides my view of the concept relationships regarding cosmetic surgery in the field of psychology.
Sociological Abstracts is a service produced by Cambridge Scientific Abstracts. Considered the premier abstracting database in the field of sociology, this service indexes and abstracts the core sociological journals and includes selective coverage of journals in other related disciplines. Abstracts are culled from over 1,700 serial publications, resulting in a total of approximately 600,000 records (as of May 2003). Citations from the core sociological journals published since 2001 also include bibliographic citations from the article, which in turn may link to abstracts. In addition to journal entries, the service also abstracts conference papers, books, and dissertations. Coverage in Sociological Abstracts begins in 1963 and is international in scope. The index is updated on a monthly basis, with around 2,500 new records added each month. Some full text documents are available that are directly linked to Drexel’s e-journals.
When first arriving at the Sociological Abstracts search page, the user is presented with the quick search interface. This search allows for the option of searching keywords, author, title, journal, or any field, and limits of “latest update”, “journal articles only”, “English only” and selectable date ranges. Sorting can be done by date range or relevancy rank, and the records display can be changed to show citation only, citation and abstract, full record, full record without references, or custom fields. Selecting the advanced search option allows the user to build a search strategy using changeable search fields or typing a command line search, and includes the options of the limits described above. In addition to these search techniques, users can browse the author, journal name, or publication type indexes, or conduct a thesaurus search. When using the thesaurus, users can browse for terms using the hierarchical, rotated, or alphabetical index. The hierarchical index shows broader, narrower and related terms, and in some cases, scope notes. The rotated index shows an alphabetical list of all related terms for a single word, while the alphabetical index shows a simple alphabetical list or terms surrounding the word or phrase entered. When a user selects a term from one of these indexes, a search is conducted automatically using the index term as a descriptor.
When I searched for “cosmetic surgery” using the Sociological Abstracts thesaurus, I found that this term is used for the term plastic surgery. The following eight related terms were also listed:
While a relationship can be drawn between these terms and cosmetic surgery, I decided to only search with the term cosmetic surgery, as the related words and phrases could easily be associated with many other topics which could, in turn, skew my search results. However, using cosmetic surgery as my descriptor resulted in only 12 citations, the earliest originating in 2001. In order to diagnose my search problem, I retraced my steps through the thesaurus and found that the term cosmetic surgery had only been added to the index this year. I attributed the dearth of citation results to the recent inclusion of my term to the database, and tried a new search. I conducted a keyword search of ((cosmetic surger*) or (plastic surger*)), which resulted in 89 citations; a more acceptable amount. To test my hypothesis regarding the newness of “cosmetic surgery” as a descriptor, I looked at a few citations from my new results list that were not included in my initial results list. The following is one example:
TI: Title The Medicalization of Feminine Beauty: A Study of Cosmetic Surgery AU: Author Mark, Marie Elizabeth AB: Abstract Cosmetic surgery represents the newest area of medicalization in which medical doctors are expanding the use of medical knowledge and technology to encompass appearance issues. Moreover, because women comprise the majority of those who employ cosmetic surgery, gender is an important dimension in any discussion of this phenomenon. In my analysis of cosmetic surgery, I employed the feminist cultural model used by Bordo (1993) in her analysis of eating disorders. More specifically, I conducted a qualitative, in depth interview survey of 26 women who had undergone cosmetic surgery. Among the issues explored were the conscious motivations and feelings experienced by these women, their perceptions of the ideal woman's body type, decision-making issues, and the perceived and actual benefits and risks associated with their surgeries. A number of my narratives revealed pressure from others, both subtle and overt, concerning their decisions to undergo cosmetic surgery. Among them were comments from significant others, as well as the influence of the images of models and actresses featured prominently in the media, particularly on the younger women interviewed. Other findings concerned the increasingly accepted perceived connection between physical health and beauty, and the role that cosmetic surgeons play in the assessments of what needs to be surgically altered. One finding that was both unexpected and surprising was the apparent lack of awareness among most of those interviewed of the influence of sociocultural factors on their decisions to undergo cosmetic surgery. At the end of my study, suggestions were made concerning possible avenues of future research. PY: Publication Year 2001 DE: Descriptors *Medicalization (D507100); *Femininity (D297000); *Females (D296700); *Body Image (D087950); *Surgery (D845400); *Decision Making (D201000); Feminist Theory (D297400); Sociology of Culture (D810750)
In this example, cosmetic surgery is the topic of the dissertation, and yet the most relevant descriptor listed is Surgery. A descriptor search of “surgery” lists 265 citations and would clearly include more types of surgery than just cosmetic (the first 25 citations from such a search include hysterectomy, cesarean section and prophylactic surgeries in addition to cosmetic). Although keyword searching does not generally provide the level relevancy across citations that descriptor searching provides, it was my best option in searching this particular database. My results spanned from 1967 to 2003 and included 4 books, 1 book chapter, 5 dissertations, 11 conference papers, 19 book reviews and 49 journal articles related to plastic or cosmetic surgery.
Routledge International Encyclopedia of Women: Global Women’s Issues and Knowledge
Published in 2000, this four-volume encyclopedia is comprised of entries that address international women’s concerns and feminism in both theory and practice. The general editors state that this resource was generated by the recognition that “the preservation of women’s knowledge and experience – in terms of the body, the community, work, the environment, and history – is vital to women’s visibility and empowerment in the future” (Kramarae & Spender, 2000, vii). The purpose of the encyclopedia is to provide an introduction to the ideas, theories, and actions relating to women in society. The following thirteen thematic categories are addressed throughout the encyclopedia:
The International Encyclopedia of Women is, according to the editors, intended for use by advanced high school students, undergraduate and graduate students, scholars and professionals dealing with women’s issues. Each authored entry in the encyclopedia is cross-referenced to other entries in the “See Also” section, and includes references for further reading.
In order to explore the sociological treatment of cosmetic surgery, I conducted another crude title analysis, this time using the results gathered from my search of Sociological Abstracts. In this case, I extracted key words and phrases from document titles in an effort to better understand the key concepts represented in the literature. I then grouped words and phrases together that I felt were indicative of general concepts in order to discern any visible trends. As with the PsycINFO analysis, my method was highly subjective; others undertaking such an analysis would no doubt find different ways of arranging the terminology encountered.
I found nine general concepts to be themes in the literature, many of which are interrelated. For each concept, I conducted a narrower search of Sociological Abstracts, using concept-related keywords, to get a better feel for how these concepts are represented throughout the results.. Table 3 provides a breakdown of concepts, search terms, and percent of the literature representing each concept.
|67.4||60||The Body in society: body ideals, objectification, social view of body||(body or bodies)|
|33.7||30||Society, culture and social behavior: cultural motivation, embodied citizenship, collective behavior, social equality||(societ* or cultur*)|
|21.3||19||Feminism: feminist perspectives, feminist theory||feminis*|
|20.2||18||Gender: male, female, transsexualism||gender*|
|18||16||Agency and identity: choice, power, self-knowledge||(agency or identi*)|
|13.5||12||Methods of transformation: technology, specific cosmetic surgeries||(technolog* or transform*) with specific surgeries found in titles|
|11.2||10||Media: television, magazines, etc.||media|
|.08||7||Consumerism: economy, commodification, culture of consumption||(consumer* or capitalis* or economy or commodi*)|
|.05||4||Medicalization of appearance/beauty||Medicalization|
* search terms were Added to the original search string ((plastic surger*) or (cosmetic surger*))
It is easily discerned from these results that well over half of the literature indexed relates to the concept of the body in society, and over one third relates to the general concept of society, culture and social behavior. Concepts such as body ideals, body objectification, collective behavior and social motivation are key ideas found in the literature. It is clear to see that the discipline of sociology, focusing of these points, often views cosmetic surgery as the alteration of the body in order to cohere to societal constructs of beauty. These findings also serve to reinforce the notion that sociology is, in the most general terms, the study of society. It is only natural then that the bulk of the literature deals with society and culture and the role of the body within.
Feminism and the concept of gender also play key roles in the sociological literature. Over one fifth of the citations relate to gender, while an additional one fifth relates to feminism. Most of the literature regarding gender examines the construction of gender identity by use of cosmetic surgery, and the reinforcement of femininity ideals. The theories of feminism addresses how cosmetic surgery affects women socially. It is interesting to note that two feminist perspectives are found in the literature. The dominant feminist perspective is of women who elect cosmetic surgery as “victims of false consciousness whose bodies are disciplined by the hegemonic male gaze”…; while the other perspective asserts that these women are exercising choice in controlling their bodies (Gagne & McGaughey, 2002). The following abstract reveals how the concepts of feminism and gender are often dealt with simultaneously in the literature. In it, we see a criticism of the inconsistency in feminist theory relative to gender and cosmetic surgery.
TI: Title Women's Self-Starvation, Cosmetic Surgery and Transsexualism AU: Author Lienert, Tania AF: Affiliation Women's Studies Deakin U, Geelong Victoria 3217 Australia SO: Source Feminism & Psychology, 1998, 8, 2, May, 245-250 AB: Abstract Contends that feminists, who denounce the pressures put on women to diet excessively & undergo cosmetic surgery to enhance their beauty, should also condemn the pressures that lead transsexual males to "change sex." The connections between women's self-starvation/cosmetic surgery & male transsexual surgery are discussed, suggesting that both reinforce gender stereotypes by mutilating the body to conform to ideals of "femininity." The failure of feminists to criticize transsexual surgery is often based on the notion that to do so oppresses transsexuals themselves. This assumption ignores the reality that pressures on transsexuals to achieve perfect bodies are the same as those applied to women. It is argued that feminists must reject all bodily alterations as violent & unethical, & focus instead on striving to change stereotypical media images of feminine women & masculine men, coupled with education & counseling to help persons accept themselves as they are. Limiting criticism of bodily alteration to women exhibits a double standard. 16 References. J. Lindroth. DE: Descriptors *Feminism (D297300); *Sex Stereotypes (D760200); *Sex Role Identity (D759300); *Surgery (D845400); *Human Body (D372600); *Transsexuality (D876600); *Attractiveness (D057900); Eating Disorders (D237150); Femininity (D297000); Masculinity (D495900) CL: Classification 1940 the family and socialization; sociology of sexual behavior. 2959 feminist/gender studies; feminist studies
It is worth noting that this article is classified in “feminist/gender studies”, reinforcing that in the field of sociology, these two concepts are often linked.
The remaining five concepts each command less than 20% of the literature. The idea of agency and identity focuses on the individual in society and his or her empowerment and/or self-knowledge. Some of the literature highlighting this concept explains that the factor of choice in cosmetic surgery is empowering to the individual. Works regarding transformation focus on how modern technology allows for the alteration of the body in society. Some specific transformative surgeries are noted such as breast augmentation, rhinoplasty, and genital surgery/ mutilation; however, not nearly as many are found in this resource as are found in PsycINFO . Media is another concept dealt with in the literature. Typically, the focus is on media’s portrayal of female beauty ideals; television and men’s magazines are the media most frequently critiqued. The concept of consumerism is also noted in the search results, and usually focuses on the influence of consumer culture on the body. Finally, the idea of the medicalization of beauty, the process of exerting medical authority over the concept of appearance/beauty, is mentioned in three citations.
It is notable that many of the nine patterns in the literature that I have reviewed can be found within the same work. The following abstract exemplifies this commingling of concepts:
TI: Title Bodies at Work: "Doing Femininity" at a Feminist Magazine and at a Men's Pornographic Magazine AU: Author Dellinger, Kirsten A; Citeroni, Tracy AF: Affiliation Dept Sociology & Anthropology, U Mississippi, University 38677 [tel: 662-915-7323; fax: 662-915-5372] EA: Email Address mailto:firstname.lastname@example.org SO: Source Southern Sociological Society (SSS), 2003 AB: Abstract Feminist scholars were among the first to see the body as a legitimate area of sociological inquiry & are well known for arguing that the "personal is political." Accordingly, they have produced a vast literature that examines the link between mass media images of women's bodies & various personal troubles such as low self-esteem, eating disorders, & the increasing use of cosmetic surgery. Although groundbreaking, this work leaves us with two problems: (1) these accounts often unintentionally portray women as "cultural dupes" with little agency of their own & (2) the focus on the broader "media images" of women's bodies ignores the specific cultural contexts in which real women negotiate these images in everyday life. This paper is based on in-depth interviews & participant observation with workers in a range of occupations (accountants, editors, administrative assistants) at a feminist magazine (Womyn) & at a heterosexual men's pornographic magazine (Gentleman's Sophisticate). This comparative case study allows us to examine the specific strategies women use at each workplace to negotiate very different cultural images of women's bodies. The women at GS face the challenge of distinguishing themselves from the sexually accessible porn stars portrayed in the magazine, while the women at Womyn face the challenge of maintaining their right to be "sexy" in the context of a political fight against the widespread portrayal of women as sex objects. Each workplace context calls for women to use different strategies to creatively construct their professional/sexual/gender work identities. We outline these strategies, examine their consequences, & discuss the extent to which "body work" is required of all women workers. LA: Language English PY: Publication Year 2003
This work incorporates concepts of the body in society, culture, feminism, gender, agency and media in dealing with cosmetic surgery. Such synthesis of sociological concepts is found throughout the results found in Sociological Abstracts.
The Routledge International Encyclopedia of Women addresses cosmetic surgery at a number of points; the entries of Anatomy, Surgery, Disease and Health each briefly touch upon the topic, and a two-page entry is devoted to cosmetic surgery alone. Within these entries the reader finds a strong feminist perspective. In fact, the editors note in the Encyclopedia’s introduction that
Traditionally, encyclopedia articles have tended to be – or to be presented as – “value-free”; but feminist scholarship often acknowledges the “politics of the personal,” or the political importance of women’s personal experience, and takes an interest in transforming the theory, practice, and purpose of social institutions. Many of the entries in this encyclopedia of women offer “values” in this sense, and we believe the reader will enjoy and learn from the cultural exchange that they represent. (Kramarae & Spender, 2000, viii)
While some of the articles found in Sociological Abstracts address the positive feminist perspective of empowerment relating to cosmetic surgery, no such treatment is found within this resource. It is clear throughout the encyclopedia that the editors view the practice with distain.
The Encyclopedia’s entry of Cosmetic Surgery explains from the outset that cosmetic surgery differs from reconstructive plastic surgery, noting that only the former is addressed in the entry. The entry is divided into five subheadings. The first, Motivations, examines how social pressures motivate women to undergo cosmetic surgery. In stating that “cosmetic surgery is a medical ‘solution’ for a purely social problem” (Rome, 2000, p.240), the author presents the view that insecurity, low self-esteem, perceived unattractiveness, and lack of access to employment are problems rooted in society, and not the individual. In the next section, Cosmetic Surgery and Women’s Role, it is explained that
cosmetic surgery reinforces the role of women as objects for men’s use rather than as people who can be accomplished in their own right….The social endorsement of reshaping women to fit a certain image leads directly to the concept of woman as commodity….Messages from partners, employers, and the media, as well as real discrimination against certain groups of people, can all have an impact on a woman’s aesthetic sense of her own body that may coerce her – subtly or explicitly – to think that she needs surgery. (Rome, 2000, p.240)
We find in this excerpt the same concepts of body objectification and commodification, cultural motivation, and media that were found in the entries in Sociological Abstracts. In the section titled Risks and Outcomes, the significance of risks in surgery, including death, is addressed. In The Practice of Cosmetic Surgery, readers find a pronounced criticism of cosmetic surgery practices for their advertising and lack of regulation – the author makes certain to note that in the United States, any person with a medical degree can legally perform cosmetic surgery. Surgeons are also maligned for having “rarely done serious studies on whether or how a particular procedure changes the clients psychological state” (Rome, 2000, p.241), touching upon the perceived psychological benefit of cosmetic surgery. Finally, in Cosmetic Surgery and Feminism, the author calls for women to find ways to increase self-esteem without resorting to the knife. Methods mentioned by the author include attending workshops to learn how to be more assertive, and reconceptualizing their bodies so that “’droopy eyelids’ are transformed to ‘wisdom curves’… and breasts that ‘sag’ after nursing become, instead, ‘relaxed and flowing’’ (Rome, 2000, p.241). The entry is cross-referenced to advertising, body, cosmetics, ethics: feminist, fashion, images of women: overview, and surgery.
Other entries in the encyclopedia briefly touch upon cosmetic surgery as well. The entry on anatomy references cosmetic surgery as an instance if how the manipulation of the body is easier to accomplish than the changing of societal attitudes: “the statistics on cosmetic surgery show that psychosocial pressures to conform to ideals of beauty, despite many analyses and criticisms of the female role in heterosexual relationships, are still far stronger for women than the fear of pain and health hazards.” (van der Ploeg, 2000, p.52). This idea of psychosocial pressure is similar to what we have seen in the PsycINFO literature. The entries on Surgery and Health also speak of cosmetic surgery; the Surgery entry includes a short paragraph synopsizing the contents of the Cosmetic Surgery entry, while in the Health entry, under the subheading Women’s Health Movements around the World, it is explained that “Women’s rights groups in the developed North have called attention to the disfiguring of women’s bodies through cosmetic surgery, and the self-mutilation implicit in crash diets, which are used to make women more closely resemble society’s standards of beauty.” (Forte, Akhter & Norris, 2000, 2000, p.953). Here again, we see the concept of the view of the body in society. The last mention of cosmetic surgery is the following sentence found in the entry on Disease:
Self-hatred is a lucrative commodity: in 1982, the American Society of Plastic and Reconstructive Surgeons stated that small breasts are a ‘deformity…a disease which in most patients results in…a total lack of well-being due to lack of self-perceived femininity.’ (Zones & Fugh-Berman, 2000, p.389)
Such a quote serves to underscore the editors’ negative views regarding the practice of cosmetic surgery.
Figure 2 provides my view of the concept relationships regarding cosmetic surgery in the field of sociology
America: History and Life
America: History and Life is considered the premier index of secondary literature regarding North American history, while Historical Abstracts is its companion resource with literature covering non-North American history. Spanning from pre-history to the present, the subject coverage of America: History and Life includes political and social history, current events and area studies. Historical Abstracts offers similar coverage from the mid-fifteenth century to the present. The electronic versions of both resources, produced by ABC-CLIO, provide the user with the ability to search the same content of the print versions of the resources. A variety of publication types are covered, including journal articles, books, book chapters and essays, and dissertations. America: History and Life’s approximately 400,000 citations (some including abstracts) are culled from over 2,000 journals throughout the world in over 40 languages, and Historical Abstracts citations are gathered from approximately 1,700 journals. Using these resource at Drexel, some full text documents may be available via direct linking to online journals. America: History and Life began its coverage in 1964 and Historical Abstracts began its in 1955. Both are updated on a monthly basis.
After logging on to either electronic resource, the user is presented with the simple search option where he/she can search by keyword and/or subject, author, title, language, journal name or document type. The Advanced Search option, more helpful to the savvy searcher, allows for some or all of these fields to be searched simultaneously, along with the additional fields of publication date, time period, and entry number. Another feature found in Advanced Search is the capability of browsing or searching for an term within the indexes of subject, author/editor, language, document type, journal name and time period. Finally, selecting User Options from the main menu allows for modification of the manner in which results are listed; sorting can be ascending, descending or unsorted, and citations can be ordered by any of the simple search fields.
In searching for the term cosmetic surgery, I immediately realized how less sophisticated the America: History and Life and Historical Abstract subject indexes were than the thesauri found in PsycINFO and Sociological Abstracts. I first selected the Subject Terms Browser and searched for “cosmetic surgery”. This brought up an alphabetical listing of terms that included cosmetics, cosmetics industry and cosmetologists, but not my desired term. I next tried “plastic surgery”, and was presented with a list including plastics and plastics industry, but again, not my desired term. Finally, I tried “surgery”, and was greeted with Surgery (plastic) in the list of results. I was dismayed, to find that my search resulted in only 12 citations in America: History and Life, , so I again tried the keyword search that had helped during my Sociological Abstracts search: (kw= ((plastic surger*) or (cosmetic surger*). However, this search only retrieved five additional citations, each of which seemed not very relevant to the topic, so I decided to stick with the original subject search. Of the 12 citations (the earliest from 1990, the latest from 2001), there were two dissertations, seven book reviews, and only three journal articles. My search of Historical Abstracts resulted in only four citations: two articles, one dissertation and one book.
The Dictionary of American History
The third edition of the Dictionary of American History contains 4,434 entries and spans 10 volumes. According to the editor, Stanley Kutler, The Dictionary has been the leading reference work in United States History for more than six decades, and is “committed to making the voluminous record of the past readily available in one convenient source, where the interested reader can locate the facts, events, trends, or policies of American history” (Kutler, 2002, xv). The editors also note the that scope of the history discipline’s interest has changed over the past 25 years to include an emphasis on social, cultural, personal and demographic considerations; and that these considerations are taken into account throughout the entries. Each authored entry in the dictionary includes cross-references in the “see also” section, and a bibliography.
Out of the 16 citations found in America: History and Life and Historical Abstracts, seven were book reviews, leaving a total of 9 works eligible for review. Due to the limited amount of literature available, an analysis on the scale of that preformed with results from PsycINFO or Sociological Abstracts could not be completed; too few citations were available for one deduce any real trends in the literature. In fact, only a few concepts were repeated within the nine works listed. To complicate matters, only five of the citations provided abstracts to further enlighten the reader to the content of the articles. Though stymied by the paucity of literature and the lack of abstracts for almost half of the usable citations, I attempt find some commonality between the titles.
One aspect that all citations had in common was their historical content; certainly unsurprising as the sources were historical indexes. Of these, one covered the period of the 2nd c through the 20th, three dealt with the 20th century only, and five covered the 19th through 20th centuries. One abstract notes that cosmetic surgery emerged at the end of the 19th century in the United States and Europe; this fact makes it understandable that most of the literature covers the 19th Century to the present. Additionally, many of the works reference “cultural” or “social history”, showing that change in society and culture has some effect on the historical elements of cosmetic surgery.
Another concept that is found in the abstracts is the historical link between the body and identity. One abstract states that the author “traces the practice of cosmetic surgery… especially the link between facial configuration and social identity in post-World War II American culture” (Haiken, 2000), while the another explains that at the time the first American association of plastic surgeons was formed, “the Victorian notion generally prevailed that beauty was a reflection of inner qualities” (Haiken, 1994). Although not specifying this linkage directly, an additional work tie in to this concept, stating in its abstract that it “explores several of the myths and literary-artistic commentaries that revolve around cosmetic face lifts ranging from ancient East Inuit legends to Victorian and 20th-century English literature, Japanese literature, and movies” (Doniger, 2000). This historical link between identity and the body is similar to the findings in sociology, where self-perception is often dictated by body ideals in contemporary cultures.
A final concept found in the literature is the use of cosmetic surgery to change the appearance of one’s ethnic or racial background. Two of these citations do not provide abstracts, but the titles suggest the concept embodied: a book entitled “Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery” (Gilman, 1998) , and a dissertation titled “Bodies of Work: Cosmetic Surgery and the Gendered Whitening of America” (Eichberg, 2000). Additionally, the abstract of the article “Proust’s Nose” states that it “discusses how Jews, in their effort to acculturate within Christian society, have resorted to cosmetic surgery or disguises to hide their facial characteristics…”(Gilman, 2000). Again, such a concept is not far removed from the sociological literature; the idea of acculturation is similar to individuals desiring to “fit in” to the tight constraints of beauty and normality in our society.
The Dictionary of American History contains a short entry on Cosmetic Surgery and another regarding Breast Implants. In the Preface to the Dictionary, the editor states that “ as new generations of Americans examine their history, the priorities, importance, and interpretations of this history evolve….The facts that historians choose to emphasize, and the manner in which they render certain events, mirror the way society views itself and its past.” (Kutler, 2003, xv) This being said, it is surprising how objectively this resource treats cosmetic surgery. Unlike the International Encyclopedia of Women, the dictionary provides an historical account of cosmetic surgery devoid of any value judgments, rendering the content neutral (and extremely dry).
Like the entry found in the International Encyclopedia of Women, the Cosmetic Surgery entry in the dictionary begins by delineating cosmetic surgery as separate from reconstructive surgery, noting that it is performed solely for reasons of aesthetically enhancing appearance. After cursory biographies of the plastic surgery pioneers Gasparo Tagliacozzi and Charles C. Miller, the entry reads
Plastic surgery remained a small and obscure area of medicine until World War I. Trench warfare caused facial wounds so frequent and severe that special groups of doctors were formed to deal with facial injuries…. By 1921, plastic surgeons holding both medical and dental degrees organized into the American Association of Oral and Plastic Surgeons; in 1914 the name was changed to the American Association of Plastic Surgeons. The American Society of Plastic and Reconstructive Surgeons was formed in 1931, followed by the American Board of Plastic Surgery in 1937. (Ennis, 2003, p.422)
The entry provides a brief history of the origins of cosmetic surgery and plastic surgeon associations in the United States, and little more. Social and cultural aspects of such surgery are not discussed (save for the development of plastic surgery techniques during WWI), even though the editors had implied in the preface that such aspects would be found throughout the resource.
As with the Cosmetic Surgery entry, the entry of Breast Implants is purely historical and value-free in its treatment of this subject. The entry begins with a history of breast augmentation beginning in the late 19th century, and discusses the history of the silicone implants of the mid to late 20th century. The only discussion of social implications is an even-handed treatment of the debate regarding the safety of silicone implants:
Implant advocates blamed complications on poor surgical technique, not silicone. Satisfied recipients argued that women, as part of their ability to control their own bodies, had a right to choose implants. Opponents argued that women had been misled, exposed to unnecessary health risks, and sacrificed for corporate profits….Controversy continued because numerous scientific studies after 1995 disputed the links between silicone implants and disease. (Dorr, 2003, p.533)
Although this entry does point out the main features of the silicone beast implant debate, its cursory treatment does not provide information relating to the social affects of such surgery. While acceptable for a very brief historical account of cosmetic surgery, the entries in the Dictionary of American History do not shed much light on the social or cultural aspects of this topic.
Figure 3 provides my view of the concept relationships regarding cosmetic surgery in field of history.
Much overlap in content is found in the treatment of cosmetic surgery by the disciplines of psychology, sociology, and history; concepts of body image, technology, self and social views permeate the literature of each discipline (see Figure 4). Differences exist as well; for instance, the manner in which each discipline defines cosmetic surgery as either including reconstructive surgery or as a purely voluntary aesthetic endeavor. The use of similar forms of resources in each of the three disciplines, helped to clarify the similarities and differences in psychology, sociology and history. The following is an appraisal of the resources used, who would benefit from their use and how, and how the content of the literature helps define the focus of the disciplines.
Each resource used to explore cosmetic surgery in the three disciplines provided a unique look into how the disciplines view this topic in terms of their own research. The electronic indexes allow the user to view the research presented in journal articles, monographs, dissertations and gray literature. Indexes also allow the user to impose various limits on his or her search so that he or she may focus on specific dates of publication, or include additional keywords to find the most meaningful research relating to a topic, as I have done in the case of Sociological Abstracts. Dictionaries and encyclopedias, on the other hand, provide the user with a broader view of the topic as it relates to the specific discipline. These resources are best used at the outset of research, in order to develop a general understanding of a topic prior to reviewing more specialized resources. Each category of resource has its strengths and limitations in use by the researcher.
Overall, the electronic indexing and abstracting services used in this paper provided more thorough coverage of cosmetic surgery than the print resources used. These electronic resources would be most accessible to savvy undergraduates, graduate students and professionals, and all would benefit from a librarian-aided tutorial, especially in the use of subject headings and search limits. PsycInfo allowed for the most flexibility in searching, in that I was able to limit my search in terms of population, and the ability to save searches saved valuable time. The fact that Plastic Surgery is an APA Subject Heading was also helpful in my research. However, the technical and clinical content found in many of the citations would most likely be of benefit only to graduate students and professionals. Sociological Abstracts also provided a good amount of relevant literature, but using this resource was more time-consuming as it did not provide the level of sophistication in its search interface that was found in PsycINFO. Sociological Abstracts also presented the problem of not indexing earlier articles with the subject heading of Cosmetic Surgery. Researchers using Sociological Abstracts could easily encounter the pitfall of using only the cosmetic surgery heading and finding only12 results. Similar to PsycINFO, graduate students and professionals may make better use of some of the content of Sociological Abstracts, due to the amount of advanced theory presented in some citations. America: History and Life and Historical Abstracts also presented some difficulty in locating the appropriate subject heading. Although Surgery (plastic) is listed in the index, one would have to know to search for Surgery in order to find it. Users of the history indexes could assume that no subject heading existed relating to cosmetic surgery if they did not think of this approach. The history indexes also provided far fewer results than PsycINFO and Sociological Abstracts; a disappointment in my research and an indication that this topic would be a potential avenue for more researchers to explore. Lacking much technical or high theory in its citations, the historical indexes could be used by higher-level undergrads as well as graduate students and professionals.
In terms of print resources, all three were easy to use. By looking up the terms “cosmetic surgery” or “plastic surgery” in the indexes (or by locating a term alphabetically, in the case of the Dictionary of Psychology), users can find the page numbers of references to these topics within the volumes. Each resource afforded varying degrees of content. The Dictionary of Psychology offered the least, while The Dictionary of American History provided slightly more information in its entries on cosmetic surgery and breast implants. Both of these resources presented a factual, value-free description of cosmetic surgery. The Routledge Encyclopedia of Women provided the most coverage out of the three, in not only devoting a two-page entry specifically to cosmetic surgery, but also referring to it in entries on Anatomy, Disease, and Health. However, readers need to be aware that this source is far from objective in its discussion of cosmetic surgery. The Dictionary of Psychology and The Dictionary of American History could be used by high school students as well as those of higher educational attainment, while The Routledge International Encyclopedia of Women would be best used by upper level undergraduates and above, as it presents more theoretical and opinionated content.
Perhaps the greatest strength of the cosmetic surgery-related entries in the print resources is that they existed at all. Core reference materials such as The Encyclopedia of Sociology, Encyclopedia of Psychology, the International Encyclopedia of the Social and Behavioral Sciences, and many others were consulted in my research, and none but those used in this paper provided any mention of cosmetic or plastic surgery. Why this topic is neglected in the reference literature is puzzling. It may be that, in the discipline of psychology, broader themes related to this topic, such as body image or pathological traits, are emphasized in the references tools. Additionally, most of the controlled literature in psychology is in the form of journal articles (Herron, 2002, p.348). It could be that researchers in psychology do not expect such topics to be covered in reference sources. It is even more surprising that the reference literature in sociology lacks mention of cosmetic surgery, being that it is such an interdisciplinary area of study. It may be that, again, the reference literature in this field emphasizes more broad concepts, such as beauty norms in society. I expected to find few references to cosmetic surgery in the historical reference resources, as I had already conducted my index searches and found that little had been published regarding cosmetic surgery.
Users of the resources presented in this paper will often be guided to additional resources that they may not have initially considered. Monographs remain an important resource that some researchers may not think to explore at the initiation of their search process. The references for further reading in the print references sources, and the book reviews found in the electronic indexes point users to monographs. Books such as Venus Envy : A History of Cosmetic Surgery, by Elizabeth Haiken, Enhancing Human Traits : Ethical and Social Implications , edited by Erik Parens, Dubious Equalities and Embodied Differences: Cultural Studies on Cosmetic Surgery and Reshaping the Female Body: The Dilemma of Cosmetic Surgery, both by Kathy Davis, were all frequently cited in the resources, and provide detailed coverage of the social aspects of cosmetic surgery. Researchers would benefit from perusing the content of these monographs for additional analysis of the topic.
What is revealed about the three social science disciplines through the study of cosmetic surgery is that they all focus on the individual and society, but it different manners. The results from PsycINFO and the Dictionary of Psychology clearly support the view that psychology is primarily focused on the INDIVIDUAL in society. Titles dealing with clinical aspects of the discipline focused on the pathology of individuals and the role of the clinician. Those dealing with psychosocial aspects dealt with how individuals perceive their bodies, and the attitudes of individuals regarding various forms of surgery. Roughly half of the titles regarded specific surgeries performed on individuals. Moreover, the Dictionary entry stressed how plastic surgery may aid the wellbeing of the individual who suffers from deformity. Results from Sociological Abstracts and the Routledge International Encyclopedia of Women sustain the view that sociology deals mainly with the individual in SOCIETY. The citations found in the index show that important concepts included the social view of the body, body objectification in society, and collective behavior, to name a few. In addition, the feminist perspectives found in both the citations and in the International Encyclopedia of Women note the social problems underlying women’s motivations and attitudes toward cosmetic surgery. Historical Abstracts, America: History and Life, and the Dictionary of American History help maintain the notion that history studies the individual and society over TIME. References are made in the indexes to social history and the social myths related to appearance, while the Breast Implants entry in the Dictionary of American History briefly reviews the social debate in the past decades regarding this topic.
An analysis of an interdisciplinary social science topic such as cosmetic surgery can aid a researcher or information specialist by exposing the overlap and divergence of concepts related to the topic in each discipline. In the case of cosmetic surgery, it was interesting to come across similar trends in the literature across the fields, while also observing the distinct discourse each discipline presented. If time had allowed, it would have been interesting to see how other disciplines, such as anthropology and economics, treat this topic. Would similar related concepts be found? Would it be difficult to locate information on cosmetic surgery in these disciplines? A thorough exploration of cosmetic surgery across all of the social sciences would be a worthwhile undertaking.
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