Carl Elliott, the author of Better Than Well, talks about amputee wannabes, Extreme Makeover, and the meta-ethics of bioethics

The Pursuit of Happiness

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	Better Than Well: American Medicine Meets the American Dream [Click the title to buy this book] by Carl Elliott Norton 357 pages, $26.95

Earlier this year, the pharmaceutical manufacturer Allergan announced the "Be The True You 2003 Mall Tour," a traveling roadshow of sorts making the rounds of the nation's shopping centers, offering customer testimonials and consultations with doctors about Botox, a wrinkle-smoothing compound derived from botulinum toxin that won FDA approval for use as a cosmetic last year. When it hit the market, Botox was hailed in the media as the newest, strangest thing under the sun, and to the extent that it's not every day that a close cousin of botulism is touted as the latest route to youth and beauty, such fanfare was understandable. But for all its apparent novelty, Botox was only the most recent of a host of innovations promising renewal and redemption via scalpel, needle, or pill.

Such is the focus of Carl Elliott's new book, Better Than Well, an ambitious and accessible look at how people use medical "enhancement technologies" from Botox to beta-blockers in the seemingly endless struggle to look younger, feel better, and declare themselves happy and fulfilled. Elliott is uniquely qualified to deal with such issues of body and mind—after finishing medical school, he pursued a Ph.D. in moral philosophy instead of entering clinical practice—and in his book he digs deeply, examining such transformative standbys as cosmetic surgery and antidepressant drugs, as well as subtler innovations like piercing, tattoos, and speech therapy for people looking to shed their regional accents. Though the methods Elliott writes about range widely, they are all similarly entangled with delicate issues of identity and self-esteem.

While personal anxiety is a driving force behind the demand for enhancement technologies, Elliott notes that other factors—not least the macroeconomics of the pharmaceutical industry—can hardly be left out of the equation. (A tagline on the Web site promoting the Botox tour is instructive on this point: "CONSULT a Physician at your Local Mall".)

And as he sifts through the occasionally risky and often controversial answers medicine has offered in response to our discomforts and insecurities, Elliott comes up with nearly as many questions of his own: Is it moral to improve oneself through artificial means? Can medical solutions address deep social needs? When you reinvent yourself, who do you become? Elliott observes that our preoccupation with medicalizing and diagnosing all that ails us may not necessarily hold the key to the wholeness, comfort, and happiness that the popularity of enhancement technologies suggests we crave. Indeed, this clinical impulse has the potential to obscure as well as to explain. Elliott writes:

On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and more creativity. I do not want to deny the benefits of psychoactive medication. I just want to point out that Sisyphus is not a patient with a mental health problem. To see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity.

Carl Elliott is a professor of bioethics and philosophy at the University of Minnesota, and a visiting associate professor at the Institute for Advanced Study at Princeton. He is the author of The Rules of Insanity (1996) and A Philosophical Disease (1998), and a co-editor of The Last Physician: Walker Percy and the Moral Life of Medicine (1999). He lives in Minneapolis with his wife and three children.

We spoke recently by telephone.

—Benjamin Healy

[A portion of Better Than Well first appeared as "A New Way to Be Mad" in the December 2000 Atlantic.]

http://www.theatlantic.com/doc/200308u/int2003-08-05

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