Rise & fall of the Surgeon General: the nation wasn't ready for Joycelyn Elders' blunt messages about sexuality.

• Author: Wilson, Paula

The nation wasn't ready for Joycelyn Elders' blunt messages about sexuality.

After Joycelyn Elder's resignation in December, 1995, the U.S. had no Surgeon General throughout 1996. How could the public and the media go from decrying the right and wrong ways to approach the health of the nation to utter silence on the matter? The issues did not go away, just the Surgeon General.

The problem with Joycelyn Elders was not with what she was saying, but the role she personally inaugurated as Surgeon General. The powers that be have decided that public talk on sexuality is inappropriate. By Elders' own account, however, the public dialogue on health-related issues must be a part of the Surgeon General's duty. This was a fundamental and entirely overlooked issue in the situation surrounding her dismissal.

In 1996, I interviewed Elders in Little Rock, Ark., where she has resumed her position as a professor in the Department of Pediatrics, University of Arkansas for Medical Services at Children's Hospital. Looking back at her experience in Washington, she explained that the bully pulpit was her instrument of power. She perceived her mission as Surgeon General to hold a public dialogue on America's health and welfare, maintaining that "The first thing that you have to do if you're really going to use power is you have to get people's attention; they've got to know who you are. You see if they hate you, they're still going to listen to what you say, and if they love you, they're really going to listen. The worst thing is for everybody to ignore you, and so I think the Surgeon General's office is the office where it is very important to be able to get people listening to you, thinking about it, and talking about it . . . that is where you get change." Whatever power Elders may have had, rhetorical or otherwise, was born out of the debate over publicly discussed issues pertaining to sexuality.

The psychology behind the issuing of that power to Surgeons General and the public discussion of private issues merits examination. First, in the midst of the debate between conservatives and liberals, a third and vital population virtually was left out of the dialogue--the libertarian Generation X. Second, the role of the Surgeon General is different now than it was 30 years ago because the circumstances surrounding America's national health are different. It is time to re-evaluate the services that office provides.

In an examination of the public exchange over Elders' rhetoric, consumers of her messages are delineated easily when their perspectives are divided into terms of generational orientation. Although these admittedly are sweeping generalizations, it is plausible to place the birthdates of conservative Republicans in the Silent Generation (192242), the White House Democrats as baby boomers (1942-62), and the most important audience for...