On Identity and the Changing Physical Form
My body has had a number of upgrades and optimizations in the past year.
In June, an ophthalmologist put me in a dentist-style chair, stretched my eyelids around a small circular instrument that fixed them wide open, and shot lasers down at my cornea, chiseling away at the flawed orb until my myopia gave way to 20/20 vision.
In November, an aesthetician with uncanny eyebrows sat me in a similar reclined chair and held my mouth in place with one hand while she repeatedly slipped a syringe into my lips with the other. After each puncture, she’d pause, then slowly push the plunger down the barrel, sending a surge of Restylane, a stabilized hyaluronic acid, into my lips. I looked bee-stung and bruised when I left the clinic, but in a few days, I simply had fuller lips.
In December, a reproductive endocrinologist prescribed me letrozole and estradiol, then clomiphene citrate, then a combination of letrozole and clomiphene citrate plus some more estradiol for good measure, all finished off with a self-administered shot of human chorionic gonadotropin. These chemicals were sent in to pull the levers of my sex hormones and make my body, which hasn’t menstruated or ovulated in decades, produce a baby.
As I sit here in February, I’m looking at my laptop with laser-corrected eyes, balm freshly applied to my newly full lips, another admixture of synthetic hormones circulating through my veins (the one in December didn’t take; we’re going for round two).
There were also involuntary upgrades, ones forced upon me not by vanity or convenience or desire, but by my own body’s need to survive. There’s the itchy four-inch scar across my upper back marking where a bespectacled surgeon cut out a piece of my skin in November, a trapezoidal continent with a melanoma mountain in its center. There are also the three titanium pins in the head of my left femur, cradled by the hip socket, once necessary to hold my leg together and now permanently engulfed by bone, an insect trapped in amber—this one, admittedly, happened a couple years back. But still.
The truth is, I’ve been actively modifying my body for decades.
There were small, silly things at first, like when I was in elementary school and obsessed with the Olsen twins. In my desire to look like them, I used to lie in bed with my thumb pressed hard against the tip of my nose, willing it to flatten out, to take on the soft, wide shape I saw on the faces of my idols. In the bathroom I’d smash the cartilage of my nose up against my face for as long as I could stand it, then slowly take my hand away to see if it looked different.
Then in sixth grade, teetering on the precarious precipice between childhood and adolescence, I set my sights on more serious changes. Newly aware of the need to be attractive to the opposite sex, my female peers and I were, of course, occupied with all the quotidien tasks of making one’s body more desirable: the grooming and primping, the straightening and curling. But I went bigger; or maybe that’s precisely the wrong word.
The bodily change I affected when I was eleven years old was highly specific and shifted the course of my whole life. My goal was, simply, to be smaller, which in the body of an adolescent girl is like trying to run down an up escalator. Still, the frantic pace of my compulsions—my secret midnight exercise, the miniscule quantities of food I allowed through my (then Restylane-free) lips—managed to overtake my body’s biological programming, thwarting its attempt to attain the adult shape of its genetic destiny. I ate so little that I ended up in the ICU, my body hooked up to machines whose constant beeping reassured the doctors and nurses and me that my heart had not, in fact, stopped beating.
I got out of the ICU, of course, and the story of my anorexia unfolded from there, with all the attendant ups and downs of such a disease. But that’s not why I bring it up here. I only mention it because these choices that I made at age eleven did concrete, specific, and permanent things to my body: I stunted my growth by an estimated three inches, and never developed the feminine hips or ample breasts of the other women in my family. I froze my body in its sixth-grade form. It’s the body I still live in today.
Except, it’s not.
Bodies change on their own, of course. It requires nothing but the passage of time. Age lengthens my nose, creases my forehead, darkens my once-blond hair, leaves my skin parched and my eyes more sunken than they were. My lips, once full and luscious, grow thin and cracked, the upper one disappearing when I smile (until this past November, that is).
Not to mention the wildest of bodily changes, when one body creates and then houses a whole other human body. A few years ago, a different reproductive endocrinologist on the other side of the country put a different combination of synthetic hormones in me and, miraculously, that resulted in the existence of my daughter. Pregnancy, though transitory, left my form forever changed, as it does to so many women: the lower half of my right leg bulges with varicose veins (they’ll be there forever, my doctor tells me, but I’ve researched “varicose vein removal surgery” more than once); my nipples are darker; my stomach is peppered with tiny red dots, blood vessels burst from its expansion.
All of this on top of the titanium pins in my leg and the scar on my back, my Restylane-filled lips and laser-corrected eyes.
“Wrinkles mean you laughed, gray hair means you cared, and scars mean you lived!” This message—proclaimed from novelty drinkware and crocheted wall hangings, from “lifestyle” Instagram accounts and engraved bracelets—is maybe true, in that the body does, in one way or another, always bear the evidence of your life. But it makes me wonder: if I get Botox for the wrinkles on my face (which, in time, I almost certainly will), how does that alter my relationship to that person from my past who laughed?
In studying body tissue renewal, the Swedish molecular biologist Dr. Jonas Frisen found that the body’s cells replace themselves every seven to ten years. From the top of your head to the tips of your toes, every one of your cells dies and is replaced by a new one within the course of a decade. It evokes the ship of Theseus, that classic paradox of metaphysical identity:
The ship wherein Theseus and the youth of Athens returned from Crete had thirty oars, and was preserved by the Athenians down even to the time of Demetrius Phalereus, for they took away the old planks as they decayed, putting in new and stronger timber in their places, insomuch that this ship became a standing example among the philosophers, for the logical question of things that grow; one side holding that the ship remained the same, and the other contending that it was not the same. —Plutarch
If every part of my body has been changed—my active tweaks and alterations, plus the constant sloughing off and regeneration of cells—what’s my relation to the person I was ten years ago? My mind, too, has changed, transformed through a process known as neuroplasticity, a phenomenon that illustrates the brain’s malleability. Neuroplasticity asserts that our experiences and memories alter the physical shape of the brain through sprouting—the forging of new neural connections—and rerouting—the strengthening or weakening of existing connections. This means that the map of your brain, that network of pathways that lead to your thoughts and actions, is redrawn again and again. “Any man could, if he were so inclined, be the sculptor of his own brain,” declared the Spanish neuroscientist Santiago Ramón y Cajal on the subject.
I’ve certainly tried to sculpt my brain: I’ve been meditating every day for the past few months, hoping to train my mind to be less promiscuous with its dispensation of cortisol. My brain has also been changed by life itself. There was the pregnancy, which science says reduced my gray matter and increased my need for attachment. There was also the time I was attacked on a street in Bushwick, when I bit a man’s lip and tasted his blood in my attempt to escape, which, according to my trauma counselor, changed the composition of my neurons.
I like the lips I see when I look in the mirror today. But whose are they?
A dualistic view of the world offers a tidy solution to this conundrum. Mind-body dualism, the philosophy of Aristotle and Plato, of Descartes, says that the mind and body are distinct and separate, that the soul—or mind, or self, or whatever word you’d like to use as a placeholder here—is an independent entity piloting around a big earthly body. If this is the case, then all the changes my body has undergone don’t matter in terms of my identity. If there’s a central, metaphysical “me” that lives inside my body, then what I do to its external shell shouldn’t have much bearing on it.
Monism, on the other hand, complicates things. Rather than viewing the mind and body as two fundamentally different substances, monism says that only one single substance exists, and that all divisions are arbitrary. Our minds are not another kind of stuff, they’re just what our brains are doing on a neuron level. Most science is monistic—asserting that minds are the result of the physics of things—and so are most philosophers today. According to a recent survey of active philosophers, a significant majority take the view of physicalism, a form of monism that says, fittingly, that everything is physical. There is no “me” above and beyond my body.
In the meditation app I’ve been using (in the aforementioned attempt to change my brain), they talk a lot about this. The creator of the app, Sam Harris, speaks frequently on the fallacy of self, the idea that you are inside the body. In one popular YouTube video, he explains that “the self is an illusion—the sense of being a thinker of thoughts in addition to the thoughts, an experiencer in addition to the experiences, the sense that we all have of riding around in our heads as a passenger in the vehicle of the body . . . Most people don’t feel identical to their bodies, they feel like they have bodies, they feel like they’re inside the body.” He goes on to explain that this makes no anatomical sense, that every part of experience is delivered by the brain’s processes, and thus each human is “a changing system” in which no unitary self moves from one moment to the next, unchanged. Our existence is centerless, defined by whatever thought currently occupies our attention, he says. In this context, the physical fact of our body is the only thing that remains constant from one moment to the next.
In The Sun at Midnight, the writer Laurence Galian argues that a dualistic view of things is not only false, but also takes away from the experience of life. He writes that thinking of our bodies as vessels that we live inside creates an internal division, and he equates this viewpoint to people who drive campers equipped with TVs into the wilderness: “Are they experiencing the nature around them? They have an insular experience.” The TV here plays the role of our ceaseless thoughts, that marathon of whims and impulses that keeps us rapt as we go about our days, forgetting ourselves entirely.
So, the consensus seems to be, we are our bodies. But whether we are only our bodies remains up for debate. In his 1994 book The Astonishing Hypothesis, the molecular biologist Francis Crick wrote:
“You,” your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules . . . You are a pack of neurons.
Thankfully for those of us who find this conclusion highly depressing (hi), there’s pushback against it. Back to Harris, who argues that Crick’s astonishing hypothesis “misses the fact that half of the reality we’re talking about is the qualitative, experiential side.” In other words, Crick ignores the idea of consciousness, which Harris describes as “what it’s like to be you” and which is the closest thing to a notion of “self” that monism tends to allow. Consciousness can’t be reduced to information and neurotransmitters, Harris and others argue. Neuroscientists can correlate experiential changes with changes in brain state, but that does not capture the individual experience of consciousness itself.
Thinking of consciousness as my “true self” can be reassuring, but just for a moment. Because the thing is, as my two-month meditation practice and thirty-six years of life have taught me, consciousness changes from second to second. Harris points out, again and again, that our entire being is consumed and defined by whatever happens to catch our attention at a given moment. In this moment, “I” am the irritation I feel when my daughter spills all her beads on the floor; in the next, “I” am the love that surges when she buries her head in my arm and tells me I’m her mommy. As a matter of experience, that’s all I am in those moments.
So, the consensus seems to be, our minds are a product of our brain’s neuronal activity, and anything that can’t be defined by that firing of neurons—our consciousness—is continually transforming. In this framework, where does identity live? Though many espouse the liberation of transcending ego and abandoning the idea of a self or a personal identity—your philosophers, your yogis, your Burning Man types — for most of us, that idea leaves us unmoored. It’s as simple as: I must live every day being me, and it helps to feel like “me” is real, is uninterrupted.
What I want is an anchor point, and what better anchor than the body? It’s something I can see and touch, something that is tied physically to the world, something constant. Even though I know, though Dr. Frisen told us, that my body today is not the same one it was a decade ago, it feels that way. In third grade, I sharpened a number-two pencil for a standardized test, and then promptly, accidentally, jammed it into the palm of my right hand. Twenty-eight years later, that graphite mark is still there under my skin. I am not attempting to argue with Frisen, to claim that the cells in that hand are the same ones I had in elementary school; I’m sure there’s a scientific explanation for why the cells regenerate but the mark persists. But regardless, the existence of that mark implies a throughline, a tie between that self and this self, typing these words. My body proves that I exist.
The apparent constancy of the physical body explains why I and others cling to it as central to our identities, especially given the capricious nature of consciousness. And yet, I keep changing that body, undermining the idea of physicality as a constant. But maybe, I suggest to myself, this doesn’t make my claim to my body more tenuous, but actually strengthens it. Maybe my body becomes more me the more that I actively shape it. These changes reflect the choices I’ve made, the agency of the consciousness within. They make my body less real but more true, perhaps; or vice versa.
Humans have been actively changing their bodies for a long time. Think of the neck elongation of ancient Celts and some African peoples today. Think of stretching earlobes, nostrils, or chins with gauges. Think of foot-binding and corsets.
Foot-binding, birthed out of a male erotic fascination with court dancers’ feet in tenth-century China, was a recognized status symbol in China until the nineteenth century. Young girls’ feet were broken and tightly bound to permanently alter their size and shape, forming them into what were called “lotus feet.”
Corsets, some think, have been around as early as the Minoan civilization back in 3000 BCE, becoming the height of fashion from the sixteenth century through the Victorian era. Today you’ll find them all over Instagram, vouched for by influencers with enviable bodies, though they now go by “waist trainers.” While unsubstantiated, the claim and hope with these items is that they will permanently change the shape of the torso to one with a cinched waist between ample hips and bosom.
Body modification technology has, of course, advanced. The field of cosmetic surgery blossomed in the 1960s and has continued to progress and evolve from there. Aesthetic procedures like breast augmentation, face-lifts, tummy tucks, and many more have become safer and less invasive, more natural-looking and, interestingly, less taboo. Just a few years ago, my friends and I would have vehemently denied to one another that we’d ever consider cosmetic enhancement; these days, we burst to tell one another, in intimate and animated tones, what we’ve had done, what we’re going to do, which procedure we recommend.
According to data from the American Society of Plastic Surgeons, surgical cosmetic procedures have been on the rise for the past five years. Almost eighteen million people underwent “surgical and minimally invasive cosmetic procedures” in 2018, nearly a quarter of a million more than the year prior. In 2020, $16.7 billion was spent on cosmetic procedures, and 11 percent of women say that they’re more interested in plastic surgery now than they were before COVID. The most popular procedures during that first pandemic year were nose jobs, eye lifts, face-lifts, liposuction, and boob jobs. I waver between feeling proud and insecure that the one procedure I’ve had (so far) didn’t make the list.
People say and think wildly different things about what plastic surgery is and means. The actress Kristen Stewart equates it to “vandalism,” saying that women who surgically alter their appearance “are losing their minds,” and the Egyptian feminist writer Nawal El Saadawi calls plastic surgery “a postmodern veil,” implying that it is a means of hiding, whether out of propriety, shame, or otherwise. The reality star Khloe Kardashian, on the other hand, argues that plastic surgery should be viewed as not dissimilar to makeup. “We’re all putting on a fucking mask basically every day anyway, when you dye your hair, you’re changing who you are, and I don’t think there’s anything wrong with that,” she told Cosmopolitan. Rather than hiding ourselves, as Saadawi argues, Kardashian asserts that the changes we make to our appearance actually create the self, and the manner of change—whether cosmetic or surgical or otherwise—is immaterial.
Then, of course, there’s Joan Rivers, the ur-example of a cosmetically enhanced woman. She once joked she’d had so much plastic surgery that when she died, her body would be donated to Tupperware, a nod to the notion that cosmetic enhancement makes one less human. “I wish I had a twin, so I could know what I’d look like without plastic surgery,” she famously said, suggesting that there exists some platonic, untouched version of herself. If that twin existed, would her unaltered form be a more “real” version of Joan Rivers than Joan Rivers herself?
On the most extreme end of the spectrum, there are full facial transplants, which are reserved for those whose faces have been severely disfigured by injury, disease, burns, or birth defects. The practice is “potentially deeply disturbing” for the patient as well as their loved ones, in the words of the UK’s National Health Service, as such a drastic change can upend one’s sense of identity. Research has shown, however, that after a period of many years, “identity and appearance merge.”
The most modern form of cosmetic enhancement doesn’t actually alter the body at all, but merely the way it appears to others. Filters, Photoshop, and Facetune offer people the option of making their digital image look exactly how they wish their corporeal form looked. Because this digitally enhanced version is so much more public and permanent than the actual human in the photo, it can often feel more real to its subject. I’ve certainly felt ugly after glimpsing myself in a mirror, only to upload a pretty photo of myself to Instagram, get positive feedback, and feel beautiful for the remainder of the day. The reality of our bodies, in these cases, can feel like an afterthought. We forget we have them, are surprised when they remind us of their existence with their hunger or thirst, their fatigue, their need to pee.
Some people think that the recent surge in plastic surgery can be attributed to how much time we’ve all spent looking at our own faces on computer screens over the past two years. It’s been called the “Zoom boom,” and is allegedly caused by people being unpleasantly surprised by how they appear on-screen. I can relate. In October, I conducted a virtual interview for an article and recorded it on Zoom. When I played the recording later to transcribe it, I was aghast; how had nobody told me about my disappearing upper lip? The next day, I made an appointment to get lip filler, my first cosmetic procedure.
This sense of surprise at my body’s appearance wasn’t exactly new to me. I’ve long felt disassociated from my body, caught off guard by unexpected reflective surfaces. Part of this can be chalked up to the body dysmorphia that accompanies my eating disorder: the photos of me at my skinniest are quite startling, even difficult to look at, and yet I know that I “felt fat” when the pictures were taken.
But it’s not just that. Sam Harris continually challenges the notion that we live “in our heads,” and I understand the point he’s making: there’s not some transcendent, independent “me” that hides out in my brain and steers my body around. But consciousness does originate in the brain, and for us mere mortals who haven’t yet reached ego transcendence, it’s difficult not to feel like your “self” lives behind your eyes, and, as a result, not to see your body as foreign. Eckhart Tolle wrote that “most people spend their entire lives imprisoned within the confines of their own thoughts.” As I go through my day, a rotating kaleidoscope of thoughts and emotions fill my mind, and I forget that my body exists. When I see it, it’s a shock.
My husband is 6’7″, and I’m 5’1″, yet I completely forget how physically small I am until I see photos of us together. In high school, I remember standing next to my best friend, looking at our reflections in the mirror, and losing the ability to see a distinction between our faces. “Don’t we look alike?” I asked, and she laughed at the notion. She was right, we did not look alike—she had long, straight blond hair, bright blue eyes, a round face and upturned nose; I had a wild mane of curly auburn hair, hazel eyes, my face narrow and nose long, all of it covered in freckles—but, I suppose, our minds were so aligned that I felt like we did.
So what, I wonder, does it feel like to look like yourself? I have spent hours scrutinizing my appearance in the mirror and yet, as I go about my day, I forget my body. The mental image of my face grows fuzzy; I cannot remember whether I like or don’t like my legs; I have no idea of the placement of moles on my arms.
My body often feels like an inscrutable nuisance, requiring my constant diligence to keep it in line, which I’ve done through starvation and surgery, pills and punctures, cosmetics and capsules. But there are fleeting moments when I grasp that I am my body, that there is no separate entity, and I wonder: is there some more true version of myself that I’ve been fighting against my whole life?
Humans have come a long way when it comes to our ability to improve and optimize bodies. Had I been born in a different era, it’s not unreasonable to imagine that I would be functionally blind, childless, in possession of a pitifully thin upper lip. Breaking my leg might have crippled me for life; my melanoma would have spread, spiderlike, across my back.
Martha Graham once said that “the body never lies.” But it can and it does. In a sense, my lips and eyesight are a lie. My body’s artificially induced ovulation is a lie, one so skilled that it tricked my body into producing a human. We can force our bodies to become untrue to themselves so that they can become whatever we’ve decided we want them to be.
In a sense, though, Graham is right. There are limitations to our ability to control our bodies. There are things we cannot obfuscate, cannot fix, cannot undo. Then there’s the body’s biggest trump card, the thing that haunts our existence and taunts us with our inability to prevent its inevitable arrival: death.
Indeed, as Titus Lucretius Carus put it sometime in the century before Christ was born, “Mind cannot arise alone without body, or apart from sinews and blood . . . you must admit, therefore, that when the body has perished, there is an end also of the spirit diffused through it.” No matter how I “improve” my body in the rest of my years, no matter how fervently I force it to bend to my desires through pharmaceutical or surgical or cosmetic interventions, that body is ultimately the one that calls the shots. My body decides when this is all over.
I’ve always been preoccupied with death. I’d interrogate my mom about it at bedtime when I was little, and still today the thought of its inevitability—for me and every person I love — causes me to break into a cold sweat in the middle of the night. I want desperately to believe that immortality is possible.
But my body is not only my anchor to this earthly life, it is me.
What, then, does it mean that I’ve actively transformed it in so many ways?
The thing about the filler in my lips is that it dissolves. Over the course of a year, my body will slowly metabolize the hyaluronic acid. By Thanksgiving, my lips will be restored to their original form. I’ll be the old me again.
Except, then again, I won’t. Maybe I’ll be pregnant. Maybe I’ll have gotten that Botox. My organs will all be a little older. And many of the cells that make up my body today will have been replaced by new ones.
Dr. Frisen, the man who discovered that the cells in our body die and are replaced every seven to ten years, also discovered something else. He discovered that not every cell in our body does this: a few, located in the cerebral cortex, endure from birth to death without renewal. Maybe this new information makes the notion of bodily identification more comprehensible. There are physical parts of me that have been there since day one, that have never changed, and perhaps they are where any sort of self resides. Perhaps “I” am that handful of cells in my prefrontal cortex.
But, of course, that’s absurd. Certainly I’m not a cluster of cells; certainly I am the entirety of my body as well as the intangible, mercurial consciousness that exists within. I identify equally with the new cells of my arms, my legs, my chest, my face—none of them more than ten years old, some much newer—as I do with that ancient cluster of cells in my brain. In the end, my body and I are one and the same regardless of the changes it has undergone.
But because it is mine, because it is me, does not mean that I understand it, or like it, or even recognize it. No matter how I change it, my body is both indistinguishable from me and a total mystery.
When I look in the mirror, I will both know that it’s me and be surprised. I will understand viscerally what it is like to be in my body—the fit of my pants, the fall of my hair on my cheeks, whether I’m full or hungry, the flutter of anxiety in my stomach, an eyelash in my eye—and yet I will also, undoubtedly, meet my own eyes with a fleeting moment of surprise. And this will be the case regardless of whether or not I re-up my Restylane in November.