10 Introduction
individual’s perceptions of the costs and benefits of the action (11). As they
move toward adopting a particular change in health behavior, individuals
may pass through several consecutive stages, from precontemplation to
action (12, 13). But what happens when serious disease threatens a whole
life, and all aspects of it must shift? Periodically, we all engage in unhealthy
behaviors, but these doctors have spent years training, pushing patients to
alter activities. The physicians here now observed themselves behaving
like their patie nts. In addition, they self-diagnosed and self-treated, and
saw themselves doing so—at times as if they were a third party. Rarely
can or do people who experience such split identities talk about the ex-
perience. Many came to weigh risks and benefits and end-of-life decisions
differently, and now deviated from professional norms, pursuing novel
approaches. In politics, where one sits, affects where one stands. I soon saw
the degree to which this phenomenon worked in medicine, too.
Their stories also say much about how people construct their iden-
tities more generally, in an ever more complex and fluid world: the stages
and strands of our lives. For millennia, artists, poets, and philosophers
have explored the phenomena of personal transformations. Ovid’s Meta-
morphoses all concern mythic figures changing: Narcissus transforms from
a man to a flower; Pygmalion’s statue changes from stone to flesh. In
Kafka’s Metamorphosis, a man wakes up to find he has become a cock-
roach, and sees the world as an insect.
Yet major debates persist about notions and natures of selfhood.
Emerson and American ego psychologists such as Heinz Hartmann have
urged individuals to find their ‘‘true selves’’ (14). Yet Proust writes of
characters who are a composite of many selves. His hero Marcel has a self
that tries to enter high society, a self that interacts with his mother, one
that prides itself on possessing a lover, and one that mourns a lost love.
Postmodernists such as Jacques Lacan and Foucault further question es-
sentialist notions of ‘‘the self’’ as a single entity, arguing that identities are
multiple, fluid, and socially constructed in different settings (15, 16, 17,
18). What does it mean to ‘‘be’’ Indian or African, male or female, Wes-
tern-educated or not, gay or straight, a doctor or a lawyer, healthy or sick,
or an amalgam of several of these categories? Such identities can be
shifting and flexible, rather than rigid and fixed.
Most of us usually alter our lives only gradually, but serious disease
transformed these doctors more dramatically—into patients.
Generally, patients with serious medical problems have to manage
stigma. The sociologist Erving Goffman described how individuals learn