Cherubism

BBC1, Wednesdays at 9 10 pm, 7 to 28 March

The face serves many important functions, ranging from supporting the airway and the organs of special sense through to forming the most distinctive aspect of our personality. Since society began, facial appearance has been important. Psychologically, the concept of beauty and ugliness can result in a variety of psychiatric conditions, while abnormal development, trauma, cancer, or surgery affecting the face can cause considerable physical and psychological morbidity. Socially, discrimination based on facial appearance occurs in both workplace and classroom. The human face is therefore of great interest--as Cicero said, "everything is in the face."

The Radio Times described The Human Face as the definitive guide to the history of the face. Four 50 minute episodes, which have taken a year to complete, explore identity, beauty, expressions, and fame. Evidence from medicine, surgery, and psychology is presented in the form of case documentaries and comic sketches linked by veteran comedian John Cleese, a coauthor on the series, and actress Elizabeth Hurley.

The first episode, entitled "Face-to-Face" examines facial expression as a method of communication. Two cases illustrate the difficulties that can result either when facial expression is made difficult due to abnormal facial nerve development, as in Mobius's syndrome, or when facial expressions cannot be interpreted, as with Asperger's syndrome. A vignette focuses on an arguing couple on the brink of divorce, who are sent to a research unit to learn how to understand and hence avoid provocative facial expressions. More for dramatic effect than for its relevance is the inclusion of a US study claiming features of facial expression on a single photograph could predict success and happiness for an individual 40 years later.

The second episode, "Here's Looking At You," is an improvement on the first. The concept of facial deformity is introduced using an individual with cherubism, while the US plastic surgery phenomenon is demonstrated by a Mexican woman who undergoes a "Westernisation rhinoplasty" to adopt a more Caucasian appearance, something that many in Britain would consider inappropriate. Failure to consider body dysmorphic disorder at this point was surprising. The episode also discusses the cognitive pathways involved in face recognition and the resulting neuropsychological disorders such as prosopagnosia, the inability to name familiar faces, but the discussion becomes oversimplified.

Although the first episode is rather disjointed, and the sketches with Mr Cleese and Miss Hurley somewhat laboured, the series improves in the second episode. However, much more could have been made of this fascinating and complex subject in this ambitious and expensive production. Most of all, The Human Face highlights the problems encountered when documentary researchers and writers unfamiliar with a subject exclude core scientific material in exchange for that of high journalistic impact. Somewhat surprisingly, this British production also seemed aimed at the US market and gave the impression that expertise did not exist in the United Kingdom. It does raise the question whether marketing of programmes abroad is now of prime importance for the BBC.

The final two episodes were unavailable to us. Entitled "Beauty" and "Fame," they are likely to be popular because of the public appeal of these subjects. In the press John Cleese has described this project as "a total nightmare" For those who miss the nightmare, a book is available for just under 20 [pounds sterling].

Nayeem Ali specialist registrar in oral and maxillofacial surgery, Royal London Hospital

Paul Farrand lecturer in medical psychology, St Bartholomew's and the London School of Medicine and Dentistry

COPYRIGHT 2001 British Medical Association
COPYRIGHT 2001 Gale Group