Table Of ContentFace/On
Face/On
Face Transplants and the
Ethics of the Other
Sharrona Pearl
The University of Chicago Press chicago & london
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2017 by The University of Chicago
All rights reserved. No part of this book may be used or reproduced in any
manner whatsoever without written permission, except in the case of brief
quotations in critical articles and reviews. For more information, contact the
University of Chicago Press, 1427 E. 60th St., Chicago, IL 60637.
Published 2017.
Printed in the United States of America
26 25 24 23 22 21 20 19 18 17 1 2 3 4 5
ISBN- 13: 978- 0- 226- 46122- 9 (cloth)
ISBN- 13: 978- 0- 226- 46136- 6 (paper)
ISBN- 13: 978- 0- 226- 46153- 3 (e- book)
DOI: 10.7208/chicago/9780226461533.001.0001
Library of Congress Cataloging-in-Publication Data
Names: Pearl, Sharrona, author.
Title: Face/On : face transplants and the ethics of the other / Sharrona Pearl.
Description: Chicago ; London : The University of Chicago Press, 2017. |
Includes bibliographical references and index.
Identifi ers: lccn 2016037671 | ISBN 9780226461229 (cloth : alk. paper) |
ISBN 9780226461366 (pbk. : alk. paper) | ISBN 9780226461533 (e-book)
Subjects: lcsh: Face—Surgery. | Transplantation of organs, tissues, etc.—
Social aspects.
Classifi cation: LCC RD523 .P39 2017 | DDC 617.5/20592—dc23 LC record avail-
able at https://lccn.loc.gov/2016037671
This paper meets the requirements of ANSI/NISO Z39.48- 1992
(Permanence of Paper).
C o n t e n t s
1 • Introduction: Eff acing 1
2 • Mind/Medicine 10
3 • Losing Face on Film 49
4 • Decoding the Face-T ransplant Debates 88
5 • A Very Special Makeover: Face Transplants on Television 123
6 • Conclusion: Face Transplants and the Ethics of the Other 156
Acknowledgments 181
Appendix: Face Transplant Recipients 187
Notes 191
Bibliography 223
Index 237
C h a p t e r 1
Introduction: Eff acing
In David Lodge’s wonderful academic satire Changing Places, we are intro-
duced to the game Humiliation. The point of the game is for participants to
reveal which classics of literature they have not read; the winner is the one
whose gap is most humiliating. In the book, the winner (the loser) is a litera-
ture professor who has never read Hamlet. He wins the game, and he loses
his job.1 (The game has become rather popular in certain circles. You may
wish to try it; I leave that time-s uck to you.) Here’s my own personal ver-
sion of Humiliation: I’ve never seen John Woo’s 1997 fi lm Face/Off in one
sitting. Appalling, I know. But in my defense (and leaving aside evaluations
of the movie itself, which . . . I’ll leave aside), the face transplant(s) that take
place in the movie are fundamentally diff erent from those I explore in this
book in ways that are deeply signifi cant. In the fi lm, John Travolta’s character
switches faces with the terrorist portrayed by Nicolas Cage as part of a heroic
quest to save lives. He doesn’t want to do it, but he quells his misgivings and
conducts this major personal sacrifi ce in service of the greater good. The face
transplant at the heart of the fi lm is done for the benefi t of others despite the
individual cost. It’s a heroic masculine journey that will end when the world
is saved. It’s reversible. John Travolta will get his old face back. And while his
experiences posing as a terrorist criminal mastermind may change him (and
they do—spoiler alert), in the end, he gets his life back. He gets himself back.
Facial allotransplantations (FAT), commonly known as face transplants,
are not reversible. While their eff ects may be temporary (faces, like all other
transplanted material, can be rejected and lost), the old faces are, by defi ni-
tion, gone forever. The old selves attached to the old faces are perhaps gone
2 Chapter One
forever. (But isn’t that true of us all? Isn’t every moment that passes a moment
of our lives and our selves gone? And aren’t we now diff erent as a result?) And
while face-t ransplant recipients may on some level undergo the surgery for
others, to shield the world from their faceless condition, they are, in the end,
doing it for themselves, for their own ease of life and ability to navigate the
world. They may do it for their relationships with others, for their ability to
develop relationships with others or deepen ones that had been compromised
by facelessness and the trauma that led to it, but the surgery is ultimately not
a heroic project, not in the save- the- world kind of way. Even though, as we’ll
see, it is sometimes painted as one. But its personal nature is often presented
by bioethicists and journalists as cosmetic, and maybe even selfi sh, and maybe
even cheating. The face transplant, in these terms, is an indulgence rather
than a medical necessity, and we’ll explore how these are two very diff erent
categories of intervention. Except, as I show, when they are not.
These two distinctions, the nonreversibility and the highly personal na-
ture of the face transplant, matter deeply in the way that the surgery and its
recipients are understood, presented, discussed, and debated. At stake here
are the reasons that people get face transplants and the risks—both medical
and psychological—that recipients undertake with the surgery. At stake here
is the way that a new face may bring with it a new identity. At stake here is
the very meaning of faces themselves. And the meaning of facelessness. That
matters too.
This is not (simply, or even at all) a book about the historical stakes for the
face. That topic is too, too big. People have thought about it, and written about
it, well and in depth. Though I bring some of these theorists of the face to bear
at the end of this book (Lévinas, fi rst and foremost, and Deleuze and Guattari,
Goff man, Sennett, and Butler), I don’t wish to reproduce their work.2 Also I
can’t; the long history of the face surpasses the modesty of my intentions here.
Well, sort of. This is a book about the stakes for changing the face, and the
changing stakes for the face. This begs the question of the meaning of the face,
and I think about it with the help of these scholars, and carefully off er my own
speculative theories. But rather than looking backward, I push forward, using
the face and the most dramatic manifestation of its manipulations to date, the
face- transplant surgery, as a way to think about the self, and its always- public
representation, as always changing. As always becoming.
I approach the face transplant through the framework of the index, the
indexical relationship between the face and character. When that index is
vexed, when the context for the correlation has changed, what do our reac-
tions tell us about the meaning (for us) of the face, and the fl exibility of its
Introduction 3
symbolic features? And what about when that index is vexed in the most ex-
treme way, by substituting not just another face, but the face of another? What
does that tell us about both the face and the condition of facelessness? That’s
my question. My answers are in the book that follows, but I’ll give you some
hints: the index of the face has always been unreliable. The face and the self
are always changing and have always been always changing. The face trans-
plant brings that unreliability to the fore, as our reliance on the index itself is
being undermined. As it should be. We should encounter the faceless just as
we encounter the face. Faces are not the index to humanity, no more so than
facelessness. We owe the faceless the face-t o-f ace encounter as well, and the
ethical obligations incurred therein. We don’t always live up to these obliga-
tions to the faceless; we don’t always extend to them our acknowledgment of
their basic humanity. That might be changing; it certainly ought to.
So how should we (re)conceptualize the face while still taking very se-
riously the importance of embodied experience? That’s what, in part, this
book tries to fi gure out. Like all processes, it’s a journey. Writing this book,
I’ve gone on a journey. It started in the nineteenth century, in Britain, with a
graduate- school project on faces and their relationship to character. It became
a book, and I became an academic.3 And that book thinks about the face as an
index, ultimately arguing that our reactions to the faces of others tell us more
about ourselves than the people around us. It also thinks about how people
self- consciously fashioned their faces and appearance to play to the index.
Maybe to manipulate it.
I took those ideas and assumptions to this book, also about faces. (It turns
out—and I truly didn’t know this before—that I’m a little obsessed with faces.
With the face- to- face.) But what I knew about faces in the nineteenth century
turns out to be wrong in the twenty-fi rst. It turns out that while some impor-
tant things stay the same—bodies matter, faces matter, our relationships to our
own faces and to the faces of others matter so very much—other things have
changed. And at the end of this book, I outline not only how the face and its
status have changed but also how my own thinking around the face and the
interlocutors of the face has changed. As I hope you’ll see, this is a very per-
sonal project in addition to an academic and professional one. It’s a project
of fi ghting for the voices and the humanity of the faceless and disfi gured, the
visually diff erent and disabled, and thinking about why they need fi ghting for.
Thinking about why we have denied the humanity of the faceless or, rather,
why we imagine humanity to be vested in the face, and what happens when
that assumption is shown to be false. In the conception of the face as index,
the faceless are left out. They are, in a way, left for dead.
