Sex, Culture, and Justice: The Limits of Choice (2 page)

introduction

I’ve had [cosmetic] surgery. . . . There comes a point when something bothers people enough that it affects the way they live their lives every day, and that’s the time they have cosmetic surgery. Most don’t have it to be ultra-glamorous. The average person has it to feel normal. To have what society perceives as a normal-sized nose or bust.

—
lindsay mullins
, quoted in James Meek, ‘‘Prime Cuts’’

You have to learn how to wear [Manolo Blahnik’s stiletto-heeled] shoes; it doesn’t happen overnight. But now I can race out and hail a cab. I can run up Sixth Avenue at full speed. I’ve destroyed my feet completely, but I don’t care. What do you really need your feet for anyway?

—
sarah jessica parker
, quoted in Rebecca Tyrrel, ‘‘Sexual Heeling’’

In 2002, several newspapers reported the case of Myriam Yukie Gaona.
1
Gaona was described as a former stripper with no medical qualifications who had posed as a cosmetic surgeon in Mexico for sev- eral years. She had injected substances into thousands of people, mostly women, to reduce or augment their breasts, stomachs, buttocks, and calves. Many of her patients were attracted with promises that, after the procedures, they would conform to an artificial and idealized standard of beauty: one patient, Maria Concepcion Lopez, says that she visited Gaona because ‘‘‘she said she’d make us look like Barbie dolls.’’’
2

The injections were successful at first. More and more patients were drawn to visit Gaona’s surgery by word-of-mouth, seeing the appar- ently amazing results that other women had achieved. One woman even took her husband and her daughter along for injections. However, patients increasingly began to complain of serious medical problems,

1. See Jo Tuckman, ‘‘She Said She’d Make Us Look Like Barbie Dolls’’; Agencies via Xinhua, ‘‘Mexican ‘Beautykiller’’’; Alicia Calderon, ‘‘Fake Plastic Surgeon Accused of Harm- ing Hundreds in Mexico.’’
   

2. Tuckman, ‘‘Barbie Dolls.’’
   

   including aches and pains, lumps that burned when the weather was sunny, and skin that turned black and dead. Medical investigations found that Gaona had been injecting people with mixtures of industrial silicone (usually used to seal windows and doors), baby oil, vegetable oil, and motor oil. Patients had to have mastectomies, have limbs am- putated, and undergo agonizing surgical procedures to drain their bod- ies of congealed globules of silicone and oil. By December 2002, over 400 alleged victims had received remedial medical treatment, over 160 women and one man had filed legal complaints, and Gaona was await- ing trial for impersonating a medical doctor, causing serious injury, and administering drugs without a license.
   

   In Britain a year earlier, an Oxfordshire Community Health
   nhs
   Trust conducted a survey asking 164 women about their footwear hab- its and preferences. The survey found that one in five women wore high-heeled shoes in order to please her boyfriend, husband, or boss, and that one in three women liked wearing high heels. More than 80 percent of women said that they would not change their style of shoe to improve a foot problem. The Head of Podiatry Services at the Trust, Philip Joyce, predicted that three out of four women would have foot problems by the time they were sixty, often as result of wearing high- heeled shoes. ‘‘We have tried for years without success to persuade women to wear the dreaded sensible shoes,’’ he told the
   Telegraph.
   ‘‘High heels have a long history of social status, sexuality and power. It is not really surprising, by the time girls are four years old they know that Disney’s high-heeled glass slipper does not fit the ugly women.’’
   3
   

   Most liberals would interpret these two cases very differently. The first, the case of Myriam Gaona, is contemptible in many easily defin- able ways, and a clear affront to the rights and freedoms of the women and men who suffered at her hands. Her actions, after all, were built on deception. According to the allegations, Gaona lied to her patients about her medical qualifications, displaying fake medical certificates in her offices. She also lied to them about her procedures, claiming that she was injecting ‘‘citrics’’ and ‘‘collagen’’ rather than industrial sili- cone and motor oil. It is clear, from the liberal perspective, that those women and men who suffered crippling and life-threatening injuries at Gaona’s hands are victims of a serious injustice. It is also clear that Gaona should never have been allowed to perform the injections, and that she ought to be prosecuted.
   

3. Celia Hall, ‘‘Sexy High Heels Are Worth the Agony, Say Women.’’
   

   On the other hand, we might think that the women in the Oxford- shire foot survey are victims of no such injustice. They were not de- ceived into buying high-heeled shoes. They do not wear high-heeled shoes in the mistaken belief that the heels are not damaging to their feet, since 80 percent of the respondents said that even an actual foot problem would not cause them to change their habits. Liberals would, I imagine, argue that such women are exercising their freedom to choose what to wear on their feet, and to decide whether the aesthetic advantage of high-heeled shoes outweighs the risk of foot problems. No liberal would suggest that the manufacturers of high-heeled shoes ought to be prosecuted, or that injustice has been done.
   

   But are the cases really so different? Gaona’s lawyer, Jose Julian Jordan, does not think so. The
   Shanghai Star
   reports him as saying, ‘‘Here, injecting someone isn’t a crime. If you tell me, ‘I want volume here, I want to reduce this,’ and a doctor tells me the treatment is correct and you are already an adult, I’m not cheating anyone, I’m helping with what you’ve asked me to do.’’
   4
   Of course, Jordan’s claim is somewhat disingenuous—in Gaona’s case, the treatment certainly wasn’t ‘‘correct,’’ and Gaona was not a doctor. But he raises an issue of crucial relevance to liberal thought: if an adult wants to undergo a dangerous procedure, or take part in a harmful practice, with what legitimacy does the state prevent them from doing so? If people may legitimately decide to wear high heels despite the danger to their feet, should they not also be allowed to decide to undergo industrial silicone injections? If Gaona had told her patients that she had no formal medi- cal qualifications, and that there was a risk of injury from her injec- tions, would she have been doing anything wrong?
   

   In this book, I suggest that there are in fact many similarities be- tween the cases of the Mexican and Oxfordshire women, and that lib- eral theory is not well equipped to deal with those similarities. Both cases involve women who voluntarily risk harming themselves, albeit to different degrees and with different levels of information, in order to conform to standards of beauty. Both cases, in other words, involve women taking risks in order to conform to social norms. Moreover, both cases illustrate women attempting to conform to social norms, not only to please others, to avoid sanctioning from others, or to gain their approval, but also to please themselves. Both the Mexican and
   

4. Agencies via Xinhua, ‘‘Mexican ‘Beautykiller.’’’
   

   the Oxfordshire women want to look attractive, and feel happier about themselves when they do. But their desires to please themselves and others by conforming to beauty norms is not an isolated, individual decision or preference. It is defined and regulated by the social context that they live in, exemplified by
   Sex and the City,
   Barbie dolls, and the Disney version of Cinderella.
   

   Most liberal theory, I argue in this book, is built on conceptual prem- ises that prevent it from criticizing this process adequately. As a result, the liberal values of freedom and equality are compromised. Liberal theory tends to support and protect people’s freedom to make harmful choices that threaten their well-being or their equality, rather than pro- tecting their freedom to resist inequality and supporting them in doing so. As such, liberals can end up protecting inequality and social con- straint. Feminist theory has generally been much more successful at analyzing and criticizing cases such as the two just described. In part, this greater success is because feminist philosophers, in theorizing the nature and variety of women’s oppression, have been much more will- ing than liberal philosophers to take on the issue of social construction and the limits it places on individual autonomy. In particular, feminists have been more willing to adopt certain ways of theorizing about social construction and autonomy. I suggest, then, that theories of social con- struction can usefully be used to develop a normative approach that more adequately addresses inequality and unfreedom.
   

   In the course of the book, I draw on the work of feminist theorists, and particularly on feminist work that highlights the position of women in the private sphere. Much of what is lacking in liberalism is illustrated by paying attention to this sphere. If we consider the work- ings of personal relationships within patriarchal society, and particu- larly the supposedly appropriate roles of women, it becomes clear that many liberal policies that aim to maximize freedom and equality actu- ally perpetuate systematic inequality.
   5
   Moreover, many feminists find the combination of theories of social construction with liberal values particularly fruitful. Analysis of the social construction of subjects can be similar to feminist arguments concerning the entrenchment of gen- der difference despite formal equality, and liberal normative argu- ments are crucial to the feminist critique of patriarchy.
   

5. This point has been made by many feminists, but see particularly Susan Moller Okin,
   

   Justice, Gender and the Family.
   

   The book also reacts to theories of multiculturalism, which can be seen as drawing on both liberal and social constructionist arguments. Multiculturalism appears to challenge the liberal commitment to uni- versal values, a challenge that is also posed by social construction, by highlighting cultural differences and particularities. And yet culturally sanctioned inequalities, in particular gender inequalities, highlight the need for universal liberal normative claims. Liberals and feminists can- not achieve freedom and equality if these values are allowed to remain culturally particular. The challenge, then, is to combine a liberal femi- nist commitment to universal values with an awareness of the ways that culture structures our identities and relationships.
   

   Social Construction
   

   Consider the following words of an anthropologist named Fran, speak- ing in the late 1970s:
   

   I don’t particularly like my breasts right now. They’re just too saggy and large according to the ideal of body proportions. . . . In many cultures sagging breasts are a sign of
   beauty
   and are sought after. . . . Most tribal societies don’t favor upright breasts. That is mostly a Western cultural ideal. From a tribal society’s point of view, we always want to look
   immature
   (
   laughs
   ) and there’s a lot of truth in that. . . . You’d think that with all the information I’ve been exposed to I’d feel better about myself. But when your whole upbringing and your cul- ture have made you internalize these fetishes as ideals, there are just too many pressures working on you. I am a product of my culture.
   6
   

   Fran is one of the women featured in Daphna Ayalah and Isaac Wein- stock’s
   Breasts: Women Speak about Their Breasts and Their Lives
   , for which ordinary women of all ages consented to having their breasts photographed without any makeup or airbrushing. Some of the women have had breast implants or reductions. Some have had mas-
   

6. Fran, an anthropologist, in Daphna Ayalah and Isaac Weinstock,
   Breasts,
   136; empha- sis in the original.
   

tectomies. Some were lactating. Accompanying the pictures are testi- monies given by the women about their feelings toward their breasts. They talk about their insecurities about their bodies—their ‘‘tremen- dous anxiety and self-consciousness’’
7
—and their desire to conform to a normalized ideal.

Perhaps the greatest contribution of the book is the direct evidence it provides that, despite women’s worries, there is no such thing as ‘‘normal.’’ Or, to put it another way, the category of ‘‘normal’’ encom- passes enormous diversity. Most of the women pictured have natural breasts, unremarkable and yet utterly astonishing at the same time, for unenhanced breasts are so rarely seen. Despite the ubiquity and visibil- ity of the photographed breast, in its natural form it is concealed. This point is made clear by women’s reactions to Alayah and Weinstock’s photographs prior to publication: ‘‘The one observation that most women made during their brief exposure to the photographs was about the variety of breasts. ‘I always thought breasts looked pretty much the same. How amazingly different they all are. They seem to have differ- ent characters—like individual faces.’’’
8

Although the book is nearly thirty years old, explicitly intended as part of the second wave of feminism, the women in it could just as easily be speaking today. Susan Bordo urges us to recognize that ‘‘now, in 2003, virtually every celebrity image you see—in the magazines, in the videos, and sometimes even in the movies—has been digitally modified. Virtually every image. Let that sink in. Don’t just let your mind passively receive it. Confront its implications.’’
9
The enormous rise in the number of women undergoing cosmetic surgery empha- sizes that, despite decades of feminism, women still feel compelled to conform to some ideal standard. The UK Breast Implant Registry re- corded 9,731 patients receiving new cosmetic implants in 2004. In other words, in the United Kingdom a woman receives her first breast implants every single hour, twenty-four hours a day, 365 days a year. Between 1993 and 2004, the Registry records 68,177 women having a total of 185,952 cosmetic breast implants.
10
The American Society for

7. Ibid., 13.

8. Ibid., 15.

1. Susan Bordo,
   Unbearable Weight,
   xviii.
   

2. In addition to the 9,731 women who had new breast implants in 2004, 961 women had replacement implants. Numbers of first cosmetic breast implants reported have risen from 474 patients in 1993 to 9,731 in 2004. Statistics from the UK Breast Implant Registry,
   Annual Report 2004.
   The Registry is a voluntary record, meaning that actual figures will be higher than recorded.
   

   Aesthetic Plastic Surgery reported 364,610 cosmetic breast enlarge- ments in 2005—up 9 percent from 2004. That figure amounts to more than forty-one operations every hour.
   11
   

   In attempting to understand and criticize phenomena such as breast implants, feminists can turn to a combination of liberal normative val- ues with a theory of social construction. Social construction enables feminists to understand how it is that patriarchy persists in liberal soci- eties and despite formal equalities: as Fran notes, norms of gender inequality are deeply rooted within individuals and social structures, and cannot be uprooted without radical change. Such an understand- ing is crucial to the feminist claim that gender inequality persists de- spite formal, legislative equality. Liberal normative values provide a program for change: they suggest that we should aim for freedom and autonomy even from within the confines of social construction, and that we should also aim to increase gender equality.
   

   However, several problems arise when attempting to reconcile lib- eral values with theories of social construction. How can the recogni- tion that all social forms constrain people, by constructing their sense of what is possible or appropriate, be reconciled with the liberal desire to emancipate individuals from norms that limit their autonomy? Does social construction rule out autonomy? Moreover, if normative values themselves are the product of social construction, how is it possible, both philosophically and epistemologically, to criticize our own values? In particular, how is it possible to maintain that liberal normative val- ues are more than the situated and relative values of a particular time and place, just like the beauty norms of different cultures that Fran describes? On what grounds can we argue for liberal or feminist change?
   

   In general, we can identify three key issues arising from a feminist reconciliation of liberalism and social construction: how we should un- derstand the thesis of social construction, the (im)possibility of univer- salism in the context of social construction, and the appropriate liberal response to difference. These issues inform the rest of the book. The first issue, how to understand social construction, is tackled in Part
   

3. American Society for Aesthetic Plastic Surgery, at
   http://www.surgery.org/. The soci- ety also reports a 444 percent increase in cosmetic procedures in the United States in 2005, as compared with 1997. In 2005, women were the patients in 91.4 percent of cosmetic surgeries. For women, breast augmentation was the second most popular procedure after liposuction.
   

   One, in which I develop an account that draws on both the poststruct- uralist work of Michel Foucault and Pierre Bourdieu and the feminist approaches of Catharine MacKinnon, Seyla Benhabib, and Nancy Hirschmann. The second and third issues, of how to combine univer- sal liberal normative values with an awareness of social construction and the fact of difference, are the main focus of Part Two. In the re- mainder of this chapter I consider the varied liberal uses of choice, and the work of some of the liberal feminists who have attempted to reformulate them.
   

   Liberalism, Feminism, and Choice
   

   In this book I combine a liberal approach to normative values and reasoning with a feminist awareness of social construction and gender inequality. This combination is not in itself original: many feminists have attempted to retheorize or utilize liberal values. In part, feminists have felt the need to reconfigure liberalism rather than merely use it intact because of the historical fact that liberalism’s grand claims to provide universal freedom and equality often have not delivered those things for women (and various other social groups). As Catharine MacKinnon asks, why has liberalism ‘‘needed feminism to notice the humanity of women in the first place, and why [has it] yet to face either the facts or the implications of women’s material inequality as a group, has not controlled male violence societywide, and has not equalized the status of women relative to men[?] If liberalism ‘inherently’ can meet feminism’s challenges, having had the chance for some time, why hasn’t it?’’
   12
   

   One consequence of feminists’ need to engage philosophically with liberalism, rather than merely adopt and apply it, is a greater awareness and development of theories of social construction. To understand why it is that patriarchy persists despite formal legal equality, feminists have had to analyze how gender inequality is so deeply entrenched in social norms that individual free choice cannot overcome it. Different liberal theories give different weight to choice, and are differently mindful of social construction. In general, the greater the weight given to choice, the less the attention paid to social construction; for as I
   

4. Catharine MacKinnon, ‘‘‘The Case’ Responds,’’ 709.
   

   argue throughout this book, an adequate understanding of the latter illustrates what is wrong with the former.
   

   A brief survey of contemporary liberal thought illustrates the vari- able relationship between choice and social construction. At one ex- treme are those liberals, or libertarians, who ignore the implications of social construction and consider individual choice to be the final and unproblematic beginning of normative theory, with some process or pattern of preference-satisfaction at the end. Examples are thinkers such as Robert Nozick and Chandran Kukathas, who focus only on the extent to which individuals are able to choose and act atomistically and pay no consideration to how society forms people’s preferences or to how people’s preferences affect society. A different form of liberal the- ory, which nevertheless has some connection to libertarian thought, is luck egalitarianism. Exemplified in the work of theorists such as Ron- ald Dworkin, G. A. Cohen, and Richard Arneson, luck egalitarianism (in very general terms) is the view that equality requires that individu- als are compensated for disadvantage that results from certain forms of luck. However, if individuals have made choices that led to their disadvantage, then they are deemed responsible and may not claim compensation. Luck egalitarians may take account of some forms of social construction, recognizing, for example, that individuals’ choices may be perverted by the influence of others. However, it is crucial to the luck egalitarian project that a sphere of responsible, individual choice can be identified, and that this sphere is thereby immune from considerations of justice.
   

   An alternative and familiar use of the concept of choice in liberal thought is through the device of freedom of exit. This idea states that certain sorts of inequality which would otherwise be unjust become just if the individuals concerned are able to leave the group or social arrangement responsible for the inequality. If they remain within the group, they are assumed to have consented to or chosen the inequality, thus making it compatible with justice. This device is used by a wide range of theorists, from the libertarian theory of Kukathas to the far stronger egalitarianism of Brian Barry and the liberal feminism of Aye- let Shachar and Marilyn Friedman. There are two main reasons for this diversity of support for freedom of exit. First, it demonstrates the fundamental relationship between liberalism and choice. Few liberals have felt able to deny that individuals’ self-regarding choices can be just, and have thus been loath to criticize hierarchical social groups if
   

   membership appears voluntary. Second, the doctrine of freedom of exit is versatile since it can be coupled with various different degrees of awareness of social construction. For libertarians such as Kukathas the nature and conditions of the choice to remain within a disadvantageous relationship are unimportant, while for feminists such as Friedman it is necessary to ensure that the choice is free from certain sorts of social construction. Thus, although Friedman agrees that ‘‘cultural practices that violate women’s rights are nevertheless permissible if the women in question accept them,’’
   13
   she places various constraints on the sorts of conditions that must be in place if a woman’s acceptance is to count. I discuss the strategy of freedom of exit in detail in Chapter 4. Its key problem is that even an account such as Friedman’s cannot escape the fact that cultural practices are inevitably reinforced by the sorts of social norms that undermine an individual’s ability to make the sort of ‘‘free’’ choice that justice would require.
   

   Another strategy for focusing on choice while placing various condi- tions on the nature and circumstances of that choice is deliberative democracy. In the liberal tradition this idea has been developed in the work of thinkers such as Ju¨rgen Habermas, John Dryzek, and Amy Gutman. Seyla Benhabib’s version of deliberative democracy, which she terms ‘‘discourse ethics,’’ is useful, since it is developed along dis- tinctly feminist lines. According to discourse ethics, democratic delib- eration and the policies that result from it must proceed in accordance with three principles: egalitarian reciprocity, voluntary self-ascription, and freedom of exit and association. The general idea is that when discourse is constrained in these ways, it is proper to follow those poli- cies and principles that are agreed upon, and which thus have been chosen by the participants. The constraints are needed, in part, because of the problem of social construction: if we allow choice to rule un- checked, we risk being bound by decisions that result from various forms of social domination or oppression.
   

   However, there is considerable tension in this desire to prioritize choice while also constraining it. For example, it is unclear how much egalitarianism is required by Benhabib’s discourse ethics. In places, it appears as though egalitarianism is brought about if and only if delib- eration demands it, since Benhabib states that ‘‘discourse ethics does not present itself as a blueprint for changing institutions and practices;
   

5. Marilyn Friedman,
   Autonomy, Gender, Politics,
   188.
   

   it is an idealized model in accordance with which we can measure the fairness and legitimacy of existing practices and aspire to reform them,
   if and when
   the democratic will of the participants to do so exists.’’
   14
   The problem with this approach is that it is disingenuous to talk about or wait for the emergence of a democratic will in circumstances of inequality, for there can be no truly
   democratic
   will until equality is already established and protected.
   

   Perhaps, then, equality is to be stipulated in advance. This is the implication of other parts of Benhabib’s work. Her first principle of discourse ethics is egalitarian reciprocity, which states that ‘‘members of cultural, religious, linguistic and other minorities must not, in virtue of their membership status, be entitled to lesser degrees of civil, politi- cal, economic and cultural rights than the majority.’’
   15
   Moreover, Ben- habib assumes that one dissenting voice against inequality establishes a democratic will for its abandonment.
   16
   These provisions solve the problem of inequality but they do so while leaving little role for the majoritarian choice, which was the original reason to favor discourse.
   

   There are similar problems with Benhabib’s second principle, vol- untary self-ascription: ‘‘An individual must not be automatically as- signed to a cultural, religious, or linguistic group by virtue of his or her birth. An individual’s group membership must permit the most extensive forms of self-ascription and self-identification possible.’’
   17
   But it is impossible for an individual not to be ascribed to a linguistic group by virtue of birth, for if an individual is to express a preference about her group membership, she must already have learned a lan- guage that she did not herself choose. Benhabib may mean simply that such group memberships must not be ascribed by virtue of birth once and for all, but if that is the case, it is not clear why she labels the principle ‘‘voluntary self-ascription’’ rather than ‘‘freedom of exit.’’ In- deed, the idea of ‘‘voluntary self-ascription’’ does not sit easily with the idea of social construction. It is a laudable aim to enable individuals to be the authors of their own lives. However, there is at least a tension between the idea that individuals can be ‘‘self-interpreting and self- defining’’ and the view that they are ‘‘constituted through culturally- informed narratives.’’
   18
   

6. Seyla Benhabib,
   The Claims of Culture,
   19.
   

7. Ibid., 115; emphasis in the original. 16. Ibid., 116.