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In a chapter of Jennifer Egan’s A Visit from the Goon Squad that takes the form of a celebrity profile gone terribly wrong, a magazine writer rhapsodizes over the perfect complexion of his nineteen-year-old movie-star subject, Kitty Jackson:

Because Kitty is so young and well nourished, so sheltered from the gratuitous cruelty of others, so unaware as yet that she will reach middle age and die (possibly alone), because she has not yet disappointed herself, merely startled herself and the world with her own premature accomplishments, Kitty’s skin—that smooth, plump, sweetly fragrant sac upon which life scrawls the record of our failures and exhaustion—is perfect. And by “perfect” I mean that nothing hangs or sags or snaps or wrinkles or ripples or bunches—I mean that her skin is like the skin is like the skin of a leaf, except it’s not green. I can’t imagine such skin having an unpleasant odor or texture or taste—even being, for example (it is frankly inconceivable), even mildly eczematous.

Our growing sense that the magazine writer’s admiration for his subject is not entirely wholesome is finally confirmed when he admits to his “desire to break her in half and plunge my arms into whatever pure, perfumed liquid swirls within her. I want to rub it onto my raw, ‘scrofulous’ (ibid.), parched skin in hopes that it will finally be healed.”

Egan’s fictional celebrity profile offers real insight into the social meanings of our skin, which seems at once absolutely natural and given, and yet also deeply marked by race (of course), class, and relative privilege. Barring a particular disorder, most babies have perfectly soft skin; as the years go by, only the most lucky teenagers and adults are able to preserve it. “Life scrawls the record of our failures” on our skins, and so whereas the wealthy, the pampered, the lucky, can continue to enjoy skin that is, like Kitty’s, smooth, plump and taut, the unlucky, the clumsy or the indigent often find their skin turned into a visible record of their troubles. And, as Egan suggests, this situation produces the possibility of a dermatological politics—as those denied the privilege of good skin have good reason to resent those who do possess it. Bad skin is sometimes described as “angry;” this physiological metaphor may also be literalized.

In our daily lives, we consider it rude or unkind to stare at someone’s else’s acne. But it turns out that many people do wish to look closely. A memorable 2016 New York Magazine profile of dermatologist Dr. Sandra Lee, whose YouTube handle is “Dr. Pimple Popper,” revealed a startlingly huge audience for online pimple-popping videos, which Lee scores to songs like Duke Ellington’s “Just Squeeze Me (But Please Don’t Tease Me),” Mtume’s “Juicy Fruit” and French Montana’s “Pop That.” At the time of the article’s publication, her YouTube account had amassed 850,000 subscribers and more than 350 million views. She soundtracked one video to the Doors’s “People Are Strange” and captioned it, “People are strange. Strange because they like to watch this stuff. But I’ve realized you strange people are not alone—there are many of you!”

A recent piece in the Guardian laments that while 80 percent of eleven to thirty year olds suffer from acne, signs of the condition rarely appears in the world of young-adult literature, “perpetuating the myth of physical perfection.” Perhaps acne seems, to many contemporary authors, an inevitable part of life that can go without explicit depiction in fiction—lacking a particular goal of disgusting or disconcerting the reader. But what might we have to gain from not airbrushing out the skin-deep imperfections of our fictional characters? Must such a frank gaze operate in a spirit of voyeurism, or can we look in a spirit of sympathy? And if we look more closely at “bad” or “angry” skin, what do we hope to see?

When “bad skin” does appear in fiction, it often seems to operate as a sign or symptom of social marginalization. We first meet the protagonist of Sherman Alexie’s 2007 novella Flight, a fifteen-year-old half-American-Indian orphan, for example, as he counts the pimples on his face (he finds 47) in front of the bathroom mirror. “Call me Zits,” he riffs on Melville, elaborating later, “I’m ashamed that I look like a bag of zits tied to a broomstick. I wonder if loneliness causes acne. I wonder if being Indian causes acne.”

Bad skin in fiction can draw a line between those who suffer from it—the unlucky and the outcast—and those who view the sufferers with pity or disgust. A character in Flannery O’Connor’s “The Displaced Person” has skin that makes him appear as if he’s been buried and then dug up: “His teeth and hair were tobacco-colored and his face a clay pink pitted and tracked with mysterious prehistoric-looking marks as if he had been unearthed among fossils.” In O’Connor’s “Revelation,” the hypocritically genteel Mrs. Turpin observes her neighbor in the waiting room of a doctor’s office:

Next to her was a fat girl of eighteen or nineteen, scowling into a thick blue book which Mrs. Turpin saw was entitled Human Development. The girl raised her head and directed her scowl at Mrs. Turpin as if she did not like her looks. She appeared annoyed that anyone should speak while she tried to read. The poor girl’s face was blue with acne and Mrs. Turpin thought how pitiful it was to have a face like that at any age.

Mrs. Turpin experiences a comeuppance when the acne-scarred girl, a college student named Mary Grace, becomes enraged by the older woman’s scrutiny, and hurls her textbook at Mrs. Turpin’s head—in what can be read as a revolutionary act on the part of the dermatologically angry.

No contemporary author is more obsessed by the disorders of our skin than Ottessa Moshfegh—who like O’Connor seems at once to judge her characters mercilessly and to evoke a powerful sympathy for them. (Moshfegh’s publisher, as it happens, declares her “our Flannery O’Connor” in the jacket copy of her new book.) Of the fourteen stories in her new collection, Homesick for Another World, a remarkable twelve (86 percent!) contain overt reference to characters’ bad skin: to acne, pimples, scars, pock marks. Acne often defines the difference between the sexually desirable and the undesirable. When the title character of “Mr. Wu” visits a house of prostitution, he observes that one of the teenagers working there “had stiff shiny hair like the woman at the arcade”—the object of Mr. Wu’s unrequited desire— “but her face was covered in hard little pimples.” In “No Place for Good People” (a very O’Connorian title!), “Francis looked like the runt of the litter—small shouldered, pale, with blackheads and pimples around the corner of his mouth and nostrils.” In “An Honest Woman,” “Jeb laughed again … His strange, spotted face and bulbous nose made the girl look away.” And bad skin can also be a marker of low privilege or class status; the narrator of “Bettering Myself,” a drug-abusing, irresponsible teacher at a Catholic school in New York City, observes that “the other math teacher was a little Filipina who I knew made less money than me … She had some kind of respiratory disease and a big mole on her nose.”

Male characters seem better-equipped than Moshfegh’s female ones, psychologically, to endure bad skin without correspondingly low self-esteem—or we could simply call this the delusion of male privilege. To refuse to be ashamed of bad skin becomes a marker of a perverse form of male authenticity. The feckless narrator of “Malibu” declares, “It was true: I had pimples. But I was still good-looking … I was always picking at my pimples. I covered the marks they made with girls’ liquid foundation, which I stole from Walgreens.” Whereas a character in “A Dark and Winding Road” “had terrible cystic acne in high school—big red boils of pus that he squished mindlessly in front of the television. He didn’t care how he looked. He was a real guy’s guy.”

Mosfegh has commented about Homesick for Another World, “I think I’ve written a book about trapped people.” Bad or diseased skin is, in this sense, a marker of what used to be called “literary naturalism”: that is, a reminder that to be human is to be unfree, defined by circumstances and external conditions, inhabiting a body that will slowly fall apart, often in disgusting ways. When the French novelist Émile Zola’s work—which defined naturalism as a movement—first began to be translated into English, it was condemned (in a memorable 1888 motion in the British Commons) as “sheer beastliness” amounting to “dirt and horror, pure and simple.” A case could be made that Moshfegh sometimes focuses too unrelentingly on the “dirt and horror” of our bodies. The collection’s onslaught of skin disorders can create a wearying effect over the course of the collection, as the blackhead and pimple count mounts ever-higher. In her less-satisfying stories, Moshfegh can seem to leave a reader to gape at the characters’ bad skin (among their other problems) only to feel relieved that he is not himself so afflicted—like the character on a Caribbean vacation who watches “a dog covered in mange and bleeding pustules rub itself against a worn wooden signpost. He was lucky, he thought, not to be that dog.”

That character, the protagonist of “The Beach Boy,” is in fact an actual dermatologist by profession. John, a successful Upper East Side doctor in Manhattan, is, unusually for Moshfegh, more like O’Connor’s Mrs. Turpin than the sullen, acne-ridden Mary Grace next to her in the waiting room: that is, one of the world’s fortunate, rather than one of the afflicted. After his observation about the dog, “he felt ashamed of his privilege.” “John could have been a cardiologist,” Moshfegh explains, “but he’d pursued dermatology instead. At parties, he wowed people with descriptions of boils and rashes and growths, strange hair patterns, nasty scars, pus-filled cysts, bizarre freckles, cancers, moles. ‘Within six feet of this fellow, you could detect the distinct smell of porcini risotto,’ he’d say. ‘His armpit was filled with fungus.’”

If, as I’ve suggested, bad skin in fiction often marks a distinction between those unfortunates who suffer from it and those, blessed with good skin, who view the sufferers with pity, fascination, or disgust, John occupies a third category, that of those, like Dr. Sandra Lee and other dermatologists and cosmetic surgeons, who make their living from bad skin—and who are therefore able to view the gruesome bad skin of others, from a suitable professional distance, as an endless palette of individual idiosyncrasy.

It is tempting to expand this category of those who make a living from bad skin to include another professional class: that of authors like Moshfegh. Moshfegh probably realizes that John, in his ability to “wow” an audience with his accounts of the grotesque problems of his patients, more than a little resembles a fiction writer. But if Homesick for Another World operated entirely in the mode of a dermatologist—profiting from the bizarre human comedy of its subjects’ skins—it would be a less satisfying book than it is. A doctor like John is professionally bound to pursue one goal: to diagnose and to heal bad skin, to fix it. A good fiction writer makes it possible for us to look at a problem without trying to cure it—to permit our bad, scrofulous, angry, or simply weird skin to mean a nearly infinite number of things.

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