Our terror of doctors and of medications is a generalization of the same anxiety that drives us to them, another form of hypochondriasis. Obviously both doctors and medications have the potential to do great harm, first of all because they are creatures of this civilization. Doctors responded too frequently to patients’ demands for antibiotics, for example, and compromised the usefulness of antibiotics in the course of launching a spectacular advance in the evolution of bacteria. I think it is fair to assume that doctors are responding too frequently now to other demands, whose consequences will, in not too long a time, bring fresh and vivid new grounds for anxiety. We will not reflect, or draw the lessons of experience, because fearful people improvise solutions, and feel too powerless to consider a problem from the point of view of their own responsibility.
Here I should make a distinction between the fictional and the false. They are entirely different things. The givens of the collective fiction I have been describing are that societies decay; that youth ends and the body fails; that strangers sometimes mean us harm and friends sometimes connive in our ruin; that things are rarely as they appear to us; that out of any present circumstance there might arise misfortune in the face of which we would be utterly helpless. Not a word of this is false. Common sense will confirm it all.
Nor do we indulge in the falsehood that we can make ourselves secure, even while desperate effort is clearly assumed to be the appropriate response to our condition. We are busy as rodents. But this is for the most part not real purpose, merely anxiety expending itself. Beside their root in fact, I think these collective narratives may have something like an organic life, in the way they invade experience and transform it to the uses of their own survival. Anxiety-driven people are right to be anxious. They are prone to stress and burnout, to illness and early death. They have trouble creating satisfactory friendships and families. What if they have misappropriated their time just sufficiently to allow their children to become ominous strangers? What if they have made a too single-minded investment of their lives, and then the market for their skills plunges? These things happen — anyone who has ever glanced at a newspaper knows it. They are right to lie awake.
The truth to which all this fiction refers, from which it takes its authority, is the very oldest truth, right out of Genesis. We are not at ease in the world, and sooner or later it kills us. Oddly, people in this culture have been relatively exempt from toil and pangs and from death, too, if length of life may be regarded as a kind of exemption. So why do these things seem to terrify us more than they do others? One reason might be that, as human populations go, we are old. A few decades ago the median age was in late adolescence, and now it is deep into adulthood. Midlife has overtaken the great postwar generation. So the very fact that we have, in general, enjoyed unexampled health has brought us in vast numbers into the years where even the best luck begins to run out. This is true of the whole Western world.
Less fortunate countries have younger populations, so the nonchalance for which youth is famous, and for which it was once admired, may be imagined to figure in their sense of things more importantly than it does in ours. It is true that they are warlike. But it is true also that a crankiness is rising in the great gray West, a brooding over old grudges and injuries, that can only alarm. I think we may have begun to see youth as Preadulthood Syndrome, a pathology to be treated with therapy and medications if it is our own, and a pestilence to be isolated if it is the youth of fecund and short-lived populations. The anxious find special terrors in unpredictability.
Jefferson said every generation has the right to make its own laws, and perhaps it has as well the right to identify illness for its own purposes. It could be that the society is too brittle just now to tolerate rambunctiousness, and not confident enough to attempt discipline or acculturation. To say that behavior is aberrant is much more powerfully coercive among us than to say an action is wrong. It implies the behavior is not really willed or controlled, and this undermines the self-confidence of the offending person. It also excuses him from responsibility, though, curiously, those taken to be the cause of his illness — his parents, usually — are assumed to have caused it through freely chosen and straightforwardly reprehensible behavior, for which blame and punishment are just and therapeutic. This makes no sense, and no one cares. The narrative is about something else, something involving fusions and displacements and improvised reconciliations among incompatible conceptions or metaphors, and we are so invested in this work that we do not choose to see the clumsiness of it. The inconsistency probably means nothing more than that we can neither accept the idea of responsibility nor be rid of it, so we relegate it to the minor characters.
I suggest that, for us, the sense of sickness has replaced the sense of sin, to which it was always near allied, and that while we are acutely aware of the difficulties surrounding notions of good and evil, we ignore, though they are manifest, the equally great difficulties surrounding notions of sickness and health, especially as these judgments are applied to behavior. Antebellum doctors described an illness typical of enslaved people sold away from their families, which anyone can recognize as rage and grief. By medicalizing their condition, the culture was able to refuse the meaning of their suffering. I am afraid we also are forgetting that emotions signify, that they are much fuller of meaning than language, that they interpret the world to us and us to other people. Perhaps the reality we have made fills certain of us, and of our children, with rage and grief — the tedium and meagerness of it, the meanness of it, the stain of fearfulness it leaves everywhere. It may be necessary to offer ourselves palliatives, but it is drastically wrong to offer or to accept a palliative as if it were a cure.
Perhaps some part of our peculiar anxiety might be accounted for this way. Historically, cultures have absorbed those irreducible truths about the harshness of life and the certainty of death into mythic or religious contexts. The long miseries and vanquished heroics of Troy inspired the world for millennia, though there is not much in the tale to offer comfort except the spectacle of futility on an epic scale. I am not sure we have at the moment any notion of comfort in that sense, of feeling the burdens which come with being human in the world lifted by compassionate imagination. Our always greater eagerness to describe ourselves as sufferers makes us always less willing to identify with suffering as a fact of human life. It may be that we cannot bear to undermine our sense of special grievance, or our belief — consistent with the medicalization of our sorrows and in general with our ceasing to value inward experience — that they are indeed aberrant, that they say nothing meaningful to us or for us.
Our civilization believed for a long time in God and the soul and sin and salvation, assuming, whatever else, that meaning had a larger frame and context than this life in this world. Polls indicate that we in America have not really abandoned these beliefs, and that is interesting, because what I have called our collective fiction is relentlessly this-worldly, very serious indeed about material success, of all things. Success, that object of derision in every wisdom literature ever penned, not more dignified now that it is so very slackly bound to real attainment, not more beautiful now that its appurtenances generally amount to a higher tawdriness. Knowing this, we nevertheless make it stand in the place of worth. Among us, a pedestal one day is a pillory the next, because we fawn on people who would have been fortunate, in some cases grateful, simply to have escaped notice. Then we punish them relentlessly for being no more than they are and always were. This while we continue to speak very much as though success were a thing to be envied.