effectual waitperson: Could botox change your life for the better?

Tuesday, January 22, 2013

Could botox change your life for the better?

Michael Bond, consultant

(Image: Thierry Du Bois/Reporters/Eyevine)

In The Face of Emotion, Eric Finzi explores how one of the world's most popular cosmetic procedures could alleviate depression

THE idea that emotions and feelings are triggered by changes in the body, rather than the other way round, seems counter-intuitive. Yet this idea has been entertained by psychologists for more than a century. In 1890, the father of them all, William James, wrote: "Common-sense says, we lose our fortune, are sorry and weep; we meet a bear, are frightened and run; we are insulted by a rival, are angry and strike... The more rational statement is that we feel sorry because we cry, angry because we strike, afraid because we tremble."

Recent research has put flesh on the bones of these musings. Neurobiologists such as Antonio Damasio of the University of Southern California have demonstrated that emotions begin with actions - rapidly increased heart rate, for example - and end with the perception of those actions - the sensation of fear or anger. Damasio calls this the "body loop": the brain learns of the body's response to change via chemical and electric signals conveyed by the bloodstream and nervous system. Thus feeling follows behaviour; the mind follows the body.

In The Face of Emotion, Eric Finzi explores how this plays out in facial expressions. There is no doubt these are integral to the way we embody and experience emotions: simply forcing your face into a smile or frown will induce feelings of happiness or sadness. Finzi, an American dermatological surgeon, is a fundamentalist in the church of embodied emotion. He believes facial expressions are "the power behind the throne", the principal driver of our moods and feelings.

More than that, he thinks he can change people's feeling of mental well-being by manipulating what they can do with their face. And for some years he has been doing just that by injecting botox into the corrugator, or "frowning", muscle of depressed patients to prevent it from contracting. This, he reasons, interrupts the feedback loop to the brain that causes their negative outlook and thus improves their mood.

It sounds incredible. Finzi seems to be saying that people with depression can cure themselves just by looking happier, or by repressing their ability to look sad. Yet he describes some striking success stories. One person who had had severe depression for 13 years felt so much better after botox that he decided not to take his Prozac. Another who had tried therapy and various antidepressants with no effect reported a "dramatic improvement" after Finzi's work. Finzi mentions several clinical trials, such as one last year in the Journal of Psychiatric Research, that confirm his findings.

Is this a solution to depression or is it merely cosmetic? Time and more research will tell. Finzi does acknowledge the treatment is no cure, and that the injections need repeating every few months to maintain the effect. He says his patients do not feel better simply because they look better - not all of them had pronounced frown lines before treatment (a contracting corrugator does not always leave wrinkles). Yet given the effect of social interaction on mood, it is possible that some of the improvement is due to those around the treated person reacting more positively to a brighter countenance.

This is one of several questions that Finzi fails to address. He has a knack of glossing over or not recognising potential downsides. What are the effects of not being able to express sadness or anger? How might it affect the way we relate to others, beyond boosting our ability to bluff in poker? Some studies, not mentioned in the book, suggest that because botox impairs people's capacity to mimic facial expressions, it can make them seem less trustworthy or likeable. None of this gets much of a look-in. It all sounds a bit too good to be true.

Yet The Face of Emotion is well worth reading. The scientific debate about the regulation of the emotions is as lively as ever, and this is a provocative and insightful contribution. Some of the outcomes Finzi reports look remarkable, even if the mechanism is unclear. As one satisfied patient testifies after receiving botox to reduce his anger, "I don't really understand how this is working, but my wife says keep it up."