This month?s theme is ?Natural?; the concept of ?natural? relative to human behaviour is as abstract as the concept of ?normal?- the latter being a cycle on the washing machine!

Society influenced by many sources defines and shapes these constructs. Over time what is initially viewed as unacceptable can become acceptable. For instance, tattoos in the 50s and 60s were associated with those on the edge of mainstream society, such as a spell at Her Majesty?s Service or hard-core criminal fraternities such as the Chinese Triad. Today it is a fashionable adornment for either gender, the body is a canvas, but you had better pray that your tattooist considers it as the Sistine chapel. Yes, a good tat looks spectacular on a firm twenty one year old body, but what about on the wrinkled body of a seventy year old? That once awesome dolphin you had tattooed on your hip as a youngster is going to look like a cod on the fishmongers slab next to the scar left by the hip replacement!

Society in part defines what is acceptable regarding physical appearance; additionally we have our personal value judgements that may correspond or conversely rebel against the ?norm?. Hence, ?beauty is in the eye of the beholder? – such a cliché among others such as ?beauty comes from within? and, ?it?s what?s inside that counts?. Expressions like these are no comfort for those who suffered at the hands of the schoolyard bully with shouts of ?beaky?, ?porky? or ?crater face?. There are a considerable number of people in their 30s, 40s and older who still suffer psychologically, at the hands of the bullies who shaped them into individuals low in self-esteem and poor self-identity, who can?t bear to look in the mirror. Some of these individuals go on to develop a range of anxiety/personality disorders, even becoming substance misusers through self medicating.

Over time, differing representations of supposed beauty emerge, from the buxom Pre-Raphaelites to the heroin chic of the Paris catwalk. Some women are so lacking in self-identity that if they think it?s fashionable to be stick thin they purge and take enough laxatives to keep any chemist in business and then have a set of silicon 34DDs stitched into their emaciated chest. Katy Price has had so many breast adjustments as has Pamela Anderson (role models for many young females) they might as well have a couple of zippers sewn in for ease and convenience.

Currently there is an unrealistic and distorted perception of the female form. A number of research studies found that young males and females considered ?Barbie? type proportions as the normal and natural female shape. This breast, waist and hip ratio when applied to the human physical frame is physically unreasonable, not that it?s deterred some American women who have elected to have a couple of ribs surgically removed and liposuction to emphasis their silicon DDs.

The strive for perfection or ?Barbieness? – ?I?m a Barbie girl in the Barbie world life in plastic, it?s fantastic? – has seen a growth in an enormous range of body modification procedures. There is a procedure for every part of the body, invasive and non-invasive. Hair extensions/transplant, chemical peels, skin bleaching, spray tan, Botox, silicone filler, dental veneers, breast/penis enhancement, liposuction, breast enlargement/reduction and buttock lift. Breast augmentation is the number one cosmetic surgery procedure, then rhinoplasty with the face-lift coming third.  Forty percent of individuals who?ve had one procedure will go on to have another at some point.

Facial cosmetic surgery is an industry in its own right, with full/semi face-lifts, rhinoplasty, brow lift, chin/cheek implants, upper/lower lid blepharoplasty, lip plumping etc. etc. If an individual has facial surgery, it is either to look more youthful or to alter a feature that causes emotional distress such as a large nose or a receding chin.

In moderation, for the psychologically stable, surgical modification is beneficial and can have a powerful positive effect increasing self-esteem and worth. Unfortunately, there is a growing trend where some individuals have pushed modification to new realms – the realm of self-mutilation. These include Michael Jackson, Dennis Avner, Jocelyn Wildenstein aka ?The bride of Wildenstein?, Pete Burns, et al.  If beauty is in the eye of the beholder, their cosmetic surgeons must have done a hell of a lot of acid at med school. There is a high probability that these ?lusus naturae? – self-made freaks, have a personality disorder where as ?pre-opts? they felt so psychologically detached from society they converted their internal often unconscious psychological feelings into an external expression of their physical appearance. For some it is ?you don?t accept me now, so if I change you will accept me?.   Cosmetic surgery to them is the answer when the real change needed is in the mind and that takes time and dedication.  The result is only to be disappointed post op and so look to further surgery to provide a solution. For others it is a case of two fingers up to the world, ?you don?t accept me so I?ll give you a concrete reason for not accepting me?, this goes a long way to relieving their anxiety, as they then have a  concrete reason for not being accepted.

What about the ?Barbies? who nip and tuck as often as they visit the hair salon? Some will have body dysmorphic disorder (BDD) which is a preoccupation with a slight or imagined defect with some aspect of physical appearance. One to two percent of the population suffer with BDD. Disorder behaviours include mirror checking or mirror avoidance, avoidance of bright lights, heavy use of cosmetics, hair grooming, skin picking, physician visits, and social avoidance. Distress over BDD may lead patients to undergo repeated cosmetic surgeries in futile attempts to conceal or correct perceived defects. Psychologically BDD is related to anxiety disorders, depression and alcohol/substance misuse.

Although it is a cliché, there is a lot of sense in the expression that beauty comes from within; although there is nothing wrong with modification in moderation and for the right reasons, it is not a panacea for someone who feels unloved, misunderstood or unattractive on the inside. In the short term, it might fill a void; get you attention when clubbing in a skimpy top but not for long if there is nothing inside of spiritual value to give the other person. Excessive cosmetic surgery is always about self worth and esteem.  It?s a shame our first impressions are based on physical attractiveness and we ignore the natural beauty and wonder of what its like to be truly human, possibly not perfect but natural.