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by Carl Elliott
W.W. Norton, 2003
Review by Christian Perring, Ph.D. on Feb 24th 2003

Better Than Well

In Better Than Well, philosopher and bioethicist Carl Elliott examines the meanings of enhancement technologies for American life.  His central examples are drugs such as Prozac, Ritalin and beta-blockers, cosmetic surgery, and body modification.  His approach is not to methodically analyze the benefits and problems associates with these methods of self-transformation.  Rather, he meditates and ruminates on issues connected with these technologies, approaching them repeatedly from different perspectives.  He discusses measurable trends in social behavior, themes in literature and film, and interviews he has with many different people.  Elliott has an enviable fascination in the world around him, and he shows a great facility for drawing unexpected connections between different ideas.  Better Than Well is not so much an argument against enhancement technologies as an extended exploration of reasons one might have to be suspicious of our growing dependence on them.  It’s a sprawling, tangled work of social study that deliberately refuses to advocate a general theory about “the problem with enhancement technologies.”  In other works, Elliott has expressed admiration for the philosophy of Wittgenstein (see his A Philosophical Disease, reviewed in Metapsychology December 2000), and this new book could be understood as a collection of remarks in a Wittgensteinian spirit, intended to nudge the reader into adopting a new perspective rather than entering into an existing ethical debate.  Better Than Well is an important contribution to cultural criticism, being both serious and enormously engaging in its style. 

Given Elliott’s approach, there’s not much of an argument to summarize.  Nevertheless, his stance is clearly critical.  He starts his book with the case of the tranquilizer Serentil marketed by Sandoz in the late 1960s, and he finishes with Elvis Presley:

When Elvis died at the age of forty-two, lying face down on the bathroom floor with his silk pajamas around his knees, his toxicology report found Elavil, Aventyl, codeine, morphine, methaqualone, Valium, ethinamate, ethchlorvynol, amobarbital, Nembutal, Carbrital, and Sinutab, some in ten times their lethal doses.  This was not the result of any central authority slotting people into castes.  It was the result of free choices made in a search for some peculiar kind of American happiness.  (304)

Along the way, he discusses Stephen Hawking’s computer voice synthesizer, sex-reassignment surgery, body building, Kingsley Amis’ novel Lucky Jim, the Japanese mental disorder taijin kyofusho, several novels by Walker Percy, broadcaster Christine Dury who had surgery to stop her from blushing, the Mall of America, consumer capitalism, Richard Ford’s novel Independence Day, John Howard Griffin’s memoir Black Like Me, groups of people who desire surgery to make them amputees, the Chinese tradition of binding girl’s feet, compulsive email checking, Carlo Collodi’s children’s story Pinocchio, and John Frankenheimer’s 1966 film Seconds.  He invokes the ideas of historian Alexis de Tocqueville, sociologist Erving Goffman, African-American scholar W.E.B. Du Bois, feminist bioethicist Margaret Olivia Little, philosopher of science Ian Hacking, and political theorist Charles Taylor.  The pace is fast and thoughts rush by.  Readers could be forgiven for being unsure exactly where Elliott stands on some crucial issues.

It is clear that Elliott’s main focus concerns people’s desire for medical technology to help them for perceived problems that don’t normally qualify as medical disorders in a strict sense.  He takes a somewhat skeptical view of the objectivity of categories of mental disorder, and is concerned that there are often fads and temporary trends in psychiatric diagnosis.  He emphasizes that people often use the language of identity or authenticity to justify their needs for this technology, and he gives sustained attention to the claims of people who say they are incomplete without the technology or who need it in order to be true to themselves.  He examines the notion of cultural identity and shows how it has become an important force in everyday thinking.  He also expresses interest in the more modern idea that we have no core being but rather we take on various roles in different contexts.  In the end, it is not clear that Elliott is ready to endorse any particular view of cultural identity. 

Some are likely to find Better Than Well a frustrating read, because Elliott seems so reluctant to frame his views in argumentative form or to even state his ideas in general claims.  He comes to some conclusions, generally at the ends of chapters.  For example, “Authenticity can be packaged, commodified, and put to work for capitalism” (p. 128), “As long as we live in a society in which a person’s happiness is so dependent on the opinions of others, we will always have the problem of people feeling oppressed by cultural standards” (p. 206), and “Once self-fulfillment is hitched to the success of a human life, it comes perilously close to an obligation… to the self” (303).  Maybe the strongest arguments can be derived from his examining the use of enhancement technologies in contexts of race and gender.  It is easy to see how it is problematic to encourage the use of technology that would enable black people to pass as white, because this reinforces the valorization of white over black.  We can see how encouraging women to get breast implants and fat reductions to conform to the cultural standards of beauty reinforces a shallow view of the nature of beauty.  Behind these analogies is the assumption that many enhancement technologies make us adopt questionable values, and Elliott is keen to keep us aware of the positive aspects of features people often way to free themselves (or their children) of—shyness, melancholy, blushing, short attention spans, and the separateness of children from their parents. 

Elliott’s words of caution are certainly timely and deserve careful attention.  He does not pretend to prove that enhancement technologies are always wrong, and he even admits that he is sometimes tempted to use these technologies himself.  Ultimately though, the book would have been more persuasive if it was less anecdotal and more ready to engage in straightforward moral argument.  This is not to wish that his approach were like that found in most other academic books.  Elliott deserves recognition and respect from the academic community for his ability to bring these philosophical and ethical issues to the wide readership this book will surely gain.  Rather, it is to wish that he had done more to enable his readers to identify his starting assumptions and method of argument and then to decide for themselves where they stand.  Nevertheless, Better Than Well is an impressive achievement on a par with other landmark works in social criticism, and it should lay the ground for further discussion of these enhancement technologies within medicine, medical ethics, the medical humanities, and among the general public.


© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Review. His main research is on philosophical issues in medicine, psychiatry and psychology.