As longtime readers will know, we have a standing interest in the ways modern medicine enhances and reconfigures nearly every feature of modern life. Without question, medicine has improved and extended our lives. And yet, as it does so, it also reconfigures them—not least in the way it conditions the expectation that medicine can make us, in Carl Eliot’s words, “better than well.”

This week, a single line stuck out from a recent and remarkable series of stories in the Washington Post titled “Unnatural Causes: Sick and Dying in Small-Town America.” This particular story is about a spike in overdoses and suicides for white women in one central California town, where accidental overdoses among white women have tripled, and suicides have doubled, since 1999. Authors Kimberly Kindy and Dan Keating report that, in response to these alarming spikes, a “loose network” of medical professionals and counselors have found themselves performing a kind of social triage. Kindy and Keating surmise that these service providers are “struggling to understand a generation of women overwhelmed by modern life and undone by modern medicine.”

These terms—overwhelmed by modern life and undone by modern medicine—characterize the result of the hope we vest in medicine to solve problems, particularly those that don’t have a clear medical solution. One of the pernicious ironies of modern life is that while particular medical developments are extending and enhancing the lives of some citizens, basic medical services (particularly preventative medicine and mental health services) retain less social value than they should. This lack of basic services is the essential insight from a recent Spotlight investigation of mental health services in Massachusetts for the Boston Globe. One study the Globe cites reports that from 2013 to 2015, one-third of community mental health providers reported closings within the state. As they put it:

The result is a system that’s defined more by its gaps and gross inadequacies than by its successes—severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.

This account carries forward the line of thought we have developed in previous briefings on the social effects of shifting norms and priorities in mental health treatment. (For new readers: in Vol. 51, we highlighted Dan Barry’s recent book on the plight of the “Bunkhouse Boys,” and, in Vol. 40, we featured Christopher Payne’s photographic chronicle of America’s derelict mental health facilities, “Asylum.”) When it comes to treating chronic mental illness in particular, we have shifted almost completely away from a system built upon relationships of dependence, and toward an outpatient, medication-focused model premised upon the hope of independence. This shift, of course, has benefitted many. But what happens when this approach goes underfunded? As the Globe’s account shows, we are soon to find out.

The pressure we place upon modern medicine is also evidenced in our third piece, a poem by the recently deceased Max Ritvo. As his obituary from the New York Times shows, Ritvo’s poetry showed immense promise, particularly as he battled cancer in his early 20s. One poem, published recently in the New Yorker, stands out. Titled “Poem to my Litter,” it is Ritvo’s letter to a set of lab mice undergoing an experimental gene therapy that may, at some point, in some way, lead to a treatment option for his particular form of cancer. Ritvo’s poem (reproduced below and read aloud by the author here) gives poignant and deeply human expression to our struggle with modern medicine—that sense of being simultaneously overwhelmed and undone.

Poem to My Litterby Max Ritvo

My genes are in mice, and not in the banal way
that Man’s old genes are in the Beasts.

My doctors split my tumors up and scattered them
into the bones of twelve mice. We give

the mice poisons I might, in the future, want
for myself. We watch each mouse like a crystal ball.

I wish it was perfect, but sometimes the death we see
doesn’t happen when we try it again in my body.

My tumors are old, older than mice can be.
They first grew in my flank, a decade ago.

Then they went to my lungs, and down my femurs,
and into the hives in my throat that hatch white cells.

The mice only have a tumor each, in the leg.
Their tumors have never grown up. Uprooted

and moved. Learned to sleep in any bed
the vast body turns down. Before the tumors can spread,

they bust open the legs of the mice. Who bleed to death.
Next time the doctors plan to cut off the legs

in the nick of time so the tumors will spread.
But I still have both my legs. To complicate things further,

mouse bodies fight off my tumors. We have to give
the mice AIDS so they’ll harbor my genes.

I want my mice to be just like me. I don’t have any children.
I named them all Max. First they were Max 1, Max 2,

but now they’re all just Max. No playing favorites.
They don’t know they’re named, of course.

They’re like children you’ve traumatized
and tortured so they won’t let you visit.

I hope, Maxes, some good in you is of me.
Even my suffering is good, in part. Sure, I swell

with rage, fear—the stuff that makes you see your tail
as a bar on the cage. But then the feelings pass.

And since I do absolutely nothing (my pride, like my fur,
all gone) nothing happens to me. And if a whole lot

of nothing happens to you, Maxes, that’s peace.
Which is what we want. Trust me.


Questions, concerns, kudos, or other feedback? Contact editor Philip Lorish at