10
" In The Triumph of the Therapeutic, Philip Rieff famously argued that the typical American has come to think of himself less as a citizen than as a kind of patient, whose life purpose is to develop, sustain, and fine-tune his psychological well-being. For Rieff, this therapeutic turn is a logical consequence of civic and spiritual decline. Somehow our sense of the purpose of living has slipped out of joint from the social conditions that once sustained it. We are no longer at home with ourselves, never quite comfortable with our place in the world. Instead, we are like castaways on a strange island, unfamiliar with local conditions, unable to rely on the old ways of going on. Perhaps something about the way we live now produces this distance from one another, or perhaps we distance ourselves from one another and live the way we do as a result. Either way, we have become more narcissistic, but narcissistic in a way that is peculiarly dependent on things outside ourselves: that is to say, what other people are saying and thinking about us. Rieff puts it this way, “When so little can be taken for granted, when the meaningfulness of social existence no longer grants an inner life at peace with itself, every man must become something of a genius about himself.”33 "
― Carl Elliott , Better Than Well: American Medicine Meets the American Dream
11
" As long as we live in a society in which a person’s own happiness is so dependent on the opinions of others, we will always have the problem of people feeling oppressed by cultural standards. We may be able to detach the problem from racism, so that beauty snobbery is racially egalitarian. We may be able to detach it from sexism, so that men are just as obsessed and fretful about their bodies as women are. We may be able to detach it from social biases against the short, the able-bodied, the gray-haired, and the wrinkled. But the problem will not go away. Like a particularly enthusiastic leech, it will find some other place to attach itself, and the deeper problem will remain untouched. That deeper problem is not simply the problem of racism or sexism (although those are problems too), but the fragility of selves that depend so intimately on the good opinions of others for their survival. "
― Carl Elliott , Better Than Well: American Medicine Meets the American Dream
13
" During our early years of medical school, my classmates and I were given a course in physical diagnosis. Usually, we practiced on one another. Each of us would percuss a classmate’s chest or listen to his heart with a stethoscope. But some procedures were considered too personal to practice on a classmate. For some of these, we were assigned a “model patient”—someone from the community who was “compensated” in exchange for undergoing an examination. This was how I performed my first rectal exam. A large group of us were led into a room where our model patient was bent over an examining table with his pants around his ankles. One by one, we approached him nervously from behind, inserted a gloved, lubricated finger into his rectum, and felt around for the prostate. “Thank you,” we all said politely to the model patient as we removed our index fingers from his anus. The model patient stared straight ahead, saying nothing. What made the experience oddly disturbing was not just the forced, pseudo normality of the instruction or the fact that the exam could have been done more privately, but the instrumentality of the encounter: a pretend patient bending over naked for anonymous strangers in exchange for money. The fact that the model patient had been paid did not make his work seem any less degrading. (Tipping him would have made it even worse.) "
― Carl Elliott , White Coat, Black Hat: Adventures on the Dark Side of Medicine
