May 23, 2008

The genesis of the American medical drama and

Nip/Tuck and the spectacle of the real.


The genesis of the medical drama in American television provides an interesting landscape of transformation. Beginning in the late 1950s and early 1960s, these early shows were very conscious of not upsetting the image of doctor as infallible hero. This tradition continued for some time into the 1970s and early 1980s until a change occurred in the genre, in which subsequent shows increasingly depicted the fallible nature of these doctors’ humanity. Nip/Tuck (Murphy, 2003-present), perhaps the most thematically intriguing of the current medical dramas, is discussed in some detail, in regards to its treatment of the surgery scene and notions of perfection. Firstly, however, the earlier shows that have set up the generic conventions and forms will be discussed.

The early narrative form of the medical drama was relatively simple and these shows always sought to reinforce the image of the physician. Shows such as Ben Casey (1961-1966) and Dr. Kildare (1961-1966) were typically set in a hospital, featured a young male physician, his mentor, as well as patients, nurses and other doctors. These physicians were the kings of the hospital – and each episode primarily centred on one patient’s combination of physical and emotional or social problems.

The disorders suffered by these show’s patients tended to be acute rather than chronic, which allowed the narrative to progress toward a climactic scene, usually a surgery which involved the curing of the patient or very rarely, their death. Ben Casey (Vince Edwards) and Dr. Kildare (Richard Chamberlain) were the ideal physicians in that they consistently saved lives with relative ease, fixed broken marriages and families and gave patients a stronger will to live (Strauman & Goodier, 2008). The generic trope that started with these two important shows is that of the mentor role guiding the young, but inexperienced, physician. It is an important trope in the medical drama and has been used widely in the genre since these two shows.

Dr. Kildare

Dr. Kildare (1961-1966)

While this simple formula held sway for many years (excluding shows such as St. Elsewhere (Brand & Falsey, 1982-1989) which emphasised grittier, decaying hospitals), a considerable shift occurred in the 1990s in portrayal of doctors on television, as well as in the medical drama as a genre. This change began with shows such as ER (Crichton, 1994-present) and Chicago Hope (Kelley, 1994-2000). These newer shows attempted to demonstrate a higher degree of realism and complexity in their portrayal of doctors and hospitals, and opposed this idealistic view of the physician seen in earlier medical dramas. They used moral dilemmas where the doctor characters were shown to be racist, misguided, unsure, or uncaring toward one another (Strauman & Goodier, 2008), repeatedly highlighting the fallible nature of these medical practitioners. These doctors were, however, still positioned to the spectator as acting in the best interests of their patients, and in doing so these newer medical dramas retained some of the aspects of the ideal physician seen in earlier shows.

Currently, three shows – Grey’s Anatomy (Rhimes, 2005-present), House (Shore, 2004-present) and Nip/Tuck – offer three perspectives on this broad genre, using narrative forms and generic conventions that differ from one another. Grey’s Anatomy tends to focus on the relationships between the doctors as the driving force behind the narrative, as well as displaying 2 or 3 extraordinary cases that help the doctors to learn lessons that parallel their personal lives. In its intense focus on the relationships between the fictional surgical interns at the Seattle Grace Hospital, Grey’s Anatomy becomes the most soap-opera of the current shows. House, provides a largely different take on the medical drama than that of Grey’s Anatomy, is a mystery show set in a hospital where the disease acts as villain and House acts as investigator and hero (Strauman & Goodier, 2008). Though a flawed a human condition is presented in the character of Dr House (Hugh Laurie), wherein he is seen popping prescription pills throughout most episodes, he is still reinforced as a positive medical figure through his case solving ability. Nip/Tuck presents the most flawed and ambiguous vision of the doctor yet encountered in the medical drama – perhaps appropriate for the world of plastic surgery that our two “heroes” inhabit.

First surgery scene from “Pilot” episode – a facelift for a paedophile wanted by the mafia

Nip/Tuck is, as the show’s creator Ryan Murphy (2003) describes, ‘a show about skin on every level – skin in plastic surgery, skin in sexuality’. The show is, though, also about going beyond skin, and looking at flesh and the insides of the human body, both metaphorically and literally. The flesh of the human body is privileged through spectacularly over-the-top (in regards to visuals and sometimes the nature of the procedure) surgery sequences, in which cosmetic surgery is rendered an unnecessary invasion into the body. Indeed, the boundary between reconstructive and cosmetic surgery is consistently negotiated, with the latter depicted as a narcissistic practice (Tait, 2007), through which ‘people externalise the hatred they feel about themselves’ (Sean (Dylan Walsh), season 1: episode 1).

The surgical scenes in Nip/Tuck offer what Tait (2007: 128) calls the ‘spectacle of the real’. While other medical dramas such as those in ER and Grey’s Anatomy have shown surgery to be a relatively non-invasive process, Nip/Tuck‘s gory sequences function to focus attention and reiterate the “truth” of that which is being witnessed (Tait, 2007). The strong emphasis on photorealism have led viewers to question the constructed nature of the scenes, indeed many excruciating hours is spent making the prosthetics. This intense focus on gruesome, realistic parts of the surgeries in Nip/Tuck challenges the viewer to watch the rupturing of skin and flesh, and to watch the intervention of healthy bodies (although sometimes they are disfigured) in the name of fixing internal problems (self-esteem issues) with an external solution. As ruptured skin and flesh fills the screen, the ‘viewing engagement becomes of a different order’ (Tait, 2007: 128).

The complete suspension of narrative in Nip/Tuck’s surgical scenes is another point of departure from traditional medical dramas, which use surgeries to drive the narrative forward or as an episode’s climax. Instead Nip/Tuck’s surgical scenes primarily function to display the aesthetic spectacle of gore, flesh, blood, skin, cutting and slicing. These things are given privilege by Murphy’s camera in this first surgery scene (season 1: episode 1), wherein a paedophile mobster (Geoffrey Rivas) who has raped his mob boss’s daughter receives a facelift so at to hide from the world. The face of the patient is torn up on screen and the way images are put together highlights the blood and flesh of the surgical body. The musical track that accompanies surgeries in Nip/Tuck, in this instance The Rolling Stones – Paint It Black, often act as ironic counterpoint to the images on screen. Here it also adds a percussive rhythm to the brutality of the facelift. Murphy’s primary aim is to depict an assault on the body; a violation and intrusion of the normal. Indeed, in his research for the show, creator Ryan Murphy (2003) was told by plastic surgeons that the impact of a facelift is akin to that of “going through the windshield of a car at 70 miles per hour”, and he takes this approach with the initial surgery – the world of Nip/Tuck shows surgeries to be a brutal deconstruction (and reconstruction) of the body in the name of perfection.

Christian shows Kimber what the ‘perfect 10’ really looks like

Perfection is the commodity that this industry thrives on, or more specifically, the striving for perfection because one can never fully attain it. The doctors continually sell the opportunity to reach external perfection through a nip and a tuck with their scalpels, and the characters often realise their internal ugliness which is not so easily fixed. The scene from the pilot (episode 1:season 1) in which Kimber (Kelly Carlson) is told what the “perfect 10” really looks like, sets up the sort of satirising that the show will continue with in subsequent episodes. Through his outlining of a number of unnecessary surgeries for model Kimber, Dr. Troy (Julian McMahon) engenders a sort shame and humiliation in Kimber, who eventually has the surgeries he viciously outlines. Over the course of the show’s 5 seasons, Kimber’s character tells a cautionary tale of the excesses of surgical culture (Tait, 2007) – she becomes a cocaine and ice addict (in separate seasons), a porn star, a scientologist and is hunted by the Carver character, whose mantra “beauty is a curse on the world – it keeps us from seeing who the real monsters are” could act as a haunting epitaph for Kimber.

While offering an extreme take on the medical drama (and a significant formal departure in terms of the surgery scene), Nip/Tuck continues the thematic tradition of imagining the medical practitioner as fallible human being, prone to the most human errors – particularly in their morally void personal lives. As a satire on the deeply superficial world in which we live and on the commodity of perfection, it is ambivalent in that it allows the dramatic to overcome the political issues that it briefly engages in.


Goodier, B.C., Strauman, E. (2008). ‘Not Your Grandmother’s Doctor Show: A Review of Grey’s Anatomy, House and Nip/Tuck’, Journal of Medicine and Humanties, 29: 127-131.

Murphy, R. (2003). ‘Giving Drama a Face Lift’ on Nip/Tuck: The Complete First Season [DVD]. USA: Warner Bros. Television.

Tait, S. (2007). ‘Television And The Domestication Of Cosmetic Surgery’, Feminist Media Studies, 7:2, 119 — 135.


2 Responses to “”

  1. machinepeople said

    Any thoughts on the performativity of the doctors in the Grey’s clip in terms of notions of idealised, heroic doctor? I think the kinds of masculinity on offer in each of these shows is worth investigating further. Something in he nip/tuck MTV sequence also strikes a chord in contrast to the protest masculinity of fight club. though that’s not a medical show of course, but the ground covered in CHC on that and commodity culture might give you some food for thought.

  2. aweekendmurmur said

    Hmmm interesting you should mention these points – maybe i bit off more than i could chew in 1500 words. The masculinity thing is very intriguing – certainly in regards to Nip/Tuck where surgery counteracts the emasculating experiences in the doctors’ personal lives. George (Grey’s clip) is emasculated through the surgical experience, especially in front of spectators and must fight to recapture his ‘manhood’ through early episodes in the show.

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