We should rethink what we mean by beauty, Debashis Singh advises

"From a man's face I read his character"
Petronius
"Physical beauty is the sign of an interior beauty, a spiritual and moral beauty"
Schiller

Medicine has always viewed beauty as a fairly trivial affair, subscribing to the notion that "beauty is only skin deep." But we live in a society obsessed with physical appearance, where from every news stand and billboard beautiful faces stare out at us. So what must it be like to have a face which is not deemed culturally appropriate? For people who are blemished, scarred, or deformed beauty is not an insignificant matter but something that they have to wrestle with on a daily basis. One study into the effects of facial disfigurement on individuals found that an "unsightly scar or the conspicuous defect may well be as severe a social and economic handicap as complete physical incapacity."¹

What makes a person?

What is it that makes a person beautiful? Is it, as Plato would have us believe, a precise interlocking of parts to create an ideal form, or is it, as current scientific thinking suggests, related to facial symmetry.^2-7 Whatever the definition, the fact remains that on a daily basis we make assumptions about and modify our behaviour towards people based purely on their physical appearance.

People who are deemed unattractive seem to have all manner of undesirable qualities attributed to them from the assumed mode of HIV acquisition (unattractive people were perceived as more likely to have acquired HIV through homosexual relationships)⁸ to mental disturbances.⁹ They were more likely to have more aggression manifested towards them¹⁰ and more likely to be carded for purchase of alcohol than their attractive peers.¹¹ One study even found that psychotherapists perceived the unattractive clients as in need of more therapy and being more psychologically impaired than the attractive clients.¹²

Even subtle alterations to physical appearances seem to alter perception. In a recent article published in Political- Psychology images of Presidents Clinton, Reagan, and Kennedy were manipulated to see if subtle feature alterations (either enlarging or reducing eyes and lips) were powerful enough to shift social perceptions of them.¹³ The study found that by enlarging Clinton's eyes and lips he was made to seem more honest and attractive, whereas by reducing the eyes and lips of Kennedy and Reagan they were perceived as being cunning and less powerful. Where does this association between outer beauty as a reflection of inner goodness arise?

Beautiful is good

Perhaps the association is made as children when we are read fairy stories (regarded by many as a medium through which children assimilate the norms of acceptable appearance and behaviour) and hear of "wicked ugly witches" and "treacherous one legged and one eyed pirates." Captain Hook, Rumpelstiltskin, Long John Silver, and the Ugly Sisters are bound as much by their stigmas as their villainy, as though, through their deformities and blemishes their evil nature is revealed which is in sharp contrast to their flawless adversaries.

This theme bleeds into celluloid. Basic and Applied Social Psychology scrutinised five decades of top grossing films and found that attractive characters were portrayed more favourably than unattractive characters on multiple dimensions, further strengthening the beauty and goodness stereotyping.¹⁴ Hollywood films commonly counterpoise attractiveness with unattractiveness to assist the audience to separate the heroes from the villains. In The Wizard of Oz, Margaret Hamilton's green warty skin as the Wicked Witch of the West seemed to symbolise immorality just as scars in films such as Scarface and Robin Hood Prince of Thieves do. It is not surprising to learn that evil Darth Vadar has got rather a rough complexion as he raises his helmet in The Empire Strikes Back.

We equate physical defects with sin

There seems to be a clear message. It is easier to be bad than good if you are ugly. Given this repetitive message it is of little wonder that a patient with facial scars is recorded as saying, "I always have to explain how I got these, I'm afraid people will think I'm an ex-convict."15 This comment alludes to our still common tendency to equate physical defects with sin, which presumably began as a defence mechanism used in the formation of group identity. So those who looked different were somehow different and treated as such. This is the core of racism where stigmatisation and alienation are often employed. Examples of this can be found throughout history and in all cultures. From sixth century Greece, where an ugly or deformed person was chosen to take up the evil that caused a town's famine or plague by being publicly beaten and burnt to death, to nineteenth century England, where Joseph Merrick (the so called "Elephant Man") was forced to exhibit his "monstrously" diseased head and cauliflower- like skin in order to earn a living.

Beauty and behaviour

American psychologists have long enthused over the halo effect: the way in which we all subconsciously perceive attractive people and adapt our behaviour towards them. The converse is also true, and we also alter our behaviour towards those culturally deemed unattractive. This is exemplified in the quote: "Most adults... pretend that my birthmark does not exist, but occasionally I meet someone who cannot take their eyes off me. Sometimes they visibly recoil, with the result that any communication between us breaks down." ¹⁶

Those who have skin disfigured by disease must contend with a pathological process which can be viewed and judged by the world. This has many psychological implications. Many such patients have to deal with several feelings, ranging from guilt, perfectionist yearnings, distorted notions about the contagion, dirt, sexuality, and paranoia. This may lead to the afflicted individual withdrawing from society.¹⁷

A letter of referral to the Skin Camouflage Clinic exemplifies the pressures, which may work towards this withdrawal: "My face is disfigured and I cannot go out on my own. People make signs behind my back and sneer. It is awful that they can be so cruel and ignorant. Every day seems to get worse. I cry myself to sleep every night. I am desperate."¹⁶

These feelings may be slowly growing and festering in the individual from an early age. A mother writing about her son notes that "even at 3 years old, when people stop me and ask what's happened to my son's face or anyone discusses his birthmark and he can overhear, he tries to hide his face. He isn't just embarrassed, he appears to be ashamed of it. It appears that all he knows is that his face is different, and people keep talking about it."¹⁶

Beauty is a serious matter and by redefining it and all its connotations we can go some way towards realising that beauty is not defined by perfection. Beauty resides somewhere deeper than the skin. Perhaps David Humes's 1941 definition is more appropriate: "Beauty is not a quality in things themselves, it merely exists in the mind that contemplates them, and each mind perceives a different beauty."