Author Richard Powers

DATE December 12, 2006 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Richard Powers talks about his book "The Echo Maker,"
identity, the enforced continuity of consciousness, and using
voice recognition software instead of typing his book
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest Richard Powers won the National Book Award for fiction last month for
his novel "The Echo Maker." Before he started writing books, he studied
science. And his knowledge of science, medicine and computers is apparent in
his novels like "The Gold Bug Variations," "Operation Wandering Soul" and
"Galatea 2.2." "The Echo Maker" is about the mysteries of consciousness and
identity and draws on the discoveries of neuroscience. As the book opens, a
27-year-old man is lying in a coma after surviving a car accident and his
sister's on her way to see him in the hospital. She watches over him as he
emerges from the coma and slowly seems to become more like his old self. But
something has gone wrong in his brain. He thinks his sister is really an
imposter.

Richard Powers, welcome to FRESH AIR and congratulations on the National Book
Award. I'd like you to start with a reading from your new book "The Echo
Maker." Would you just set it up for us?

Mr. RICHARD POWERS: In this passage Karin Schluter, who has returned to the
hometown that she spent her life trying to escape, is nursing her brother back
from a very severe car accident, and he has come back a great part of the way
from a full coma, but as she discovers in this passage, and continues to
discover, he's not coming back quite as the brother that he was before the
accident. So this passage is vocalized through Karin.

"He talked more than he had before the accident. He swung from bouts of rage
into a sweetness he'd lost at the age of eight. She told him the doctors
wanted to move him out of the hospital. Mark glowed. He thought he was going
home. `Can you tell my sister I've got the green light'? Tell her Mark
Schluter's out of here. Whatever's been holding her up, she'll know where to
find me.' She bit her lip and refused even to nod.

She'd read in one of Daniel's neurology books never to humor delusions.
`She'll be worried about me. Man, you have to promise me. Wherever she's
gone, she needs to know what's happening. She was, like, always looking after
me. That's her big thing. Personal claim to fame. Saved my life once. My
father came this close to snapping my neck like a pencil. I'll tell you about
it someday. Personal stuff. Trust me, I'd be dead without my sister.'

It tore her up to look on and say nothing, and yet she felt a sick fascination
at the chance to learn what Mark really said about her when talking to someone
else. She could survive this for however long it took him to come back to
reason. And his reason was solidifying daily.

`Maybe they're keeping her away from me. Why won't they let me talk to her?
Am I somebody's science project? They want to see if I'll mistake you for
her?' He saw her distress but mistook it for indignation. `Hey, OK, you've
helped me, too, in your own way. You're here every day, walking, reading,
whatever. I don't know what you want, but I'm the grateful recipe.'

`Recipient,' she said.

He stared at her, baffled. `You said "recipe." You mean recipient.' He
scowled.

`I was using the singular. You look a lot like her, you know. Maybe not
quite as pretty, but damn close.'"

GROSS: That's Richard Powers reading an excerpt of his novel "The Echo
Maker."

Richard, tell us a little bit about the neurological disorder that's
responsible for the character--you know, for the brother not being able to
recognize his sister and thinking that she's impersonating his sister.

Mr. POWERS: The disorder is called "Capgras syndrome." It's one of a family
of misidentification syndromes, and in Capgras the sufferer looks on upon
people close to him as somehow substitutions. And the--its--disorder's
remarkable because it's very selective. The sufferer has no problems with
neighbors or colleagues or even friends. But those people who he's most
intimate with emotionally, those people he loves, he refuses to accept. He
says, `They look like my family, they sound like my family, they act like my
family, but they're imposters. They've been substituted. They're government
agents or they're aliens.'

GROSS: Is there any neurological explanation for why the syndrome only
affects people whom you're very close to?

Mr. POWERS: The prevailing suggestion is that when we make a recognition,
there are at least three regions of the brain that are involved. And one does
the actual pattern matching, you know, color of hair, width of eyes, length of
face. And this is extremely precise. We have very specialized circuits in
place for recognizing faces. Of course, there's the portion of the brain
that's responsible for memory association. So once you make a face
recognition, there's a whole slew of memory traces and associations that are
released by that face.

And in the Capgras sufferer, both of those are intact and they're both still
speaking to each other, both of those regions. What's missing is what the
rest of us still have, namely a very low level area of the brain called the
amygdala, which is responsible for deep-seated emotions, you know, very primal
hope and fear. And in the Capgras sufferer, this simply isn't somehow
in--triggered, or in communication with these other two areas when a facial
recognition is made. So in a sense the sufferer looks at someone and says,
`This looks like my sister, dresses like my sister, sounds like my sister,
acts like my sister, but just doesn't feel like my sister.'

GROSS: You know, in reading your book and in reading about this rare
neurological disorder in which you believe that your loved ones are really
imposters, it made me think about movies like "Invasion of the Body Snatchers"
and "Invaders from Mars." Now in those movies, the people really are
imposters.

Mr. POWERS: Right. Right.

GROSS: They're science fiction films with, like, elaborate metaphors within
them. But I was wondering if you were thinking about that, too. This seems
to be an almost like archetypal fear.

Mr. POWERS: In fact, the neurologists and neuroscientists who write about
Capgras often mention those kinds of narratives, those films. And I guess it
is a deep-seated fear. And I think it's because even those of us who haven't
experienced full-fledged Capgras, either as a sufferer or, you know, as a
witness to one, must somehow sense that that capacity, that decoupling of
intellectual recognition and emotional recognition, is in us. And in fact,
Capgras may just be an extreme case of the kinds of things that any one of us
could experience in a temporary or attenuated way.

I mean, the most obvious example is, you know, who of us hasn't sworn undying
love for someone and incredibly intimate and sort of profound self-shaking
connection to a loved one, and then after some passage of time, a change in
events, say, `No, I actually, I was wrong. I don't feel connected to that
person at all.' We're all completely capable of renarrating ourselves and...

GROSS: No, no, and what you say in that situation is, `You're not the person
I once knew. You're not the person I fell in love with.'

Mr. POWERS: Yeah.

GROSS: `You're not my real mother.' Whatever. Yeah.

Mr. POWERS: Something happened--right. Something happened to you.

GROSS: Something happened to you, yeah.

Mr. POWERS: Yeah, yeah.

GROSS: Now...

Mr. POWERS: And we change our story. You know, the self is an incredibly
ingenious novelist and is constantly revising its sense of continuity and
wholeness.

GROSS: What you just said about the self being a novelist, I imagine this is
one of the reasons why, as a novelist, you're interested in exploring this
neurological disorder, because it changes the sense of self and your idea of
the people around you. And of course, as a novelist, you're creating selves,
lots of them.

Mr. POWERS: That's right. That's right. It was almost inevitable, I think,
that I would want to write about these disorders and the deep neurology of
narrative at some point. This book is, in some ways, I conceived of it as a
neurological mystery story which, in some ways, might almost be a redundancy,
right? That the brain itself is a kind of mystery story.

But the link, of course, is that the processes in the brain are held together
by narrative. We report to ourselves, you know, when we think about our
identity, who we are, we present ourselves to ourselves as continuous and
stable and whole and, you know, the same person we were 10 years ago. And
completely understandable in a kind of Aristotlean, you know, sense of
wholeness and, you know, that our lives have a comprehensible beginning,
middle and end and it's all very clean.

And in fact, the self is just kind of a late-day addition to this incredibly
noisy parliament of hundreds of parts in the brain, and it's only by very
fancy footwork and an insistence on narrative logic that we can hold together
these, you know, two or 300 parts and present it to the world as a solid and a
single thing.

GROSS: Now, there's a neurologist in your book who investigates this case and
examines the character, the character of Mark. And this is a doctor who seems
to be inspired by Dr. Oliver Sacks, the famous neurologist who has written
many books of case studies, the case studies of his own patients. It sounds
like you want to interrupt me here.

Mr. POWERS: Well, I was just going to say for purposes of legal protection,
I should probably say...

GROSS: I knew you were going to say that. Right.

Mr. POWERS: ...that his--that Dr. Weber's work in the book probably very
closely resembles the kind of work that Sacks does, but as a human being, of
course, he draws nothing on the life of Sacks. In fact, the work of the
neurologist Gerald Weber in the book is a real composite of 10 or 11 different
neurologists, all of whom have done amazing and incredibly fascinating work in
documenting neuropsychology over the last 20 or 30 years. All the ways that
the brain can go wrong. And of course for somebody who's devoted his life to
really looking under the hood and seeing what can happen down there in this
noisy kind of seething network of parts, the self can become very unstable
just by virtue of the intellectual knowledge of how unreliable the self is.

GROSS: Yeah, he says--I like this phrase a lot--you have him say that this
case is a chance to see just how "treacherous the logic of consciousness" was.

Mr. POWERS: Yeah. The old unreliable first-person narrator again. What
happens, I guess, in the story is that because, you know, Mark has been so
radically transformed but can't see that it's he that's different and not the
world, his sister has to come and take care of him and be near him and attempt
to fulfill her sense of self, which is as the good sister to the bad brother.

But the problem for Karin, of course, is that her sense of self depends upon
being ratified by her brother in this role that she's given herself: the
protector, the caretaker. So when Mark comes out of his disastrous close head
trauma and says, `You're not my sister,' Karin has to ask herself the
question, `Well, then who am I?' She calls the neurologist, Dr. Weber, and
interests him in this rare and strange case. She catches him at a moment in
his life where his own self narration, that of an empathetic and a careful of
examiner of people who haven't been given voice and a kind of presenter of
these people to the broader public, has come under fire. The public, in a
way, who has embraced his earlier books has now turned on him in saying, `This
isn't empathy; this is exploitation.' And he suddenly is challenged to make a
more profound empathetic connection to his patients just to prove that his own
sense of self is intact.

GROSS: My guest is Richard Powers. His latest novel "The Echo Maker" won the
National Book Award for fiction last month. We'll talk more after a break.
This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Richard Powers and his latest
novel, "The Echo Maker," won a National Book Award for fiction in November.

Now, you studied the sciences before you started writing fiction. What got
you to switch from science to literature?

Mr. POWERS: That's a good question. I guess it was a kind of intellectual
claustrophobia. And when I was young, I was always certain that I would be a
scientist, but I couldn't decide which science, you know? One week it was
geology and the next week it was oceanography and the week after that it was
chemistry. And also, you know, I really loved music and I loved history and
so forth. So when it really came time to specialize and do what we all have
to do, namely close all the doors but one, I really panicked. I started
school, university, as a physics major with the idea that somehow physics, as
a kind of fundamental discipline, would give me that aerial view where I could
somehow connect all these other interests and keep them alive through my own
specialized study. And in fact that wasn't the case. The farther along I
went in physics, the more I realized that advancement in the field would
really require specialization to the point where I might not even understand
the physics that my, you know, the next office down was doing in the same
department.

So I think it was at that point that I located--I guess recovered, in a sense,
an old love of reading and thought that perhaps literature, as this sort of
universal conversation about who we are and how we know the world, might be
the place to keep that generalist spirit alive. A novel can treat physics.
It can treat chemistry and can treat history, and in fact, my nine novels have
been forays into all of those other disciplines that, at one moment or another
in my life, I thought I might pursue.

So it's an incredibly lucky choice for me. I feel, I wake up every day
thinking, `How am I getting away with this?' I'm actually able to do all these
road-not-takens and live, at least for two or three or four years,
vicariously, lives that I had to close the door to long ago.

GROSS: Now, I've read that you've been using computers since the 1970s, since
like the mid-`70s. Is that about right? Earlier than that?

Mr. POWERS: That's right. Maybe a little earlier. I got my first personal
computer in `77, so that was about the time they were really first appearing
as commercially available products.

GROSS: And you've written computer related themes in your fiction.

Mr. POWERS: Yeah.

GROSS: But on the other hand, like this new book, apparently, instead of
sitting at a computer and typing the words onto the page, you used voice
recognition software so you could speak the words into the computer.

Mr. POWERS: Mm. That's right.

GROSS: I found that kind of interesting. I don't know, speaking for
myself--not that I'm a writer, but I do have to write things--but I find like
it almost uses a different part of my brain to write than to speak, and I'm
not sure that that's a bad thing, because there's a certain carefulness you
want in your writing that is impossible to get in your speaking, and you feel
like if somebody's reading you that you owe them. You know what I mean?

Mr. POWERS: Mm.

GROSS: You owe them a more careful and considered and perfected language.
That is, I think, probably easier to get in a writing kind of mode. And I
really wanted to hear your thoughts about that.

Mr. POWERS: Yeah. Well, you've put your finger on it. Typing and speaking
are two completely different neurological activities. Both are very
complicated, both are going to invoke--each one's going to invoke very
different combinations of regions of the brain. And we put tremendous amount
of effort into learning how to type and learning how to compose and type at
the same time. It's, however, a highly artificial interface and extremely
unnatural. You know, it's a little bit like a dog walking on its hind legs.
And there are many things that you can't do when composing and typing at the
same time. If you've ever tried to talk to somebody who's typing, you can see
just how fully engaging the act of pressing out one letter at a time on a
keyboard is.

For me, the great advantage of speaking over typing is it puts me in touch
with longer phrases. It allows me to think in terms of the music of the
prose. I'm not constantly interrupting my memory to change from inventing a
clause and then keying it in letter by letter, which is the exact opposite of
sense and sound. Rather, I can hear my characters speak; I can hear the
rhythm and the meaning of the passage that I'm working on. I can flow more
smoothly directly from memory to composition. And, of course, I can always go
back and edit and do the kind of careful massaging that you're talking about.
The first spoken draft is just the beginning.

But here's an example: When you write, if you're like a lot of writers, you
will read that passage aloud at some point, either to someone else or to
yourself. Flaubert, for instance, is great about, you know, he had this place
that he would go to and he would yell out his sentences as a way of testing
their authenticity and testing their music. And that's because when we read,
we subvocalize. And we hear sentences and paragraphs as oral phenomena. And
much of the meaning of the passage comes about through the sound. So for me,
being able to hear the sound during composing puts me in greater proximity to
the way that this sentence is going to mean in the mind of the reader.

GROSS: Richard Powers' latest novel "The Echo Maker" won the National Book
Award for fiction last month. He'll be back in the second half of the show.
I'm Terry Gross and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross back with Richard Powers. His
novel "The Echo Maker" won the National Book Award for fiction last month.
It's about a man who emerges from a coma with a rare neurological disorder.
Powers' novel draws on his background in science and computers. When we left
off, he was describing how he wrote "The Echo Maker" using voice recognition
software so that he could compose his novel by speaking instead of typing.

OK, so you spoke your book with voice recognition software into your computer.
At the same time, I understand that you didn't speak for a year when you were
younger.

Mr. POWERS: Yeah. Well...

GROSS: When was that and why?

Mr. POWERS: That was actually in 1998. I was living way out on the north
shore of Long Island. And it was partly self-imposed. I wanted to put myself
into a new state of consciousness for writing a very different kind of book.
It was the book "Plowing the Dark," which involved, in part, the experience of
a hostage in Beirut in the late `80s. And I guess the idea in part was to,
again, do a kind of vicarious empathetic--to the extent possible--recreation
of the consciousness of what happens to us when we're that isolated and we
don't have this network of people to see and connect to and to ratify
ourselves against. I think, also, it was just as an experiment as a writer to
see what would happen to my prose after that degree of isolation. It was a
way of refreshing, I think, and reinventing myself as a writer.

GROSS: So during the period when you weren't speaking, like, when you were
out in the street and people weren't close enough to you, you know, didn't
know you well enough to know that you had decided not to speak for a certain
amount of time, what did you do when people would ask you something? I mean,
you weren't carrying a sign saying, `Sorry, guys, I'm mute this year'? I
mean--yeah...

Mr. POWERS: No, that's right. I couldn't, you know, I couldn't actually do
the experiment as completely as I would've wanted.

GROSS: Oh, I see.

Mr. POWERS: You know, I still had to go shopping. You know, and I still had
to buy my groceries. And when the cashiers said, `How you doing?' you know,
I...

GROSS: Right.

Mr. POWERS: At that point, you know, what was really interesting in
its--`How are you doing?' and there I would be stuttering and stammering, you
know, to try and remember how I was doing. Yeah, those minor interruptions,
actually, and the amount of limited social contact that I did have during that
time period, was always intensified because of that background of silence and
the awareness that after this interaction I would be going back into the cave.

GROSS: You know, in your novel you're using this neurological disorder to
help you explore the question `What give us our sense of self and what are
some of the ways that that can go wrong?' When you were 11, your family moved
to Bangkok, Thailand...

Mr. POWERS: Mm-hmm.

GROSS: ...because your father became the principal of the international
school of Bangkok. How did it change your sense of self when, as an
11-year-old, when your sense of self is still being formed, you were suddenly
in a, you know, in a country in a very different part of the world?

Mr. POWERS: Yeah. I think on that, and I think that really was the
transforming event in my life. At 11, you know, the brain is so plastic still
before puberty. We moved to Bangkok and within six months I was speaking Thai
just from being out on the street, you know, without any formal study. You
know, when you have a new immersive experience when you're young, you're
completely capable, you know, chameleon-like, of just changing and taking on
this alter ego. The real culture shock, for me, happened when I came back to
the United States at 16. You know, I thought I knew this place and I thought
it was my country and my culture. And in fact those years away, of being in
another country, you know, speaking another language, and living a very
different kind of life, made it a weirdly estranging experience, you know.
Talk about misidentification syndromes, you know? Here I was back in the
Midwest, back in suburban Chicago, and simultaneously recognizing my native
country and feeling very much estranged and outsided.

And I think that's the kind of prototype experience that creates the narrative
imagination, when you're both in your life and sitting on your own shoulder
looking at it as if you're an outsider. That kind of double existence, I
think, really was instrumental in me in setting up a kind of sensibility that
was invaluable later on in telling stories.

GROSS: You know, that sense that you were describing of, like, of living life
but also kind of sitting on your shoulder watching yourself live your life.

Mr. POWERS: Mm. Yeah.

GROSS: It's kind of like the writer's position, in some ways, because you're
doing it and then you're standing back and observing and reporting to yourself
what it is...

Mr. POWERS: Yep, yeah. Absolutely the writer's position.

GROSS: ...you've done. Yeah, so, OK, it's the writer's position. But it's
not a very comfortable position when you're not writing, I don't think. I
mean, how do...

Mr. POWERS: Oh.

GROSS: ...how do you like that feeling of standing outside yourself and
watching yourself?

Mr. POWERS: Well, you know, it's interesting because, in a way, that's the
condition that I tried to create in Dr. Weber in the book. He
simultaneously...

GROSS: This is the neurologist.

Mr. POWERS: That's right, the neurologist who's been called in to study
Mark. His wife, for instance, teases him he has become well known as a
popularizer of neuropsychology and she refers to the role that he plays in
public as "famous Gerald." And so Weber simultaneously, you know, doing his
science and doing his writing, but aware of the degree to which he is
performing this other person. So again, it was, for me it was a pleasure to
kind of vicariously inhabit somebody who suffers from the writer's ailment,
never entirely both feet inside the experience, but aware--recursively
aware--of the degree to which they are performing themselves.

And you're absolutely right. When you can't do that, when you can't somehow
move back and forth from the world of experience to the world of imagination
and a world of representation, a sense of vertigo and disorientation does
result, which is why, I think, you scratch a writer and you're going to find a
compulsive inventor. You know, someone who, if he or she isn't writing for a
couple of days, is bound to descend pretty quickly into erratic behavior.

GROSS: Well, Richard Powers, thanks so much for talking with us. And again,
congratulations on the National Book Award.

Mr. POWERS: Thank you so much, Terry.

GROSS: Richard Powers' latest novel, "The Echo Maker," won the National Book
Award for fiction last month.

Coming up, we talk with Alex Kuczynski about her book "Beauty Junkies," a look
at the cosmetic surgery industry by a reporter who's had several procedures
herself. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Alex Kuczynski talks about her book "Beauty Junkies,"
the reasons behind the rise of cosmetic surgeons and surgeries
for younger people, and her own experiences under the canula
TERRY GROSS, host:

In the hopes of looking more attractive and youthful, more Americans are
having their noses done, faces lifted, foreheads Botoxed, buttocks
liposuctioned and breasts augmented. Between 2003 and 2004 alone, there was a
44 percent increase in the total number of cosmetic surgery procedures,
according to the new book "Beauty Junkies." This examination of the cosmetic
surgery industry was written by Alex Kuczynski, a reporter for The New York
Times style section. Her book is part journalism, part memoir. She's had
several procedures herself.

Let's start with you just running through a list of some of the procedures
you've had done.

Ms. ALEX KUCZYNSKI: I had been a long-time user of Botox, I would say from
the age of 27 to 37. I'm now 38. I had my congenitally-puffy upper eyelids
nipped and tucked into my eyelids so that they are a lot--my eyes are a lot
brighter. I had a little liposuction on my posterior. I dabbled in collagen
to fill in folds in my face that're referred to as nasolabial folds. And then
I had one disastrous encounter with another filler that caused my upper lip to
grow to the size of a yam. And this happened, unfortunately, while I was on
the way to the funeral reception of one of my best friends, which is--he would
laugh about it. At the time, I wasn't laughing about it.

GROSS: Why did you get so much work done?

Ms. KUCZYNSKI: I have been writing about the subject of cosmetic surgery and
the advances in dermatology since I was at the New York Observer, which was
many, many years ago. And I've been at The New York Times for nine years now.
And I'd began to find the subject really fascinating. And in 2002, I wrote a
piece about how Botox was about to be approved by the Food and Drug
Administration for use to treat what dermatologists called the 11s, which are
those lines, the glabellar lines between your eyebrows that look like the
number 11. And the story appeared on the front page. And I got about 150
letters and e-mails from readers, half of whom were completely outraged, and
half of whom were really eager to know where they could get their hands on
this stuff. And I was fascinated by the reader response to that piece. I
mean, these were New York Times readers, so this was not a group of people I
sort of expected to go gaga about, you know, wrinkle treatments.

And then I continued to write about the subject, and wrote about deaths at the
Manhattan Eye, Ear and Throat Hospital during plastic surgical procedures. I
wrote about a doctor in Florida who, you know, basically paralyzed and almost
killed people by using his own sort of mixture of horse-grade, you know,
medical botulinum toxin A to treat them with Botox. I went--yes, sorry, I...

GROSS: You're underscoring here a lot of things that have gone wrong, so why
did you want to do these things to yourself?

Ms. KUCZYNSKI: Well, you know, the doctors I visited for my procedures--and
I really only received treatment from one doctor, a woman in New York who's a
plastic surgeon and a member of the American Board of Plastic Surgery, which
is the only legitimate board concerning these doctors. And she is, you know,
was very safe and very judicious with me, and I would suggest, you know, I
would point to my neck and say, `God, I've got rings around my neck like a
tree,' you know? `Can you get rid of those?' And she would say, `Are you
crazy? You're 32 years old,' you know? `We're not doing that.' And she would
send me away and say, `No. No, no, no.'

But every time I interviewed a plastic surgeon or a dermatologist about one of
these other stories, I would always at the end of the interview say, `So if
you were me, what's the one thing you would do?' And they would all reach out
and with the soft nub of their eraser at the end of their pencil they would
pick up my upper eyelids and say, `Definitely bilateral upper bleph,' meaning,
you know, bilateral upper blepharoplasty, which is an upper eyelift.

GROSS: That's really setting yourself up, though, to go to a plastic surgeon
and say, `What would you fix about me?' It's...

Ms. KUCZYNSKI: Well, I know, I know, I mean, because everyone--I mean, in
the eyes of a plastic surgeon, there's something fixable on everyone. Yeah.

GROSS: Now you mentioned that you first started getting Botox treatments when
you were 27. And in that sense...

Ms. KUCZYNSKI: Right.

GROSS: ...you are representative of a new trend in cosmetic surgery, because
the way you describe it, more and more younger people--people in their
20s--are electing to have cosmetic surgery. What do you think accounts for
that?

Ms. KUCZYNSKI: Well, plastic surgeons and cosmetic surgeons are--and
dermatologists--are very heavily pressing upon younger people the notion of
prophylactic dermatology and prophylactic cosmetic surgery. You know, if you
use the Botox now at 27, 28, 29, you won't form wrinkles necessarily that
we'll have to treat later. And I think they do this for a lot of reasons. I
mean, it's kind of a feeder system of plastic surgery, you know? If you're
doing something in your 20s and feel comfortable with it, you'll return in
your 30s, your 40s, your 50s, your 60s.

You know, the old model was that, you know, 65-year-old woman would show up
and have a face-lift. Or a porn star would show up and have her boobs
augmented. But that's a very old model now. And the new model is to
encourage younger people to do things and to encourage boomers to do things.
So you have a really kind of explosive growth in the entire industry, because
people from, you know, both ends of the age population are, you know, sort of
rushing towards this.

GROSS: One of the things I really wonder about plastic surgery is the
pain--know, even procedures that sound kind of minor have risk and have pain
afterwards. And it just strikes me that people now are willing to take so
much medical risk and subject themselves to so much pain just in the hopes
they're going to look better and be more attractive to other people.

Ms. KUCZYNSKI: Mm-hmm. It's--I must tell you, I mean, of the two surgical
procedures I had, having liposuction was extremely painful. I wasn't prepared
for the pain. And I wasn't prepared for the shame of it, either. I felt
really guilty about it because it costs several thousand dollars. And that's
money that could've gone to something a lot better. And it was extremely
painful.

GROSS: Would you describe the procedure? Just give us a basic overview of
it?

Ms. KUCZYNSKI: Well, you know, the surgeon puts you under--and I remember
being very surprised that they positioned me on the operating table face-down,
because I thought, well, you know, I should be like Debra Winger in "Terms of
Endearment," you know, sort of supine on a bed looking upward, or like in an
episode of "ER." But of course, you know, they needed the work site, you know,
at hand, which was my posterior. So I was face-down. The surgeon--the
anaesthesiologist--puts you under. The surgeon takes a canula, which is
something that looks like a knitting needle, but with a hole at the end, and
that's attached to a vacuum device, and then entering in just one hole in
your, let's say right buttock, suctions away fat.

And in my case it wasn't a huge quantity of fat, but my plastic surgeon did
tell me on days that she has a lot of liposuction surgeries scheduled, she
never goes to the gym because she works with such vigor and such intensity and
such brutality on the body that she burns thousands of calories. And I
thought, `My god, I can't believe, you know, you're doing this with such force
that you actually--you're burning calories by doing this.' It's not a delicate
procedure by any means.

GROSS: You say you think one of the reasons why the cosmetic surgery industry
is flourishing is because of the manner in which we pay for health care.
What's the connection between health insurance and the cosmetic surgery
industry flourishing?

Ms. KUCZYNSKI: Well, what's, you know, what's fascinating is that, you know,
in the early `90s, the health care industry was restructured in terms of
insurance, and you had the rise of the HMO. A lot of doctors have decided
they hate dealing with what's become an increasingly complex insurance
reimbursement plan. So if you have an MD, you can practice cosmetic--you can
call yourself a cosmetic surgeon. You know, a gastroenterologist can take a
weekend seminar in liposuction and say `I'm a cosmetic surgeon now.' It
doesn't go the other way. You know, a gastroenterologist can't say, `Hm, I
think I'll just do cataract surgery now.' Well, he's not certified to do that.
So no insurance company will pay him to do that. But, on the other hand, you
know, cosmetic surgery is paid over the counter, it's cash up front. So there
is no insurance hassle. My--I mean, god, I've met heart surgeons who quit
heart surgery to become cosmetic surgeons. And they're not members of the
American Board of Plastic Surgery, but they are, you know, perfectly good
doctors.

GROSS: My guest is Alex Kuczynski. Her new book about the cosmetic surgery
industry is called "Beauty Junkies." We'll talk more after a break. This is
FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Alex Kuczynski and she writes
for the Thursday style section of The New York Times. She has a new book
about cosmetic surgery that's called "Beauty Junkies."

Don't take this the wrong way. I don't mean this as like a personal affront
or anything, but do you ever feel like a fake because you know part of your
face and part of your body were sculpted by surgeons, and that they're not
what is naturally yours?

Ms. KUCZYNSKI: Yeah. Well, that's interesting, and I don't take affront to
that. Do I feel like a fake? I would imagine, I think my most honest answer
would be yes, I feel part of me is fake. My eyelids are fake. And yet in,
you know, in every reality show and with every patient I interviewed, people
uniformly responded, `I don't feel like a fake; I feel more like the real me,
the real me that God intended me to be.' People really fixate on this notion
of what they want to look like and fasten upon that as this ideal. And when
they get there, they think, `This is the real me. Because the real me is not
wrinkled and old looking. The real me doesn't have saggy breasts. The real
me doesn't have a droopy rear end. The real me has perky breasts and bright
eyes and big, white teeth. And the real me looks young and hopeful.' And
there is--people cannot abandon that notion of the real me. I mean, I think I
will be the only person on the planet who's had cosmetic surgery who will say,
`Yes, I feel part of me is fake,' but not that much of me is fake so I don't
feel too bad about it.

GROSS: You know, as we said, one of the procedures that you had done was you
got your lips poofed.

Ms. KUCZYNSKI: Yes.

GROSS: And you had real trouble with that afterwards. What were, like, what
is the procedure and what were the problems you ran into?

Ms. KUCZYNSKI: Well, it was something that I had read about. It was a
filler that is made of Hyaluronic acid, a form of synthetic Hyaluronic acid.
Hyaluronic acid is the kind of--it's an acid that is--it's a substance that is
found in rooster combs. It's a kind of gelatinous substance that had
previously been used to treat athletes, you know, to make their joints better
lubricated. And a company hit upon the idea that it could be used in a
synthetic form to plump up lips or, again, the ever-deepening nasolabial folds
of the human face, you know, or acne scars, or what have you.

And I'd never tried it, and I again went to my plastic surgeon and I said, `I
want to try this,' and she said, `You really don't need it; your lips are
fine.' And I actually look at my lips today and I think, `Why would I ever
have thought to put something in my lips?' And the substance had been approved
for use in the face but not in the lips. It's perfectly legal to use
substances in what the FDA calls an off-label manner. You know, if it's been
approved by the FDA for one use, doctors are able to use it to address another
issue, you know. So we--I said, `Let's try it in my lips; it should work
really well.'

Anyway, long story short, it turns out that patients who, you know, are
sensitive in the lip area, you know, should take steroids for several days
before having this substance put in the lip area. And so I--my lip swelled up
to the size of a yam. And my doctor put me on steroids and sent me home with
steroid cream, and I couldn't leave the house for four days. And then finally
when my lip returned to sort of a semi-normal lip, the skin, which had been
stretched so tight, fell off in little thin slivers over the course of about a
week. And it was really, you know, a horrifying experience.

GROSS: And how do your lips look now?

Ms. KUCZYNSKI: Well, they're normal. I haven't done anything to them since
that, and that was three years ago.

GROSS: But you still have the stuff in there? You didn't get it taken out?

Ms. KUCZYNSKI: Well, no, the stuff is eventually absorbed by the body, so...

GROSS: OK.

Ms. KUCZYNSKI: ...it's something like Botox or collagen. You know, I've had
collagen a couple of times. I've had fascia, which is a form of collagen
derived from cadavers, you know, also put into my face. This is many years
ago. And that, it is absorbed by the body.

GROSS: May I just interject a `Wow' in there.

Ms. KUCZYNSKI: Yeah. Yeah. Oh, the cadavers?

GROSS: The cadavers, yeah, wow. So what was the moral of the story when your
lips kind of poofed to the size of a yam?

Ms. KUCZYNSKI: Well, I mean, the moral was, I, you know, I looked skyward
and said, `I am a jerk, you know, I have hit rock bottom.' Because I had kept
the appointment. I'd gone to the funeral of a very close friend of mine and
there was a reception afterwards, and I'd thought, well, you know, we were
going to make some remarks there, and somebody said, `You should stand up and
make a toast;' I said, `Fine, I will, but on my way, I'm just going to stop in
at the doctor's because I have this appointment and I really don't want to
miss it and I really don't want to miss it, and by the way I'll look really
great by the time I get to the funeral reception.'

So of course I couldn't go, and, you know, I thought of my friend Jerry, you
know, staring down at me--or up at me--from wherever he was, and I thought,
`Jerry would say to me, "You're a complete and total and utter jerk, and I
can't ever believe you were my friend, and I hope you write about this so
people realize what a fool you were."'

GROSS: So would you ever do--get anything on your face done again?

Ms. KUCZYNSKI: My immediate answer is no, and I hope never to have to ever
again. I'll never say never.

GROSS: Right.

Ms. KUCZYNSKI: I'll never get breast implants, but, I mean, hopefully I'll
never have breast cancer and have a reconstruction, but hopefully I'll never
have anything done on my face again.

GROSS: Well, Alex Kuczynski, thank you very much for talking with us.

Ms. KUCZYNSKI: Thank you so much.

GROSS: Alex Kuczynski reports for The New York Times style section. Her new
book is called "Beauty Junkies."

(Credits)

GROSS: I'm Terry Gross.
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