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.