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.

One of the great, romanticized notions about therapy that is ready-made for Hollywood is the turning point moment. Take 1997's Good Will Hunting, for instance. After Will (played by Matt Damon) has been in therapy a short time, his therapist (played by Robin Williams) ups the ante by pulling out Will's file and reading off the list of abuses Will suffered. In response, Will lifts his shirt and exhibits his scars, trying valiantly to maintain his toughness while his therapist keeps repeating, in mantra fashion, "It's not your fault, it's not your fault" until Will dissolves in tears and holds onto his therapist as if his life depended on it. After this climactic moment Will no longer needs therapy. He leaves the safety of familiar surroundings and his friends and drives cross-country in the hopes that he can win back the girlfriend he unceremoniously dropped when she wanted to get to know him better (before therapy turned him into a sensitive male).

Television shows involving cosmetic surgery and makeovers also play to our longings for that single moment when everything changes. And, certainly, there's the sense that the patient's life will inevitably change for the better. But this is also where the cynical nature of plastic surgery reveals itself. For, unlike therapy, which, ideally, cultivates self-acceptance, isn't the point of plastic surgery oftentimes to look good to others, to attract others, to receive the approbation of others? And doesn't this run counter to the notion of being true to oneself?

I tuned in recently to two plastic surgery reality TV shows on the same night. Extreme Makeover, true to its name, houses someone in the "Makeover Mansion" and has the person made over in every conceivable way by the "Extreme Team". On this episode, Mike, a deputy with the police force in LA and a previous ice skating champion, was ready to make a change. Mike's story was a touching one: he'd had his nose broken five times and his heart broken by his ex-fiancé who'd ended the engagement just days before the wedding date and soon after, she became engaged to someone else. And so Mike had the following procedures done: nose job, chin implant, his ears pulled back, liposuction to remove belly fat, and laser eye surgery to correct his vision. He also had his teeth whitened and his hair colored. And, he worked with a trainer for four weeks, after which his trimmed down and buffed up physique was fitted for a custom-tailored suit.

When the bandages came off one week after surgery, Mike looked at himself in the mirror and said, "It's like a different person staring back at me now." Notice, he did not say, "Now, there's the real me."

On Dr. 90210, Liz, a 23-year-old Las Vegas pole dancer, went to Beverly Hills plastic surgeon Dr. Rey to have her sagging breast implants removed and replaced with new, even larger, implants. Believe me, observing Dr. Rey cut open Liz's breasts, pluck the old transplants out of the bloody cavity and then shove the new ones in wasn't pretty.

After her first post-op visit, Dr. Rey commented, "In a few months it will have a beautiful 17-year-old look. That really healthy, perky look. She's gonna look beautiful." (Maybe I'm naïve, but I didn't realize the goal was to make a 23-year-old woman look like an underage girl). When another dancer commented to Liz, post-implant surgery, that she was bound to receive a lot more attention from customers now, Liz responded, rather defensively, "I didn't get them done for work. I wanted cleavage."

We've come a long way from the 1993 Seinfeld episode where Jerry breaks up with his girlfriend Sidra (played by Teri Hatcher) because Elaine tells him (in error, it turns out) that Sidra's breasts were fake. Then, when Sidra catches on, she taunts Jerry with one of the most famous lines from the show: "They're real, and they're spectacular!"

I understand the allure of plastic surgery. Who knows -- I might even give in to its enticements myself someday, despite my misgivings. I can also appreciate how the before-and-after makeover stories lend themselves so perfectly to the reality TV genre. But, I must admit, my night of plastic surgery spectatorship left me feeling sad and rather nauseous. Whereas, when I watch movies like Good Will Hunting and Ordinary People (which undoubtedly inspired many of the therapy-oriented movies of the '90s) I'm left with a renewed sense that, corny as it sounds, what's inside a person is what matters most. And, despite mounting evidence to the contrary, I'm going to hold onto that quaint belief.

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