Saletan cued in immediately on the quote from the co-director of the Vascular Birthmark Institute, that "every child has the right to look normal."
The thing I find fascinating (in a disturbing way) about this quote is not so much the continued "rights" creep ("Oh, the world owes me a <fill in the blank>") as the idea that we should "cure" abnormality.
Even if we accept that all children born with vascular birthmarks look "abnormal," if we "cure" their abnormality, there are so many other dimensions to physical appearance that there will inevitably be other cosmetic maladies that need to be similarly "cured": shortness, for instance. I still bear the psychological scars due to being called "shrimp" all through my elementary school years.
I wonder if Dr. Warner has his way, will we have a governmental panel setting standards of physical appearance? Medicare paying for skin lightening/darkening? Governmentally-mandated abortions in the interest of the (potential) child's right to a normal appearance?
Of course I realize it's just a cosmetic surgeon who is a little full of his own importance, but it just got all my "dystopia" synapses firing all at once.
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Be warned-- There's a disturbing pic of a guy with his throat cut beneath SenojRetep's initial article.
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Sorry Scott (and any others who inadvertently viewed offensive material).
Although, if you can get past the picture, the post is quite fascinating (part of a series Saletan's done about Predator drones and terrorist tactics in Pakistan).
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This was a good article, in my opinion. I liked that the author didn't come to a firm conclusion, and left a lot of the questions open.
I strongly believe kids should be accepted regardless of physical disfigurement. That is a right worth me fighting for. However, I'm also aware that this world is not fair or just or even nice, for the most part. It's tricky. Are gender reassignments covered by insurers? While the situations are undoubtedly different, there does seem to be a similarity when you consider the mental/emotional suffering, self-hate, and sense of alienation from one's own body (not all kids will feel this, but some likely do). If an insurer will cover gender reassignment, you could make a case that they should cover severe facial disfigurement, too. Neither may be strictly medically necessary, but where's the line?
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Given the totality of the cosmetic surgeon's comment, I expect that the range of normal is being interpreted differently by different people here.
Within the subset of the most typical 60%? Or 95%? Or 99%? How far does "normal" extend: including one standard deviation out from the mean, or two, or three, or ...? You can read the cosmetic surgeon's comments in a way that seems nonsensical by using a very tight definition of "normal," but I think that would be an unnecessarily uncharitable interpretation.
He speaks of "severely disfigured," not just any vascular birthmark. And I'd disagree with the essayist that "Disfigurement per se is cosmetic," insofar as it implies "[only] cosmetic." Sometimes disfigurement is functional impairment, sometimes not. "Malformed" is a closer synonym*** to "disfigured" than is "cosmetic," and malformations identified by appearance can come with or without functional impairment, which can itself be mild or quite severe.
Disfiguring birthmarks along the lines of Joseph Merrick's condition are "abnormal" in a different way than, say, a small hemangioma on the forehead. Similarly, a man who is 3 feet 6 inches is different from the norm to a much greater extent than a (white, US, 40-year-old) man who is 5 feet 6 inches. The latter is within the range that 95% of the US white male population falls into -- not at the mean, but still within what is called "normal," for a given definition of "normal." Still short, but within the normal range. (95% is a common range used to define "normal height" in the US.)
Defining ranges is always problematic. Just definiting terms is always problematic. But nothing is perfectly defined, and in order to have any sensible discussion, we have to work within the slipperiness of language.
I suspect that the cases presented at this conference as "not merely cosmetic" were more in the lines of >99% outside the mean than within 95% of the mean.
So I understand the concern, and I agree with some of the points, but I think the concerns raised go over and beyond the quotation cited. Worth talking about, but not justifiably laid on the shoulders of that person, who might well (and more likely) be making a much more limited claim that is not so concerning.
--- ***Technically, "malformed" is usually used to describe a difference arising from embryological development, whereas "disfigured" can describe a difference arising from development or from external forces after birth (usually the latter, though).
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quote:The Times describes a baby at the conference who "has a circular, purple mark on her forehead about the size of a nickel." --from the linked Slate essay)
The problem is that this case could have well been presented at this conference as a mild disfigurement, not associated with the presentation that the quoted surgeon was making in which he speaks of "severe disfigurement." If he indeed was referring to a hemangioma on the forehead about the size of a nickel -- non-ulcerated, not exposing the underlying skull, and so forth, just a typical small hemangioma -- as a "severe disfigurement," I'd consider that most concerning.
From what we know, though, it may well have been a totally different part of the conference. And yet the essayist seems to assume that this case is a part of the same discussion he quotes the surgeon from, when just noting that the NYT says that case was also presented at the conference. Maybe, maybe not. I'd be surprised if that case was presented as "severe disigurement" given the discription, though.
When the surgeon is quoted as saying "This is not cosmetic," it is immediately after the paragraphs about the child with a "swollen neck and an enlarged tongue, causing his words to be nearly unintelligible even after two tongue-reduction procedures" -- a case the essayist himself notes as "a no-brainer" because of functional impairment.
The discussion of the child with a nickel-sized lesion came much before that, at the beginning of the article, and the surgeon noted that the family could wait and see how it developed, or it could be removed ("fairly eas[ily]"). It doesn't seem to be connected to to the discussion of severe disfigurement at all.
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CT, have you ever read about any of the research using active MRI scans that suggests that humans respond positively to conventionally beautiful facial features- even very young children? I was given to understand (via an undergrad Psych course) that it had to do with a very basic appreciation in humans for symmetrical features and apparent signs of health- indicating, I suppose, reproductive ability and diverse and healthy genes.
We've all known people in our lives who were tragically ugly. I've had a few friends who were, and I know that even my friendly relationships with those people were probably not helped along by their appearance- I may not have included them in gatherings of other friends, and my other friends were probably less likely to take to them; I can't be sure of the reasons I think so. More importantly, I know from these experiences that the very ugly people I've met have lives that are often devoid of intimacy, and their personalities have been very brittle, sometimes bitter. I know that I too avoid talking or socializing with people I find distracting in appearance- both for beauty and ugliness. Through all that, I tend to think that we can pine over a better society, but more reasonably and effectively, we can deal with the problem more directly, and try to make these people look better. I realize the danger in such a goal, and how it goes along with the thinking of eugenics and racism, but I think there's something else involved. Ugly is not a race or an ideology, and yet we all know, or can agree generally, on what it is in people, and we can all generally agree that we don't like it.
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Having a port wine stain on your face is a big old pile of no fun. (Misery, sometimes.) I wonder if the editorialist's relative would be so enthusiastic to endorse her own right to not look normal? I wonder how she would have felt about her right to not look normal if her birthmark had stayed around instead of vanishing "after a time"?
Government panel setting standards of physical appearance? Please. Warner's making the argument that health insurance companies should cover the costs of birthmark removal. You may think they shouldn't, and that the potential emotional/ mental health problems of having a facial birthmark don't justify insurance coverage. That's fine--but don't act like it's the first step toward Harrison Bergeron.
Just as a point of comparison, since it was brought up, I did a far from thorough google search, and it looks like the costs of human growth hormone treatment is covered pretty regularly--though certainly not all of the time.
CT did a nice job of pointing out that "normal" means different things in different situations. To give it a personal spin: There's probably a "short kid" in most classes. Where I grew up, I was the only child/ adolescent in my town with a noticeable facial birthmark. Big difference.
Given my experience, I do think insurance companies should cover birthmark removal. It's very easy to say "we won't pay for that because if kids were just nicer, it wouldn't even be a problem." Health coverage usually does and should encompass more than maintaining the body's physical functionality.
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I have a birth mark that was supposed to disappear before puberty (according to everything I've read) but never did, though thankfully it's not on my face. I'm trying to imagine what it would be like to have that birthmark on my face, rather than my lower back where it's generally only seen when I'm at the beach. As it is now, I get occasional questions about it, usually timid and curious, cause it looks like a big bruise basically, but I just say it's a birthmark and it's not a big deal. I don't imagine that would be the case at all if it was in a more noticeable location.
We can argue the unfairness of aesthetics in our culture until the cows come home, but short of some draconian measures instituted to attempt to FORCE us away from deeply ingrained views on what is and isn't attractive that have been instilled in us since birth, it's really just not fixable, at least not from the government.
On the one hand, I'd look at it and say that lots of kids have bad luck in the genetic lottery and end up with a dizzying array of problems that set them at a disadvantage in life that we often DON'T fix, often to their detriment, and often when they are perfectly fixable. If we have the means to fix it, shouldn't we do it for their sake, to give them the best shot at a decent life?
I agree with Liz, in that I think it should be covered. Either cover that, or the mountain of therapy that could come from a kid being mercilessly teased by other kids, and from possible socially dysfuntional skills that might develop because of it. Kids already have enough challenges in getting through the social rigors of life, why force them to suffer through more if it can be fixed?
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I agree with everything you wrote Lyrhawn. But I understand the other argument as well. We are asking kids to change their appearance because of humanity's shallowness. The ugliness is in humanity, not those who simply look different. It may not be realistic to change that, but there's something to be said for trying.
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Part of my problem with the whole concept of correcting "abnormality" is the moving target that is "normal." 100 years ago we wouldn't have been talking about birthmarks (unless we were Hawthorn); there were much more extreme physical deformities that made birthmarks a relatively benign abnormality. So we fix cleft lips, and we treat club foot (both of which are functional abnormalities as well as aesthetic abnormalities) and eventually we get to birthmarks. And if we fix birthmarks it'll be something else. The search for "normality" is futile, since short of uniformity the human population will always engage in aesthetic discrimination (not in a negative sense; our minds are just trained to spot differences and categorize according to them). We can shrink the standard deviations, but we'll always have people who are further away from "normal" than others.
Further, while I sympathize with the desire to remove challenges, I also think something might be lost in taking away that adversity. It's possible to kill with kindness (to misapply Shakespeare) and often character is forged in the furnace of adversity. I think it is presumptuous to suppose that being "normal" will necessarily (or even on average) improve the individual, or society as a whole.
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SenojRetep, what do you mean by "character" being forged by adversity? What kind of character? What's the net average benefit to the person who goes through adversity (or is the net benefit to society, not the individual)? Would you create adversity if you had the option, to forge character?
I don't think any of us would deliberately cause a child to go a week without eating, even if that experience was likely to produce some stunning literature or something later on in life. Would we?
If adversity fuels [something good], then lack of adversity will eventually lead to less [something good]. However, unless our unmet potential leads to more net adversity, that doesn't seem so bad to me; it seems we've broken even or better. And if it does net more adversity? More [something good], I guess.
I think we should err on the side of heading off undeserved and unearned suffering, to the extent we can do so and preserve civil liberties. No state-mandated correction of birthmarks, but let the parents have the option, and recognize that it IS a "problem" if only because of the imperfect humanity of the rest of us.
I wouldn't worry too much about homogeneity. There's been quite a trend in tattoos and body piercing. I say let people choose their physical abnormalities. And we will continue to identify people by what they think and what they do, as much as by what they look like (and I see no evidence that we're trending toward homogeneity in behavior, despite centuries of effort to enforce social norms).
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One of my professors had a port wine birthmark that covered half his face. Obviously he succeeded anyway, but it used to shock me every time I saw him. And one of my granddaughters still needs surgery to make her eyes more normal, as thanks to a birth defect she has little vision in the eye which looks permanently off to the side. They plan to pin it in place so it always looks forward, since she has no muscles to control the eyeball. But she is smart and popular, so a rather ugly defect has had little effect on her life. However that may have been in part because she has always attended the same small private school, while a child who attends a new school each year has enough trouble making friends if he looks normal. In truth, as with all cosmetic or corrective surgery, deciding what to do demands extensive discussion of each individual case.
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quote:Originally posted by Liz B: Having a port wine stain on your face is a big old pile of no fun. (Misery, sometimes.) I wonder if the editorialist's relative would be so enthusiastic to endorse her own right to not look normal? I wonder how she would have felt about her right to not look normal if her birthmark had stayed around instead of vanishing "after a time"?
Government panel setting standards of physical appearance? Please. Warner's making the argument that health insurance companies should cover the costs of birthmark removal. You may think they shouldn't, and that the potential emotional/ mental health problems of having a facial birthmark don't justify insurance coverage. That's fine--but don't act like it's the first step toward Harrison Bergeron.
Just as a point of comparison, since it was brought up, I did a far from thorough google search, and it looks like the costs of human growth hormone treatment is covered pretty regularly--though certainly not all of the time.
CT did a nice job of pointing out that "normal" means different things in different situations. To give it a personal spin: There's probably a "short kid" in most classes. Where I grew up, I was the only child/ adolescent in my town with a noticeable facial birthmark. Big difference.
Given my experience, I do think insurance companies should cover birthmark removal. It's very easy to say "we won't pay for that because if kids were just nicer, it wouldn't even be a problem." Health coverage usually does and should encompass more than maintaining the body's physical functionality.
Amen!
My cousin was in the first group of HCG clinical trial subjects. Even with the shots, he ended up considerably shorter than his sister and his mom -- neither of whom is all that tall. (His dad is.)
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heh. I would totally be for covering the costs of cosmetic surgery on people's faces so that they don't have to have fuggo marks or stains on their faces as kids. The cost to benefit ratio in terms of quality of life improvement is strangely high which prevents me from considering the cosmetic surgeries extraneous or frivolous.
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The fact that we can't fix everything is not a logical excuse for failure to fix the things we can.
The fact that there are borderline cases where decisions are always controversial, isn't a logical reason to avoid decision in the cases that are clearly not borderline.
I've known less than half a dozen people in my life who've had significant facial birthmarks. Its not like we are talking about cosmetic surgery for the half of the population whose facial features are below average.
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I have a friend whose step daughter has a port wine stain (vascular) birthmark on her face.
Her mother insisted on having several treatments to fade the birthmark while she was a very young child. Evidently the treatment (I believe it was a laser treatment) was extremely painful, enough so that the daughter suffered significant lasting emotional trauma from the treatments.
While I fully support the idea that cosmetic surgery for people with this type of disfiguring malformation should be available and covered by insurance, I have serious questions about the ethics of forcing a young child to undergo any very painful or dangerous medical procedure that is solely cosmetic in nature.
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quote:Originally posted by The Rabbit: The fact that we can't fix everything is not a logical excuse for failure to fix the things we can.
The fact that there are borderline cases where decisions are always controversial, isn't a logical reason to avoid decision in the cases that are clearly not borderline.
I've known less than half a dozen people in my life who've had significant facial birthmarks. Its not like we are talking about cosmetic surgery for the half of the population whose facial features are below average.
Completely agree.
I also agree on the ethical problem with forcing a child to undergo a painful procedure for purely cosmetic reasons. (Some birthmarks have health risks, such as high probability of precancerous cells, and that's different.)
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I agree with what Rabbit and Rivka have said.
This is obviously something that needs to be handled on a case-by-case basis. The kind of doctors who perform surgeries like this in cases where they are needed and appreciated? Nothing less than saintly. The concept of setting some sort of regulation about what counts as ugly? Ridiculous.
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quote: We are asking kids to change their appearance because of humanity's shallowness. The ugliness is in humanity, not those who simply look different. It may not be realistic to change that, but there's something to be said for trying.
I agree with your underlying point--that we should try to do what we can to avoid noticing when someone has a big red or purple mark on his or her face, and if we notice it not to think anything of it one way or the other, or find the person less attractive because of it--but I want to point out again that no one is asking kids to change their appearance. The doctor wants for the procedure to be a financial option for kids and their families who want the procedure.
Now, you could make the argument that parents are making this decision for their children before the children themselves are capable of making it for themselves. I think that's a reasonable objection--but I'll tell you that when I was four years old my mom found me trying to scrub off my birthmark because of what some children had said to me at nursery school. So how old does a kid have to be before we decide she's old enough to say she doesn't want the big red blotch on her face anymore?
quote: I also think something might be lost in taking away that adversity. It's possible to kill with kindness (to misapply Shakespeare) and often character is forged in the furnace of adversity. I think it is presumptuous to suppose that being "normal" will necessarily (or even on average) improve the individual, or society as a whole.
"presumptuous"
Remember, we're not talking about being "normal"--we're talking about not having an immediately noticeable BIG RED BLOTCH on your face.
We'll trade--you can have all of the character I developed in middle school, and I'll take your lack of a birthmark. Oh, wait--we don't have to make such an impossible deal! There's a procedure that can lighten the birthmark...it's expensive, but maybe health insurance can cover it!
quote: I have a friend whose step daughter has a port wine stain (vascular) birthmark on her face.
Her mother insisted on having several treatments to fade the birthmark while she was a very young child. Evidently the treatment (I believe it was a laser treatment) was extremely painful, enough so that the daughter suffered significant lasting emotional trauma from the treatments.
This is a different issue altogether, and a possible real ethical dilemma for a parent...but not, imo, for the insurance company.
There are different removal procedures, so I'm not questioning the traumatic experience of your friend's stepdaughter--but not all procedures are nearly that painful. I had a laser treatment and it felt a lot like having a rubber band snapped against my face multiple times. It stung enough to make my eyes water, but it was much less painful than (for example) spraining my ankle. It then felt hot for a few hours, and was a little tender (like a brushburn) for a day or so. I'm just bringing up the difference so you know that it's not always so awful.
The fact that it was *less* painful, though, doesn't mean that a parent should authorize it on a child's behalf without serious thought & consideration. I'm sure it would have seemed much more painful if I hadn't really understood what was going on.
I'd like to add that I don't need the doctors to be saintly. I think they should get paid. That's why I think insurance should cover it. Posts: 834 | Registered: Jun 2005
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I'm going to jump in on this one, though I rarely post over here.
I do think that procedures like this on a birthmark shouldn't be covered under normal health insurance - for many of the reasons stated here already. Is it hard on a kid sometimes? Yup. But you know what? If it wasn't a port-wine stain, it'd be something else.
You're fat. You have ugly hair. Your nose is big. You're mother is white and your father is black. You're a boy. For kids, it doesn't matter. Now, those with an obvious difference have an obvious scapegoat - everything would be different if I just didn't have that mole above my eyebrow.
Hate to tell you - it's called growing up and deciding what effect other people's opinions are going to have on you.
Do I sound unsympathetic? Prolly. Why? I grew up with a very large port-wine stain on my left cheek. Did I get teased - oh yeah. Did I wish as a kid that I didn't have it sometimes? Yes. Did it effect my life in any real way? Well, let's see:
I'm now 32, I'm a classical tenor, and have performed professionally to some small extent - didn't effect me in auditions or performances. I've taught at the college level, and teach at the high school level. I'm married and have 2 kids. And I also still have that red mark on my cheek. Rarely do I even have anyone comment on it. Of course, many wonder, but the only ones who ever ask are children.
"What's that on your face?" "A birthmark." "What's that?" "Well, you know how some puppies have spots, and others don't?" "Yeah." "Well, I have spots." "Oh!" (Kid runs off and plays)
I can't see how my life would have been any different without it. The same character traits that caused it to have little long-term effect on me would have been the same if it were a big nose instead. Those who would be permanently traumatized would have likely found something else to be affected by.
Like it or not, it's a COSMETIC surgery. If you're not going to cover nose jobs or breast augmentation, there's no reason that this should be covered. Samp - I really don't see the cost versus quality of life issue here. And if the argument is that so few people are affected by it that we should cover it, I would counter it by asking - if we argue that this should be covered, what really is the difference between this and a nose job, or a breast augmentation, or tattoos, for that matter. We're talking about alteration of your natural appearance either way - not a gross distortion like Mr. Merrick's.
This is not to say that I don't think anyone should ever have them removed - but it's far different for an adult to decide to go through cosmetic surgery than a child. I would be just as against a parent bowing to their child's wishes to have a port-wine stain removed as I would if an 11-year-old wanted to have her nose done.
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Don, I'm glad you jumped boards to share your similar experience which led to the opposite viewpoint.
Part of me wonders if the difference is partially male/ female, given the different levels of expectation for attractiveness/ personal appearance for males and females--but a birthmark is just as noticeable on a boy, and I at least had the option of wearing makeup. (I guess a boy could wear makeup, too, but that would probably have a worse social outcome than the birthmark.)
Although I think this is a cosmetic surgery that should be covered, I certainly agree with you that it's a cosmetic surgery. (Not always, of course; it seems that we've all already agreed that there's no need to dispute whether or not to remove birthmarks that also endanger a child's health in one way or another.) Still, it's a very particular type of cosmetic surgery.
It's quite different from a tattoo: it's not an adornment, it's the removal of a blemish.
Same reason goes for being different from breast augmentation: birthmark removal doesn't add something attractive, it removes something unattractive.
It's closest to a nose job. And I think I'd probably be in favor of insurance covering a nose job if it's serving essentially the same purpose as birthmark removal. That is, if the nose is disfiguring enough to be immediately noticeable, and that the disfigurement is unusual enough that it doesn't fall within, say, the 95% "normal" range that CT mentioned above. (I don't know the incidence of facial birthmarks but I'm positive it's much lower than 5%. So perhaps the "normal" range for covering a nose job should be different?)
As for a parent allowing a child to have a birthmark removed: I think parents should have the final decision, but I also don't think it's comparable in this case to a nose job at 11. For one thing, at 11 the child isn't done growing; also, the level of risk seems to be much lower for most birthmark removal surgery than for rhinoplasty. (This is after a cursory google search to confirm my suspicions; if someone knows more, please correct me!)
If the parent just thinks the child should deal with it until he or she is an adult and can make the decision on his or her own--well, I might disagree strongly with that position, but I support the parent's right to make it.
Curious now: What would you think about an 11-year-old wanting to wear makeup to cover the mark? How about an 8-year-old?
(edited for typos)
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Again, it's an attitude thing - if you see it as a blemish, that's assigning a negative association with it. I simply don't think of it as a blemish, and I was encouraged to approach it that way all throughout childhood. I DO see it as a similar thing to a nose job - you're correct - an 11-year-old is not done growing, and the nose will change. So will a birthmark. Mine has changed color slightly over the years. (Actually it changes color regularly according to mood and health.) Parts that used to be visible are gone now.
What would I think about an 11-year-old wearing makeup to cover a birthmark? Honestly, it would be dependent on what you believe about 11-year-olds wearing makeup in general. I don't happen to believe that an 11-year-old should be wearing makeup, so I would feel the same if my children had facial birthmarks.
As a parent, doing that for a child would be the same as telling the child, "Yes, you ARE unattractive, and let me do what I can to help you not be unattractive." It's completely an attitude thing.
Notions of beauty are fleeting. Prominent noses were once considered very attractive, as was being overweight. Desires of children are even more fleeting. We are the ones who tell a child which of their desires are of value - when they see the first thing on the store shelf that is shiny, and ask for us to buy it, we tell them no. (Most of us... ) That sends the message to the child, through reinforcement, that those shiny things do not hold value, and over time, that notion lodges into the child's consciousness.
Change the idea of a birthmark to other things that were considered unattractive or a deformity. In Chinese culture, large feet on girls was considered unattractive, and so the tradition of binding feet began. If this tradition were around now in the US, would you feel the same way?
I vehemently disagree with the idea that it's the parent decision to make physical alterations of this type to a child. (Gross deformities are very different.) Children cannot do certain things under the age of 18 beacause we recognize the fact that a child does not have wisdom to make certain decisions for themselves, because of the fleeting nature of their desires. Furthermore, there are many things that a parent CANNOT make a decision for a child to undergo - marriage being one example.
Being a stage performer, I often need to wear stage makeup for performances - heavy makeup in which my birthmark is not visible at all. My wife hates seeing me like this - she finds that lack of mark on my face to be disconcerting; that something about myself has been fundamentally altered from the man she loves.
As I said, it's all attitude - if you think it's a detriment, it's going to be so. If your parents have told you all your life that it isn't, and you give the child a context to understand and to cope with the teasing, it's not an issue. And it doesn't matter if you're talking about a birthmark, straight hair, a big nose, a low voice, blue eyes, etc.
I'm reminded of the Dr. Seuss book about the people with the stars on their bellies...What was the title of that??
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quote:Part of me wonders if the difference is partially male/ female, given the different levels of expectation for attractiveness/ personal appearance for males and females--but a birthmark is just as noticeable on a boy, and I at least had the option of wearing makeup.
There is no doubt in my mind that having a big read birth mark on your face will be a much bigger issue for girls than for boys. You can argue that this is an unfair double standard, that appearance shouldn't be any more important for girls than it is for boys, and I would agree in theory. But in practice, the simple fact is that girls and women are judged more by their physical appearance than men in every world culture. If a man is smart, or witty, or athletic -- people will forget about his physical appearance. This just isn't as true for women and there are studies that back this up. A disfiguring facial feature is a bigger handicap for a woman than it is for a man.
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quote:I don't know the incidence of facial birthmarks but I'm positive it's much lower than 5%. So perhaps the "normal" range for covering a nose job should be different?
According to wikipedia, 3 -5 out of 1000 people are born with vascular birthmarks most commonly on the face. So it is less than 0.5% of the population we are not just talking about outside the 95% interval, we are talking about outside the 99.5% interval.
It isn't fair to compare this to having a big nose or being overweight unless you are talking about conditions that occur in less than 1/2 a percent of the population. Cosmetic surgery is a different story for a person that has a big nose (even an unusally big nose) than it is for a person who has a malformed nose (perhaps like these children)
[ November 19, 2008, 09:59 AM: Message edited by: The Rabbit ]
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quote:Originally posted by Liz B: Part of me wonders if the difference is partially male/ female, given the different levels of expectation for attractiveness/ personal appearance for males and females--but a birthmark is just as noticeable on a boy, and I at least had the option of wearing makeup. (I guess a boy could wear makeup, too, but that would probably have a worse social outcome than the birthmark.)
Maybe some, but I wouldn't necessarily take Don's experience as standard for men (not to invalidate it, of course).
I dated a man for several years with a rather large birthmark covering the side of his head, his neck, his upper arm, and part of his chest. It wasn't a port wine stain; I forget the exact medical name for it. Basically a darker patch of skin covered with thousands of very closely packed moles.
He grew up being insulted and told that no one would ever be attracted to him, to the point where he would physically flinch when I complimented his appearance. I don't think in the three years we dated that he ever once actually believed that I didn't find him ugly; he just thought I was saying otherwise to be nice to him. He did most of his socializing over the Internet, where he felt less judged.
If he could have had it removed, he would have done so in a heartbeat. But there's no way he could have afforded the surgery.
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quote:As I said, it's all attitude - if you think it's a detriment, it's going to be so. If your parents have told you all your life that it isn't, and you give the child a context to understand and to cope with the teasing, it's not an issue.
I disagree. Well, actually, I agree with the first part but not the second. Yes, if you think it's a problem, it will be. I certainly believe that your birthmark became a non-issue for you. I think that is unusual. Yes, it is important for a parent to help a child cope with anything that would cause teasing--but to think that that somehow solves the problem for every child is unrealistic. Again, I'm not questioning your experience--I just am questioning its universality.
quote:...the nose will change.So will a birthmark. Mine has changed color slightly over the years. (Actually it changes color regularly according to mood and health.) Parts that used to be visible are gone now.
That has not been my experience. Well, it does get darker with mood, but nothing substantial has changed about it--other than the surgical lightening I had done. Anyway, the point doesn't really apply--the reason not to do a rhinoplasty at 11 isn't because the nose might suddenly look better (although as the face grows, that might be the case); it's because the surgery can't be done well on a growing nose, and as the nose grows the surgery might be undone.
quote: Notions of beauty are fleeting.
Hm. Perhaps someday a large facial birthmark will be considered a sign of beauty. Somehow I'm skeptical.
quote:Change the idea of a birthmark to other things that were considered unattractive or a deformity. In Chinese culture, large feet on girls was considered unattractive, and so the tradition of binding feet began. If this tradition were around now in the US, would you feel the same way?
If all girls had a birthmark at birth and the procedure to remove it involved a years-long, excruciatingly painful process that resulted in all being crippled and some dying, then I would be as against birthmark removal as I would be against footbinding. Since that's not the case, the comparison doesn't apply.
If a person had feet that were out of proportion to his or her body to the extent that they were out of the 99.5% range of normality (thanks, The Rabbit), and the procedure to change this was not terribly painful and had few serious risks, then I would certainly hope that health insurance would cover it.
quote: Being a stage performer, I often need to wear stage makeup for performances - heavy makeup in which my birthmark is not visible at all. My wife hates seeing me like this - she finds that lack of mark on my face to be disconcerting; that something about myself has been fundamentally altered from the man she loves.
I think your wife sounds wonderful.
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quote:Originally posted by Don Domande: (Gross deformities are very different.)
How do you decide what counts in the range of "gross deformity" and what does not, when you are using the term?
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quote:There is no doubt in my mind that having a big read birth mark on your face will be a much bigger issue for girls than for boys.
I would agree with that - it is a bigger issue for women. However, my dean at a college I taught at until recently was a woman with a large birthmark on her face, too. She seemed to have no problems dealing with it, and had a very successful professional and personal life. Again, I think it comes down to how you deal with things, and how your parents teach you to deal with it.
Ambyr:
quote:I dated a man for several years with a rather large birthmark covering the side of his head, his neck, his upper arm, and part of his chest. It wasn't a port wine stain; I forget the exact medical name for it. Basically a darker patch of skin covered with thousands of very closely packed moles.
Isn't this my point, though? You dated him for several years - obviously it wasn't an issue for you, or I think for most decent people. It's too bad that HE felt that way about it, but I think it comes down to how you deal with adversity of any kind. I suppose it's the argument about whether your personality is in place the moment you're born, or whether your environment shapes you.
Liz:
quote:I certainly believe that your birthmark became a non-issue for you. I think that is unusual. Yes, it is important for a parent to help a child cope with anything that would cause teasing--but to think that that somehow solves the problem for every child is unrealistic. Again, I'm not questioning your experience--I just am questioning its universality.
I don't think it solves the problem for every child. But I would surmise that the percentage of people for whom it becomes a non-issue is exactly the same as the number of people who learn to deal with negative feedback from others in the general population is exactly the same. We all know people who have self-esteem issues and are obsessed with a negative self-image who to all of us look perfectly normal, or we consider valuable. Those with birthmarks simply have one thing to focus on, and blame it on.
quote:Hm. Perhaps someday a large facial birthmark will be considered a sign of beauty. Somehow I'm skeptical.
Huh. I don't think I'd be so quick to say that. Beauty marks? Cindy Crawford, Marilyn Monroe? Actually, I've seen a few women with port-wine stains that were stunning - and the birthmark only enhanced it, not detracted. Again, the norm? No. But I would not say that such a thing would never be considered a sign of beauty. All it would take is for someone high-profile who was attractive to catch the public's fancy, and people could conceivably paint fake port-wine stains on their faces. Women certainly did with "beauty marks". The ideas of what is attractive are so irrational, that I'm not discounting ANY possibility.
quote:If all girls had a birthmark at birth and the procedure to remove it involved a years-long, excruciatingly painful process that resulted in all being crippled and some dying, then I would be as against birthmark removal as I would be against footbinding. Since that's not the case, the comparison doesn't apply.
My apologies - I should have completed my thought that began with that. The second part of my argument should have been that such a tradition began with the idea that small feet are more desirable than larger feet. Over time, this warped into the practice of forcing the feet to be small.
So if we are okay with cosmetic surgery to make someone more "attractive" as a child, the question becomes where the line exists between necessary and unnecessary.
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quote:How do you decide what counts in the range of "gross deformity" and what does not, when you are using the term?
A deformity that affects the physical health of the child, or limits their ability to perform most daily tasks. I suppose a better way to describe it is structural deformities, rather than strictly cosmetic differences.
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posted
Every time I look in this thread, I'm reminded of Ted Chiang's Liking What You See: A Documentary.
(For those who haven't read it, it's a short story that takes place in the near future where the technology to induce calliagnosia, which gives you a mental state rendering you immune to (or insensitive to) beauty, has been developed. Some people chose to use the technology, others do not, and the story centers around a private college that is considering requiring all of its students to use it. Highly, highly recommended, like all of Chiang's fiction.)
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quote:How do you decide what counts in the range of "gross deformity" and what does not, when you are using the term?
A deformity that affects the physical health of the child, or limits their ability to perform most daily tasks. I suppose a better way to describe it is structural deformities, rather than strictly cosmetic differences.
I think you may mean "functional" rather than "structural."
So, there is no cosmetic difference that could be sufficiently severe that you would call it a "gross deformity," even if it lead to no functional problem (in some strict sense)?
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A side note: I think even most functional problems are often better addressed through providing adequate supports, rather than surgery. I'd generally defer to the choices of the person affected, although I think that such choices are only well-informed when adequate appropriate supports are made easily accessible and the person has full exposure to people who have made all sorts of choices about these options, if at all possible.
I doubt I'm more on the side of intervention than most of you, even those arguing against it. On the other hand, I think discussions of this topic can be muddled and unclear, and that lack of clarity (when it occurs) does the topic a real disservice. I'd rather be clear about what we mean and just what it is we each argue to be supported or avoided, and why.
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Yes, I think functional would be a better word, though structural in the sense of deformities in skeletal and physical structure I would probably feel differently about (of course, most skeletal abnormalities would have to wait until adulthood to correct, due to bone growth). I have no issue, for example, with the example that rivka cited earlier (HCG, was it?), unless people are using them in ways other than to correct a medical condition.
Is there NO cosmetic difference that could be suffficiently severe for me to call it a gross deformity? None that I can think of, but I won't say that absolutely. Another type of cosmetic difference that I see sometimes that I would put under the same category are people with two very different color eyes. I think it's very disconcerting at first to talk to such a person, when you converse with eye contact. I'm sure they endured some teasing as children as a result.
I understand that surgery to change such a thing would be much riskier than I understand modern surgery to remove a birthmark would be (I doubt it's possible), but I think the same standard applies. It is a physical difference that really has no effect on the functionality of the person.
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I have a brother in-law who is legally blind. Despite his disability, he has a successful marriage, beautiful children, a doctoral degree and a rewarding career. In many ways he is a more functional human being than many people with 20/20 vision. Following Don's logic, this demonstrates that severe visual impairments are just an attitude thing. If you have the right attitude about it, being blind isn't a problem. Treatment for this form of blindness should be considered a luxury, no different from LASIK surgery for any near sighted individual. If we start saying that every child has a right to normal vision, pretty soon we will paying for surgery for everyone who has a minor astigmatism.
At least that's where Don's logic leads us.
There is a very fundamental difference between being legally blind and needing glasses to read or drive a car even though there is a continuum between the two.
Likewise, there is a very real difference between having a large disfiguring mark on your face, and having a big nose or freckles.
The fact that some people are able to function well despite severe visual impairment or disfiguring birthmarks, doesn't change the fact that they are a serious and sometimes debilitating burden for many people who have them. The fact that you can learn to live and live fully with impairments of many kinds, doesn't mean we shouldn't treat them when possible.
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quote:Originally posted by Don Domande: Yes, I think functional would be a better word, though structural in the sense of deformities in skeletal and physical structure I would probably feel differently about (of course, most skeletal abnormalities would have to wait until adulthood to correct, due to bone growth). I have no issue, for example, with the example that rivka cited earlier (HCG, was it?), unless people are using them in ways other than to correct a medical condition.
I think rivka may have meant HGH (human growth hormone), not HCG (human chorionic gonadotropin, which is the hormone produced by the placenta to support a developing pregnancy and tested for in pregnancy urine & blood tests). Or maybe it is something I am unfamiliar with.
I am trying to understand what you are saying, and I don't mean to put words in your mouth. (Or to set some kind of trap! Honest questions.) So you mean that for a significantly short person (say, for example, predicted adult height of 3 ft 6 inches -- not easy circumstances, but with reasonable supports, certainly one in which a person could perform most of the standard activities of daily living), you would support the use of human growth hormone to achieve a more typical adult height, yes? Because this is a difference in bone structure rather than in skin structure?
quote:Is there NO cosmetic difference that could be suffficiently severe for me to call it a gross deformity? None that I can think of, but I won't say that absolutely. Another type of cosmetic difference that I see sometimes that I would put under the same category are people with two very different color eyes. I think it's very disconcerting at first to talk to such a person, when you converse with eye contact.
I am thinking more of something like severe ichthyosis, which leads to skin that is so severely scaled (and burned-appearing after shedding) that it can make persons not recognizably human. And I mean that literally (if you google, you will find mostly cases of non-severe forms, by the way). I am not linking unless I must, as it seems cruel and inappropriate to point at someone online for the purposes of making a point. But I can edit out identifying features and post an image I host if I must.
Such people can carry out the activities of daily living, although I'd be more quick to intervene in such a case (if I could) than someone shorter than average, even much shorter than average. For me, the deciding point isn't bone vs. skin.
---
My horse in this race, if I have one, is that framing the discussion in terms of either "just" cosmetic or not does a disservice to the real complexity of the issue (and the very broad range of variety of the human experience). Similarly, framing it in terms of either we intervene surgically or we purely intervene socially does many of the people who are struggling through this a disservice as well -- people directly affected, certainly, but also caregivers and medical professionals.
The situations are complex. The answers must be, too, to reflect that. And it's easy to point fingers and say "you just don't get it" (from any perspective), when it's likely that none of us get all of it.
My preference is to view permanent changes as more of a last resort than an initial answer, although I certainly don't think it shouldn't be on the table. I'd also prefer to approach a given individual circumstance from multiple perspectives, when possible: how can we support acceptance rather than just change things?, but also, how can we change things to assist in dealing with problems?
I am interested in discussions about how changing the extremes to fit in a more typical range ends up affecting that range itself. I'm interested in how viewing some things as "assistances" actually covers up how much "assistance" is provided invisibly to people generally viewed as typical. Those, I think, are great discussions to have.
I'm less interested in absolutes such as "we shouldn't intervene whenever the issue is 'only cosmetic,'" because I think they are not as productive, not reflective of and open to the really wide range of individual circumstances. It closes down discussion, not opens it up, I think.
quote:Originally posted by Don Domande: Yes, I think functional would be a better word, though structural in the sense of deformities in skeletal and physical structure I would probably feel differently about (of course, most skeletal abnormalities would have to wait until adulthood to correct, due to bone growth). I have no issue, for example, with the example that rivka cited earlier (HCG, was it?), unless people are using them in ways other than to correct a medical condition.
I think rivka may have meant HGH (human growth hormone), not HCG (human chorionic gonadotropin, which is the hormone produced by the placenta to support a developing pregnancy and tested for in pregnancy urine & blood tests).
Indeed. Bad typo there . . .
quote:Originally posted by Jhai: Every time I look in this thread, I'm reminded of Ted Chiang's Liking What You See: A Documentary.
(For those who haven't read it, it's a short story that takes place in the near future where the technology to induce calliagnosia, which gives you a mental state rendering you immune to (or insensitive to) beauty, has been developed. Some people chose to use the technology, others do not, and the story centers around a private college that is considering requiring all of its students to use it. Highly, highly recommended, like all of Chiang's fiction.)
posted
If you go to Ted Chiang's wikipedia site you can find (legal) links to several of his short stories online. He's one of my top authors, well, ever - and I suspect his stories will particularly appeal to you (given their subjects & tone).
I've thumbed through Uglies in Borders, but didn't think it worth buying when my bookcases are already overflowing - I'll see if I can find it at the library.
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Differences in others' perceptions may or may not make a significant difference. In high school I had a casual acquaintance named George who had some moral objection to cheating on tests. That did no harm until he got in a senior civics class with a first year teacher who took no precautions whatever against cheating. That did not bother me because the teacher gave quite simple tests, so I just studied the material and scored 100% every time, without having to worry about whether to cheat myself. But George was a marginal student who was failing the class because the cheating drove the test scores so high, and failing meant he would not graduate with his classmates. So I felt morally obliged to make a public protest to the teacher, which was one of the more uncomfortable incidents of my life, but fortunately my classmates did not rend me apart with their teeth. Having perhaps grown wiser, today I should write the teacher a note; but I was impulsive as a boy.
Anyway various controlled studies of teachers' grading behavior suggest to me that Don Domande's grades were probably 10% lower throughout school because of how he looked. That probably did not matter for him, as judging from how he writes I suspect he attended a good university. And it would not have mattered to poor George, who only wanted to exit gracefully from high school, and for whom college would have wasted everyone's time. But there are students on the margin for whom the difference would mean having an opportunity for college, or having no opportunity. You cannot pretend that, for an actress going for a starring role in a major motion picture, it makes no difference how she looks. Sometimes appearance is in truth all that matters, or at least important to getting what someone wants. If a man wants to become President of the United States, he has an enormously better chance if he is over six feet tall. Maybe that is silly, but it is what the statistics say.
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quote:. Furthermore, there are many things that a parent CANNOT make a decision for a child to undergo - marriage being one example.
In most societies and through most of human history, marriages were arranged for children by their parents. Its a very modern idea that people should choose their own mates. Several of my friends from non-Western cultures have marriages arranged by their parents and are very happy with the way it has worked out. At least one couple I know, who have lived in the US for several decades, think its far superior to the way modern westerners do things.
This isn't to say that I agree, only to point out that this claim is not nearly as generally accepted or obvious as you imply.
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quote:Originally posted by Jhai: If you go to Ted Chiang's wikipedia site you can find (legal) links to several of his short stories online. He's one of my top authors, well, ever - and I suspect his stories will particularly appeal to you (given their subjects & tone).
Cool. "Division by Zero" looks good. Silly people at work keep disturbing me, though. Posts: 32919 | Registered: Mar 2003
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Hmm. It's very good. The structure is very well done (and very mathematical and symmetric, which is consistent with the theme of the story). But I don't believe the basic premise. Which I guess makes me very like Renee before the story.
I bet my mom would enjoy it. Maybe my dad.
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I would recommend the "Uglies" book series. Atlest the first one. I wasn't too impressed by the second and third. The more interesting characters and themes are in the first book. Its a quick and easy read. Grab it at the library or curl up in a corner of the bookstore.
Its a series I hand-sell at the bookstore because I get sick of teen and pre-teens buying "Gossip Girl."
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Division by Zero is one of my favorites of his. I don't want to believe the basic premise either - but I can imagine how troubling it would be to understand it. Sort of like understanding Goedel (which we did in advance logic), but in the opposite direction.
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But nothing is perfectly defined, and in order to have any sensible discussion, we have to work within the slipperiness of language. ![[Wink]](wink.gif)
And we will continue to identify people by what they think and what they do, as much as by what they look like (and I see no evidence that we're trending toward homogeneity in behavior, despite centuries of effort to enforce social norms).
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