A Crisis of Face

Prologue, Errata, Apology

I have been trying to write this essay for over a year now, which is completely and utterly ridiculous (to give you some idea, the file name I’m working from right now is “laser eyes crisis of face redux part eleventy the return of the revenge electric boogaloo.docx”).

It’s way too embarrassingly personal for this blog (so I thought; it probably still is), but it is also too pedantic and research-y for my personal blog. Here is where I default to my crappy academic first-paragraph structure in which I namedrop Montaigne, don’t end clauses with prepositions, and remind you of the etymological origin of the word “essay.” It means to TRY. You TRY to read it, I’ll TRY to write something that makes sense: it’s totally a social contract. Take your expectations and lower them to the floor. Done? Good.

Once upon a time, this was going to be the story of how two days after my 28^th birthday, I took a bunch of Valium and let this guy I had never even met before shoot lasers into my eyes and now everything is clear, yay rainbow puppies unicorns ironically-chosen pop songs about rain and clarity!

The thing is – the things are – as follows:

1) The lasers shot into my eyes are really only the start of the story;

2) there’s no point in writing that particular narrative, as others have before and with prettier charts and graphs;

3) It wasn’t really what I wanted to write.

But before I begin, let me answer the questions you really want to know about my eye surgery, the ones I always get asked: nah, just a little bit of Vicodin; yes, I was awake; they gave me a bunch of Valium first, which was probably the most expensive Valium I’ll ever buy, and it didn’t relax me, just made me even less filtered than usual, (ask me sometime how I corrected the surgeon’s grammar); it was about 4 months before I had 20/20 vision all the time; I paid for it with crowdfunding, working an extra job, and a 0% loan because all I really have going for me is my awesome credit score; yeah, probably; no, I couldn’t smell my eyeballs burning and late at night thinking about this, I try to tell myself that the soldering smell was the chemicals evaporating from the laser and I need to believe that, also, why are you asking me about the smell of my burning eyeballs? …Freak.

Then there’s the rambling pre-emptive apology: Why did I do this? How could I, when after a lifetime of derision, suddenly it’s like totally hot to be a girl with extremely thick glasses?

As a feminist and a socialist, I feel that it seems very bourgeois and vain to have corrective surgery or any kind of elective procedure. So why did I do it? When I tell people that by late 2010, without my glasses, I was close to being legally blind in my left eye (yet the state of New Jersey kept giving me a driver’s license), it always turns into some dick-measuring contest where people whip out glasses and contact lens prescriptions. Damn, people are so competitive.

This is what you need to know about my specific choice to do the procedure, and these are my disclosures: by late 2010, I hadn’t gotten a new pair of glasses in more than 2 years; my vision correction was about a -8 in each eye; I also had myopic astigmatism (I forget the exact degree, and it wasn’t as serious as the regular myopia, but it was fairly significant); I couldn’t see well enough to put contacts in; I was getting daily headaches from eye fatigue because my lenses were scratched up so badly.

There were numerous things I simply refused to do, or did not do, or told myself I could not do because the prospect of not being able to see or of potentially damaging my glasses was too terrifying; this included swimming and most other active activities.

By late 2010, these avoidances had become restrictive enough that they came to include leaving the house at night, even to walk around in my dark, blurry, sidewalk-less neighborhood. If the cats knocked my glasses off the nightstand, I was completely helpless. I was in an awkward donut hole of ability: I was not blind enough to fluently navigate sightlessly, but so impaired without corrective lenses that my quality of life was impacted.

I needed new glasses, but the cost would have been close to $1,000 for new lenses and frames, which was frustrating, especially when compounded by my living on a grad student salary ($13k a year!) and the fact that they needed to be replaced every other year or so.  Based on this, I concluded it would be an investment if I pursued laser surgery as it cost approximately the same as 3 pairs of glasses, and the expenditure would pay for itself in about 5 years when I factored in the increasing cost of glasses. Since corrective surgery can’t prevent presbyopia, even if I made it to 40 without needing glasses again, I’d save money (and who’s to say I’d make it to 40, full stop? Quetzalcoatl is coming back this year, right?).

Also, at the end of 2010, some terrible things completely shattered my personal life. Details are unimportant here, but some wonderful people reached out to me and asked what they could do to help. I already said this above, but gifts from good friends both online and off made the financial aspect of the surgery possible, and I emphasize that only because I really cannot ever thank them enough. Anyway, I was able to afford it due to a small discount through my grad student elective coverage, these gifts, some savings I had from launching my business, and a loan from CareCredit, which I repaid in 6 months without paying any interest.

I was, unsurprisingly, not a candidate for LASIK because my eyes were too bad, but I was cleared for photorefractive keratectomy (PRK), which is an older, more intense procedure with a much longer recovery time. That’s what I chose, and that’s what I did, and it’s worked out phenomenally well.

But that’s, frustratingly, STILL not the point. You can look up all kinds of PRK recovery diaries (I found this one very helpful) if you are curious as to how it works in terms of the recovery.

It’s also vital that I emphasize that despite what I am going to write about here, I am and remain extremely happy with the surgery and I have fewer than 0 complaints about the surgeon, the eye doctor, or anyone else at the center, all of whom were just wonderful to me. There is not one single thing I wish they would have done differently and the only clear regret I have is not having found a way to do it earlier.

It’s the unintended outcomes of the surgery and what it did to me mentally that I want to write about. I don’t know how many patients there are like me, who had had very strong prescriptions for most of their lives, and hence had no real idea what their own adult faces looked like.  I don’t know how many people suffered an almost shattering sense of disequilibrium in their self-concept, but that definitely happened to me.

After the prescriptions were done and I no longer needed the assistive features on my computer to read me through my day, I had no idea who was looking back at me in the mirror (and after the surgery, I realized I only had one tiny mirror in my house). Something was missing, but things were also better. I wasn’t who I had been or who I had understood myself to be. I didn’t know who this person was, but I seemed to be stuck with her. After a lifetime of dismissing Looks (“I can barely see; why bother? I hate superficiality! I won’t even buy a mirror SO THERE, system! Fuck makeup damn the man!”), I became acutely aware of every negative feature that anyone could possibly see in me, as well as plenty they probably couldn’t.

I was a conventionally unattractive and overeducated woman living in middle America and teaching 18-22 year old pre-business students, who frequently used teaching evaluations as opportunities to address perceived deficits in my physical appearance. Therefore, I probably had numerous self-image issues anyway, but not having my glasses was strange and redefining, so much more than I had anticipated or imagined. I had thought, prior to the procedure, that in absent moments I might try to push my glasses up on my face and I would wonder what was missing (happens all the time, even now, especially when tired). I had assumed there would be some moments of mild terror, but the amplitude of how terrifying it was to not know who was looking back at me in the mirror was at times indescribable. The cinematic metaphor to which I returned over and over was Eyes Without a Face. This is really embarrassing to admit here, even swaddled in my thick walls of protective text, but I started to really believe  / feel like I was incredibly hideous, almost monstrous. It was like being a teenager again, except it sucked more, because it’s annihilatingly embarrassing to admit I felt like that when I was approaching 30. I began to feel like my glasses had been a mask or protector, and now I was facing the world, alone, and without the barrier the glasses created.

Worst of all was when people implied that I had somehow betrayed an important identity claim or let down some marginalized group: “Oh,” a creepy guy I met via an even creepier online dating site told me, “You didn’t say you got rid of your glasses. That’s a real shame because women with glasses are soooo sexayyyy.” I wanted to punch him in the face (for a lot of reasons, actually), but I started thinking about embodiment when he said that (which I will discuss below). The smaller, less direct comments from other people stung more: “What’s wrong with glasses?” “You just don’t like people thinking you’re a geek?”

Methodological statement: Because I have a stunning deficit in my mind where most other people have common sense, I finally started Researching this just a little while ago. Specifically, I was looking for what other people have said about self-concept and PRK. I limited my search to PRK specifically because this procedure has a more involved and much longer recovery timeline than LASIK and because it tends to be used with people who have a stronger degree of correction than LASIK patients.

I wanted to find out if I was just a uniquely unconfident snowflake, or if there was a larger trend in post-PRK patients experiencing significant and significantly negative ways in the ways they saw themselves. I’m well aware of the fact that I am not personally a sample, that the plural of anecdote isn’t data, and there were significant variables in my own life that probably contributed to or exacerbated my own negative feelings. But I can’t be the only one. Right? … don’t answer that.

But I was curious, and I just moved across the country and am kind of  bored, lonely and under-employed right now (hi! hire me! I do a lot of things!), so I conducted a very preliminary literature review to see what has been said about self-concept and PRK. For the patient readers, I will discuss what I found (don’t worry, it’s only a few things), then talk about embodiment a little as if I know what I’m talking about, then I will put in a gratuitous cat picture. Why else do we have eyes and an Internet, right?

Ergo:

I found relatively few high-quality articles on this topic. Most people seem to agree that PRK and other corrective surgeries enhance self-image. Googling “self-esteem PRK procedure” yields 715,000 results, most of which I consider biased because they come from vision center ads.

I think for most people, these procedures DO enhance self-esteem, but overall, there is a lack of robust literature assessing outcomes in self-concept for patients who had a) worn glasses for most of their lives and b) had a very high degree of correction. The studies I found have small sample sizes and problematic / non-descriptive means of assessing self-image.

For example, in a 2001 study in the Journal of Refractive Surgery, most patients were actually found to have a higher self-image after a PRK procedure (see: Jerzy Toczolowski, Piotr Oles and Zbigniew Zagórski). However, the sample size of this study (alliteration! Awesome!) is very small, only 25, and it was conducted in Poland; my impression and hypothesis is that in late-capitalist, voracious, image-obsessed America, findings might be significantly different. So all this really tells me is that if I take 25 people in Poland and the adjectives they would use to describe themselves as the norm, I’m not normal (also, if I had to pick any adjectives to describe myself, not a one of them would be in Polish).

Lest you think I’m actually just severely dissonant in my perception of self, a 1995 article in the same journal – which used a larger sample – found that “The psychological findings suggest that PRK patients cannot be considered more distressed or anxious than other myopic individuals” (Erickson, Ryan and Aquavella). Of course, that study uses Myers-Briggs, of which I’m suspicious (do I talk to people at parties? It depends on the party). All this really tells me is that the sample they chose indicates there is not a greater than average degree of anxiety or distress among the group of people who are candidates for and then elect to have PRK.

This is not directly related, but for the past year I have also held Helen Rose Fuchs Ebaugh’s Becoming an Ex in high regard. While I am not a sociologist, I wonder if there is an aspect of role exit at work here. In the past year, I also left a role in my own life (career / career student / mediocre academic). I understand Ebaugh as saying that the process of announcing the role exit reduces cognitive dissonance, and repetition and easing into another role reduces this dissonance. I wonder if the visibility and then the invisibility created this cognitive dissonance for me. I had a role, which was embedded in my face, of a bookish / geeky / nerdy female, and as long as I had that item on my face, the cultural construct in which I lived seemed slightly forgiving or understanding, as I was immediately and visually ascribed as belonging to a certain group. I wore glasses for about 20 years and I had had poor eyesight for years before I got them. There was very little of my pre-procedure life that I remember clearly (again, with the seeing-words) that didn’t involve corrective lenses. But then one day they were gone. There are many moments of bifurcation in one’s life, I think, but this one was certainly the most cinematic in mine. I walked into a room a person with very limited vision (simple past, completed action) and walked out to begin the process of recovering at 20/20. The division is so absolute and crazy. Usually borders bleed into each other, but this is an absolute division.

Leaving grad school was a process, unlike the surgery. People were generally extremely positive about the surgery, and generally very sympathetic about the situations that led me to choose to leave grad school. The difference is that of verb tense, of the simple past vs. the past progressive. I did, I was doing; I became, I was becoming. I was becoming an ex-(Failed!) grad student; day by day I was less and less what I had been and more and more whatever I am now (and it’s way better). But one day I was a person with glasses. I had a procedure and then I wasn’t. I underwent a process letting go of one role; the other happened suddenly. How to reconcile that? It is only now when I understand these two fundamental changes side by side that I think I can understand why it was so shattering and that the real recovery, the mental recovery, went on for so long. I have not had time to look it up, but the rhetoric used to refer to sight, and the English verb tenses used – in all their wonderful specificity – are something somebody (else) should really look into.

I don’t know if everyone who wears glasses had similar experiences to me. As an ex-grad student, I feel compelled to mention the Cyborg Manifesto. I was a cyborg; I went through every waking second of every day with a device that allowed me to see, a device on my body and in some sense part of my body. My physical engagement with the world depended to a great degree on the correct functioning of this device. “From another perspective, a cyborg world might be about lived social and bodily realities in which people are not afraid of their joint kinship with animals and machines, not afraid of permanently partial identities and contradictory standpoints. The political struggle is to see from both perspectives at once because each reveals both dominations and possibilities unimaginable from the other vantage point” (Carraway). I no longer know on which side of the dichotomy I fall. All I can read in this quote, now, is the imaginary emphasis on the word “see.”

This change in my embodiment and interacting with the world was not as profound as the ones others undergo. I know that. But this experience really has given me a great deal of interest in embodiment, though I know virtually nothing of the theory surrounding it (recommendations?). Of all the changes in identity claims one has in a lifetime, it is virtually certain that at one point one will change how they physically interact with the world. Yet we seldom talk about it. Why?

SO WHAT? As I said before, every single thing about the staff and surgeons was wonderful. But it might be good if the corrective eye surgery field provided some psychological preparation for the profound change in self-concept that is likely to occur. Maybe we should stop fetishizing sexy glasses or understanding them as an intertwined aspect of a subcultural identity. Maybe we should normalize physical difference. Maybe we should just fund preventive measures to address the pandemic of eye issues (did you know almost 80% of urban Chinese children are myopic? [link is in Chinese, sorry]). I don’t really know what any of this does. I don’t even know if anyone is going to read all of this (if it took me a year to write it, I estimate people will read to the end by about 2015 or so). I’m sure my conclusions and interpretations are invalid and intellectually feeble, poorly informed by a useful framework. I live in the real world now, so I can’t do the usual grad-school cop-out and say “there’s just something there, you know?” More research is needed.

What do you think? Have you had corrective surgery? If so, how did you reconcile your former self with the present one? What issues did you encounter during that process? How can we understand embodiment in a world where physical difference can be erased and experiences normalized?

Epilogue

Every time I went for a post-op appointment, I walked by the Lion’s Club donation bin for glasses, which was helpfully situated by the front door of the clinic (great marketing move, there).

And just so you know – every single time, I told myself I was going to do it. I reached in and I opened my bag and touched my glasses and I suddenly could not fucking make my hand put them in the box. I just froze and pretended to be looking for my keys, and walked out the door, still getting fingerprints all over the lenses. I did this four consecutive times. But I still have them. Sometimes I look through them to try and see things the way I used to; I can’t now. It’s all a confusing blur, almost like a metaphor or something.

I just can’t let go, not of that, not of what I was.

I still can’t.

PS: I promised a cat picture:

Works Cited

Carraway, Donna. “Cyborg Manifesto, Part I.” 1985. Donna Carraway’s Cyborg Manifesto. September 2012 <http://people.emich.edu/acoykenda/cyborg1.htm&gt;.

Ebaugh, Helen Rose Fuchs. Becoming An Ex: The Process of Role Exit. Chicago: The University of Chicago Press, 1988.

Erickson, D.B., R.A. Ryan and J.V. Aquavella. “Cognitive styles and personality characteristics strongly influence the decision to have photorefractive keratectomy.” Journal of Refractive Surgery 11.4 (1995): 267-74.

Jerzy Toczolowski, MD, et al. “The Sense of Self-concept Change in Patients After Radial Keratotomy .” Journal of Refractive Surgery 17 (2001): 134-137.

 

The coming revolution over anti-aging research

On Bloggingheads’ Science Saturday, Methuselah Foundation chairman Aubrey de Gray argues that eternal life is within reach and attacks those who think it’d be a bad idea.

But here’s something he and interviewer Eliezer Yudkowsky don’t address: on the day eternal life becomes available, it might be a bad idea for everybody over a certain age. Those people would be locked into life at their current age indefinitely, while the rest of the world — their future friends, enemies, bosses and lovers — would become an ever-swelling group of 24-year-olds.

How would society react to this approaching possibility?

Untimely Ripped

If you’ve had a child in the last ten years or so – or rather, if you’ve seriously contemplated having a child for more than about fifteen minutes of your life – there’s one fact you’ve probably heard: Caesarean rates in the first world, especially in the US, are too high. Every few months brings along another article like this one, deploring the Caesarean rate and explaining (1) why it’s so high and (2) what doctors and patients should be doing to solve it, and aren’t. In many circles, unmedicated natural childbirth is held to be the best possible birthing experience — “our birthright” according to one midwife — and women who end up having a Caesarean for causes which aren’t immediately and obviously life-threatening for the baby (for instance, prolapsed cord) quite often feel that they’ve somehow been denied a good birth, or that they have let themselves or the baby down. On Plans, we were discussing how “birth is not a competition”, but human nature is such that some people will inevitably regard it as one; to have had an unmedicated birth somehow gives you a head start in the Good Parenting Stakes, and to have had a Caesarean shows lamentable weakness.

The Placebo Price Effect

On my way home from work, I heard this story on Marketplace explaining a new drug placebo study done recently. From the story:

Participants thought they were testing a new drug for pain relief. In fact, everybody got placebos. Only one difference. Some were told the pills cost $2.50, while others were told they only cost a dime. Dan Ariely, author of “Predictably Irrational,” was the lead researcher.

DAN ARIELY: What we found was that the expensive pill reduced pain to a much larger degree than the cheap pills.

This could be significant for the $59 billion generic drug industry. The study helps explain why patients generally prefer brand-name drugs, and why consumers think they are more effective than generic drugs, even though they have the same active ingredients. Glen Melnick is a health economics professor at USC.

The apocolyptic plague is fake, but the research is real

I ran across an article while browsing Wikipedia the other day which caught my interest. It was talking about the Corrupted Blood Plague which swept through the massively multi player online game World of Warcraft. This is hardly new news, having taken place all the way back in September of 2005, but like many such things, it has bubbled to the surface at a time that I was already thinking about several related topics, and has captured my attention. The interesting thing to me had less to do with the details of what happened in this particular case than it had to do with the broader concept of what incidents like this mean to the world beyond the game.

The plauge itself was entirely virtual, and never reached past the confines of the game. Within the game, many characters were affected, but even they faced no lasting ill effects. What is interesting to me is that the way in which the events of the plague played out in the virtual world has attracted a great deal of attention from serious researchers who are interested in how observation of these phenomena can be applied to improving our understanding of the real thing.

Walking the walk

Today, for those of you who don’t keep up on such things, is World Sauntering Day. This is a day during which one is supposed to walk in a “very casual, yet stylish” way. Of course, it never fails but that today would be the day I spent limping around everywhere I’ve had to go.

I woke up this morning badly dehydrated, and when I tried to get out of bed, both of my legs cramped up, and I collapsed. After stretching them out some, I was able to stand up, and eventually get ready for work. I almost didn’t make it to the car, but I did somehow get into the office. I spent the rest of the day hobbling as my calf muscles (the gastrocnemii, to be technical) slowly unwound. Even once they’d loosened up again, they hurt from having been cramped up for so long.

Knowing that I was dehydrated, and that this was likely the cause of the excruciating cramps in my legs, I drank a huge quantity of water today. In spite of this, it took until well after lunch before I could even walk at more than a slow, grinding pace. Even now, my legs ache when I walk. What should I have done to speed up this process?

The web offers little help. I have found any of a number of sites which recommend that I gently stretch the muscles that are cramping, which I certainly did. Suggestions for gentle massage also abound. Several sites suggest that one should attempt to replace lost electrolytes, as well. I had already thought of that, and tried drinking a bottle of Gatorade that I bought when I had to stop for gas on the way to work. I pity the poor clerk who tried to make pleasant conversation with me as I limped up to the counter. I fear I might not have been polite. Perhaps as punishment for my treatment of the clerk, the Gatorade did nothing to ease the discomfort in my legs.

I begin to fear that this is a problem for which there is no quick and easy solution. My conditioning in a culture of instant gratification has made me ill-equipped to deal with this situation. With luck, however, it will have gone away on its own by morning. Tomorrow, so help me, I will saunter.

Overrated: Health care innovation

Personally, I’d like to survive the next five years. I expect this will always be my position on the matter.

But should I have the same goal for the public at large? Is maximizing health really a good social policy? Here’s a novel answer: no.

I don’t object to titanium hips, defibrillator implants or other modern marvels. But as rich people’s life expectancies climb past 80, we should ask: what’s the goal here?

It’s not a trivial question; the best argument against public health care is that it slows general increases in health by dampening innovation. I agree.

But innovation is a price I’m willing to pay. My policy goal isn’t maximizing health, it’s maximizing happiness. At this point in our health-care progress, maximal happiness will come from keeping everybody sorta healthy, not keeping two-thirds of us extremely healthy.

Would I prefer cancer to be cured before I die of it? You bet. But I’m not going to vote against health care for everybody else in order to keep myself alive for a few extra years. That would be macabre.

Morning lull

Yesterday, I read an article on the BBC news site that came as a crushing disappointment to me. Which is to say, it confirmed something I’d always kind of known, but never been willing to admit to myself. The short version: a cup of coffee in the morning doesn’t actually make you energetic.

“But wait,” I cried to myself in desperation, “I always feel groggy in the morning until I have a cup of coffee!” As it turns out, the research presented in the article confirms this to be true. Now comes the crushing disappointment. You know what causes that groggy feeling? Sadly, it’s coffee.

The research shows that people who drink coffee in the morning are no more alert than their peers who go without a cup of joe. Tests of reaction and alertness show that those who consume caffeine score no better than those who abstain. This is because caffeine consumption in the morning does not provide a boost, it only provides relief from the symptoms of caffeine withdrawal.

Those who drink coffee (or other caffeinated beverages) on a regular basis aclimatise their bodies to the stimulant. Let me restate that in a way that is less of a lie to myself: Those who drink coffee on a regular basis become physically dependant on the stimulant. Overnight, they’re not getting their fix, so when they wake up in the morning, they are suffering from a mild form of withdrawal, and feel groggy and out of sorts until they get some of their drug of choice into their system. Thus, it feels like a pick-me-up, but that morning cup of coffee is in reality just getting you back to the baseline that your clean-living friends were cruising at without any chemical assistance.

The article does say that it is possible to get a boost of energy and alertness from caffeine, but it only works if you haven’t had any for quite some time. If it’s been a month (I just made that time-frame up, to be honest) and then you have a quadruple espresso, it will give you a great buzz, but it really only works the first time. Once your body gets used to it, you’re back to being a troll until you get your morning latte.

 I will note that there is a quote from a member of the British Coffee Association in the article which says, in part “…moderate coffee consumption of four to five cups per day…”. Four or five cups per day? Goodness! I don’t have a problem after all. I can stop any time I want to, honest.