About face: The affective and cultural history of face transplants

在英国，我们正处于一个关键时刻，面部移植在技术上是可行的，但还没有发生。自2005年以来，全世界只有不到50例面部移植手术，但它们的文化影响超过了它们的数量。脸是一个高度情绪化的、可见的器官，与身份、传承、交流和对美的感知有关（Bruce and Young, 2012）。由于经济和道德的原因，英国还没有进行过面部移植手术；2004年，英国皇家外科医学院暂停了手术，尽管手术在国际上越来越普遍，NHS认为手术是为了改善生命，而不是拯救生命（因此不是必不可少的）。但面部移植需要从更长远的角度来看待，不仅包括对毁容的心理和社会反应的历史，包括对毁容者的恐惧和厌恶，还包括医学创新被框架的记录（作为“弗兰肯斯坦科学”），扩展手术团队的情感体验，以及面部移植接受者和接受者/捐赠者家庭的情感体验。通过研究美国面部移植的历史和英国面部移植的发展趋势，该项目与外科医生及其扩展的医疗团队一起进行艺术和人文研究，以创建一个可用于支持伦理政策和临床实践的修订心理框架。因此，这一历史项目对人类健康和繁荣，以及外科创新的框架和理解方式具有关键意义。它将建立一个历史分析的证据基础，并对外科医生和受面部移植影响的人进行定性访谈，以显示情感和身份在历史上是如何以及为什么与面部联系在一起的。它将描绘出围绕面部移植的文化焦虑所揭示的对医疗创新的焦虑，以及个人与社会世界的互动。使用情感历史的框架来思考与面部移植相关的文化假设，作为一种“转化”行为，它将展示情感语言如何操纵面部移植的框架。例如，在使面部移植成为主流的过程中，已故捐赠者的家人和朋友被推到国际电视上，对他们所爱的人的脸的重新用途做出反应，故意给观众带来情感上的影响，显然不考虑制作人的道德责任，也不考虑心理和社会影响。对移植受者、供体家庭以及正在进行具有挑战性和改变生活的手术的外科团队的情感影响，实际上被忽视了。About Face将表明，面部移植本质上是一种情感手术，其情感影响需要纳入临床和政策讨论。从大众媒体到电影和书籍将面部移植描绘成可怕或怪异的前景，从确定合适的供体到术后患者的康复，情绪影响着面部移植的每个阶段。对接受者及其家庭的情感和社会影响在二手文献中是明确的，自20世纪50年代以来，心理学协议的出现暗示了这一点。是时候把这些放在舞台中央了。该项目将艺术、人文和社会科学研究人员与扩展的外科团队以及患有毁容的人聚集在一起，将创建一个框架，通过该框架，临床医生和政策制定者可以将面部移植作为一种情感和关注。因此，它将有助于构建和实践创新的外科实践和人类健康，在21世纪。

We are at a critical point in the UK where face transplants are technically viable, yet have not yet happened. Since 2005 there have been fewer than 50 face transplants across the world, yet their cultural impact outweighs their number. The face is a highly emotive, visible organ, connected to identity, inheritance, communication and perceptions of beauty (Bruce and Young 2012). No face transplant has yet happened in the UK for reasons that are financial as well as ethical; the Royal College of Surgeons placed a moratorium on them in 2004, though they have become increasingly common internationally, and the NHS views them as life-enhancing, rather than life-saving (and therefore not essential). But face transplants need to be viewed through a much longer lens that includes not only the history of psychological and social responses to disfigurement, including the horror and disgust shown towards disfigured people, but also the registers in which medical innovation have been framed (as 'Frankenstein science'), the emotional experiences of extended surgical teams, and the emotional experiences of face transplant recipients and recipient/donor families. By studying the history of face transplants in the US and the move towards face transplants in the UK, this project engages arts and humanities research with surgeons and their extended medical teams to create a revised psychological framework that can be used to support ethical policy and clinical practice.This historical project therefore has key implications for human health and flourishing, and the ways surgical innovation is framed and understood. It will build an evidence base of historical analysis and qualitative interviews with surgeons and people affected by face transplants, to show how and why emotion and identity has historically become attached to the face. It will chart what cultural anxieties around face transplants reveal about anxieties over medical innovation as well the interaction of the individual with the social world. Using a framework of emotion history to think through the cultural presumptions associated with face transplants as an act of 'transformation', it will show how emotion language manipulates the framing of face transplants. In the process of making face transplants mainstream, for instance, families and friends of dead donors have been wheeled out on international television to respond to the re-purposing of their loved one's faces, with deliberate emotional impact on viewers and apparently no regard for the ethical responsibilities of producers or the psychological and social effects. The emotional consequences for transplant recipients, as well as donor families, and extended surgical teams who are undertaking challenging and life-changing surgeries, have been virtually ignored.About Face will show that face transplants are inherently emotional procedures, and that their emotional impact needs to be incorporated into clinical and policy discussions. From their framing in popular media to films and books dealing with face transplants as a terrifying or freakish prospect, from the identification of a suitable donor to the rehabilitation of a post-operative patient, emotions impact on each stage of facial transplantation. The emotional and social effects on recipients and their families are clear in the secondary literature and implied in the emergence of psychological protocols since the 1950s. It is time to put these centre stage. Bringing together arts, humanities and social science researchers with extended surgical teams and people living with disfigurement, this project will create a framework by which clinicians and policy makers can engage with face transplants as an emotional and concern. It will thus contribute to the framing and practice of innovative surgical practice, and human health, in the 21st century.