Journal of the New Zealand Medical Association, 20-May-2005, Vol 118 No 1215
Better than well: American medicine meets the American dream
Carl Elliott. Published by WR Norton & Company Inc, 2003. ISBN 039305201X. Contains 320 pages. Price US$26.95 (US$16.98 on Amazon.com)
This book explores the paradoxes of self-improvement. The author is a professor of bioethics and philosophy. Its major subject is the increasing use of “enhancement technologies” such as drugs, surgery, and therapy in an attempt to improve our happiness and wellbeing. The book shares some features with any number of others such as Listening to Prozac (whose author, Peter D Kramer, contributes the Forward) and focuses on the ambiguities in its subtitle “American medicine meets the American dream”. Unlike many similar books, however, it is well worth reading.
Elliott grasps that historical and philosophical concepts lie behind the American (and to an increasing degree all Western countries) ideology of happiness and self fulfilment. He refers the reader to an array of literary philosophical and scientific readings to back up his assertions. Even better, he is humorous and sardonic and at times almost bleak in a rather un-American way (perhaps his 4 months sabbatical at the University of Otago contributed to this).
His central argument is that American culture sees the power of individual authenticity as the moral ideal. Within this, conscience is incorporated as the moral guide and the concept of self-fulfilment is seen as a democratic right to pursue ones own vision of the “good life”.
The problem with this vision is that the fulfilment is largely self reverential and therefore there are constant doubts over whether this fulfilment is adequate. The lack of any fixed or agreed upon success or failure imparts a sense of unease; we are constantly wondering whether we could be better—i.e. could be more fulfilled. This unease leads to the increasing use of enhancement techniques to ensure that we are near the top in being self fulfilled or at least reasonably competitive. The recurring problem is that we can never be sure; there is no way of validating our happiness in relation to others’ happiness.
Elliott also challenges the consolation that while these enhancement technologies apply to others they do not apply to us. He points out that we all moralise about enhancement technologies except the ones we use ourselves. He suggests that it is similar to people “living in the suburbs but pretending they are not real suburbanites”.
Finally he refuses to let us off the hook by blaming drug companies, advertising, the government or other controlling agencies. He suggests that what we grasp at is the result of free choices made in the search for some peculiar kind of American happiness.
Professor of Psychological Medicine
Christchurch School of Medicine and Health Sciences
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