Medicalization and Philosophy of Technology

I recently had an exchange with a colleague about current debates over ‘medicalization.’ She noted an assumption, by many, that medicine is fundamentally technological. She wondered what my position was. I respond:

Your first question gave me pause because I have simply assumed medicine is a form of technology. Now, my definition of technology is rather permissive, and I include techniques, skills, languages, and a host of other rather disparate items as technologies. This is problematic for a variety of reasons, not the least of which is for me to try to explain what is not technology. So, I would claim that pharmaceuticals, medicines obtained from plants/animals, etc., therapies (including bibliotherapy—which you might not agree with) and diagnostic tests would be technologies. However, I now see I am unsure of a few things. First, would a consultation/conversation with a doctor/psychologist/therapist (this last word will cause problems for a few reasons) be considered a technology? In some sense, I would say that they are; however, then I would have to say that any conversation is a technology, even about what wine to pair with a meal. That does not sound right to me, so I realize I have a poor definition of technology. If the category I consider not to be technologies includes rocks, rivers, animals (human and non), dirt, and various non-adulterated chemicals, atoms and compounds, then I have left a lot under the label technology. Perhaps the medicine—whatever that might be–, as one example, is not a technology unless it used for a purpose. That all sounds very strange and would lead me to the conclusion that pills on a shelf, microscopes, saline solution, etc. are not technologies unless/until used. That makes little sense and leads a variety of conflicts.

Setting aside this demarcation issue, I find another issue in the “biomedicalization” concept. The edited volume you linked to seems to problematize the idea of making something (like obesity or lack of attention) into a medical problem. It appears, though I need to look at the volume in more depth, that since at least the mid 20th century, a variety of issues/phenomena have now been ’normalized’ as medical ‘problems’ whereas before they were seen as social, political, epistemological, metaphysical or moral problems. Heidegger would tell me that humans have, for many centuries, been trying to ’scientize’ every aspect of life and the world. Ellul would claim that technique has been allowed to run roughshod over every aspect of human understanding of existence on the planet, turning everything into statistics to be read, counted, organized and pronounced beneficial or no. Marcuse would argue that biomedicalization further promotes the one-dimensional thinking that humans have succumbed to in the last century. Though these authors lament that trend, they offer no easy way out of it. My own thinking that medicine is, somewhat fundamentally, technology, appears to betray the prevalence of these trends: I have trouble imagining what is not a technology/technique. In a sense, then, the trend those authors describe, and what biomedicalization seems to continue, is a series of reductions that have come to be the core of modern sciences. Everything reduces to chemical compounds, biological organisms and/or physical substances and laws. Or, since nearly everything humans and our technological apparatuses can perceive is made of atoms, atoms is where we start (let’s forget for the moment things smaller than atoms).

I guess there are at least two broad questions here: is that story accurate? and, how does thinking about the world that way help or hinder humanity? Let’s bracket the first question off (for the moment, or forever, whichever you prefer) and look at the second. The descriptive part of the question would definitely appeal to scientists, doctors, engineers, social scientists, etc., because much work can be done trying to reduce things to their most basic qualities/characteristics. A problem arises with the normative side of the question: should we think about the world that way? Once we have reduced things to their most basic, can we rebuild the world again? Or, is something lost in that original reduction that, without it, does not allow the world to be rebuilt in such a way that it is what it was before the reduction? This is all getting confusing because I am having trouble articulating this point and I am not using examples, but I hope it is making some sense. I guess the point is that biomedicalization is a kind of physicalism or monism—there is only one kind of stuff in the universe: physical stuff. Non-material or non-physical things have no place; there is no Cartesian dualism. This is a world, to finally give an example, where machines can become “intelligent,” have agency, and be made somewhat indistinguishable from humans. Computational theory of mind, machine learning, and similar areas of research depend on this non-dualist world. If there is some non-material soul (or any other word we want to use that goes beyond chemical, biological and physical processes); if dualism is correct; if humans have not found some basic scaffolding from which to erect purely physical/behavioral theories of how the mind works (or if that project is impossible because physicalism does not cover everything), then we are spending enormous thought, time, effort and money on projects that had the wrong aim at the start.

Though I had not considered the concept biomedicalization before now, one part of my dissertation project approaches this topic and provides, at least provisionally, a response: physicalism is the metaphysical, moral, and ontological base for modern sciences and technologies. In STS, Latour’s ANT, and other anthropological approaches, grant agency (or at least patient status) to non-humans. Post and transhumanism are also set up on the physicalist platform that has gained momentum at least since Francis Bacon, and likely well before that. My own ideas for philosophy of technology, as a philosophy of STS, assumes physicalism. The kind of postphenomology, or mediation theory, I subscribe to assumes that the experience of phenomena have meaning because these experiences can be described—if not yet fully explained—as human experiences with the outside world without recourse to dualistic notions. I am apparently assuming that, for instance, values are non-physical, as concepts, but that they are not beyond explanation and understanding in physical terms. [I have not considered this topic in this way before—at least I have not forced myself to explain these ideas in this way before. So, I am hoping it is making some sense]

For my project, then, this theme of biomedicalization seems very important. If I want to understand a philosophy of STS, then I need a better understanding of what STS scholars writing about biomedicalization have in mind in terms of ontology. From my current, limited, perspective, this debate is entirely a physicalist one. I might be mischaracterizing that though. In any case, it seems that biomedicalization is based on a physicalist ontology, a reduction of everything to physical components and eschewing anything non-physical as irrational or simply mis-labeled. Pain is a series of chemical responses to stimuli. Health (physical and mental) is quantifiable and wholly dependent on only physical substances. Color can be assigned a number on a spectrum. Nothing escapes physical description. Nothing should escape physical description. If something does, then our techniques, disciplines, and institutions (though maybe not our religions) can say nothing about it. We cannot describe it or even acknowledge its existence. Descartes ultimately took shelter under dualism, mind separate from body, at least in part because he could imagine his mind existing without his body. Today, I think we can also imagine our minds existing without our bodies, (Hello, Ray Kurzweil!) but that does not stop us from employing physicalism as our ontology.

Work in STS, then, seems largely based on physicalism as well. I might be wrong there, and if I do make such a claim in my dissertation and/or future work, I think I will get pushback on that score. Good. I want to explore some of the philosophical underpinnings of STS work, and one way to do that is to make a claim that others will disagree with and show me where I am missing something. I am likely oversimplifying things—I cannot, apparently, escape reductionism. Have you any thoughts on what I write above? Would you, assuming you wanted a label, consider yourself a physicalist?

You likely have heard me talk of such things enough, but one aspect of STS pedagogy that I think requires more of a basis in philosophy is just such a discussion. I think intro STS courses need to overview some of the philosophical debates about dualism and monism because where each person comes down on the issue will have an impact on their own work, in both descriptive and normative senses. I do not presume to declare physicalism as the only view STS scholars should have, but I do think it is a view that most of us have, at least in the ways we present our work. The philosophy of STS I propose is monist and largely posthumanist. I follow feminist ethics, as a meta-ethics, because it accounts for humans and non-humans in somewhat symmetrical ways; it rejects the Enlightenment view of the person as acontextual, self-sufficient and (ideally) rational. I adhere to one aspect of transhumanism, at least, by claiming no important distinction between therapy and enhancement. I see autonomous technologies (for instance, autonomous military technologies) as moral patients, and ones that demand specific attention from human agents lest they be used/misused in ways that cause harm to people and environments. I see these points as consistent with each other (if you do not, please let me know), and I find that consistency to be important.

There are many gaps above that need further explication, but I hope the ideas maThe exchange starts with her describing the notion that, for most participants, debates about medicalization involve the idea that medicines are fundamentally technological.