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Identity Crisis
9/8/2003

By Katy Read

Something ails us, and Carl Elliott, associate professor of philosophy and bioethics at the University of Minnesota, has diagnosed it: Americans' obsessive pursuit of happiness and fulfillment through "enhancement technologies."

In Better than Well: American Medicine Meets the American Dream (W.W. Norton & Company, 2003), Elliott explores the ground where modern medicine, identity, and society intersect. He attempts to explain why Americans seek self-realization through conformity, why they carry around idealized images of themselves and then alter their bodies and personalities—through Prozac, breast augmentation, and more—to match those images.

But Elliott, who earned his M.D. in 1987 but gave up medicine for philosophy, stops short of criticizing enhancement technologies and this uniquely American phenomenon. Instead, with prose that has a meandering, stream-of-consciousness quality—and a dose of humor—he delves into the various ways people fiddle with their appearance and personality and, in effect, hoists a mirror in front of his "patients."

Q: As I was reading your book, people would ask me what it's about, and I'd have trouble figuring out how to answer. How would you describe your book?

A: It's hard for me to say too. I was trying to come up with a title for the book, and all the titles I came up with had to do something with the idea of identity and self-transformation and the way people are using medical technologies in order to pursue this ideal of authenticity, this elusive notion of the true self. The editors didn't like the titles; my friends didn't like them; nobody liked them. What they really liked was "better than well," the idea of using medical technology for self-improvement, which is much easier to capture in a sound bite.

That's sort of what the book is about. My main interest, though, is why are people so interested in these technologies? Why do people describe these dramatic self-transformations as a matter of becoming who they really are?

Q: Is there a distinction between the transformations possible with new treatments like Viagra and Prozac and breast augmentation, and the transformations that have been available for much longer, such as through orthodontics, makeup, hair dye, and that sort of thing?

A: One thing that's been more recent is the involvement of medicine. You've had fashion, you've had hair styling, you've had the cosmetics industry. But by and large, until recently—with a handful of exceptions, like cosmetic surgeons—doctors have pretty much seen their business as curing illness and disability. There's been a shift, where you see doctors being much more willing to get involved in this self-improvement project.

I think part of the reason that's happened is marketing by the drug industry. The drug industry has become just so enormously profitable that it's unprecedented. It's been the most profitable industry in America for the past 10 years.

The other thing is that doctors have started to buy into the idea that medical treatments can be legitimately used to treat not just physical illness but also psychological suffering. So that if you have children or adults who are stigmatized because they're too short or they're too shy or they can't sit still in class, then that's a job for medicine to fix. And that used to be different. Now, virtually any kind of so-called enhancement can be redescribed as a treatment for psychological suffering.

Q: I got the sense that, although these enhancement technologies were the springboard, you didn't want to limit your discussion to them. You cover other means of self-expression, some of them non-medical. Your larger topic seems to be how all of these relate to personal identity.

A: The book has gotten really good reviews, but one of the frustrating things is that many of the reviews have not really mentioned what the book is actually about. It seems like everybody wants to talk about breast augmentation, cosmetic surgery, Botox, Viagra. Very few reviews have talked about identity and self-transformation and authenticity, the underlying issues that were really the motivation to do the book in the first place. I keep waiting for that deeper conversation about some of these issues.

Q: OK, let's talk about some of those deeper issues. The concept of authenticity seems to be particularly important to modern Americans. But they use the word in a way that people in the past wouldn't have recognized. People say, paradoxically, that by doing something artificial to themselves or by taking a chemical they become more "authentic."

A: I remember reading Peter Kramer's book Listening to Prozac when it came out [Kramer wrote the introduction to Better than Well]. One of the things that struck me was that the patients in the book kept saying things like, "I feel like myself while taking Prozac." And my first thought was that there must be something novel about this drug; this drug must be something very different from earlier generations of antidepressants.

But then, later, I started to hear that story everywhere. People who'd gotten sexual reassignment surgery would say, "I feel like myself now; I've achieved my identity at last." People would take steroids and say, "This is how I was meant to be." It was especially striking with the amputee wannabes, people who are obsessed with having their healthy limbs amputated, who were using that same kind of narrative: "I feel incomplete as long as I have all my arms and legs." I started to think that what people were saying was not anything particular about the technologies but rather about the way we think about ourselves: what it is to live a meaningful life, and how technology can help us do that.

What interested me, philosophically, was looking at this idea of authenticity and finding out, when exactly did it come about? When did people start talking about it, when did they start looking inward to find out who they are?

Q: When did they?

A: A couple of hundred years ago, according to [Canadian philosopher] Charles Taylor. It was only then that people began to think of themselves as individuals with uniquely important inner depths. Taylor connects this to the replacement of European social hierarchies with democratic forms of government. There was a time, he says, when your social identity was simply yours by virtue of who you happened to be born to. But with the replacement of those social hierarchies with democratic society, your identity became something you had to generate on your own. Instead of looking outward—to God or truth or rationality—for guidance on how to live a meaningful life, you started looking inward, to discover your own particular talents and values and aspirations and so on. When that happens, then the idea of yourself as an individual takes on enormous importance. Your life becomes a project that you are responsible for, and that project can fail. If you're not in touch with yourself, you may be wasting your life, you may be doing the wrong thing, you may be living as a man when you should be a woman, you may be working at the wrong job, you may be living in the wrong place, you may be dressing in the wrong way, your presentation may be all wrong. It becomes a matter of getting in touch with your inner self in order to decide how to live your life.

Q: So, that idea didn't just come out of California in the 1960s?

A: California in the '60s and '70s has to be sort of the apex for the idea of authenticity in pop culture. But the ideal of authenticity goes a lot further than that. Think about psychotherapy, for example, and the idea that this inner self-exploration can give you guidance in how to live your life. Or the political idea that every person in a democratic society should be free to pursue his or her own individual vision of the good life. Or the idea of the conscience, this inner sense of right and wrong that you have to get in touch with in order to decide how to act morally. All this is shot through with the notion of authenticity.

But there is a superficial aspect to it too. Once I started working on this, I started to hear this stuff everywhere. There was a period in which in every Disney cartoon I would go to see with my kids there'd be some point at which the hero or the heroine would break into a song about becoming who they really are or following their heart. And I thought, this stuff is drilled into children from the time they can talk. This is not something unique to enhancement technologies. It is just the way we think and talk now.

Q: Do you see this as a dystopia? Your book has a detached tone, but are you critical of these changes?

A: No, it's not a dystopia. But that doesn't mean it doesn't have a dark side. In earlier drafts of the book, I was much more overtly critical. But in reading it over, I found that I didn't really like the voice when I became angry. I really hate that self-righteous tone, yet I can't resist it. Because I am self-righteous! [Laughs.] It's hard to moralize without coming off as a moralist. So I edited a lot of that out. Some people who have read it now wonder whether or not I have a problem with these technologies. And with some of them, I don't. But I think that if you read the book and don't get the impression that I'm skeptical about a lot of these things, you didn't read the book very carefully.

Q: If you hadn't edited out the more negative tone, what would you say?

A: On the one hand, if you are looking at a particular patient who is in trouble and you can help him with technology—with some sort of intervention, a surgery or a drug—then it's hard not to feel sympathy and hard not to want to help. On the other hand, when you step back and look at the broader social forces that are producing these things, you can't help but think there's something wrong with a country that's consuming 90 percent of the world's supply of Ritalin. There's got to be something wrong with a country where the most profitable drug is antidepressants. That can't be a good thing.

Katy Read (B.A. '81) is a Minneapolis freelance writer.

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