Making the world understand my face
On a packed commuter train, passengers rarely give their fellow travellers more than a passing glance. But Alison Rich is not just another face in the crowd – what is the impact of facial deformity on an otherwise normal life?
Every morning on her way to work, Alison Rich is met with sideways glances and furtive second looks. Some people stare openly, others turn away out of embarrassment.
Alison was born with a condition that impeded the development of the left side of her face and gave her spine a severe scoliosis, curving her back from side to side. From the ages of two to 13, she was strapped into a brace from her waist to her neck. She has had to deal with such reactions all her life.
She now works for Changing Faces, a charity that challenges the prejudices surrounding facial disfigurement. Ahead of a public discussion on Thursday at London’s Wellcome Institute, Alison invited me to follow her daily commute to witness the reactions of fellow passengers.
Don’t look is usually the unspoken rule of a crowded commute
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What for everyone else is a momentary shock, followed by a double-take, for Alison is constant undermining scrutiny.
As suited workers file on to the drizzle-stained platform in south London, she is met with a series of second glances. One man stares openly, his mouth slightly open, eyebrows knitted in fascination. A woman looks away, her face full of pity.
No-one actually says anything, but as passengers crowd onto the train, their eyes dart up from a newspaper, or hastily look away and then back again. One woman stares, her eyes wide in grim fascination.
“Some people we work with, people literally stand back in horror. But for me it’s that constant slow drip, drip and you can imagine what that does to someone who is not emotionally equipped.”
Findings by Changing Faces suggest 542,000 – or one in 111 – people in the UK have a significant facial disfigurement. Alison, 35, says the publicity that comes from events such as the Wellcome Trust debate helps challenge responses to disfigurement, engrained from the playground to the workplace.
“We don’t have to be PC about it. We can’t deal with it until people are aware of what they are thinking.”
While society is more accepting of physical disability, the huge growth in cosmetic surgery suggests beauty is increasingly skin-deep.
A 2007 survey by market analysts Mintel predicted people in Britain would spend about £1bn on cosmetic surgery in 2008. They found 577,000 cosmetic treatments were carried out in the UK in 2007, up from 300,000 in 2005.
Seeking to improve on nature
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Alison believes the trend is leading to a narrower definition of what people find acceptable. Professor Alex Clarke, from the Royal Free Hospital – which has ethical permission to perform the first face transplant in the UK – agrees with her.
There is now pressure not just from celebrity culture, but in what is expected from day-to-day life as well.
“It’s more the sort of presentation of highly attractive people in everyday contexts. It’s the sitcoms like Friends or Neighbors, or very good-looking newsreaders. That’s the subliminal message,” she says.
And this airbrushed ideal is emerging at an early age. For someone going through puberty with disfigurement, the anxiety and insecurity can be particularly distressing.
“Because it is coming at you from all angles, from the TV, from the internet, it’s very difficult to stand back from this and say do I agree with this? Am I happy to look the way I am?”
Alison is not opposed to plastic surgery – she has had 15 operations on her face. The decision whether to go under the knife, she says, should come down to individual choice.
And medical advances such as face transplants can raise false hopes of what can be done for people with disfiguring conditions.
Isabelle Dinoire, who received the first partial face transplant
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“You look at somebody with a pan-facial scar from a Spitfire, for example, or at somebody with a pan-facial scar from a road accident, the cosmetic result really isn’t much different,” says Prof Clarke.
It’s a point that Alison feels strongly about too.
“The first thing is that they are only available to a very small number of people with particular injuries, so everyone is not going to be suddenly walking out with a face transplant.
“The way the media has presented face transplants is it sets them out as a great white hope and plays into this stereotype that it’s absolutely impossible to lead a decent life if you have a disfigurement, and that just isn’t true.”
Coping strategy
Ultimately Alison has dealt with her disfigurement through inner strength.
At school, girls would be friendly outside the gates, but shun her in the classroom. At discos boys would stand in front of Alison before turning to her friends and refusing to dance with her.
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  I don’t look in the mirror in the morning and say ‘oh God, look at my face’  |
It was one of the cruellest reactions that transformed how she dealt with her disfigurement.
“I was in the student union and this guy came up to me and threw me against the wall and said: ‘You are the ugliest thing I have ever seen, I’d kill myself if I looked like you’. I just didn’t go out for a few days, I was quite bruised by it.
“But it also made me realize how I was going to handle myself and that I had to get strong inside. And I think even more importantly I needed to learn how to deal with these things.”
In a way, she says, he did her a favour. She now has a number of strategies she recommends to anyone concerned about their disfigurement: Look someone in the eye, have a short explanation ready, move the conversation on, and seek expert support.
But she still has bad days.
A young man who had been talking to her suddenly turned round and said: “you’d be really lovely if you weren’t so ugly”; and before her wedding a shop assistant told her: “Oh gosh, I didn’t think that someone who looked like you could get married.”
Alison is always aware of how those around are reacting.
“I never have a day off. But I don’t look in the mirror in the morning and say ‘oh God, look at my face’. I think I’m looking pretty tired today, or shall I pick up some lipstick, or ‘hey, you’re looking pretty good’.”
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