In 1908, on hearing about a young man in Vienna who wanted a nose job, Sigmund Freud made a quick diagnosis: The man clearly suffered from an "anti-Semitic persecution" and did not want to be Jewish. When he was informed that "the patient is an ardent Jew" and a committed Zionist, Freud was flummoxed. In the end, he concluded that the patient was conflicted about his father and did not want to look like him.
So what would Freud have made of Michael Jackson?
It's always tempting to look for pathologies in those who drastically alter their appearance through surgery. And Jackson certainly had surgeries. One set of photographs that has been circulating since his death documents his startling transformation over time. His nose seems to grow ever thinner, his skin ever lighter.
The images have spawned thousands of diagnoses from armchair psychologists, most of them concluding that he was "self-hating," uncomfortable with his ethnicity, his gender or both. He may well have been. But whatever the truth about Jackson's complicated inner life, his repeated cosmetic procedures do not necessarily support the diagnoses.
Almost since modern cosmetic surgery was born in the late 19th century, its practitioners have fretted about patients who return wanting further alterations. In the 1930s, the urge for multiple surgeries was given a label -- "polysurgical addiction" -- by a leading American psychiatrist, Karl A. Menninger. And indeed, the odd and often misused category of contemporary psychiatry, "body dysmorphic disorder," suggests that repeated surgeries are evidence of some underlying psychopathology.