Profile of democracy

“Everyone senses that something is wrong, but no one has the courage or energy necessary to set it right. Has man always confronted, as he does today, a world in which nothing makes sense? In which the sacred cult of liberty is confounded with contempt for the law? In which conscience casts but an ambiguous light on the actions of men? In which nothing any longer seems forbidden or allowed, honest or shameful, true or false?”

-Alexis de Tocqueville

By Peter J. McDonnell, MD

My friend, David, an ophthalmologist and loyal Ophthalmology Times reader, recently gave me a biography entitled “Alexis de Tocqueville: Democracy’s Guide,” by Joseph Epstein. The subject is a Frenchman who, as a young man, traveled to the United States ostensibly to study the democratic political system of this young country.

In 1835, he published his analysis entitled “Democracy in America.” It became a runaway bestseller, cemented de Tocqueville’s reputation as a scholar, and laid the groundwork for what he hoped would be a brilliant political career in his home country

De Tocqueville found that while he was gifted at studying and analyzing political systems, he was not successful as a politician himself. According to Epstein, de Tocqueville was guided by principle and refused to embrace the system of political favors and back room deals that allowed Parisian politicians to advance their causes. He considered his 10 years as an elected member of the Chamber of Deputies as a failure and a waste.

After traveling around America for about a year, de Tocqueville is remembered for making a number of keen observations and predictions:

• The northern states would come to dominate the south, and slavery would be brought to an end.

• Family relations were more relaxed and intimate in a democracy, and women more independent and admirable.

• Democracy, by making its citizens more alike, also made them more sympathetic, so that they could not view the deaths of large or even small numbers of people with equanimity the way aristocrats seemed able to do.

• Russia and America would one day be the two great rivals in the world.

• All governments naturally tended toward centralizing their functions, thus reinforcing their power through ever-greater control.

An interesting theme is that citizens of a democracy will lose their freedom as their governments usurp power: “It [the government] gladly works for their happiness but wants to be the sole agent and judge of it. It provides for their security, foresees and supplies their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, makes rules for their testaments, and divides their inheritances. Why should it not entirely relieve them from the trouble of thinking and all the cares of living?”

‘The great equalizer’

De Tocqueville, born of aristocratic parents, apparently considered democracy the great equalizer, and as such it encouraged mediocracy instead of greatness. “Such a society would be less brilliant than an aristocracy but also less plagued by misery. Pleasures would be less extreme, prosperity more general. Knowledge would be less exalted but ignorance more rare. Feelings would be less passionate and habits milder. There would be more vice and fewer crimes. The nation as a whole would be less brilliant, less glorious, and perhaps less powerful, but the majority of citizens would be better off. People would prefer peace to war, not out of despair of living better but out of appreciation of living well.”

While Americans are indeed, by and large, peace loving, the general idea that democracies dampen brilliance and promote mediocrity is one that strikes me as having been proven false by the passage of time. Almost 200 years later, it seems to me that most great innovations in ophthalmology and medicine are generated by physicians working in democratic societies.

Material well-being

But one thing that did resonate with me was this young Frenchman’s concern over our people’s tendency to fret over material well-being: “The desire to rise apparently gnaws at every American, yet almost no one seems to nurse vast hopes or to aim very high. All are persistent in their desire to acquire property, reputation, and power, yet though ambition is ardent and constant. . . . people usually spend their lives ardently covering the petty things they see as being within their reach.”

My theory is that young ophthalmologists-burdened with cumulative student debts now averaging close to $200,000 and the pressure to establish reputations and provide financially for their families-may tend not to carve out enough time for their children and non-work activities.

This may become more of an issue as the newspapers report declining physician reimbursement and young doctors may conclude it is “now or never” when it comes to obtaining security (the “petty things” mentioned by de Tocqueville). The problem is that children grow up and go off to college or otherwise move out, never to (knock on wood) move back in.

So the challenge for today’s young ophthalmologists is to strike the proper balance between work and life outside of the office, knowing that they have long careers ahead of them and plenty of time.

Reference

• Epstein J. Alexis de Tocqueville: Democracy’s Guide.New York: Harper Collins, 2006.