Skin Matters: An Interview with Marc Lafrance

Tomoko Tamari: Body & Society’s double issue Skin Matters: Thinking Through the Body’s Surfaces (vol. 24, 1–2) has just been published. ¹ The issue covers various fields that address how the body’s surface can form and influence the ever-changing or ‘becoming’ self. It draws readers’ attention to the complex nature of the skin, which is ‘the largest and heaviest part of our bodies’ (Lafrance, 2018: 5) as well as a sensory organ and an interface between the inside and outside of the body. It is also a signifier of identity in visual culture and a commodified entity in consumer culture. Recently, the skin has also served as a site for combining human and non-human entities in the field of biotechnology, and is on its way to becoming an artificially regenerative organic entity in the medical sciences.

You introduce ‘skin studies’ as a new subfield characterized by a transdisciplinary approach in the social sciences and humanities. To articulate this in more detail, the volume explores a genealogy of contemporary skin studies in order to show why studying the skin is an increasingly topical and exciting project. Could you say more about what you set out to achieve in the special issue and what you see as its most exciting outcomes?

Marc Lafrance: When I started working on the skin in 1999, there was very little scholarship that took it up as an object in its own right. Jay Prosser’s book Second Skins: The Body Narratives of Transsexuality appeared in 1998, but it was one of the only books that sought to think critically about how and why the skin matters as much as it does. In the years that followed, however, things changed dramatically: Sara Ahmed and Jackie Stacey’s Thinking Through the Skin came out in 2001; Claudia Benthien’s Skin: On the Cultural Border Between the Self and the World came out in 2002; and Steven Connor’s The Book of Skin came out in 2004. There was, in other words, an explosion of skin scholarship in the early 2000s, and it felt to me as though a field or – at the very least – a subfield was starting to emerge. ²

The relatively large number of scholarly works on the skin that has appeared since the explosion of the early 2000s indicates that a subfield has, indeed, emerged. So one of the things I wanted to do with the special issue was to inaugurate this subfield; that is, to more fully define and develop it by thinking systematically about what it does and why it does it. The issue has been well received, and I think this attests to both its relevance and its timeliness. Even more importantly, I think it attests to the fact that skin studies will continue to grow. Being part of this growth is, without a doubt, one of the issue’s most exciting outcomes.

TT: In your introduction, you claim that the special issue ‘avoid[s] taking “the body” as its privileged figure’ in order to focus more closely on how ‘the body’s surface is made liveable, intelligible and meaningful’ (Lafrance, 2018: 3). Could you elaborate on your orientation?

ML: My orientation was characterized by two key objectives. My first objective was to demonstrate the extent to which the skin studies subfield makes unique contributions to the more established field of body studies. There are many reasons why these contributions are unique, but the one I want to emphasize here – and the one I emphasized both implicitly and explicitly in the introduction to the special issue – is how skin scholarship allows us to rethink and refigure binary oppositions in profound and, above all, productive ways. There is, of course, a very good reason for why this is the case: the skin, as an object of critical enquiry, demands it.

As many scholars have pointed out, the skin is inherently bound up in the in-between. It is, as you mentioned earlier, an interface. And insofar as it is an interface, it challenges those who insist on binaries every bit as much as it does those who try to do away with them. As editor of the special issue, I was struck by how its contributions managed to approach these binaries with a combination of extreme scepticism and careful engagement. This combination of scepticism and engagement is really generative: it allows us to resist the oppressive implications of binaries without ignoring the ways in which they are constitutive both epistemologically and ontologically. That said, I want to be clear about the fact that I am not claiming that skin studies is the only area of critical enquiry that has managed to work with binary oppositions while, at the same time, working against them. Instead, I am claiming that because its object simultaneously reinforces and refuses these oppositions, skin studies is particularly well placed to shed light on why and how they operate as they do.

My second objective was to strike a balance between contributions that reflected on the macro-level and the micro-level life of the skin. While these two levels are, of course, imbricated in and inseparable from one another, they each have specificities that require careful consideration. So I guess you could say that I wanted the issue to be double-sided just as the skin is double-sided. ³ For this reason, the issue contains compelling considerations of how the skin is a site of power and knowledge as well as exciting explorations of how it is a site of lived experience. That said, I made a concerted effort to ensure that the issue was neither overrun with nor overtaken by contributions that emphasized how the skin both regulates and is regulated by normative imperatives. I am not saying that contributions of this sort are not crucial to skin studies. They are, and I have myself written about how the skin is bound up in the biopolitical. But given that the issue set out to inaugurate skin studies as a subfield, I wanted to be sure that the individual did not get lost in the collective. After all, the skin is in many cases the sensory organ with which we are the most intimately familiar. It is known and, indeed, knowable to us in ways the other sensory organs are not: we can see it, feel it, smell it and, if we choose to, we can taste it. Insofar as it is radically reflexive, the skin is is immensely and intensely immediate. There is, quite simply, no getting beyond it. So if we want skin studies to be true to its object, then we need to consider how the skin is felt to live every bit as much as how it is made to live.

TT: Are there further analytical approaches that interest you that were not included in the issue?

ML: As you mentioned earlier, skin studies is a transdisciplinary project. And the special issue certainly reflects this transdisciplinarity insofar as it includes a wide range of contributions from both the social sciences (e.g. anthropology, communications, sociology) and the humanities (e.g. art history, literature, philosophy). But there is no question that the articles that make up the issue apply some approaches – such as critical race theory, feminist theory, phenomenology and psychoanalysis – more than they do others. So yes, I am interested in how other approaches might make skin studies even richer and more robust. For instance, I think that affect theory (e.g. Ahmed, 2004; Brennan, 2004) could contribute a great deal to making sense of how the skin’s innumerable entanglements constitute not only the personal but also the political experience of contemporary life. In addition, I think that critical realist (e.g. Archer, 2015; Vandenberghe 2015) and new materialist (e.g. Alaimo and Hekman, 2008; Coole and Frost, 2010) approaches have a lot to contribute to skin studies insofar as each, in its own way, offers up useful tools for understanding how the skin intervenes in the dynamic relationship between the so-called natural and the cultural.

TT: What about other areas of research? Are there areas that you think could or should be further developed by scholars in skin studies?

ML: If skin studies continues to expand, then so too will its set of objects. One object that particularly interests me, and that has not received much attention, is how the skin is represented on television. As we know, television is not what it used to be. In fact, many critics argue that it has now officially surpassed the movies, as increasing numbers of A-list actors move from the big screen to the small screen (Wolcott, 2012). Similarly, the rise of streaming services like Netflix has changed the way television is both made and watched (Bakare, 2018). Indeed, television has changed in a number of important ways, leading some to refer to it as the ‘new’ television (Wolff, 2016). That said, it is not just because it has changed that television matters. It matters because it is a crystallization of our most common and, in many cases, complex fears and fantasies. Making sense of these fears and fantasies as they are crystallized in and through the new television has a lot to tell us about how the skin is experienced and understood in present-day Western societies.

TT: It is certainly true that television, as a medium, has changed. But it is not the only medium that has a lot to tell us about how the skin is, as you put it, ‘experienced and understood’. Could you say a bit more about why, exactly, you think that television deserves special attention from scholars in skin studies?

ML: Skin studies scholars have considered representations of the skin in a variety of media forms (Glenn, 2008; Laine, 2007; Marks, 2000; Pile, 2009; Saraswati, 2010). In fact, the special issue is characterized by a number of these considerations, particularly as they pertain to advertising and photography (Borgerson and Schroeder, 2018; Howells, 2018; Hurst, 2018; Skelly, 2018). But television has not yet been explored in the skin studies subfield, and this strikes me as a missed opportunity given the stunning range of representations that we see in a variety of widely viewed quality television series. ⁴ In fact, I have been especially intrigued by the television series that attempt to capture the intricate implications of self-cutting. Take Showtime’s The Affair. In this series, we are introduced to Alison Bailey: a young woman who copes with the pain of her son’s death by cutting her inner thighs with razor blades. The series represents her self-cutting as a pain management strategy: that is, her bloodletting hurts, but it hurts in a way that she can control. In other words, Alison’s self-cutting is represented not as that which creates a wound but as that which heals one. And this is borne out later in the series insofar as Alison stops cutting when the pain of her son’s death stops hurting in ways that overwhelm and, ultimately, overpower her. They may not be the most original, but the show’s representations of Alison’s self-cutting are – without a doubt – an important part of how it builds her character. ⁵

Even more than The Affair, HBO’s Sharp Objects is a multifaceted meditation on how the skin can serve as a site of both unspeakable suffering and spectacular resistance. The series tells the story of Camille Preaker, a hard-drinking reporter with a serious case of post-traumatic stress who goes back to her hometown to cover the serial murders of an increasing number of teenage girls. An ongoing reflection on what it means to return to a site of trauma, the series presents us with a complex consideration of how doing so tends to opens up old wounds both literally and figuratively. Camille’s character is built around her old wounds and how, over the course of her lifetime, they become bound up with ever more extreme practices of self-cutting.

Camille’s self-cutting is attributed to her mother and, more specifically, to her mother’s condition known as Munchausen syndrome by proxy. ⁶ Mothers with this condition make their children appear ill in order to gain attention, and this often entails fabricating signs, misrepresenting symptoms, and deliberately harming their children in order to ensure that they do not recover. While Camille is represented as a victim of her mother’s abuse, she is also represented as a survivor. And her lived experience of both is played out on and across her skin. In fact, the series represents Camille’s self-cutting as the one, and perhaps the only, thing that allows her to resist her mother’s power over her health and well-being.

Covering what appears to be her entire body, Camille’s self-cutting leaves her with an astonishing array of scars characterized by defiant declarations of agency and autonomy. Here her skin becomes an angry narrative of self-protection: it does the talking that she could not do then and cannot do now. What is more, this narrative plays a pivotal role in ensuring that Camille’s story of suffering could not be changed: not by her mother, and not by the medical authorities her mother so often manipulated. That said, Camille’s relationship to her skin is neither simple nor straightforward. It is not for nothing that we see her covering it up in shame for most of the series. But shame or no shame, it is her skin’s astounding ability to remember and its stubborn unwillingness to forget that enables her to preserve her own account of her body’s history rather than the one her mother so often tried to, quite literally, force down her throat.

Series like The Affair and Sharp Objects suggest that there is growing interest in the skin in the world of quality television. With their emphases on cutting and scarring, these series contain valuable resources for making sense of how the skin lives and is made liveable as well as with how it means and is made meaningful. I think these resources could be used to further develop what skin studies scholars have already written on cutting and scarring in order to better understand both the former and the latter as psychic, somatic and social phenomena. The special issue is characterized by a number of contributions, particularly those on skin-cutting in adolescence (Le Breton, 2018) and scars in visual culture (Skelly, 2018) that provide us with suggestive starting points for doing so.

TT: Is self-cutting the only issue that television is exploring?

ML: No, not at all. In fact, I have been pleasantly surprised by the extent to which television has taken up a wide variety of issues pertaining to how the skin shapes and is shaped by gender and sexuality, race and ethnicity, and ability and disability. Of course, gender and sexuality are addresed in both The Affair and Sharp Objects. But it is HBO’s The Night Of that takes the most impressively intersectional approach to representing the skin. The series tells the stories of John Turturro – an ambulance-chasing lawyer with a bad case of psoriasis – and Nasir Khan – a working-class Pakistani-American college student wrongly accused of murder. In a striking series of juxtapositions, The Night Of shows how each man is marginalized for having skin that fails to live up to normative imperatives. The result is a probing account of how the skin, particularly when it is stigmatized or racialized, is often embedded in an oppressive politics of social exclusion.

The show’s representations of John’s psoriasis delve deep into his everyday experiences of embodiment. Here his struggle with skin disease is no mere metaphor; it affects every aspect of his life. Represented in all of its disorderly and disagreeable detail, John’s skin disease determines how he dresses, how he moves, how he parents, how he has sex, and how he socializes. Indeed, the show gives us a pretty gritty glimpse into what it means to manage a severe case of psoriasis: the constant itching, the insatiable scratching and the inevitable despair to which he is driven by both. And, of course, it is not just the despair with which he must contend; he must also contend with the lengths to which this despair drives him as he tries in vain to control his condition. Here the medical community’s total lack of consensus with respect to the management and treatment of skin disorders like psoriasis is painstakingly revealed; he is told to bathe in bleach; to sit for hours under an expensive UV lamp; to take steriods that will make him impotent and obese; and to coat his afflicted areas in hydrogenated vegetable oil, household plastic wrap and duct tape. Despite the enormous amount of time and money he devotes to them, none of the treatments work. So he is left, alone, attacking his afflicted areas with the knitting needles he keeps in the side of his briefcase while others recoil in horror. ⁷

Like John, his young client Nasir is a pariah because of his skin. Nasir’s skin is not stigmatized by skin disease, as John’s is, but racialized by the Islamophobia of post-9/11 America. Nasir’s story is, by and large, a story of incarceration that unfolds as he awaits trial in a maximum security prison. In the beginning, Nasir’s skin is represented as vulnerable, its lack of tattoos making it appear almost naked. And these representations of vulnerability continue, as Nasir’s skin is badly burned by a mix of boiling water and mineral oil thrown at him by another prisoner. As time passes, however, Nasir’s skin changes. It becomes an armour of increased muscularity and, above all, ink. Nasir gets a new tattoo on a regular basis, and each time he gets one he moves further away from subordination and further towards domination in the prison’s hierarchy of masculinities. The hardening of Nasir’s inside (i.e. his ability to better protect himself from feelings of betrayal, disappointment and shame) travels in tandem with the hardening of his outside (i.e. his ability to endure the pain of tattoos and the strain of extreme strength training).

Once again, we see some interesting connections between what is explored in the special issue and what is explored on quality television. That is, both the special issue and quality television emphasize the complexities of cutting and scars as well as those of the stigmatization and racialization of skin. Here the issue’s articles on skin disorders can help us to understand how the former is represented on television (Lafrance and Carey 2018; Segal 2018), while its articles on the fetishization and commodification of skin can help us to understand the latter (Borgerson and Schroeder 2018).

Overall, series like The Affair, Sharp Objects and The Night Of tend to avoid opportunism and sensationalism. But the same cannot be said of two quality television shows made by Netflix. Indeed, both Marcella and The Bodyguard represent acquired facial disfigurement in an exploitative manner, linking it to danger, destruction and death. ⁸ Just as much if not more than the first three series I described, these last two call for careful scrutiny on the part of skin studies scholars.

TT: Your discussion of facial disfigurement leads me to my next question. You remark that ‘[i]n an age of stem-cell skin cultures, 3D printing and a wide range of increasingly accessible and affordable medical procedures, we could be forgiven for thinking that there is something almost invincible about the skin’ (Lafrance, 2018: 7). Shortly thereafter, however, you discuss the fact that medical technology is not yet sophisticated enough to completely cure, repair or replace organic human skin.

As you mention, ‘regenerative medicine’ has made great strides over the course of the last decade (Lafrance, 2018: 9). In fact, induced pluripotent stem cells, known as iPS cells, were recently introduced and generated for the first time by Professor Shinya Yamanaka’s group in 2007 at Kyoto University. These pluripotent cells can differentiate into any type of cell in the body and proliferate indefinitely in culture (CIRA, 2018).

In March 2017, a patient of wet-type age-related macular degeneration successfully underwent a transplantation of retinal pigment epithelial cells derived from iPS cells generated from the peripheral blood of a healthy donor. Since then, Kyoto University has announced that its goal is to ‘promote the iPS cell stock and iPS cell-based regenerative medicine by 2030’ (CIRA, 2018). These developments in cell-based medicine suggest that regenerating human skin may well be possible in the near future.

I wonder how you see this new possibility of integrating ‘human-made’ organic skin into ‘natural’ organic skin. What are the implications of this possibility for how we understand the human body in terms of the boundary between inside and outside, the relationship between subject and object, and the human being’s sense of wholeness?

ML: The bioengineering of skin is becoming increasingly advanced and, as you quite rightly point out, we may well witness the creation of viable human-made organic skin sooner rather than later. In fact, one year before Professor Yamanaka’s team generated pluripotent cells, Doctor Tsuji of the Riken Centre for Developmental Biology grew integumentary tissue that replicates the function of the skin (Takagi et al., 2016). While some bioengineered skin substitutes are already in use – particularly for the purposes of wound management – they lack properties such as follicles, glands and nerves (Halim et al., 2010). Doctor Tsuji’s skin, however, posesses these properties: it can grow hair, secrete sebum and sweat, and regulate temperature. In other words, it has the potential to work in much the same way as the body’s largest organ. Though it is still in an experimental phase, Doctor Tsuji’s bioengineered skin – like Professor Yamanaka’s iPS cells – appears to be promising for patients requiring skin graft transplants, particularly those who have have been severely disfigured by accidents, burns, combat injuries, congenital deformities, critical illnesses and gun shots. ⁹

There is no denying that the prospect of being able to grow organs, such as skin, for the purposes of transplantation raises a wide range of ethical issues. And these issues must be debated not only by those in the medical sciences but also by those in the social sciences and humanities. Skin studies scholars have a lot to contribute here. In fact, given their critical orientation, they are in a position to tell us a great deal about how the creation of human-made organic skin may give rise to large-scale medicalization, including coercive regulation, compulsive optimization and rampant commodification. That said, I think it is important that these scholars be critical not only of the medicalization of human-made organic skin but also of medicalization itself. I am, of course, not the first to point out that medicalization tends to be presented as either positive or negative but rarely both (Parens, 2011). And yet medicalization is often both, insofar as its effects change depending on the people, the practices and the procedures involved. I think that skin studies scholars need to remain alive to these changing effects in order to do justice to those who are helped by medicalization as well as those who are harmed by it.

Remaining alive to both the positive and negative effects of human-made organic skin means considering all of its implications: psychic, somatic and social. And when we consider all of these implications, then we must inevitably turn our attention to human suffering. After all, human suffering is a big part – if not the biggest part – of why there is a demand for the work that Professor Yamanaka and Doctor Tsuji are doing. There are, of course, other reasons that should concern us given they are often bound up in late capitalist eugenic projects. But it would be a mistake, in my view, to ignore the potential benefits of human-made organic skin. And we can only really appreciate these benefits if we account for the problems with the current state of facial skin graft procedures.

Current facial skin graft surgeries often lead to disappointing results (Bradbury et al., 2006; Siemionow et al., 2009; Van Den Elzen et al., 2012). In many cases, those whose faces are disfigured undergo surgery after surgery and still end up with an outcome that leaves them with what some call a ‘social disability’ (MacGregor, 1990; Pruzinsky, 1994). We can live without a lot of things, but living without a face – or, rather, living without a face that is recognized as a face – makes it difficult to survive and thrive (Rumsey and Harcourt, 2004; Rumsey et al., 2004; Talley, 2014). The considerable difficulties caused by living without a face that is recognized as a face lead many with facial disfigurements to submit to multiple skin graft surgeries. So here I want to reflect on the lived experience of these surgeries for two reasons: first, because it will allow us to understand why some of the problems they pose are the problems that human-made organic skin tries to solve; and, second, because it will enable us to further develop our thinking on the relationship between subject and object, self and other, inside and outside.

Submitting to multiple skin graft surgeries on the face is a daunting prospect to say the least. Not only are they highly invasive given their intense and inescapable immediacy, but they also involve a large number of incision sites: those made at the transplant site and those made at the donor site. The immediacy of these surgeries combined with their large number of incisions can leave patients feeling as though they are in bits and pieces. But the surgeries are not the only things that can leave patients feeling this way. There is also the aftermath of the anaesthesia, which – even when all goes well – can make patients feel as though they have been reduced to their body’s parts and processes: to their fluctuating blood pressure; their nauseous stomachs; their thirsty mouths; and their confused thought processes. And then there are the often protracted periods of post-operative care that involve applying ointments on an ongoing basis; bandaging for long periods of time; bathing only partially if at all; consuming large quantities of medication; combatting constipation and other gastrointestinal problems; sleeping in uncomfortable positions; tiring when attempting to accomplish small tasks; and undergoing physical rehabilitation. These exhausting and inexorably embodied experiences – experiences that oblige patients to take their own bodies as objects in deep and often disquieting ways – are repeated with each and every surgery. And, as many patients will tell you, these experiences do not get any easier.

The feeling of being in bits and pieces can be brought on by other aspects of the post-operative period as well. To start, there is the experience of being confronted by fresh sutures on a part of the body that is among the most meaningful and the most vulnerable. This experience – which leaves no doubt about the fact that the body’s insides and outsides have their own irreducible specificities – can be disturbing because the sutures are so necessary. Without them, the new face can fall apart because the transplanted skin cannot yet fulfil its containment function. And when the transplanted skin cannot fulfil its containment function, the new face reveals the extent to which containment itself is fragile. Most of us take our skin’s ability to contain us for granted; but when we can no longer do so, we are unnervingly confronted by our radical susceptibility to dissolution and disintegration.

The feeling of being in bits and pieces can also be exacerbated by patients’ encounters with their skin grafts in the early days of the healing process. Even when all goes well, these grafts can push patients to what I call the ‘edge’ of embodiment. Here the edge of embodiment refers to the often disturbing experience of being forced to go beyond the ‘surface body’ and into the ‘visceral body’ (Leder, 1991). When we have no choice but to go from the former to the latter, we can feel as though we have reached the limits of who we are. After all, we are not accustomed to having access to that which is beneath the skin: unlike our ubiquitous surfaces, our visceral depths do not tend to be known to us. So when we are confronted by these depths, it tends to be a destabilizingly uncanny experience. For this reason, encountering skin grafts before they have healed is not always an easy thing to do. Quite apart from the pain associated with them, unhealed skin grafts are often deeply discoloured and disconcertingly raw, not to mention covered in oozing cracks and crevices. In other words, unhealed skin grafts often look like a mix of the visceral inside and the surface outside and, as a result, being confronted by them can cause us to question the foundations of our personhood. And I might also add here that being pushed to the edge of embodiment is even more likely in the event of post-surgical complications. Haematomas, split sutures, and open wounds: all of these complications can confront the patient with experiences of extreme liminality.

The many hardships associated with skin graft surgeries on the face might be easier to take if they resulted in a satisfying outcome for those who undergo them. But, as I have already mentioned, the outcome is not always so satisfying. As a result, multiple surgeries are often required, all of which can have a serious effect on patients’ quality of life. Indeed, insofar as they can result in a distressing experience of lived separation between subject and object, self and other, inside and outside, these surgeries ought to be seen as anything but a viable solution.

TT: You seem to be fascinated by the figure of the graft: by its possibilities and its limitations and what these imply for how we make sense of the skin. Am I right?

ML: Yes, you are right. I think the figure of the graft is enormously suggestive. And it is suggestive for a lot of reasons, many of which point to an intriguing irony at work in the post-millennial moment: on the one hand, the work that Prof. Yamanaka and Dr Tsuji are doing in the laboratory suggests that the science of skin grafts is highly advanced; on the other hand, however, the skin graft procedures that surgeons are performing on a routine basis in the operating theatre suggest that exactly the opposite is true. The problems with these procedures have led surgeons to seek out other solutions, one of which is facial transplantation. Like the more routine skin graft surgeries (i.e. autografts), facial transplantation surgeries (i.e. allografts) are associated with a number of problems. But the problems with the former differ in a variety of ways from the problems with the latter.

Facial transplantations have been performed for over ten years as a way of restoring both the structures and functions of the face and its appearance. Thirty-seven facial transplantations were performed between 2005 and December 2015, 20 of which consisted of partial face grafts and 17 of which consisted of full face grafts (Sosin and Rodriguez, 2016). A recent long-term follow-up study found that facial transplantation results in relatively good outcomes, but only for about nine years (Lantieri et al., 2016). The limited lifespan of the grafts is one of the things that make facial transplantation problematic, but there are others that warrant attention.

Despite the data that suggest that facial transplantation results in relatively good outcomes, debates persist about its psychic, somatic and social implications. It goes without saying that having the face of an other grafted onto one’s own is associated with considerable challenges, many of which demonstrate that the distinction between self and other cannot be downplayed. This distinction must be taken seriously, particularly by the surgeons who make decisions about who is and is not in a position to receive a facial transplant. In fact, surgeons are clear about the fact that transplant recipients must have a strong sense of self in order to be able to accommodate an other in all of the ways that facial grafts demand (Coffman and Siemionow, 2013; Dubernard, 2011). Accommodating an other in these ways means that the self must be radically reoriented: that is, transplant recipients must learn to view themselves differently, and this different view must then be integrated into their body image. Some studies suggest that facial transplant recipients manage these radical reorientations without too much trouble (Barret and Tomasello 2015; Lantieri et al., 2008; Petruzzo et al., 2012; Siemionow et al., 2009), but other studies call this suggestion into question (Abbey et al., 2009; Mauthner et al., 2012, 2014).

Facial transplantation poses other problems too. Perhaps most importantly, the survival of the graft depends on a life-long course of immunosuppressant medication. The skin cannot be transplanted from one body to another without short-circuiting the immune system, and this leaves recipients extremely vulnerable to opportunistic infections and life-threatening diseases. Here, again, the distinction between self and other cannot be downplayed. After all, the self’s immunological response to the face of an other is one of outright rejection. And while immunosuppression can and often does prevent this rejection, it is neither simple nor straightforward to manage. In fact, managing immunosuppression means that recipients must allow themselves to be monitored by the medical system on a regular basis for the rest of their lives. Not only are their grafts surveilled, but they too are surveilled – particularly when it comes to whether or not they are taking their immunosuppressant medication. For recipients, then, facial transplantation involves a serious invasion of privacy, and this invasion is intensified by the fact that recipients are often the subjects of intrusive media attention and the objects of voyeuristic curiosity.

Both autograft and allograft transplant surgeries are associated with major problems: in the case of the former, patients often contend with multiple surgeries, difficult recoveries and unsatisfying results; and, in the case of the latter, patients often confront issues relating to identity, immunosuppression and ongoing medical surveillance. If I have gone into considerable detail about the problems associated with both procedures, then it is because I think they need to be taken seriously when we are weighing up the advantages and disadvantages of human-made organic skin. No one should have to live without a face that is not recognized as a face unless they are willing and able to do so. If human-made organic skin can give those with severe disfigurements an option that involves less suffering and better outcomes than the options currently available, then I think it needs to be viewed as a welcome development.

TT: Your discussion of the skin’s appearance and how it affects and is affected by recent technological developments leads me to return to a point I raised earlier. You talked about how the ‘new’ television provides a lot of interesting material for skin studies scholars. But I want to know more about how other new media forms might do the same, and how they too might be important for skin studies. As we know, contemporary society is characterized by the extraordinary expansion of social media, and this has given rise to an increasingly screen-mediated, mirror-saturated culture. Facebook pages and Instagram feeds are a part of our daily lives, but so too are the technological information devices – such as smart phones and tablets, not to mention the increasing number of image editing apps – that these devices make possible.

I am intrigued by how various internet platforms and media devices might influence the process of ‘reflexive embodiment’ that you discuss in the special issue (Lafrance and Carey, 2018). Is it possible that reflexive embodiment is no longer just about ‘the implication of the subject in the object’ (2018: 65), but also about the implication of the subject in the public?

ML: Yes, absolutely. I think that reflexive embodiment will be increasingly influenced by the powerful combination of social media platforms and the handheld devices – devices that are increasingly experienced as extensions of who we are – with which they are associated. The subject has always been implicated in the object, but the object has never been quite so implicated in the public. And the public I am referring to here is not just any public; it is, as you point out, a public constituted by and through screen mediation and mirror reflection. As some recent scholarship shows, reflexivity is rapidly becoming exponential in nature (Tiidenberg and Gomez Cruz, 2015). So I think you have identified one of the most relevant areas of future research for skin studies: we need more work on how the skin is represented on new media platforms and influenced by mobile devices; but we also need more work on the processes of collectivization that are brought into being as a result of these representations.

TT: We have covered a lot of ground in this interview. We have reflected on scholarly research as it relates to the skin; media representations of the skin; patient experiences of skin graft surgeries; and the advantages and disadvantages of human-made organic skin. I would like to know more about how you see your own work in skin studies developing over the course of the coming years. Can you tell me about the projects you are currently working on as well as the ones you would like to work on in the future?

ML: I am working on two projects pertaining to the skin at the moment. To start, I am continuing my work on skin disorders by conducting interviews with both patients and dermatologists in order to better understand the lived experiences of those with acne, psoriasis and eczema. As I discuss in the article that appears in the special issue, qualitative research on these experiences is very limited and needs to be further developed. At the moment, the research we have at our disposal is mainly quantitative and its explanatory potential is severely restricted by its standardized measures. As critical researchers in the social sciences and humanities, we need to be able to address skin disorders in a way that allows us to hear patients’ voices. That said, we also need to be able to address skin disorders in a way that allows us to collaborate with those in the medical sciences so as to better respond to patients’ needs and improve treatment protocols for them. So because I am interested in collaboration, I am interviewing not just patients but dermatologists as well. I want to explore what it means to be the one who responds to those suffering from skin disorders; that is, the one who is supposed to know everything and, perhaps most importantly, who is supposed to be able to fix everything. In addition, I want to examine their decision-making practices and how they make their way through the diagnostic dilemmas with which they are often presented. If all goes well, then my examination will allow me to shed light on not only the experiences of patients but on those of dermatologists too, thereby giving me a chance to open up the channels of communication between them.

My second project on the skin relates to men, masculinity and the politics of contemporary grooming advertisements. As my answers to your interview questions make clear, I have a strong interest in what media representations of the skin say about the collective fears and fantasies that characterize the post-millennial moment. Here I am interested in exploring how these fears and fantasies are articulated in and through the social construction of men’s skin. So I begin my exploration with a metaphorical invocation of what, in medicine, is known as ‘proud flesh’. In medical terms, the tissue that forms around the edges of a wound is called granulation tissue. Granulation tissue is a normal and, indeed, necessary part of the skin’s healing process. Yet when there is too much granulation, the excessive tissue that comes to surround the wound is referred to as proud flesh. In this project, I use proud flesh as a metaphor for thinking about how men’s skin is represented in the advertising campaigns of transnational grooming product companies. My preliminary findings suggest that most of these campaigns construct men’s skin in hypermasculine terms: that is, as a thick impenetrable shield and a combat-ready container. But not all of the campaigns construct men’s skin in these terms; some construct it as more open to the other, especially when that other is a spouse or a child. By continuing my exploration of how masculinity gets written onto the skin, I will be able to reflect on why and how men’s flesh is so often expected to be proud flesh.