Did you know that breast implants are becoming an increasingly popular high school graduation gift for teenage girls? Or that a growing number of women are paying $3,500 to $8,000 to improve the appearance of their genitals via elective surgery?

The upsurge in such cosmetic overhauls demands serious inquiry into the nature of the society that is spawning them and how their use may affect some women's psyches, agreed panelists at a 2005 APA Annual Convention symposium titled "After 'Our Bodies, Ourselves,'" referring to the feminist health-care tome first published in 1973 by members of the Boston Women's Health Collective and updated a number of times since.

"Why have we become so fetishistic about such narrow standards of beauty?" asked Nancy McWilliams, PhD, a psychology professor at Rutgers University and president-elect of APA's Div. 39 (Psychoanalysis), whose Section III (Women, Gender and Psychoanalysis) sponsored the symposium.

In contrast with today's obsession with sexually based appearances, the original authors of the "Our Bodies" volume had an ambivalent take on beauty because of its association with men's objectification of women, panelists said; the original authors' aim was to persuade women to accept their natural, diverse looks.

"In the 1970s, the emphasis was on staying natural with no shaving and no bras, while today, the stress is on perfection, with breast reductions and plastic surgeries," noted Judith F. Logue, PhD, of the Institute for Psychoanalysis and Psychotherapy of New Jersey.

One reason for these differences may lie in our mass, mobile culture, McWilliams suggested, which makes it harder to truly connect with others and therefore pushes appearances to the fore.

"We didn't foresee the incredibly powerful juggernaut of the beauty industry," she said.

When culture hurts psyche

These forces may in turn intersect with family dynamics and individual pathology in particularly perverse ways, suggested Deborah Blessing, a social worker in Washington, D.C., who specializes in eating disorders. She described her work with a young woman who had developed an eating disorder in her early teens after her parents' divorce, and whose father pushed her into getting a breast reduction right before she entered college.

In her work with the woman, Blessing noticed themes that plague women with eating disorders and that may have contributed to the surgery decision. A central problem was family enmeshment, where the family members' boundaries were so blurred that they couldn't sort out who was feeling what. They also tried to sort out conflicts through concrete bodily actions instead of thinking through the meaning of their emotional experiences.

With the young woman and her father, unspoken tensions about her sexuality and upcoming independence exploded in the form of the surgery, Blessing said.

"The end result was close to mutilation, with lifelong consequences," she said. "She told me sadly that she wished she knew at the time of the surgery that she would never again have sensation in her nipples, or be able to nurse her baby some day."

Masking bigger issues?

Similarly, psychologist Devon Charles, PhD, of Philadelphia's Pennsylvania Hospital, noted that a middle-aged client's decision to undergo gastric bypass surgery reflected issues deeper than the medical act alone. While the woman lost some 270 pounds as a consequence of the surgery, the change did nothing to address her underlying issues, which included a relationship with a domineering mother and a related tendency to stay in abusive relationships with men, Charles noted.

Indeed, her work with obese patients in general and with this client in particular, suggests that obesity may operate as a protection against past boundary violations and those feared in the future, Charles noted.

"For those who use weight as a defense in this way," she said, "gastric bypass surgery adds another dilemma by threatening this protective layer."

Given the pervasiveness of such surgeries, the medical and mental health professions must start addressing the importance of counseling people before they decide to make such life-altering moves, both Blessing and Charles maintained.

"How do we help our patients learn to be curious about and explore the meanings and implications of cosmetic surgery before acting?" Blessing asked. "Can we be more active and helpful to physicians and the general public about the need to sort out anxieties and motivations before invasive procedures are done?"

Tori DeAngelis is a writer in Syracuse, N.Y.