Skin Bleaching in Medical and Aesthetic Discourse
About the author: Tanisha Jemma Rose Spratt is a PhD student in the Department of Sociology, studying at Newnham College, University of Cambridge. In using two chronic diseases as case studies (vitiligo and alkaptonuria), Tanisha is exploring the relationship between patient experiences of chronic illness and identity in the United States, with a particular emphasis on the ways in which race, gender, class, and illness are performed and constructed as separate but related identities. In this post, she considers the tensions between skin bleaching as an aesthetic practice and skin bleaching as a necessary but unwanted treatment of a medical condition.
During a live televised interview with Oprah Winfrey on February 10th, 1993 Michael Jackson publically announced that he had vitiligo, an autoimmune disease that causes the subject to lose pigmentation in sporadic patches of their skin. This announcement was made in response to Winfrey’s question about his alleged skin bleaching practices, and the public assumption that this was driven by his desire to look white. Refuting this claim, Jackson argued that his whiteness was something that he had no control over because it was an inevitable result of his disease’s progression. His white skin signified his illness, not his aesthetic preferences.
In the UK, once vitiligo has spread to over 50% of the body, dermatologists often recommend that patients bleach their remaining skin pigment with specialized creams in order to have a uniform appearance.[i] The medicalization of seemingly aesthetic practices like skin bleaching raises a series of interesting questions about the patient’s moral culpability. Skin bleaching has long been considered a taboo subject in communities of colour, particularly in black communities. It is often assumed that the black subject who bleaches does so because he or she is ashamed of being black, and wants to subscribe to an idealized understanding of what it means to be “beautiful” (i.e. white). But when a person bleaches because of their medical condition the moral culpability of the act is arguably diminished. Are black people who have this disease to blame for bleaching their skin in order to have one consistent skin colour? Should they be demonized in the same way that black people who bleach their skin in order to look “lighter” are often demonized in popular culture and socio-political discourse?
Vitiligo is often referred to as a “cosmetic disease” because it does not have an adverse effect on the patient’s bodily health. Whilst the patient needs to exercise caution when facing sun exposure because of the sun’s harmful effect on depigmented patches, it does not cause any known damage to bodily organs, bones, or muscles. Moreover, because this disease only manifests itself externally, any physical alteration to the body is seen as an attempt to improve one’s appearance. In this way, the patient’s bleaching practices are rooted in a desire to adhere to a particular beauty aesthetic, which some would argue makes their motivations comparable to the motivations of ordinary people who bleach. The key difference lies in the fact that the vitiligo patient’s whitening and/ or lightening is inevitable and, thus, involuntary. Many people of colour who have this disease often claim that they would, if possible, re-pigment their depigmented areas in accordance with their natural skin colour. They do not want to bleach to “look white,” but are faced with the choice of having a uniform (and seemingly “normal”) appearance through bleaching or an “abnormal” appearance through leaving their vitiligo untreated. This choice inevitably compels them to consider bleaching; as noted by one of my study participants, “I would rather just have it be all one colour versus the patches.” In seeking to have a uniform appearance the subject demonstrates their desire to subscribe to popular beauty ideals, but this is in reaction to the stigmatising aspects of their disease and, therefore, differs significantly from the motivations of the ordinary person who bleaches for aesthetic purposes. The vitiligo patient is, arguably, compelled to make this choice because there is currently no cure for this disease.
The patients that I have spoken to thus far have not expressed any concerns about the moral implications of skin bleaching. Again, because the patient’s whiteness is inevitable, for them it is more a question of speeding up the process of whitening than anything else. One of the key reasons why many of my participants have thus far chosen not to bleach is because of their awareness of the irreversibility of this treatment. As noted by one African-American patient, “the only reason [why] I wouldn’t [bleach] is because what if they do find a cure? If they do find a cure and I’ve already [bleached] then I can’t go back and get my colour back.” Clearly this patient does not perceive white skin to be preferable, she would much rather revert to a state in which her natural skin colour covered the entirety of her body. Her sole concern is that in seeking a “normal” appearance through bleaching she would run the risk of losing the possibility of regaining her dark pigment if a cure was one day discovered. This opinion has been shared by almost all of the vitiligo patients that I have interviewed so far. This preoccupation, I would argue, diminishes the moral implications involved in skin bleaching for vitiligo patients – it is conceived of by many as an unfavourable option that would enable them to combat the stigmatising aspects of their disease rather than a way of subscribing to prevalent beauty norms that equate beauty with whiteness and/ or lightness.
Vitiligo can be psychologically devastating, and skin bleaching can be seen as necessary in combating the stares and questions that patients face on a daily basis. In concealing their disease through skin bleaching, patients are able to live their lives unencumbered by the social effects of their disease, and are given back their confidence both within public and private spaces. There is a significant difference between bleaching because of vitiligo and bleaching because of a desire to look light-skinned or white, and these differences need to be considered when addressing case studies such as Michael Jackson’s. Following his death Jackson’s post-mortem report confirmed that he had vitiligo, yet many people across the world refused to believe it, arguing instead that his “whitening” was the product of a deep-seated desire to look white because of the ways in which this “look” has been (and continues to be) idealized in Western cultures. Vitiligo patients across the world face this type criticism when confronted by members of the public who are unaware of the nature of their condition. My research addresses this issue by situating vitiligo and another disease called alkaptonuria within a broader discussion concerning the social effects of hypervisible and invisible diseases on the daily experiences of patients in the US.[ii]
[i] NHS, “Treating vitiligo,” 17/10/2016 <http://www.nhs.uk/Conditions/Vitiligo/Pages/Treatment.aspx> [accessed 20/11/2016].
[ii] Alkaptonuria is a rare genetic disease that causes black cartilage and skin pigmentation, which often leads to decreased mobility and social isolation.