Concepts of the self and self identity are part of the stock-in-trade of academic philosophy. However, grappling with such ideas is not an element of the day to day work of busy clinicians. The self rarely, if ever, shows up in an undergraduate medical curriculum, except perhaps in psychopathology.
Figure 1.
Carl Elliott
W W Norton, £19.95/$26.95/C$38.99, pp 357 ISBN 0 393 05201 X www.wwnorton.com
Rating: ★★★
This may need to be remedied as we enter the post-genomic age and as clinicians face the advent of “enhancement technologies,” many of which are within the scope of general practice. Such technologies constitute a wide range of medical and surgical interventions, whose purpose is neither restorative nor curative (at least in principle) but transformative. One essential component of such technologies is that they can transform human self identity.
What sorts of things are enhancement technologies? Carl Elliott, an American physician-philosopher, explores the use of medications such as selective serotonin reuptake inhibitors (SSRIs), human growth hormone, and cosmetic and other forms of surgery that can enhance or improve human appearance and wellbeing. He explores the history of psychiatry, the rise and fall of such conditions as a fugue state, repressed memory, and attention deficit hyperactivity disorder, as well as the emergence of new concepts such as “apotemnophilia” (an attraction to the idea of being an amputee, despite there being no medical reason for it). Therapies to reduce shyness, alter accents, and promote sexual function, and surgery to alter virtually any facet of appearance are now common. The development of gene based therapy will no doubt extend the range of enhancements available to biomedicine.
A book offering an account of such conditions runs the risk of sensationalism, but this is far from the case here. Elliott raises serious questions about the scope and nature of medical care. How do we (or can we?) make legitimate and defensible distinctions between medically necessary and superfluous therapy? Are happiness and enhanced self image the appropriate outcomes of medical intervention? Elliott intertwines his discussion of enhancement technologies with an examination of important issues in bioethics and philosophy. What is a person? To what extent are our ills socially constructed?
The problems associated with enhancement technologies are also deeply related to affluence. It is fitting that the book's subtitle refers to American medicine meeting the American dream. The enhancements that the book describes are most likely no more than a remote thought to the vast majority of the world. However, this is not to detract from the book, but to underline the importance of exploring how medical resources are developed and distributed in an inequitable world.