Abstract
The
article analyzes the impact that digital information and communication
technology (ICT) can have on medicine both as a science,
and as a
practice. The technological changes that lead to what I call 'Medicine
2.0' occur
on
several levels, such as: information overload, the physician-patient
relationship, the self-perception of both physicians and patients, as
well as
the concept of the human body and what is understood as sickness and as
health.
With the purpose of defining a pathology of the information society, an
anthropological framework is proposed based on concepts developed by
Swiss
physician and psychiatrist, Medard Boss, illustrating with a few
examples a
systematic analysis of said pathology. The article concludes by
proposing
guidelines for an ethical outline as a reference for
preventive and therapeutic care in the information and knowledge
society.
Introduction
In this article it is my
intention firstly: to give a brief description of the information
and knowledge society,
showing the impact that it can have in what we could call a 'Medicine
2.0'.
Secondly: I present a possible anthropological – not
anthropocentric –
framework for the possible systematic elaboration of a pathology of the
information society. Said framework must be reviewed critically in
relation to
other cultures and forms of knowledge on healing and preventive arts,
such as
those from East Asia or the various African and Latin American
cultures, and
consider the various possibilities and the need to ‘enculturate’
digital
techniques in different societies, with the resulting changes to
medical
structures and services which, as we all hope, would have to improve,
that is,
adapt to the needs and expectations of what we nowadays loosely term
(in the
singular) information society.
In the past century,
during the mid-sixties, the term information
overload appeared in the context of civic communications (Levy
2008, Meier
1962). But it was the writer Alvin Toffler who used it in 1970 in the
context
of the information society (Toffler 1970). Toffler indicates that
cognitive and
perceptional processes are overloaded by technological advances that
lead to a
transformation of industrial society. This thesis is confirmed by
current
neuroscience, at least when it comes to the cognitive limitations of
the brain
(Klingberg 2009).
During the seventies the
term “information explosion” was also being used in library sciences
and in
documentation in reference to the exponential growth of scientific
publications, this being a problem that had already surfaced with the
printing
press in the sixteenth century, and then became more acute as of the
nineteenth
century, when modern science first became an instrument essential to
industrial
development, as well as to political and military forces (Levy 2008,
505).
Ortega y Gasset refers in several essays to the democratic
transformation of modern
society based on the printing press (Ortega 1962, 1965, 1976; Capurro
2002).
The impasse caused by the information
explosion leads us to find solutions based on the use of computer
sciences,
arriving early on, during the nineteen-seventies, at the creation of
bibliographic databases and servers such as DIALOG, foreshadowing what
one
might refer to as ‘the Google Society’. The term ‘information ecology’
appears
in the eighties (Capurro 1990). As of 2008 there is a research group
known as
“The Information Overload Research Group” (IORG 2008) “Reducing
information
pollution”. At the start of the twenty-first century, new forms of
digital
social interaction accelerate information overload in every field on
both a
local and global scale.
Just as industrial
society once produced, and still produces, a series of pathological
phenomena,
the consequences of which we are still experiencing with some lag as
social,
economic, energy, and climate crisis, so does the so-called information
and
knowledge society – and this is the thesis that these notes lead to,
the
so-called information and knowledge society gives rise to a pathology
that I
believe to be far from analyzed in a critical and systematic fashion on
several
levels, one of which is medicine.
It is a complex subject
not only where it concerns the impact of ICT in medical research, but
also in
relationship to the changes in interaction between physician and
patient. This
is also true regarding both the terminology and the different ways in
which
knowledge, medications, and healing or prevention are exchanged and
accessed – by
patients and doctors – and their respective public health institutions,
as well
as by the authorities that shape the conversation on social justice
within and
amongst different societies in a digitally globalized world. We can
expect that
the social justice aspect of medicine in the information and knowledge
society will become intensified both
within
affluent and technologically advanced communities, as well as between
them and
other nations or regions of the world.
It is clear that a
systematic study of the pathology(ies) of the information society(ies)
cannot
be limited to diagnosing the cause of certain phenomena such as the
increasingly acute stress brought on by various forms of information
overload
as well as by phenomena of the digital world both in daily life and in
the
workplace, which leads to different types of organic and psychological
disturbances, as well as to a crisis not only for companies, but in
daily
social interactions as well, including the education system.
However, before starting
this analysis I would like to share a personal experience. In the late
nineties, my dependency, or computer addiction had spiked particularly
due to
my international professional success. The degree of recognition I
received
exploded mostly due to my Web presence. In 1999 I created an
international
network on information ethics, which grew very rapidly. It got so that
I would
forget to eat and felt very nervous when I wasn’t near my computer. In
2000 I
was made a member of the European Group on Ethics in Science and New
Technologies (EGE) of the European Commission. It was a great honor,
but it
also meant a lot of work since I had to commute to Brussels each month. Add to that the
jealousy
and resentment of colleagues, which pushed me to work even harder. My
wife
would say to me: “You are allowing yourself to be dragged along”.
On the morning of April 8
in 2005, a few months before turning sixty, I took part in a public
forum in Berlin entitled “Stem Cell
Research – Roads and Actions
in Europe” organized by the Max Delbrück
Center
for Molecular Medicine and the Friedrich Ebert Foundation, as part of
an
international congress on “Biopolitics and Regenerative Medicine”. In
the
afternoon I took the train from Berlin
to my
home in Karlsruhe.
I arrived home at around nine that night, very tired after several
hours riding
the train. Right away, I sat at my desk and started feverishly reading
and
answering my e-mails. At around ten that night my wife asked if I would
like to
watch the news on tv. As I did so, I heard my heart beating loudly, an
incessant ‘thump-thump-thump’. I tried to calm down myself and my wife.
“It’s
just a little stress. It will pass.” But it didn’t go away; instead it
continued through the night and for several weeks after, day and night.
The
next day I consulted my physician who couldn’t diagnose any type of
heart
rhythm disorder or any other cause, so he suggested that I consult an otorhinolaryngologist (ENT). The ENT told
me it
could be a virus. I felt intense stress and aches in my muscles,
specifically
in my shoulders, which is why I decided to consult an orthopedist. He
told me
the cause could be in the neck region and the spine. I had to wear a
neck brace
for several weeks. But this therapy didn’t ease the pain or the
relentless
thumping of my heart resounding in my head. Naturally all of this took
a toll
not only on our private life, but on my academic activities. I was
halfway
through the semester and needed to commute into Stuttgart several times a week.
During class
I would try to distract myself but it reached a point when I decided to
interrupt my teaching and gave notice of my illness. I slept poorly and
became
increasingly nervous. A family friend recommended that I visit a
chiropractor.
He confirmed that my pelvis was displaced which compromised the spine
and the
neck muscles. With a single motion,
he returned the pelvis to its normal position. The thumping of my heart
ceased
immediately. I breathed deeply. However, the thumping resumed shortly
after.
The muscles in my neck and nape were very stiff and exerted pressure on
the
arteries. The chiropractor told me that this stiffening should be
treated with
physiotherapeutic methods. But he also told me the following: “Mr.
Capurro, you
are not ill. You just need to change your lifestyle.” He was right. It
is clear
now that the real origin of my ailment was what we nowadays refer to as
a burnout, formerly known as surmenage,
that is, something caused by
excessive work, and in our messaging society, by an information
overload. I was completely exhausted.
A
friend helped me calm
down the next day, and I slowly started to stabilize. Conversations
with a psychologist were also a little
helpful. He suggested
that I take a few weeks off. A family friend suggested I go to Friedborn,
a
recuperation and recreation center in the south of the Black Forest, known in German as “Kurort”, or in
English as a “spa”.
When I arrived at noon on a hot August day, I was carrying with me a
suitcase
filled with books. The establishment’s director said to me: “But I
thought you were
coming here to rest”. The first few days
were very tough. I had to fight the urge to read my e-mail. That is
when I
decided to rid myself of all contact with communication devices. I
filled my
days with long walks. The forest known as ‘Hotzenwald’ is a very
beautiful
region. ‘Friedborn’ is located some seven hundred meters above sea
level,
surrounded by forests, the ruins of a medieval castle, and the Murg
Creek with
its romantic path and many springs. The center also has a very healthy
food
offering consisting of vegetables, salads, tea and natural water, all
of
excellent quality. They also offer massages and several types of
muscular
therapy services. I was lucky to chat with a very caring doctor and she
understood my problem. I started a journey towards becoming physically
and
spiritually restored. After three
weeks I had
made a full recovery. I had learned my lesson regarding one of the
problems of
the information society, the excess of information. But it was a while
before I
regained trust in my own body. The anxiety had deep roots in my bones.
I
changed my life and started taking daily walks in the woods without my
cell
phone, refusing professional invitations, and not reading my e-mails
after
eight at night. Whenever possible I now go
to bed at 10 p.m. I put my personal life at center stage. Whenever
I see
symptoms of being “dragged along” I don’t dismiss them. If possible I
will go
once a year to ‘Friedborn’. I eat healthy and light food. My body and
my
spiritual life started developing in an open and free manner. Now I can
react
calmly and with self-possession when faced with envious and resentful
behavior,
and other challenges from information society. To put it more broadly:
we need
to have – both individually and socially – an immune system that is
adapted to
the information society, or we won’t be able to survive in it, much
less attain
a good life.
I. Medicine in the
Information and
Knowledge Society
Whilst it is true that
all human society and all other living beings are in a constant
exchange of
energy-matter and information with their environment, it is clear that
in the
case of human beings, such exchange is also conducted through language
with its
syntactic, semantic, and pragmatic characteristics, which allow us a
vast array
of interpretations and actions, and these constitute the basis of what
we
understand as freedom. This realm of theoretical and practical
potentials has
been profoundly influenced by communication and information technology,
particularly in the second half of the last century and up to the
present day.
According to Michel Foucault one can
distinguish four types of technologies or techniques:
a) Technologies of
production, which enable us to produce, transform, or manipulate
things;
b) Technologies of
sign systems, which enable us to use signs, meanings, symbols, or
signification;
c) Technologies of
power, which determine the conduct of individuals and submit them to
certain
ends or domination, an objectivizing of the subject;
d) Lastly, technologies,
or techniques, of the self, which enable individuals to effect by their
own
means or with the help of others a certain number of operations on
their bodies
and souls, thoughts, conduct, and way of being, so as to transform
themselves to
attain a certain state of happiness, purity, wisdom, perfection or
immortality. (Foucault 1988, p.
18).
In
keeping with Foucault’s line of thought, in the information society,
the
digital technologies for sign systems, or ICT, are closely linked to
techniques
of the self, just as other classical technologies for signs once were
and still
are, such as: spoken language, the written word, and print (Capurro,
1995,
2003). Such technologies have an
increasingly
profound influence both on techniques of power, as well as on
production
technology. Take for example the automotive industry, an exemplary case
of this
steadily advancing automatization process based on ICT in general and
in
robotics specifically. In other words: we live in a society whose
horizon for
self-understanding, and its capacity for knowledge, production, and
action are
basically subordinated to digital media. I call this possibility of
self-understanding from and through CIT digital
ontology (Capurro 2010, 2001, Eldred 2009/2011; Capurro et al.
2013) (1).
I.1
Characteristics of the information and knowledge society
The
current information and knowledge society can be characterized from
four perspectives
that
are paradoxical in and of themselves:
Information overload
The
first characteristic we’ve already presented in the Introduction when
we refer
to information overload. I say this
is a paradoxical characteristic because, strictly speaking, there can
be no
information overload, since information is always the product of a
selection
process guided by what we believe we need. The paradox lies in the fact
that
the potentially accessible information brings with it an increase in
the number
of options. Living in a society where potential information and
possible
selections are abundant creates a problem for us when it comes to
criteria for
veracity, relevance, and quality, for instance.
Interactivity
The
second characteristic of the current information society is interactivity.
It differentiates us
especially from the information society created by the mass media with
their
hierarchical structure which turns the subject into a receptive user.
The
interactivity, which has developed at breakneck speed since the
appearance of
the Internet with services such as the World
Wide Web, electronic mail, blogs, Wikipedia and other instruments
of
digital socialization, is a clear example of the increase in
possibilities for
action and selection and therefore, of individual and collective
freedom. But,
paradoxically, some of these services are frequently
hard to control, and susceptible to being reclaimed for all sorts of
activities
with potentially harmful or destructive intentions such as computer
viruses or
SPAM.
Self-definition
In
the third place, the information society has opened a great field of
possibilities for self-definition, individually and collectively,
through
digital media, more so than political, social, and cultural structures
with their
deep roots both in geographical locations and cultural traditions.
These local
circumstances have not disappeared, but are themselves undergoing a
process of
transformation, in many cases accelerated by various kinds of global
interaction.
Material base
Finally,
the information society is a society that defines itself based on a
horizon of
digitizability. However, it should be aware that the digital
understanding of
reality is not equal to reality itself or, to put it differently,
digital
culture in all its different shapes requires a specific material
base, and its products – including the raw material itself
and the production, use, and recycling processes – are necessarily
linked to
both biological and sociological processes, which often possess
positive and
negative characteristics, since they can be extremely noxious to the
environment and the health of those that seek to use ICT to improve
their
lives. The ecological debate over the materiality of the information
society is
highly topical due to the overproduction of electronic waste and its
frequent
exportation to developing countries (Faulhaber and Zehle 2009). This
has
consequences for the conception and health of the human body, as we
shall
immediately see. The paradox resides in the fact that, parallel to
this, a
sphere of digital interaction arises, apparently divorced from physical
space-time reality – let us remember the Declaration of the
Independence of
Cyberspace by John Perry Barlow in 1996 (Barlow 1996) – this sphere not
only
meets, but becomes a hybrid with the so-called real world, and
ultimately, it
has its origins in this real material world and has ecological
repercussions
with consequences that are often dire for human health and
environmental
protection.
I.2
Towards a transformation of medicine
We do
not intend the above characteristics of the information society to be
exhaustive, but it is clear that they imply a transformation of
medicine as
well. In a recent issue of the International
Review of Information Ethics (IRIE), dedicated to ICT and medical
ethics,
Georg Marckmann, a researcher in the Department of Ethics in Medicine
at the
University of Tübingen, and Kenneth Goodman, Head of the Bioethics
Program at
the University of Miami, ask the following questions about the future
of
medicine in general, and about the physician-patient relationship in
particular, against the horizon of digital culture:
“What are appropriate uses of
health information systems?
Who
should use these systems?
What
benefits and risks do these technologies have for patients?
How does information
technology change the physician-patient relationship?
How does (and will)
medical decision-making change?
Perhaps most
fundamentally: How does (and will) information technology transform the
medical
construction of the human body and of disease?”
(Marckmann and Goodman, 2006,
3)
These questions define
the field of what I refer to as 'Medicine
2.0', that is, a change of paradigm for medicine that encompasses
its vision
of the human body as an object of research, and the corresponding
concepts of
health and sickness. I will touch again on this subject in the second
section.
Let us stop briefly and reflect for a moment on some of the possible
consequences of the information society as we have characterized it.
Information
overload in medicine
In the first place, we
have to consider the information overload
that affects both physicians and patients and, naturally, medical
research
itself. Doctors and patients face the paradox of having an unbelievable
amount
of information available on a particular disease for instance, often
without
being able to discern and discriminate based on their quality and
pertinence to
the specific case. This can lead not only to the patient’s
disorientation, but
also to a loss of the doctor’s
‘power’, if the patient is
well informed.
Something
similar happens with the information overload in the medical practice
and
research. Let’s consider, for instance ‘evidence-based medicine’ (EBM)
which,
in its tendency to base the relevance of information exclusively on
empirical
evidence, might miss information based on other theoretical paradigms.
Information
overload also has great influence on the teaching of medicine, both on
students
and professors, this being a situation that has become generalized in
higher
education. The pharmaceutical industry and its mediators, such as
pharmacies
and physicians themselves, are increasingly aware of the complex
digital
environment with its paradoxical abundance and need for selectivity.
This
situation inevitably influences both the physician’s and the patient’s
decision-making process, something Marckmann and Goodman allude to.
The
physician-patient relationship
Secondly,
let’s consider another aspect of interactivity
which affects the physician-patient relationship directly, both in the
private
practice, as well as in hospitals. It’s clear that ‘digital natives’,
as those
born within the interactive digital information society are known,
can’t
fathom, for instance, a hospital that doesn’t offer an interactive
information
system to the patient who now sees himself as an agent too, meaning
that he
expects to be able to communicate interactively with the medical
personnel,
receive information on his/her condition, recovery process, etc. What
one
usually finds in the rooms nowadays is a television set. Additionally,
they are
often asked to sign a written consent form, which is unrelated to what
should
be an interactive physician-patient relationship, which could offer the
patient, for example, a selection of personalized information, relevant
and of
high quality, that the patient can choose to use, or not, excercising
his/her
right to know. Marckmann and Goodman rightly ask: What are appropriate
uses of
health information systems? Who should use these systems? What benefits
and
risks do these technologies have for patients?”
Privacy
and Security
It is
clear that these interactive processes are closely linked to the issue
of
privacy, and therefore with all aspects related to the patient’s
security,
referring to the malicious use of their personal data, (‘security’) –
and when
the data are inadvertently used with
poor consequences (‘safety’) –;
this is something that concerns both the medical personnel and the
institution
involved. Lastly, you must keep in mind that interactive digital
networks make
new relationships possible among patients themselves, which are often
an
important form of social support that could paradoxically lead to more
disorientation, as is the case when there are misunderstandings, or
when
seemingly sufficient information leads to practical, yet erroneous,
conclusions.
I.3
Being a physician and a patient in the twenty-first century
The
information society affects both the physician and the patient in their
self-definition and self-understanding.
We mentioned before that patients are also agents, that is, that they
can and
should see themselves as such in varying degrees and according to
various
situations. It is apparent that there are, so to speak, patients who
are more
or less passive or ‘television-like’, depending also on their
interests,
circumstances and options, the same way that there are physicians who
prefer to
keep their science to themselves and not share their knowledge
interactively with
the patient during the healing process, other than through a brief
daily visit
and the request for a signature for an Informed Consent Form in case of
a
serious event. That consent is an instrument which supports the
doctor’s power,
or which often serves as a protection, so they can avoid discussing the
case
with patients, which requires time and patience.
Personalized medicine
Furthermore, digital
technology has been revolutionizing medical science for several years
now both
in the fields of diagnosis, and of healing methods. The tendency that
we can
foresee in relationship to, say, nanomedicine, is towards a
personalized
medicine in which the physician-patient relationship leans steadily
more
towards the patient’s side. He/she then becomes an agent who is vested
with an
autonomy that can paradoxically result more in a problem than in an
improvement, given that frequently, their capacity to interpret the
data
related to their case correctly is very limited (EGE 2007). Clearly,
this
development within medicine of the physician-patient relationship can
also give
rise to control systems based on ICT, which bring with them,
paradoxically, the
(potential) loss of the patient’s autonomy, as well as an information
overload
when the data are not sufficiently clear, especially when they have
possible
consequences for the patient/agent (EGE 2005). This way we begin to
answer
Mackmann and Goodman’s question when they ask: “How will information
technology
change the physician-patient relationship?” (and it will).
The
human body from the digital perspective
Let’s
reflect finally on the influence that the information society has on
the
medical vision of the human body, and the concepts of health and
sickness
themselves. Under the premise of the digital ontology I made mention of
earlier, we only understand something to the same extent that we are
able to
observe it through the digital media. This means that the human body is
essentially seen as a collection of data that can be obtained,
manipulated and
controlled through digital methods, instruments, and networks. This has
evident
consequences for the medical relationship to the human body, which
includes the
need to legally protect those data by transforming the “corpus” in
“Habeas
Corpus” into “Habeas Data” (EGE 2005, 29). This digital vision of the
human
body also opens up possibilities for transforming it beyond medical
treatments
based on digital technologies, including several forms of hybridization
of the
corporeal and the digital, such as ICT implants (EGE 2005) and the
possible
‘enhancements’ to faculties and/or physical processes of sensorial,
cognitive,
and emotional nature. The concepts of health and sickness are
considered as
information processes.
The body itself is no longer seen
as something in need of being
perfected
within certain natural characteristics – which are, more or less, fixed
–
although there are variations relating to particular eras and cultures
and
their ‘ideals’ – and based on conventional procedures, but rather as
something
to be designed with the precision allowed us by digital technology in
conjunction with molecular biology, for example, following particular
interests, but having consequences also for
future generations if it is the case that such transformations are
hereditary.
The current legal limits prohibiting changes to the human genome show
us ex negativo the possible interactions
amongst biological processes, individual and social options, and the
advanced
digital technology of the twenty-first century.
II.
Notes on a pathology of the information and knowledge society
II.1
Phenomenology of human existence
From this technological
perspective the human being is not seen as a something fixed but as a
yet-to-be-defined something from a horizon or definition that resists
being
identified as a permanent and absolute fundament or essence. It is at
once
undeniable that human existence manifests itself in a series of
characteristics, and that said characteristics actually make openness
and
change possible, with all its variations in self-understanding and
options, and
keeping in mind how unforeseeable scientific and technological
processes can
be, which are no less unforeseeable than historical circumstances and
cultural
conditioning, all of which influence and even determine individual and
collective singularities. Seen in this manner, the universal and the
singular
do not contradict each other, but it is precisely their tension which
characterizes the history of human self-definition in its variety.
It is now my
intention to propose a pathology of the information society from a
phenomenology of human existence inspired by the work of Swiss
psychiatrist
Medard Boss (Boss 1975), who in turn developed a vision of medicine
confronted
with the industrial society and in dialogue with the philosophy of
Martin
Heidegger (Heidegger 1976). It is evident that such a vision needs to
be
revised in the frame of the information society. (2)
II.2
Sharing the world
The current information
society makes it more apparent that human beings share a common world
which is
currently globalized with its base in the digital network. This concept
of
sharing or being-with-others, classically
referred to as intersubjectivity, has a long philosophical trajectory.
But it
is a phenomenology which has specially demonstrated that human society
is not
as Descartes – the father of modernity – thought: a sum of isolated
individuals, originally encapsulated in their subjectivity, but rather,
said
subjectivity is inconceivable if it is not enabled through its original relationship to other human
beings in a common world.
Under the title
‘phenomenology’ I refer to a group of authors and tendencies that
originate
particularly in the ideas of Edmund Husserl, but that have roots going
as far
back as Hegel. Phenomenology has demonstrated that aside from the
original
social interdependency, there is an interdependency with a shared world
that is
no less originary, and which is just as much a natural or ‘given’
world, as it
is artificially created by men; they are both intimately linked. What
is
seemingly ‘given’ is always inserted in specific contexts and vital
necessities.
It is evident that in the
current information society, this being-with-others is profoundly
influenced by
the interactive digital networks, as it once was by writing, the press,
or mass
media. Both normal and pathological social effects of this being-with-others-on-the-Web
gradually start to manifest themselves,
for instance, in the form of an Internet addiction,
superficially considered a ‘mental disorder’, but which can also have
organic
manifestations. The digital network is presented as a space ruled by
the moral
imperative ‘share everything with everyone’ which can lead to
exhibitionistic
and voyeuristic behavior, thus perverting the positive potentials of
interactive and autonomous communication, as is the case with diseases
such as
AIDS (Capurro 2009).
II.3
Living in time and space
Human existence is also
marked by a peculiar relationship to space and time. Our being in-space-and-time is such that we can be
with other people or remote entities without being in physical
proximity. (3)
We live in a three-dimensional temporality of past, present, and
future, which
is different from the linear temporality in which the different
instants of the now are identical
with each other, and where the past does not exist (anymore), and the
future
does not (yet) exist either. What is peculiar about human temporal
existence – even
if it is also the case for other animals in varying degree, largely due
to
their lack of symbolic capabilities – is precisely that having
been is somehow being (through
language) and so, too, is what could be.
(4) The future allows us to have time for something,
for instance, that is: we give time a meaning.
Human temporality
has a certain extension, as it does, for instance, when we say that we
have
some time to be with friends in the afternoon.
It
is apparent that the
information society, and specially the space-time dislocation that we
are
afforded by instruments such as our cell phone with Internet
capabilities, has
a profound influence on this characteristic of human existence. Perhaps
one of
the most widely discussed pathological phenomena in this field is the attention deficit or hyperactivity,
which can be caused by many things, organic as well, but which are
accentuated
in many cases, especially in children and teenagers, by a peculiar form
of
digital communication overload that can lead to psychic and organic
disorders.
II.4
Memory and history
The
power to relate to what has been is what we ordinarily refer to as memory, which is the base of human
historicity, that is, the possibility of transforming our existence
individually and collectively. The information society puts at our
disposal
virtually limitless means of storing, processing, distributing and
recovering
information whose characteristics I have examined in the first section.
Just as
it is the case with other extracorporeal media for our memory, they
presuppose
the capacity to remember and select, which is often disturbed by what
we refer
to as informational overload. At the same time, global access to
sources of
information and interactivity has fundamentally changed the
possibilities of
memory and historicity as long as such access is possible given all its
conditions: technical, economical, political, cultural, etc. I am
referring to
the problem of the ‘digital divide’ which constitutes one of the great
challenges of the recently inaugurated century, particularly if we
think of it
in relation to other divides, namely in: nutrition, education, and
health. The
digital divide can have pathological consequences of various kinds and
caliber,
such as the exclusion from socialization processes both in an
individual’s
private life, his/her education, in the economy, and politics. This can
occur both
in societies where CIT are part of the normal living standard, and in
digitally
marginalized societies. The Medicine 2.0 must be aware of this problem
and
conduct local and global studies into the matter.
II.5
Human corporeity
The two dimensions of
spatiality and temporality have a determining weight in the experience
of human corporeity. In German there are
two words for the concept of body: ‘Körper’, which designates
something
inanimate, and ‘Leib’, which designates the animated body. The animated
human
body (‘Leib’), and in varying degrees any other living body, possess
the virtue
of being able to extend in a somewhat broad manner, on a case-by-case
basis,
within the spatial-temporal realm, unyielding to the physical space
they occupy
(‘Körper’). “The limits of my bodily existence are”, according to
Boss,
“identical to those of my world-openness.” (Boss 1975, 278) According
to Boss, stress is a form of hypertension or
overload, of existential possibilities that can lead to several forms
of
depression, for instance (Boss 1975, 455-461).
An ongoing study into
demographic change and medical prevention in the realm of ICT,
sponsored by the
Federal Ministry of Education and Research in Germany, and by the
European
Social Fund (EFS) in the context of their program on the “capacity for
innovation in the modern workplace”, (DIWA-IT 2009) shows that a great
number
of the young people polled cannot imagine working exposed to permanent
stress
until their retirement. It leads not only to fatigue at the end of the
day, but
also to a gradual loss of self-control in a system where the pressure
to reach
imposed goals is compounded by being digitally connected to their
companies
twenty-four hours a day, seven days a week, following the formula 7x24.
Digital
communication forces them to react immediately to all sorts of
questions and
requests for information, and to a work system based on control. This
is an
extreme form of information overload, including an “overcontrol”, which
leads to
a loss of self-reliance when such “overcontrol” turns counterproductive
by
simulating something that doesn’t really happen (Holzapfel 2009).
Recent
suicides in French industry are a clear and tragic sign of this
situation.
The vision of the human
body that I referred to in the first section, as a collection of data
susceptible of being digitalized, is evidently reductionist, which
implies
consequences both for the self-perception of disturbances or discomfort
by the
patient –who is now also an agent –, and for the perception of the
physician
who treats the patient or interacts with him/her. On a daily basis,
Web-users
can suffer many types of organic problems that originate from their
Internet
dependency, ranging from the lack of motion, with consequences ranging
from
muscle stiffening, to a physical-psychological ostracism within a
medium that
paradoxically allows us a global exchange and (in most cases) is not
censored.
An example of this sort of confinement can be found in the film by
Austrian
director Michael Haneke “Benny’s Video” (Capurro 1995).
Within this context, it
is also very important to note the consequences for the ecology and
health of
thousands of people, especially in developing countries which have
become the
destination for waste of an extremely toxic nature in the form of digital products such as radios, television
sets, laptops,
cell phones, or iPods (Faulhaber and Zehle 2009). Each physical
lesion
will always translate into a disturbance of our
relationship to others in a shared world. Every physical ailment is
linked
to that common existence and makes our ‘susceptibility-to-harm’
manifest, as
well as our ethical-medical responsibility for the other. The study of
information
society’s pathology has to analyze in detail the various forms of
physical
disorders, which may be indistinguishable from those caused by
industrial
society, but whose specific cause may be derived from ICT and their
insertion
in our society and ecology.
Medicine
with a
holistic view of the human body (‘Leib’) in the information society,
should not
forget that physical pain is closely related to ‘ailments of the
spirit’
(sadness, anxiety, etc). Human existence is characterized by being
always in
some ‘emotional state’ or other or
experiencing a feeling; these moods are
not merely subjective, but allow us to experience ourselves, others,
and our
shared world from various perspectives and dimensions. Often, a great
love or a
great hate, won’t necessarily sequester us, or blind us, but will
rather reveal
something to us very clearly. In these moods we are more ‘inside
ourselves’
than is the case with rage, for example, which will lead us to be ‘out
of our
minds’ – and our selves for that matter.
II.6
Feelings
Other feelings -such as
anxiety- open us up to other dimensions of being-in-the-world, when we
experience a loss of grounding in matters of the world, and are offered
a
glimpse into that in which our existence is paradoxically rooted.
Discovering
and accepting our own mortality does not necessarily lead to a tragic
vision of
life. The information society makes manifest, or communicates, the death of others as it happens in
extreme cases of suffering and the struggle for justice, creating new
forms for
movements of social and political liberation, but at the same time, it
provides
new opportunities for reinforcing oppression, control, and censorship.
Positive
and pathological phenomena related to feelings in information society
are both
multiple and take on different shapes, from autonomous and interactive
communication, to situations of dependency, bullying, self-destruction,
voyeurism or exhibitionism that I have previously mentioned.
These dimensions of human
existence have to be seen as the original components in the context and
support
of human freedom, the later being defined as the capacity to opt for
diverse
forms of existence, without such freedom being absolute or equal for
all at all
times. In other words, a systematic reflection on the pathology of the
information society must take into account the various modalities upon
which individual
and social freedoms are built in a digital environment. A therapeutic
vision
cannot be limited to healing symptoms; it needs to research the complex
interweaving
of society, the world and (digital) technology. Moreover, it must
consider technological
conditions keeping in mind the various ecological, cultural, political
contexts.
Conclusion
Not just science, but
also medical practice, will continue to change deeply within the frame
of an
information society, which necessitates a careful revision process for
methods
and concepts, as well as for the structure of research institutions and
medical
practice, the industrial processes derived from these, the
physician-patient
relationship, the self-understanding of both, our view of therapy and
preventive medicine, of what can be understood in the future as
sickness or
health, and for humans’ capacity to shape themselves in all their psychophysical complexity. Medicine as a
science and
as a therapeutic technique becomes part of the relationship between
man, the
world, and digital technology; this makes philosophical reflection on
such a relationship
necessary in quest of a pathology, ethics, and therapeutics of the
medical
field.
This brief exposition on
the digital conditions of medicine and its possible consequences for an
analysis of information society’s pathology, makes manifest the need
for ethical
reflection. Evidently, faced with the dynamics of social transformation
and scientific
and technological advances, ethical reflection beginning with
principles such
as the protection of human dignity, autonomy, privacy, the natural
environment,
the freedom of research, freedom of communication, etc, is forced into
a constant
effort of reinterpretation of such principles and the underlying
values, and possible
ways to prioritize them using various ethical criteria such as the
utilitarian
or deontological as a basis.
It is also apparent that such
ethical reflection must occur on several levels, such as the academic;
or in
ethical groups integrated into political or professional institutions,
such as research
institutes and hospitals; and of course in our daily private lives,
using the
very media that bring about the pathological symptoms we have just
uncovered.
This reflection is also necessary for therapies and preventive
practices that
try to see beyond the symptoms, seeking out options for a sustainable
information society, that is, one not opposed to the natural processes
that
ultimately make the life of humans and other forms on this planet,
possible.
Finally, ethical
reflection on the information society must remain critical
vis-à-vis ‘hype’ that inevitably appears when
a
discovery or an invention seems to open up the via regia
to beat cancer for instance, or Alzheimer’s, or AIDS. It
is also important for ethical reflection to take place as early as
elementary
school, with the necessary pedagogical adjustments, so that generations
of
young people will learn to not be overwhelmed by information overload
and the various
options that pervert the sense of a life both personalized and in
relationship
with others in a shared world. This is the sense of the ancient ‘techne
tou
biou’ taken up by Michel Foucault with the concept of “technologies or
techniques of the self” (Foucault 1988) which we should revisit in the
context
of the information society (Capurro 1995). If – as Ortega writes – to
be in the
world of men is “inextricable from his desire to live well”, then it is
technology that allows us to think of life as well-being (Ortega 1965,
26), and
we should ask ourselves to what degree digital technology helps us, or
wears us
down physically, in the effort to attain a good life.
On the other hand, ethics
must abstain from doling out recipes for happiness, something
undertaken by
countless publications in what can be termed the wellness industry.
It is the purpose of ethics to invite critical
reflection on various options, leaving free choice both in civil
society and in
the political field up to the individual. This invitation to freedom is
the basis
for a medical and psychotherapeutic ethics according to Medard Boss
who, referring
to Martin Heidegger, distinguishes between a “care for the other”
(“Fürsorge”)
from one pole in which such “care” tends to take the place of the
other, to the
other pole that opens up a path for the other to care for him or
herself. (Boss
1977, 31-32; Heidegger 1976, 122).
From this perspective one
can say that twentieth century mass-media society tended to take away
the
other’s freedom, whereas the information society of the twenty-first
century
aims – or should aim – at the opposite.
Not only does Medicine 2.0 find itself in the midst of this tension,
but so
does an analysis of the pathology of the information society itself.
They must
both consider that in a globalized world it is fundamental to have an
intercultural dialogue on values and ethical principles, on the various
ways in
which medicine understands itself, and on how information societies are
based
on diverse traditions and historical singularities. What ties us
together, or
should tie us together, both in theory and practice are, without doubt,
the
United Nations’ (UN) “Millennium Development Goals” as well as: the
“Declaration
of Principles” and the “Plan of Action” of the “World Summit on
Information
Society” (WSIS). These objectives and principles show without doubt the
opposite
of a pathology of the information society without being homogenizing,
ideological, or Utopian. They are simply human.
Notes
(1) Said term must not be confused with
the metaphysical thesis that proposes that the being of things, and not
only
the possibility of understanding them, has a digital nature, which
could also
be termed digital Pythagoreanism. (Capurro
2008,
2006, Capurro et al. 2013). Furthermore, the absolutization of the
digital ontological
project in
the form of digital metaphysics can lead to ‘cybergnosis’, that is,
pseudo-religious ways of understanding cyberspace.
(4) This has been a theme, for instance, in Book XI
of
Saint
Augustine’s Confessions.
Ackknowledgments
I
would like to thank the translators Monica Santana (South Africa) and
Dr. Michael Eldred (Cologne) as well as Oscar Krütli
(Córdoba, Argentina)
and Prof. José María Díaz Nafría (León, Spain) for
their invaluable critique of this text.
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Last update: August 6,
2017