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

Abstract

The miracles of modern medicine can seem limitless. Diseases that were once debilitating or life threatening can now be cured through antibiotics, surgical procedures, and a myriad of technological advances that allow doctors to detect maladies earlier. The growing population of older adults serves as a reminder of how much medicine has changed. For example, those over 75 remember a time when people commonly died of infectious diseases, as antibiotics have only been widely used since the 1940s. Elders describe knowing people who lost their lives to polio, as the vaccine was not introduced until the 1950s. Not only are many illnesses now curable, but also the ability to prolong life has changed dramatically. Intubation, advanced resuscitation, and medications used to control blood pressure in intensive care units, which literally keep people alive, have not only saved lives but have also dramatically changed the way people live in the weeks and days before dying. Although some of these life-extending mechanisms do not actually improve quality of life (medical ethicists continually debate the acceptable use of life-extending measures), overall, medical advances combined with improved nutrition and enhanced quality of life have led to longer and healthier lives for many. However, developments in medical science and technology raise a number of important and unique issues that will undoubtedly require increased thoughtfulness as our patients get older. This chapter will address aspects of an increased lifespan as well as the influence of medical technology in the current landscape of contemporary healthcare. In particular, I will speak to hypomania and idealization in the culture of medicine, how these dynamics are both fueled by and the consequence of advances in healthcare, and how they affect both doctors and patients. I will also discuss the related issue of the devaluing of medical practitioners. Ideas of what modern medicine is capable of can be falsely seductive, setting up both patients and medical clinicians for extreme disappointment. The ways in which medicine has changed exacerbate expectations from patients and intensify reactions to physicians. It is easier to expect more from physicians, even if these prospects are not realistic, and then to devalue them when they don’t deliver. All who are involved in the modern medical encounter feel increased pressure. 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 dissatisfaction, 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.

If I’d known I was going to live so long, I’d have taken better care of myself.

Leon Eldred