Introduction

Conventionally and historically technology has been thought of as the practical application of scientific principles often, if not always, via the medium of engineering.  For centuries that may well have been a fair, if loose, definition.  For example, in the eighteenth century the application of certain aspects of chemistry and physics resulted in the discipline of metallurgy and this, used by engineers working in several fields, led to the Industrial Revolution.  Chemists working with engineers rose to the challenge of industrial production to develop textiles technology which revolutionised the weaving economy and which, while providing vast economies of scale, resulted in the destruction of a whole craft-based way of life and condemned many to reduced circumstances in the factories set up to meet the demand of the new opportunities of an economy which moved rapidly from a rural agrarian model to a city-based capitalism. 

However, during the past century advances in science, particularly medical science, have offered different, ‘softer’ outcomes. 

Post-World-War-Two medicine especially has had immense effect on people’s daily lives.  Life expectancy has almost doubled in just a century (Hench 2001).  People take for granted interventions which a generation previously would have been unheard of or else inordinately expensive.  Consequently the greater mass of the population have more control over their health, their appearance, and their general wellbeing.  The development of cosmetic surgery since the 1950s has given men and women the power to change and improve their appearance at prices generally within the reach of those on more or less average incomes.  Advances in, for example, stem cell research, cloning, and the Human Genome Project are, while dependent on machines of varying degrees of sophistication, in themselves ‘soft’ technologies.

As in traditional technologies, there are implicit systems of power, knowledge, and status, and presumably just as open to manipulation.  Nevertheless, I think it fair to suggest that these were intended, in the main, to be enabling technologies with largely benign and liberating qualities.

One aspect of biomedicine, Tissue Engineering, is of particular interest to me.  Originating out of the quest to defeat cancer, it has been developed to enable the growth of new body parts – neo-organs – in order to assist victims of accidents, disease, and congenital defects.  Having appropriated the principle of Angiogenesis in order to do this, it is itself liable to appropriation and subversion.  Just as plastic surgery was reinvented as commercial cosmetic surgery, so Tissue Engineering is capable of subversion for purposes of body modification which mainstream society might consider unacceptable but which members of the Bodmod subculture would think of as a powerful aesthetic tool to enable the development of their particular interests.

My background as a practitioner and educator in the Visual Arts provides me with a broad historical and contemporary practical context which, besides mainstream art and design activity, includes tattooing, piercing, mutilation, scarification, and branding as aesthetic and sociological practise.  It is from this background that I approached the research for this paper.

The conception and development of ideas is an essential activity of all practising artists and designers.  Trying to understand the process is certainly a preoccupation of many of us involved in education.  The many catalysts and circumstances which result in new ideas may be too complex to analyse fully during the period of creativity. Design theorists talk about the Creative Leap, (Archer 1965): the moment when reservoirs of previously held information are suddenly utilised by the designer or artist, sometimes unconsciously, to create and then develop a new idea.

In April 2000, while I was on a routine doctoral supervision visit to the Engineering Department of Liverpool University, I fell into conversation with one of their rapid prototyping specialists, Dr Matt Murphy.  He told me of some of his current work involving interdisciplinary co-operation with staff in the Faculty of Medicine where they were involved in treating accident victims who required substantial repair of bone and other tissue.  He was responsible for making the models which reproduced the form of the destroyed tissue and into which were implanted the cell structures intended to grow and replicate it. 

That conversation turned out to be a fascinating introduction to the field of Tissue Engineering and out of that grew the original idea for this predictive research - my own Creative Leap.  I approached the biomedicine as a non-specialist wishing to understand it, and that is also my approach in this paper.

The first part is what I shall describe as a ‘Layman’s Guide’ to Tissue Engineering.  In the second part I shall discuss some of the methods by which people have modified their bodies for aesthetic purposes or otherwise, and in the third part I shall outline the role which I believe Tissue Engineering is likely to play in body modification in the future.

Tissue Engineering

A standard definition of Tissue Engineering might be that it “applies the principles of biology and engineering to the development of viable substitutes which restore, maintain, or improve the function of human tissues” (Pitsburgh Tissue Engineering Initiative 2000).  Unlike normal drug therapy this is a process of integrating engineered tissue within the body of the patient to offer a permanent improvement to, or cure for, the particular condition.  For some years it has been common practice to grow cells outside the body, but it has only recently been considered possible to grow complex three-dimensional tissue and then insert it into the body where it induces further growth. 

Tissue Engineering relies for most of its applications on the principle of Angiogenesis: the growth of new blood vessels (Concise Oxford Dictionary, 1995), a natural function of the human body which was discovered in the 19th century.  Examples of this might be the monthly menstrual cycle, or the condition known as Psoriasis in which the apparently unsightly red patches on the skin are actually positive indicators of the renewal of blood vessels.

In 1972 Dr Judah Folkman of Harvard University Medical School, while researching Angiogenesis, discovered that cells already in the body can be persuaded or manipulated into producing new blood vessels (Mooney & Mikos 1999a).  Initially this was conceived to be a major breakthrough in cancer research.  In effect, healthy cells can be cultivated in vitro and reintroduced in corpo where they then promote further new growth of healthy cells.  The implications of this process were then grasped by other biomedical specialists who consequently formed the multidisciplinary teams which now develop and apply the concept. 

New blood vessels need to be created in order to encourage the growth or regrowth of almost all new body tissue.  Natural examples of this are:

• skin healing after a cut or abrasion,
• bone mending itself after a break,
• and the growth of adult teeth after natural loss of the milk teeth.

There are three main areas of Tissue Engineering activity:

1. The production of human tissues outside the body for later use:
   
e.g. skin graft replacements.  These have now been in commercial use for some years.

2. The development of devices which contain human tissues and which can replace the function of diseased internal organs:
   
e.g. the production of artificial liver.

3. The implantation of devices (which may or may not contain stem cells) which encourage regeneration of tissue. 

Hitherto, it has been standard practice to undertake either transplant or implantation surgery to alleviate at least some of the problems caused by organ failure.  In addition, as Professor Larry Hench points out in his book Science, Faith and Ethics (2001) as the average life expectancy within the last century has risen from little more than 45 to well over 75 there is an increasing need for spare part surgery, the most common of which procedures are lens renewal, heart bypasses, hip and knee replacements.  So the imperative to develop appropriate biomedical procedures increases almost daily as we all grow ever older.

In standard organ transplant practice the patient experiences high levels of pain and requires lifelong immunosuppression via expensive drug therapy.  There is also the likelihood of:

• tissue mismatch resulting in the possibility of graft rejection
• the potential development of cancers at a later stage
• short term efficacy of the transplant – many patients survive for less than a year (Hench 2001: 127)
  

Tissue engineers are attempting to solve some of these problems or at least alleviate them by custom designing and growing tissue for individual patients.

Researchers are trying to create several kinds of human tissue.  As well as those examples I have already mentioned, other ‘products’ include cartilage and bone, muscle, insulin-producing pancreatic cells, arteries, and even central nervous system tissues.  (Kolata 2000) 

One of the major drivers behind much of the current research activity is the great shortage of donor organs for those who need them.  In the USA for example in 1998 more than 21,000 people received kidney, liver, heart, lung, or other organ transplants.  However, at any time there are 62,000 people waiting for an organ and every day 100 names are added to the list.  (Hench 2001: 120)  Each year 73,000 people in the USA die of heart failure.

In the simplest form of in corpo Tissue Engineering a specific molecule e.g. a growth factor is injected into a wound or a damaged organ. This molecule influences the patients own cells to migrate to the wound site and begin to develop into the kind of cells which regenerate the appropriate tissue.  In 2001 at the Beth Israel Hospital in Boston a 73year old man with a history of severe heart problems, and given only a few months to live, received treatment which involved the introduction of healthy cells to the damaged part of his heart.  These cells began to replicate and grow new tissue to such an extent that after 4 months of treatment his surgeons described him as having “the heart of a 20 year old man” (BBC Radio 4 2001).  In November 2006, Barts Hospital in London announced trials for a similar procedure, in which 700 people will take part.  (BBC 2006)

In a more complex procedure the Tissue Engineer incorporates the patient’s own cells which have previously been multiplied in culture into what are termed ‘three dimensional scaffolds’- in effect a three dimensional model of the damaged tissue - usually made from a biodegradable polymer.  This structure is transplanted or introduced to the wound site where the cells replicate, reorganise and form new tissue.  Simultaneously the polymer breaks down.  In effect it dissolves in much the same way as suture material, leaving a natural product in the body – the neo-organ.
 

Fig 1: Diagram of Tissue Engineering procedure. Photo credit: Norman Cherry, Les Curtis

Sometimes polymers are used in combination with ceramics such as Alumina. Other scaffold materials include collagen and alginates similar to those used for dental impressions.  Methods of building these models are varied and various.  Some of the simpler forms are modelled by hand; some are knitted into a manipulable mesh, while the more complex structures are manufactured using Rapid Prototyping technology.  In such cases a scan is made of the patient’s affected area. This is converted into a CAD file from which a rapid model is built using one of several RP methodologies.  The model is normally built with a type of “honeycomb” structure into which the cell structure can be introduced.

David A. Mooney of the University of Michigan and Antonios G. Mikos of Rice University were quoted in April 1999 as saying “it is at least theoretically possible to engineer large complex organs such as livers, kidneys, breasts, bladders, and intestines”  (Mooney & Mikos 1999b).  A recent bulletin of the Pittsburg Tissue Engineering Initiative Inc, talks of “artificial liver currently under development” (Pitsburgh Tissue Engineering Initiative 2004).  On 30th October 2006 the University of Newcastle, England, announced that a team had successfully grown tiny livers to be used for drug testing purposes (Higginson 2006).

Genzyme has FDA approval to produce tissues from patients’ own cells for the repair of knee cartilage damage. Charles Vacanti of the University of Mass Medical School, Worcester Mass and his brother Joseph, already cited, have demonstrated that new cartilage can be grown in the form of ears, noses, etc.  An ear grown on the back of a laboratory mouse, generated immense amounts of media publicity a few yeas ago (BBC 2004).  This approach was utilised in 1998 when Charles and his team were able to grow bone for a patient whose thumb was badly crushed in a factory accident.  Only soft tissue was left, the majority of the bone having been lost.  The remaining soft tissue was sewn to his chest in order to give it a blood supply and keep it alive.  Bone cells were removed from the patient’s forearm and cultured in a biodegradable matrix made in this instance from coral.  In eight weeks new bone cells had grown from this culture and were moulded to the form of the lost bone. This scaffold was then attached to the hand and covered with the flesh and skin grown from the original thumb with the expectation that ultimately a new thumb would develop with fairly normal functions.   By 2003 it had blood vessels, a narrow range of motion, and a basic sense of touch (Senior Health Care Directory 2004).

Work is underway to grow new breast tissue, using existing tissue from the legs or buttocks.  While this obviously cannot have the incredibly complex structure of ‘real’ breast tissue it is considered a more than viable alternative to existing prostheses or implants which are likely to harden or leak through time.  A team from the Carolinas Medical Centre in Charlotte NC, claim to have perfected a successful method of growing such tissue, (Mooney & Mikos 1999c) and a US patent was issued in late 2003 for the procedure.  In 2004 researchers at the Bernard O’Brien Institute of Microsurgery in Melbourne developed a method of growing breast tissue which preserves its own blood supply (Bernard O’Brien Institute of Microsurgery 2004). A spokesman was unwilling to discuss this in detail until a patent is granted.

Another major success was the growing of human corneas in vitro which were then successfully transplanted back into patients’ eyes (Dobson 2000).  A member of the team at the University of California, Davis, was reported as saying that this work could pave the way for the production of “repair” tissue for other parts of the body such as “the oesophagus, pharynx, intestines, and vagina”.

Researchers in restorative dentistry are equally confident that growing new teeth will soon become a routine procedure (O’Connell 2001).

Only 37 years after the first heart transplant conducted by Dr Christian Barnard it seems almost incredible that medical scientists are now talking seriously about the likelihood rather than the possibility of actually growing new hearts in the foreseeable future (Dobson 2000).  Professor David Williams of Liverpool University, interviewed in 2000, said:  “in 10 – 15 years we will undoubtedly be able to grow new organs – and hearts will be the first” (The Scotsman, September 7 2000).

Changing Ourselves

Although Plastic Surgery as a quotidian form of medicine is very much a twentieth century phenomenon, it has a long and interesting history.  Rhinoplasty has been practised on the Indian subcontinent for well over two thousand years.  According to R E Rana, the surgeon Sushruta was active around 600 BCE, wrote a treatise on the subject, and taught at what is described as Banares University.  (Rana RE, 2002, p 76-78)  While he practised as a respectable surgeon, other forms of nose reconstruction were also carried out by members of the potter’s caste.  This expertise in such a specific area was a direct result of Indian codes of punishment whereby amputation of the nose was a common sentence for criminal behaviour.  Thus, presumably depending on social status, professionals from two quite different castes developed very high levels of specialist skill in order to bring relief to amputees.  Knowledge of the traditional Indian method of rhinoplasty travelled from India to Arabia, on to Egypt, and thence to Italy at some point during the 15th Century. 

During the 19th century German Jews sought to have their noses reduced in size in order to seem “less cold and mercantile” (Gilman 2007) and, around the same time, some Japanese were having eyelid surgery in order to look more like Westerners.

Harold Gillies and his team made the first major improvements in a century with their work for disabled airmen during and after the First World War while Archibald McIndoe and his team continued these developments during and after the Second War, treating servicemen who had been badly burned or otherwise mutilated

However, by the 1920s in the USA plastic surgery had become established as an acceptable method of female enhancement.  Sheila Jeffreys (2005: 155) relates this to the growth in popularity of beauty pageants during the period.  Cosmetic Surgery has certainly been a major part of medical practice since the 1950s in most Western countries. In recent years the growth in its use has been immense.  Between 1981 and 1989 the number of plastic surgery procedures annually  in the USA rose by 80% to 681, 000, more than half the patients being between the ages of 18 and 35.  By 2001 there were 8.5 million procedures (Bordo 2003: 246).  No figures are available to distinguish between procedures to alleviate physical or psychological distress and those for elective aesthetic enhancement.

Apparently the number of American teenagers undergoing cosmetic surgery has nearly doubled in ten years. Corrective nose and ear operations top the list. I understand that a common graduation gift from parents is now a nose or a boob job (Vogue, March 2002). In the UK the two commonest operations among young people are breast augmentation and penile extension.  

Susan Bordo refers to our modern bodies as “cultural plastic”, a consequence of living in a “culture of improvement and replacement” (Bordo 2003: 245).  According to her, Detail, “a trendy lifestyle magazine” describes some cosmetic surgery procedures as “another fabulous (fashion) accessory” (2003: 246).  Typical advertisements in British magazines refer to “…..the shape and size you have always dreamt of” or “A new body …..almost as if it’s as easy as shopping” (Vogue, March 2002).  Of course, if you have the money, in a sense it is.  

To see the prevailing physical stereotypes which the media currently seem to favour, the “tight, slender, muscular body” of Madonna (Bordo: 269) or the hunky men used to advertise Calvin Klein underwear (Bordo: xxiii) as manipulative advertisements for the bodies most of us do not have is certainly a persuasive argument, although I am not sure that commentators necessarily take account of a quite natural desire of many, though certainly not all, people to be fit and healthy through reasonable exercise.  Exercise is not the prerogative of those of us who spend hours in the gym; for example, informal and local club football is played by hundreds of thousands of British people each week. I doubt that the majority do so for anything other than the pleasure it gives, and the knowledge that it keeps them relatively fit.     

Nevertheless, the immense public interest in cosmetic surgery is underlined by recent programmes on British TV, such as the American import Nip/Tuck, and Plastic Surgery Live on Channel Five, one episode of which showed live surgery from Hollywood.  It also featured newlywed couples who had had plastic surgery honeymoons, and one on a Brazilian fitness fanatic who had undergone a phalloplasty to his already substantial member.  The presenter then invited viewers to text in stills or video clips of parts of their bodies which they thought needed improving (Plastic Surgery Live, Channel Five 2005).

In Italy one of the hits of 2004 was “Scalpel: Nobody’s Perfect” on Italia 1 which each week featured young women seeking to “improve parts of their bodies which they are convinced are ruining their lives”.

Given this kind of lightweight (one might even say flippant) and extensive media exposure, it is perhaps no wonder that ordinary people no longer see cosmetic surgery as something for the rich, or film and media stars.  Everyone can now be, or try to be, one the “master sculptors” of this age of cultural plastic (Bordo: 245).   It should not be surprising then to discover that doctors now recognise a new category of sufferers: “polysurgical addicts” or, more colloquially, “scalpel slaves” (Bordo: 248). 

Orlan has practised as a performance artist since the 1970s, doing so with varying degrees of adulation or ignominy, depending on one’s viewpoint.  For many, she is very much a cult figure, a heroine; for others a pariah.  Sheila Jeffreys describes her as having a pornographic purpose and compares her to porno film star Houston (Jeffreys: 161). In 1977 at the International Contemporary Art Fair in Paris she scandalised the public with her show “baiser de l’artist” when she offered a kiss (only a kiss) to anyone who paid her five francs. Other performances involved sperm-soaked bedsheets and the opportunity to view her vulva through a giant magnifying glass, perhaps pre-empting Tracy Emin’s installations by more than a decade.  Since 1990 she has regularly undergone not just facial but partial body reconstruction (Wilson et al. 1996).  As a performance artist, she says that her subject is her own body.  She describes what she does as “Carnal Art”.  She says: “Lying between disfiguration and figuration Carnal Art is an inscription in flesh, as our age now makes possible.  Carnal Art does not inherit anything from the Christian tradition against which it fights.”  Referring to the Martyrs, she says: “Carnal Art is not self mutilation.  Reversing the Christian principle of the word made flesh, the flesh is made word” (1996: 88).

She has undergone a series of plastic surgery operations to progressively transform herself, utilising features found in Old Master paintings of Venus, Diana, Europa, Psyche, and the Madonna.  In each of these, she undergoes the surgery without general anaesthesia, preferring to be “awake” in order to direct proceedings.  These are, after all, performances as well as medical procedures. Each operation has been performed via a video link to an audience watching in real time from another location, usually in a different city.  In the most recent she had silicone implants inserted in her temples and cheeks in order to accentuate these physical features.   She has employed fashion designers and stylists such as Paco Rabanne, Issey Miyake, and Charlotte Caldeberg to create clothes for her and the other participants in these events (1996: 89).  Finding surgeons willing to undertake this work was difficult at first (1996: 90) but four have been involved in the nine operations to date, the New York-based “feminist plastic surgeon” Dr Marjorie Cramer having carried out the seventh, eighth, and ninth.  The words “feminist plastic surgeon” are Orlan’s own, and I have to presume that Dr Cramer would describe herself as such.

Orlan has claimed to be planning with a team of Japanese surgeons to have the longest nose it is possible for them to build, (Jolique 2002) but up-to-date information has been very difficult to come by.  In 2006 she was appointed as a Visiting Scholar by the Getty Institute in Los Angeles, although her official bulletins do not make clear the nature of the scholarship being undertaken there.

It is certainly extreme. Is it ethical?  Is she ethical?  Are the surgeons who perform on her behaving ethically?  They are well aware that they are part of a performance.  Does that make them actors, or artists, as well as doctors and nurses?  What about the traditional ethics of medicine – the Hippocratic Oath which they have all taken?   Are these procedures simply a flippant use of talent and technical expertise intended for the relief of suffering masquerading as performance art?  Is it perhaps little more than a form of entertainment or commerce?   As well as the videos, offcuts and fluids from the operations are framed and offered for sale, a practice of which many commentators are very critical. 

While Jeffreys is straightforward in her denial of Orlan as an artist, Kubilay Akman is somewhat more positive, (Jan 2006).   He describes her art as “deadly serious”.  For him, she is demonstrating resistance to stereotypes of aesthetic authority (2006: 2).  He considers her art to be a genuine contribution to postmodern theories of identity and her project(s) an example of “utopia built upon the body”.  Carnal art rejects authority, domination, and the normal codes of power. 

However, Orlan’s wish to control the form and effect of her own body as art has to be carried out as part of a cooperative effort.  Does that then negate the premise from which she proceeds?  She is not, in fact, in sole control.

Fig 2: Clint Hallam. Photo credit: Paul Hutton

In 1998 a New Zealander, Clint Hallam, (see Fig 2) had the world’s first arm transplant.  (Meek 2000)  Some time previously he had lost part of his right arm in a sawmill accident and had tried hard to find a sympathetic surgeon who would consider transplantation. Ultimately he had to travel to France to find a surgical team prepared to do the operation, such were the doubts about the ethics of his proposal in Australia, where he then lived.  Yet there was a team in Lyon prepared to argue the value of the procedure - and presumably also to accept the fee.  In the event, instead of being the wealthy individual he had claimed to be, he turned out to be a conman and absconded (Whittell 2000).  Needless to say the wrath of the mainstream medical community was suitably visited upon the French medics for their “unethical behaviour” in having undertaken such a “costly and unproven technique”.  As it happened, for various reasons, (mainly financial), he stopped taking the necessary immunosuppressant drugs, as a result of which the “new” arm ceased to function and in 2002 he succeeded in persuading another medical team to amputate it. 

The cult of the Body Beautiful has a long tradition in Western society.  The homoerotic idealisation of athleticism of the ancient Greeks is well documented.  Physical fitness has been part of the fabric of Western education systems for at least two centuries.  The English public school system, on which the British Empire might be said to have been founded, considered physical prowess to be as important as academic achievement.  Regardless of the cultural reasons for it, (Bordo: 246) gym membership is now one of the trappings of a Western middle class lifestyle, often one of the perks provided by companies for their employees.  Any day or evening of the week, gymnasia, once the sweaty, smelly, preserve of only the serious bodybuilding fraternity – the “meatheads” – are full of ordinary men and women stretching, bending, pumping iron, spinning, running on the treadmill, and doing aerobics in an effort to shed fat, build up bulk, or achieve better muscle definition, all in order to look better.  Whether they do so to conform to a culturally-imposed ideal or simply to achieve more individual and personal goals I shall leave others to argue.  

Fig 3: Scarified back of a Nuba woman. Photo credit: Horst Luz

For centuries people have had themselves tattooed, pierced, scarified, and mutilated (see Fig 3) (Caplan 2000: 69).  These were originally marks of conformity, normally identification of belonging, a mark of pride, often part of a rite of passage, sometimes a mark of punishment or expulsion (Gröning: 1997). Paul in his letters to the Galatians (6: 17) wrote “I bear the marks of Jesus branded on my body”, signifying his conversion and adherence to a practice of the early Christians which sought to invert the then prevalent practice of the Romans of tattooing their slaves to denote possession (Thomas 2005: 116).

We are aware of such practices continuing in many parts of the modern world thanks not only to the more or less instant communications we take for granted but also for the intrepid souls who have carried out field expeditions to record them.

It has often been presumed that tattooing was introduced or, to be more precise, reintroduced, to the West by the antipodean expeditions of Captain Cook during the eighteenth century.  Sydney Parkinson, the official artist on Cook’s first voyage in 1769, made detailed drawings of the tattows covering the bodies of the South Seas islanders encountered (2005: 9) and there are many references to members of this and subsequent expeditions befriending the natives and submitting to the tattooing process.  Indeed Parkinson and Banks, the botanist on the 1769 voyage, were tattooed on their arms on this occasion, the mark intended as a souvenir of the great adventure (2005: 44).

However, Caplan (2000: 69) insists that tattooing was undertaken by the ancient Picts in Britain and written evidence seems to point to this (Thomas 2005: 13).  Several writers and adventurers have recorded tattooing or examples of “puncturing” in places as varied as Siberia, Tunisia, Palestine, and the Americas (2005: 15).  The Portuguese navigator Pedro Fernandez de Quiros recorded tattooed men in 1595 in the islands south of Luzon but these were described as Pintados (painted people), a word which normally would have been used to describe the Picts, ie Europeans, especially British or Scots, thus suggesting either a known link with an earlier period or perhaps some knowledge of an ongoing tradition (2005: 33).

Public Record Office documents record how tattoos had become a major signifier of seafarers by the 1830s (2005: 77).  Although during the nineteenth century tattoos were mainly worn by the lower and criminal classes this was not their exclusive preserve.   Senior Admiralty figures adopted the practice in colonial Burma and encouraged their immediate juniors to follow suit, while the British Army urged its officers to have their regimental arms tattooed on their bodies to encourage an esprit de corps ….. and also to assist in identifying the dead on the battlefield (Caplan 2000: 145).  In 1862 the then Prince of Wales was tattooed during a visit to the Holy Land and from the 1890s there were several published examples of tattooed upper classes and Royalty (2000: 146).

Today, at least in Western or Northern society, they are more likely to be manifestations of non-conformity, of rebellion, of individuality.  Nicholas Thomas considers that many of those who have undergone tattooing have been influenced by “naïve New Age romanticisation of indigenous culture and spirituality” (Thomas 2005: 29).  Be that as it may, there has certainly been a gentrification and mainstreaming of the practise (Demello 2000), a long journey from its more recent working class or criminal uses.  In Russia this may be explained by the effect on mass consciousness of the tattoos of those who suffered under the communist regime.  Fifty percent of the population served in the armed forces and as many as one in five at some time found themselves in prison where it would have been difficult to avoid being marked as a newcomer to a place “beyond life” (Plutsner-Sarno & Baldaev 2003: 51).

Although in 1960s America and Europe tattooing was still the preserve of the lower or marginalised classes,  a number of factors such as Vietnam, the sexual revolution, and an interest among art students, some of whom became tattoo artists themselves, led to the “Tattoo Rennaissance” (Caplan: 236).  Some of them also designed jewellery for piercings, and works by artists such as Bruce Nauman lent authenticity.  From my own experience, art and design students have been writing dissertations and creating visual works based on tattoos, piercing, and other body practices for at least 20 years.  Currently in Britain, Freshers Week is when large numbers of new students are initiated by having the first mark made on their bodies.

Fig 4: Erik Sprague, aka Lizardman. Photo credit: Kevin Wisniewiki/Rex Features

Erik Sprague, aka The Lizardman is one of the most commonly recognised BodMod performers. At the time of  the photograph (shown as Fig 4) he had undergone tongue and dental surgery, had had Teflon implants and 400 hundred hours of tattooing, with a further 200 hours to go.  He expressed his desire for a tail to complete his “translation”.  “If I could have a real tail, if I could have real tissue, I would like one” he said (Dobson 2000).

Readers will also be familiar with illustrations of other people with Teflon implants.  Every day we are likely to meet people with multi piercing.  At one time I imagined that The Lizardman or the tattooed and pierced lady shown in Fig 5 or Bob the Enigma (Fig 6) and his wife Katzen, (Fig 7), the Puzzilion act, were extreme and outlandish but in the course of my research I have found many other examples of unusual practices which might render these much less so than I had originally supposed.

 

Fig 5: Tatooed and pierced woman. Photo credit: Paul Calloway

Fig 6: Bob the Enigma. Illustration courtesy of bmezine

Fig 7: Katzen. Illustration courtesy of bmezine

Pearling of the penis began as a practice of the Japanese Yakuza Mafia while in prison (Body Modification Ezine 2004). Originally small pearls of about 3-4mm in diameter were inserted under the skin (see Fig 8).  In Russian prisons a similar practice was performed whereby small beads were sewn into the prisoner’s foreskin and what are described as “whiskers” or “bracelets” set into it (Plutsner-Sarno & Baldaev 2003: 49)  In Western society today implanted Teflon beads of varying diameters are used, with the intention of improving sexual performance.  Normally the beads are arranged in a deliberate pattern but unfortunately sometimes they slip out of position, spoil the aesthetic effect, and cause discomfort, or worse.   Examples of stapling, pocketing, heavy genital and other sexual piercings are fairly common illustrations on Body Modification Ezine, the major internet site for those interested in BodMod. 

Fig 8: Beaded and tattooed penis. Illustration courtesy of bmezine

 

As part of its 20th anniversary celebration Galerie Ra in Amsterdam ran a design competition entitled “Jewellery of the Future”. Elisabeth Scheuble won with her “self implantation kit” intended for insertion into the scalp (see Fig 9).  As far as I am aware, this was simply an idea, but clearly there are people who might well wish to make it a reality (Galerie Ra 1996).

Fig 9: Self Implantation kit by Elizabeth Scheuble. Photo credit: Paul Derrez, Galerie Ra

In the Summer of 2006 I undertook a residency at Oregon College of Art and Craft in Portland, Oregon and while there I gave a public presentation of an earlier version of this paper.  As it happened, there were some members of the local BodMod community present and they expressed interest in opening a dialogue.  I found them to be very receptive people, mostly graduates undertaking professional jobs such as photographers, book restorers, accountants, theatre costume designers, and jewellers.  Some of them had undertaken suspension and talked about the sense of achievement and “otherness” that this experience had given them.  In some ways they felt that their tattoos and other modifications such as multiple piercings and Teflon implants, offered a peculiar sense of belonging, while nevertheless marking them out as different to the rest of society. Issues of culturally imposed body stereotypes were no less important to them than some of the authors to whom I have referred earlier in this work. One of them writes a daily Blog for a limited group of associates and friends.  In it she gave her initial reactions to my lecture and a group conversation then took place over several weeks in which they discussed not only my thesis but their own reasons for being involved in BodMod, their rejection of body stereotypes or at least their individual attempts not to be enslaved by those which they perceive to be culturally predominant.  But they also recognised that some women whom they knew well had genuinely enhanced their lives and become happier by undergoing elective cosmetic surgery.  It became clear that some of them have a genuine interest in the potential for a more natural form of bodily intervention than that currently offered by Teflon or Silicone implants.

You may not admire or approve of the examples I have referred to.  You may even be disgusted by some or all of them.  However, moral philosophers refer to the Three General Principles, the first of which is Respect for Autonomy.  This is the concept of Personal Self Governance: individuals have an intrinsic value and have the right to determine their own destiny (Hench 2001).  These examples of body decoration, or reconfiguration, have been undertaken by people practising their own free will and presumably their own moral and aesthetic convictions. 

The Future

So, now that Tissue Engineering technology is so advanced and proven to work I believe that it may soon be possible to have a three dimensional culture of your own cells inserted under your skin and  watch and feel it grow into bone, cartilage, or other soft tissue.  You may not be attracted by the idea, you may be appalled by it, you may think that it is unnatural, undesirable, even unethical, and a misuse of important medical research.  However, as I hope I have demonstrated in my references to Plastic Surgery, what is groundbreaking and intended to alleviate suffering and misery today is likely to become almost routine tomorrow.  Once it becomes routine it becomes commercialised – and many of the intellectual property rights of Tissue Engineering are already held by commercial companies.  The Melbourne team which has developed breast tissue believes that financial backing to fully develop the process will come from organisations with an interest in commercial cosmetic surgery applications, presumably one of the “transnational corporations” which Jeffreys dislikes so much (2005: 172); they do not expect that public funding will be made available.  Yet, this is an outcome of research which at its outset had an altruistic purpose.  As I have shown with Orlan and Hallam, if you are persuasive and articulate enough you can most likely find a medical team to do almost anything you want if it’s legal and the resources are available.  Some of the more extreme Teflon implantation procedures are already performed in countries such as Mexico and Brazil where medical regulation is less stringent, or else underground in the USA and Britain.

Six years ago when I wrote my first paper on this subject the British biomedical researchers were unwilling to discuss it with me because of their perception of it as an irresponsible thesis.  At the time, especially given the nature of the Creative Leap to which I referred earlier, it probably did seem to them that I was some sort of “crazy man”, as one of them is said to have described me.  However, as I have developed my research they have been much more willing to share their information and to express interest in the possibilities of the use of Tissue Engineering in this way.  There has never been a denial of the possibility of what I have suggested, but now there is genuine interest in my predictions and a willingness to engage.

By contrast, the University of Western Australia in Perth has for some years hosted Symbiotica, a multidisciplinary team which includes designers, biologists, artists and computer specialists with an interest in exploring such issues.  Their website illustrates inter alia, a collaboration with the performance artist Stelarc for whom a third ear was grown (Symbiotica 2004).  Whatever one might think of this or any other particular project, the Symbiotica lab is a serious academic undertaking in which the creative dialogue between artists and scientists is actively encouraged and from which the results so far have been thought provoking and fascinating.

This paper is not offered simply to shock or to titillate.  Artists and designers have always been receptive to new technologies.  This is one new ‘soft’ technology with potentially far reaching consequences and which therefore needs serious consideration.  I should like to encourage psychologists, sociologists, philosophers, and social anthropologists to join in debate and discussion to ensure that the development of Angiogenetic Body Adornment is treated responsibly and seriously as its potential develops into a reality. 

There seems no reason why the more adventurous amongst us might not wish to explore the possibilities of experiencing Angiogenetic Body Adornment. It might arguably be safer than implanting alien materials such as silicone and teflon-coated steel (see Fig 10) for which there is anecdotal evidence to indicate at least occasional breakdown within the body, and might give opportunities to create new physical conformations made  possible only by stimulating natural growth.  Besides Orlan and Stelarc there are other artists, such as Franco B, who use their bodies as the material for their creative practice and I think it not unreasonable to imagine that in future there will be multidisciplinary collaborations to grow external parts of the body to make them more prominent, more decorative, more beautiful, or even deliberately more ugly, and certainly more provocative.  I can imagine Orlan and Eric Sprague being among the first to undertake practical experiments of this sort.

Fig 10: Clavicle with new implants. Illustration courtesy of bmezine

The biotechnology will allow the final form and size to be accurately calculated and controlled by the designer working in conjunction with the biomedical specialists.  Thus the human subject, whether a performance artist or member of the public, becomes the designer, directing and collaborating with the other participants in a unique project which until very recently might have been thought of as pure science fiction.  I envisage the first stages being a visual process where the subject might draw, model, or use computer software to design the bodily additions or decoration.  Sophisticated software will then calculate the mass, volume, and surface area of the three dimensional model to be made.  Weight will depend on the material to be used for the scaffold.  Depending on the form, this might be made by hand or via rapid prototyping.  The biomedical specialists will accurately calculate the growth properties of the culture made from cells previously taken from a suitable body site.  The model will be impregnated with this and surgically inserted into the body where the cells will begin to grow and replicate themselves as the scaffold naturally dissolves.  Gradually, over a period of weeks and months, the selected part of the body will take on a new form as the implant generates its own angiogenetic growth and becomes an integrated and integral part of it.  This is Carnal Art in possibly its purest form, where the individual has control over manifesting his or her individual identity (Akman 2006: 1) and one in which anyone might transform him or her self according to an individual philosophy and personal critique of the beauty concepts currently predominant in our society.

Figs. 11 to 15 are initial illustrations suggesting what might be possible:

Fig 11: Shows proposed soft tissue growth on the forehead. Photo credit: Norman Cherry/ Les Curtis

Fig 12: Shows exaggerated growth of already prominent bones.
Photo credit: Norman Cherry/Les Curtis/David Miles

Fig 13: Shows soft tissue growth around the wrist. Photo credit: Norman Cherry

Fig 14: Shows proposed further detailed bone growth.
Photo credit: Norman Cherry/Les Curtis/David Miles

Fig 15: Shows proposed soft tissue growth on the forehead.
Photo credit: Norman Cherry/Les Curtis/David Miles