"American Dream"

By Byram Ozer | 3.26.07

According to the current cynical polarization of our political landscape, there are two types of “patriots”: those that wrap themselves in the flag to espouse a nationalist and individualistic agenda and those that constantly question the integrity of the nation to which they devote their passion and strive for working toward the common good. This dichotomy has been framed in a number of unflattering ways, including those that prey on gender stereotypes (male vs. female perspective), age stereotypes ( college-kid vs. mature adult perspective), and a whole slew of more inappropriate name-calling.

Steve Rogers, known by most people as “Captain America” or just Cap, seemed to embrace elements of both of these definitions. His inception in the early 1940s to fight for the “American Dream” is just one permutation of many comic book heroes’ births (compiled most notably in “The Escapist” from The Amazing Adventures of Kavalier and Clay): a scrawny pipsqueak gets himself injected full of some experimental superhuman substance (whoever said steroids weren’t All-American?) to become the red-white-blue adorning spandex-sporting superstar that we know and love today. Or, more accurately, that we knew and loved, Cap having gotten himself bullet-riddled only several weeks ago by none other than his femme fatale. Until his untimely end, Cap’s story had encompassed the spectrum of patriotism: literally wrapping his bustling brawniness in the American colors to fight all that threatens the American way of life while maintaining his roots as a sensitive art student and providing the safety and security that much of the American citizenry craves.

Some say that Cap always fought for and represented the American Dream, but that dream has changed over time. In an effort to explore this notion in a scientific manner, I decided to examine the literature available on the “American Dream” in PubMed. Strangely, discussion of the American Dream in the scientific literature was scant before the 1980s, despite its origins in the early 19th Century and its coinage by James Truslow Adams in the 1930s. With little to no evidence in the literature, and given the baby booming of the 1950s and the free loving of the 1960s, I was left to assume that the absence of written documentation suggests that people were busier living the American Dream rather than writing about it, at least until the Reagan administration.

When the literature of the American Dream gathered steam in the early 80s, however, there seemed to be a running theme of somberness and cautionary tales. By far the most prophetic of these warnings was Wicklin’s publication in Dental Students entitled “Reaganomics is dimming the American dream” linking trickle-down economics to the downfall of affordable dental education and training. Others focus on the changes in the nursing field, like Nursing Times’ “Shattering the American dream” about the challenges in unionizing nursing professionals and “Mental health nursing: American dream or American nightmare?” in which the hardships of psychiatric nursing are explored.

Interestingly, nearly a fifth of the 34 hits come from nursing periodicals, which is an indication that these health care professionals are either obsessed with naïve metaphors or are in desperate need of a raise and better working conditions. Arguments for the latter, the justifiable gripes regarding the American health care system, are bolstered by the fact that nearly another fifth of the articles talk about management of the American health care system, all of which pronounce relatively dismal outlooks. In Reinhardt’s article, “Dreaming the American dream: once more around on physician work policy,” the author discusses, as a comment, the feasibility of physician workforce planning such that distributions of health care offerings are more equitable and evenly balanced. He contrasts systems that are based on centrally managed systems, in which the government can dictate physician distribution, with both the ‘wholesale market’ and the ‘retail market’ for health care, in which the distribution is determined by either a management organization or the well-informed health care consumer, respectively, in conjunction with the fundamental laws of capitalistic supply and demand. The eventual conclusion he reaches after outlining each philosophy and their serious complications is that physician workforce planning must begin at the level of the doctor and that they should be seen as ‘human capital’ and an investment in society. C ertainly this is a noble view, but he accurately notes that this shift in perspective is unlikely to break the guild mentality of physicians.

In other articles, the notion of the American dream is used as a contrast for certain medical trends and ailments. In the more cynically titled “An American Dream: To Develop Coronary Artery Disease,” the author bemoans the absence of etiological evidence for this disease (this was back in 1988), but then waves off factors of stress and suggests, by contrast with immigrant families who suffer less from atherosclerosis, that coronary artery disease is an inherently American pastime. In another paper that describes the ethical implications of Prozac, the author explores the contrariness of existential crises and fleeting self-awareness and self-purpose to the American Dream and cautions the use of Prozac for ailments involving the very real American quality of alienation (which leads me to wonder whether we would have had Hermann Hesse in the age of Prozac).

The classical notion of the American Dream as the pursuit of material and physical wellbeing was only addressed in two articles, one of which endorsed the commonly- held narrative of material pursuits impinging upon spiritual and personal development. The other countered this claim by examining longitudinal data and concluded that the inverse correlation between materialistic motivations and various measures of personal happiness could almost always be offset by the achievement of those materialistic goals. In other words, we shouldn’t underestimate the power of money to buy happiness.

Only three articles that I read seemed to remotely support the existence of an American Dream as we know it, either linking the exploration of Lewis and Clark to the development of thoracic surgery, praising the open access to AIDS care and medications for an immigrant, and detailing the career and confirmation process of Clinton’s Surgeon General David Satcher. But with the exception of these few articles, most of the rest espoused a more dismal viewpoint of the American Dream, a rare intrusion of bleak politics into the usually sterile world of PubMed reports. It thus seems only fitting that Cap has died: as a product of the cutthroat world of health sciences and a symbol of the American Dream, scientists, much like comic book fans, had given up on him a long time ago.