Shame and Medicine Exeter
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Post-op drifting after reconstructive surgery, in a wide-open, multi-bed recovery room partitioned by wavy muslin walls, I heard one strangled sentence above the racket of skittering curtain hooks.

“Honey, I’m a monster!”

My gaze swiveled toward a half-hidden silhouette backlit by fluorescent bed lamps. His large palm cupped the phone close, but I heard it—throaty, stifled, breaking into dry sobs, his long torso buckling. My heart flipped, remembering my own disfigurement, with hours to lie there remembering.

Any patient losing face to predacious cancers may feel himself prey to the surgeon’s blade, even as the blade saves his life. What’s left of me? he thinks. Who am I now? Or, I might as well be dead. Psychologist Nichola Rumsey calls disfigurement “… initially a sort of bereavement, followed by tremendous…overpowering sense of inadequacy and isolation.”

​No battle waged in the craniofacial operating theater can be won outright, but rather protracts over months, even years of adjustments. The crucial challenge is to rally patients like us—rescued, but facing devastation nobody anticipates. Whatever can be done has been done; we’re now disease-free. Not dying. Just scarred. Ugly. Ugly for life. The disease-free patient’s road back thus becomes not just grueling, but also lonely, in what memoirist Lucy Grealy described as “the deep, bottomless grief… called ugliness.”  Meaningful restoration depends as much upon a surgeon’s shamanistic insights, and the caliber of adjuncts, as upon scalpel and stitch.

Neurophysiologist Jonathan Cole calls disfigured faces “… the most public of all… always on display… [which] may come to define a person’s whole existence and persona.” Indeed, psychologists study disfigurement as “Quasimodo Complex”. Quasimodo. The deeply empathic “Hunchback of Notre Dame”, of whom Victor Hugo wrote there is “nowhere on Earth a more grotesque creature.”​

Alas, human predilection for pleasing harmonies is universal, and not unique to our exhibitionist era. From the Golden Age of Greece through the Golden Age of Hollywood to the Viral Age of TikTok, beauty becomes virtue by equivalence. Physical beauty, timely shaped, signifies the “good”, the “worthy”. Nineteenth century America, e.g., introduced architectural reforms called “The City Beautiful”,  intended to advance moral and civic virtue through urban beautification. Accordingly, cities also passed “Ugly Laws”:​

Any person who is diseased, maimed, mutilated or in any way deformed… an unsightly or disgusting presence… shall not expose himself or herself to public view…

Discreetly color-coded benches were designated for any such persons who wished to take the air—well past 1970, in some cities.

Beyond personal shame, disfigurement also encumbers interpersonal relations. For ordinary human communication relies upon mini-movements of tiny facial muscles, orchestrating our utterances, giving them life, conveying meaning and personal identity. Indeed, human faces in conversation instinctually mimic others’ mini-expressions—thus affirming us in our conveyed identity, seeing it reflected in others’ facial mimicry.

After my initial barrage of facial surgeries, I couldn’t form any facial expression whatsoever. No micro-expressions issued from me; precious few rebounded. I missed seeing myself reflected. I lost track of my subtext.​ Behind my mask of stitches, staples, and scars, I felt bereft of myself.

But the mask is equally intrinsic to communication.

Come on, smile! This smarmy tip hounds women still, as indictment, veiled rebuke, and invitation to mask. Alas, my natural neutral is an unladylike glower. Moody. Preoccupied, perhaps. Come on, smile! It can’t be that bad! I’ve heard it forever. That disarming comeuppance from chirping superiors, always surprising, undermining, infantilizing.

Contemplating theater, operaphiles Linda and Michael Hutcheon, MD, write, “the psychic state of the singer onstage, open to intense public scrutiny and competition, [is] of crucial importance… [and] that psychological state has physical manifestations.” (Bodily Charm, 2004.)

Singing the role of Sieglinde, for example, I immersed myself unreservedly. The love scene, the mad scene, the shadowed Norse Gestalt. I was totally into it. So much so that one influential critic opined: “[Sieglinde] kept making awful faces, perhaps for vocal-technical reasons; perhaps for inappropriately exaggerated acting ones…”

I read the morning paper while commuting to my day job. Everyone on the train craned to watch my world implode. I wanted to wrap my burning face in the Boston Globe. Still, my public humiliation did shake loose some unexpected fan mail.

“The critic’s remarks remind me of my wife’s father, who tells her she’s not very attractive when she’s angry…” read one. This stranger’s nose-gay sweetly assuaged my performer’s ego—and an ancient wound as well. For decades earlier my father had scalded me with the same reproach. When tears spilled onto the page, I realized how long I’d craved redress. Of my mad scene, a violinist in the orchestra said, “When my aunt began to hallucinate with dementia, she looked exactly like you up there…”

Such reassurances shored me up to reprise my role the following week in Manhattan. To overcome my shame, I’d have to locate within myself an authentic definition of beauty, and repossess my face, my organ of expression—however “awful”, “inappropriate”, or “exaggerated”. My next performance garnered soul-soothing huzzahs. One critic pronounced my Sieglinde “best of all… ”

Tethered abed, a mash-up of what was and what might be, heavy-hearted with my neighbor-patient’s sorrow, I sensed something gentler surfacing. Just an inkling.

Maybe we’re not monsters. Whatever the papers say.


Kathleen Watt –

A version of this essay appears as Chapter 59 in the memoir “Rearranged” (Heliotrope Books, 2023.).

4th October 2023

Photo by Joeyy Lee on Unsplash

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