Alexander Edmonds

Learning to Love Yourself: Esthetics, Health, and Therapeutics in Brazilian Plastic Surgery

Brazilian plastic surgeons have successfully promoted a psychotherapeutic rationale for cosmetic surgery. This article critically engages with this ‘philosophy’ of health, analyzing how it is deployed in busy teaching hospitals. I show how a tradition of intimate hierarchy and class dynamics in medical institutions informs the experimental ethos of clinical practice as patients internalize a psychotherapeutic notion of health and management regimes of female reproduction and sexuality that are becoming normalized among upper social strata. In the process, cosmetic and healing rationales become blurred as patients pursue an expansive, qualitatively defined state of well-being that I call ‘esthetic health’.

“Almost Invisible Scars”: Medical Tourism to Brazil

Along with a handful of other nations in the developing world, Brazil has emerged as a top destination for medical tourism. Drawing on the author’s ethnographic fieldwork in plastic surgery wards, this article examines diverse factors—some explicitly promoted in medical marketing and news sources, others less visible—contributing to Brazil’s international reputation for excellence in cosmetic plastic surgery. Brazil’s plastic surgery residency programs, some of which are housed within its public health system, attract overseas surgeons, provide ample opportunities for valuable training in cosmetic techniques, and create a clinical environment that favors experimentation with innovative techniques. Many graduates of these programs open private clinics that, in turn, attract overseas patients. High demand for Brazilian plastic surgery also reflects an expansive notion of female health that includes sexual realization, mental health, and cosmetic techniques that manage reproduction. Medical tourism is sometimes represented as being market‐driven: patients in wealthier nations travel to obtain quality services at lower prices. This article ends by reflecting on how more complex local and transnational dynamics also contribute to demand for elective medical procedures such as cosmetic surgery.

Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Primary healthcare providers’ views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua

Objectives To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers’ awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become ‘gate-openers’ to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

The Biological Subject of Aesthetic Medicine

This article explores how race, sexual attractiveness and ‘female nature’ are biologised in plastic surgery. I situate this analysis in relation to recent debates over the limits of social constructionism and calls for more engagement with biology in feminist theory and science studies. I analyse not only how the biological is represented by biomedicine, but also how it is experienced by patients and, most problematically, how it is entangled with social constructions of beauty, race and female reproduction. Drawing on ethnographic fieldwork conducted in Brazil, I focus on plastic surgery, but also analyse how this specialty is linked to Ob-Gyn and endocrinology. I argue that medical procedures instantiate a biologised model of beauty I call ‘bare sex’ (Edmonds, 2010) that is defined in terms of racial traits, anatomy, reproductive processes, hormones and ‘secondary sexual traits’. While this is a historically specific model, it is also one that is inscribed on patients, altering anatomy and physiological processes. It thus has the potential to create a biological self-awareness that cannot fully be accounted for by a social constructionist analysis.

The unintended consequences of sex education: an ethnography of a development intervention in Latin America.

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention – and of the larger global field of adolescent sexual and reproductive health – is to create more open parent-to-teen communication. This paper analyzes the projects efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the interventions language and practices. While the intervention emphasized the goal of ‘open communication,’ its participants more often used the term ‘confianza’ (trust). This norm was defined in ways that might – or might not – include revealing information about sexual activity. Questioning public health assumptions about parent–teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge.

Body Image in Non-Western Societies

This article discusses a range of body modification and conceptions of the body in non-Western societies. It also analyzes difficulties in applying the primarily Western psychological notion of body image to different societies. Body modification is a near human universal, but has many meanings and aims. Some of this diversity may be lost due to globalization, which has the potential to create disturbances in body image and impose Western aesthetic standards. As beauty industries spread to the non-Western world, however, they are often transformed in line with local values and meanings, yielding new, hybrid body practices and distinct health challenges.

[Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil].

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.