Technology, Idealization, and Unconscious Dynamics in the Culture of Medicine

Abstract

Betsy's situation is illustrative of one kind of suffering in older adults. Living a longer life carries with it a number of complications and risks for the development of new conflicts, as well as the reemergence of psychological issues that are related to emotional functioning and attachment. Although Betsy's story has many more facets to it, including a deep fear of dependency, her situation raises a number of familiar issues that affect those who live into their 80s, 90s, and those who live to be 100 or more. The first is the genuine shock of living so long. At the time of Betsy's birth in 1911, the average life expectancy for both men and women was 51.49 years (National Center for Health Statistics, 1999). Today's average life expectancy is 77.8 years (National Center for Health Statistics, 2007). As we saw in Chapter 1, it is now more common for people to live well into their 80s, with an increased likelihood of living longer. As suggested above, people in this generation have often had the experience of losing loved ones to common disease. Secondly, although it might be easy for those of us who are younger to speculate that people such as Betsy should be happy to be alive and in good health, it is not uncommon for patients to express a feeling of cruel irony associated with such a long life: Some people who are healthy and cognitively intact well into old age are fully aware of the potential ills that could happen to them, as they have seen countless friends and family succumb to dementias, cardiovascular diseases, and other ailments. Many of my older adult patients have talked about wishing they would die quickly, to avoid the fate of people they know who have strokes or dementias, as they have seen these others live on in a state of limbo, hovering between life and death. One only has to visit any skilled nursing facility where there are a number of incapacitated adults who are solely dependent on others care to appreciate and understand this fear. However, the greatest apprehension expressed by many of my own patients is that they will remain cognitively intact in the face of severe physical impairment. They worry intensely about being aware of their own impairment, while powerless to do anything about it. Their peers who are demented and confused suffer a great deal, but their suffering can be muted by episodic confusion. Those with mild cognitive impairment, or even normal age-related changes, can be especially worried about losing even more of their cognitive and physical abilities. This is a realistic fear. The longer people live, the more likely they are to develop medical illness. The ability of medical technology to prolong life, as well as the ever-increasing aging population creates a number of issues that are new to many of us as mental health clinicians.

This chapter will address aspects of an increased lifespan as well as medical technology in the current landscape of contemporary healthcare. In particular, I will address hypomania and idealization in the culture of medicine, how these dynamics are both fueled by and the consequence of technological advances, and how they affect both doctors and patients. Conversely, I will also discuss the related issue of the devaluing of medicine and medical practitioners. Changes in modern medicine, including the emergence of advanced medical technology, exacerbate expectations from patients and reactions to physicians. Given the changes in both life expectancy and medical technology, it is also easier to expect more from physicians and to devalue them and the medical system. Increased pressure is felt by all who are involved in the modern medical encounter. These dynamics, as well as the idiosyncrasies inherent in the culture of Western medicine create conditions for both patients and physicians that eventually lead to disappointment, frustration and a sense of helplessness. There are also increasingly unique challenges for mental health clinicians in talking to patients about the difficult feelings associated with a long life, feelings about their relationships with physicians, as well as their feelings associated with bodily failure. Indeed, many patients present as expecting definite and clear answers to complicated questions.