He changed so much, but why?

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.

But sometimes surgeries and other cosmetic medical procedures are simply pragmatic attempts to deal with disfigurement or stigma. There is some evidence that Jackson suffered from a patchy bleaching of the skin called vitiligo, which occurs in all races but is most evident in those with the darkest complexions. If he did, he may have undergone skin-lightening procedures in an attempt to minimize the splotching.

Jackson’s surgical reshaping of his nose is usually attributed to a racially based self-loathing. But that’s not necessarily what it was. One of the things the earliest cosmetic surgeons also understood was that psychological discomfort with specific aspects of one’s appearance is not necessarily a psychiatric disorder.

Some Jews in Germany as Hitler gained power, and some Irish in America during the 19th century, certainly changed their appearance to allow them to “pass” in societies that wrongly saw the shape of their ears or noses as indicators of inferiority. During Reconstruction, African Americans had operations to correct so-called parrot noses. Certainly many of those were undertaken by light-skinned individuals wishing to pass as white, but should a desire to escape repression really be viewed as a pathology?

Many people opt for surgery or other cosmetic treatments out of a simple desire to look their best. Vietnamese Americans undertake nose jobs and double eyelid surgery not to “pass” but to change aspects of their appearance for the sake of standards of beauty that are as “Asian” as they are “American.” American Jews have nose jobs not to look “less Jewish” but to more closely approximate the beauty norms of the society in which they live.

Ethnic-specific plastic surgery is now common -- and it is usually not motivated by a desire to pass so much as a desire to improve one’s self-image. Just look at the growing popularity of Botox, widely used by men as well as women. Most of those who get the treatments aren’t trying to pass for 20; they just want to look good for their age. Is that self-hatred?

Whatever Jackson’s motivation for changing his appearance, we should not assume that his surgeries were proof of an underlying psychopathy. I hope that millions of Botox users out there will agree.