My 4-year-old daughter wore her Supergirl costume to the airport last month. Once we passed through security, she ran through the terminal with her satin cape trailing behind her. The other passengers smiled. One even whipped out her phone to snap a picture or a video. When we boarded the plane, the flight attendants addressed her as “Supergirl” and gave her complimentary headphones. After the flight, I heard someone at baggage claim say, “This must be the right carousel because I see Supergirl’s family here.”
Perhaps it’s obvious to others, but I never thought about how “pretentiousness” derives from “pretend” until I read Dan Fox’s new book-length essay, Pretentiousness. I never thought about how it’s charming for a child to pretend to be something or someone else, yet that kind of acting from an adult is usually derided. “Pretending is what kids do to figure out the world,” Fox writes. “Children do not put on airs. A child might be precocious … but it’s rare that a child is called pretentious. That insult is reserved for the pushy parents.” I swear the Supergirl costume was entirely my daughter’s idea, but my wife and I did not fight her. Instead, we encouraged her, thinking that she might behave better on the flight if the trip to Arizona seemed like a hero’s adventure.
Did I detect mockery in the way that person at baggage claim said “Supergirl’s family?” Yes. Were my wife and I being accused of pretentiousness? Maybe. Should I care? Fox would argue no. “Being pretentious is rarely harmful to anyone. Accusing others of it is. You can use the word ‘pretentious’ as a weapon with which to bludgeon other people’s creative efforts, but in shutting them down the accusation will shatter in your hand and out will bleed your own insecurities, prejudices, and unquestioned assumptions.”
Brushing off commentary at the baggage carousel is an easy takeaway from Pretentiousness. I’d like to focus on the harder lessons of Fox’s essay. Early in the book, he quotes Oscar Wilde: “Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.” An American author might have gone with Mark Twain: “A man is never more truthful than when he acknowledges himself as a liar.” Indeed, Pretentiousness provides a justification for lying, which I do all the time as a doctor. I know that sounds awful, but it’s also entirely true, and not just about my doctoring but the doctoring of virtually every physician I know. If “lie” is too uncomfortable a word, then substitute “act,” as Fox does. “Medical professionals ‘act’ in front of patients to make them feel more comfortable or take their advice seriously,” he writes. “A discomfort with pretense is also a discomfort with power, or with the fear that nobody is in control, only acting as if they are.”
Once a month, I serve as the precepting physician in fellows’ clinic. In this clinic, patients see doctors-in-training, who in turn present their cases to an attending physician for help (sometimes) or formal approval (most of the time). When I’m precepting, I often joke around with the fellows in the conference room. Our discussions of their very sick patients are educational but also quite informal. I like to say, “Let’s get into character,” when we walk back to the exam rooms to meet the patients. I doubt the fellows pick up the Pulp Fiction reference – in the movie, the hitmen played by John Travolta and Samuel Jackson, finishing up a casual conversation about foot massages as they reach the front door of their targets, adjust their suit jackets and say to each other, “Let’s get into character” – but I’m sure they understand exactly what I mean about the character of a compassionate doctor.
Pretending to be someone other than your true self runs the risk of breaking a social contract, Fox worries, but I’m not sure doctors have subscribed to the same contract that patients have. The fellows and I tell jokes in the conference room because we know we can’t help some of these patients – the sicker the patient, the lighter our conversations.
Twice a day, on my commute to and from work, I’m surrounded by hospital advertisements touting “A transforming, healing presence,” “More science, less fear,” and “Dedication beyond measure.” These slogans are promises that hospitals make on behalf of doctors. In discussing ridiculous car names (e.g. Mitsubishi Shogun, Renault Captor, and Chevrolet Cavalier), Fox describes the delusion of “ever-deferred promises of personal betterment through acquisition. It’s there in advertising campaigns that use the radicalism of a previous era in order to market the products of today – the absorption of transgression and dissidence, into just more categories of consumer values. ‘Because you’re special.’ ‘Because you’re worth it.’” Those could easily be hospital slogans, and patients want doctors to play the role suggested by these slogans. So I wear my white coat the way Travolta sports his black suit and the way my daughter flips her Supergirl cape. Perhaps the true social contract is one where we all agree that pretending (or acting, or lying, whatever term you’re most comfortable with) is necessary.
As a doctor, I take off my mask – I stop pretending – when I write essays like this one. A writer friend once asked me, “Do you worry about your patients reading your stuff, especially when it’s online?” I told her I try not to think about it, because if I think about it, then I won’t be able to write. I consider myself to be most truthful in the arena – trying to create something artistic – where others most often toss around the pretentiousness label. I concede that just saying I’m more genuine when I’m writing than when I’m practicing medicine could invite accusations of pretentiousness. According to Fox, however, that concession is exactly why it’s not pretentious: “Pretentiousness resides in someone’s lack of awareness that their ambition might exceed their capability, or inability to laugh about one’s own limitations.”
I have a confession. I debated about including that graph on doctor jokes vs. patient illness. Once I saw it in the essay, I realized I was ripping off a Demetri Martin joke about his ability to draw mountains over time. But then I looked at Demetri Martin’s joke graph and realized that my graph wasn’t a rip-off but rather the result of one artist influencing another (if I can call myself an artist). I’m still not sure if the graph is funny or adds anything to this essay, but I like it, so I’m keeping it (assuming the editor of this piece agrees). Fox writes, “One reason art is labeled pretentious is because it embraces creative risk, and risk often entails failure. Failure is one mechanism by which the arts move forward – just as it is in science.”
Fox continues, “To understand the artistic process is to accept that pretentiousness is part of the creative condition, not an affliction. Pretentiousness is about over-reaching what you’re capable of, taking the risk that you might fall flat on your face.” It’s okay if I fall flat on my face when writing an essay, and I’ve accepted that I can’t cure every patient who walks into my clinic. Being Supergirl’s father, though, is about as risky a move that I’m willing to make as a parent.
Andrew Bomback is a physician and writer in New York.