American Bioscience Meets The American Dream Yet it would be a mistake to think this is merely a matter of the market creating an illness. It is also a matter of a technology creating an illness. Wherever we can make the tools of medicine work, the condition that we are working on tends to be reconceptualized as a medical problem. It used to be the case that some people could not have children. This was not a medical problem; it was an unfortunate fact of nature. But once new reproductive technologies -- such as in vitro fertilization and sperm donation -- came on the scene, that fact of nature was reconceptualized as a medical problem. Now it is called "infertility" and is treated by medical specialists. This kind of reconceptualization runs throughout the history of psychiatry. When the new disorder of "neurasthenia" arose in the 19th century, we also got the new treatment of "rest cures" in private clinics. When the new disorder of "gender dysphoria" arose in the mid-20th century, we also got new surgical techniques for sex reassignment. When anxiety disorders became widespread in the 1950s and '60s, we also got "minor tranquilizers" such as Miltown and Valium. And when the concept of hyperactivity became widespread in the 1970s, we also got an upsurge in prescriptions for Ritalin. For people who worry about the extent to which enhancement technologies are being used nowadays, it is tempting to look for something or someone -- the pharmaceutical industry, psychiatrists, cosmetic surgeons, the fashion industry or sometimes simply "the culture" -- to blame. In the end, however, these technologies could not have taken off in the way they have without the traction provided by the American sense of identity. In America, technology has become a way for some people to build or reinforce their identity (and their sense of dignity) while standing in front of the social mirror. We all realize how critically important this mirror is for identity. Most of us can keenly identify with the shame that a person feels when society reflects back to him or her an image that is degrading or humiliating. But the flip side to shame is vanity. It is also possible to become obsessed with the mirror, to spend hours in front of it, preening and posing, flexing your biceps, admiring your hair. It is possible to spend so much time in front of the mirror that you lose any sense of who you are apart from the reflection that you see.

That’s a long quote, and I have a lot of thoughts on this article. First (more to come later), regarding the mirror referred to in the last paragraph above: I think the mirror is internal as well as external. People’s drive to shape their identity is not driven solely by the pressures of others’ judgments (real or hypothesized). It’s driven by self-judgment.