Are Plastic Surgeons America's Top Therapists?

Are extreme makeovers the psychotherapy of the new millennium? If movies and TV are reliable cultural indicators (and they usually are), one would certainly think so. Last year, 10.2 million cosmetic surgeries were performed, up 11 percent from the previous year. Talk therapy, in the meantime, is suffering some setbacks, with insurance companies limiting their coverage to fewer sessions and more and more people turning to antidepressants and anti-anxiety medications to help them cope with their problems. Television and film are naturally reflecting this changing reality.

The '90s brought us therapists in Good Will Hunting, Prince of Tides, Frasier, What About Bob, Analyze This, and, perhaps most importantly, The Sopranos. The trend became so noticed and talked about at the time that the American Psychological Association even held a symposium titled "Analyze This: Hollywood's Portrayal of Psychiatrists and Psychologists."

While therapists (real and fictional) continue to appear on TV and in the movies (most notably in Running with Scissors), therapy no longer seems to have the cache it did in the '90s. Even in the initial episodes of season six of The Sopranos, Tony spent little time squirming in his seat at Dr. Melfi's office, as compared with prior seasons. True, he was in a coma and then recovering in the hospital for the first few episodes. But, in past seasons the therapy sessions were so integral to the series, the writers would never have scripted a storyline that kept Tony out of therapy for so long.

Those in search of self-esteem in today's TV shows bypass the therapist's office and head straight for the plastic surgeon's. Extreme Makeover, Dr. 90210, and Nip/Tuck are among the popular programs featuring cosmetic surgery, while other shows like Queer Eye emphasize less invasive but no less cosmetic techniques for self-improvement, such as men having their backs waxed or foregoing white dress shirts for purple ones. Makeover mania has even extended to the home on shows like Extreme Makeover: Home Edition, Trading Spaces and, again, Queer Eye, where decorating guru Thom, armed with paintbrush, blue tape, and chenille fabric completely transforms drab, dingy, dirty rooms into boutique chic living environments.

Even Oprah, who made self-analysis and personal revelation not only acceptable but admirable, and brought therapy to the studio couch with the introduction of Dr. Phil on her show in the late '90s, seems to have shifted her focus to improving one's life by getting in shape, dressing in fabulous clothes, and living in a beautifully decorated home. As she remarked on one of her many home decorating segments, "Surrounding yourself in beautiful spaces changes the way you feel about yourself. It does."

There's no question that we're witnessing a quiet revolution in how we think about self-improvement: rather than addressing our lives from the inside-out, we're now addressing them from the outside-in. It would be easy to conclude that we've simply become superficial or that advanced surgical techniques have unleashed our latent shallowness. But my point is not that we've become superficial or shallow, it's that we've become cynical.

Therapy is an idealistic -- even romantic -- proposition. At its root is the belief that if only a person could become more herself, she could eliminate, or at least reduce, the neuroses and anxieties and depression that stand in the way of her achieving things or attaining love or just plain feeling better. In other words, it's a search for the true self, with the hope that the true self, once revealed, will turn out to be pretty fantastic.

Plastic surgery, typically, is an acknowledgment that one's true self (big nosed, flat-chested, thick-thighed) is not good enough. Even for those who say they simply want their outsides to match how they feel inside, that's still implying the outside appearance isn't right. There's something wrong with it, something wrong with them. And so, it seems to me that cosmetic surgery is a movement from one's true self to a contrived self, oftentimes in the hopes that others will be more attracted to that contrived self. That strikes me as, well, more than a little cynical about the nature of love and attraction. This contrast between the idealism of therapy and the cynicism of cosmetic surgery becomes even clearer when comparing the portrayals of therapy sessions on TV and in the movies in the '90s with today's portrayals of plastic surgery sessions.