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From Digital Medicine to Embodied Care

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The Vulnerability of the Human World

Part of the book series: Philosophy and Medicine ((PHME,volume 148))

Abstract

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed into the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia.

We’re no computers, Sebastian. We’re physical.

Blade Runner (1982)

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Notes

  1. 1.

    See U. Kühne, Der Mensch als Industriepalast, published online in “Heise”, available at https://www.heise.de/tp/features/Der-Mensch-als-Industriepalast-3384323.html

  2. 2.

    A. Coravos, J. C. Goldsack, D. R. Karlin, C. Nebeker, E. Perakslis, N. Zimmerman, M. K. Erb, Digital Medicine: A Primer on Measurement, in “Digit Biomark” 2019;3, p. 33, doi: 10.1159/000500413.

  3. 3.

    For some basic definitions, I refer the reader to the World Health Organization, Seventy-first World Health Assembly A71/20, Provisional agenda item 12.4, 26 March 2018, Use of appropriate digital technologies for public health, available at https://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_20-en.pdf

  4. 4.

    A. Coravos et al., Digital Medicine: A Primer on Measurement, p. 35.

  5. 5.

    A. Coravos et al., Digital Medicine: A Primer on Measurement, p. 39.

  6. 6.

    T. Metzinger, Subjekt und Selbstmodell. Die Perspektivität phänomenalen Bewußtseins vor dem Hintergrund einer naturalistischen Theorie mentaler Repräsentation, 2nd edition. Paderborn: Mentis., 1999, p. 284.

  7. 7.

    C. Blakemore, The mind machine, London: BBC Publications, 1988, p. 272.

  8. 8.

    See T. Fuchs, In Defence of the Human Being. Foundational Questions of an Embodied Anthropology, Oxford: Oxford University Press 2021.

  9. 9.

    Aristotle, De Partibus animalium, OUP, Oxford 1972, p. 62.

  10. 10.

    See The Egyptian Book of the Dead, Dover Publications, NY 1985.

  11. 11.

    See S. Finger, Minds behind the brain. A History of the Pioneers and Their Discoveries, Oxford: Oxford University Press 2000; C. Schoonover, Portraits of the Mind: Visualizing the Brain from Antiquity to the 21st Century. New York: Abrams 2010.

  12. 12.

    See D. Purves et al., Neuroscience (6th edition), Oxford: Oxford University Press 2018.

  13. 13.

    See D. Chalmers, Facing up to the problem of consciousness, in “Journal of Consciousness Studies”, 1995, 2 (3): 200–219.

  14. 14.

    W. Penfield, The Mystery of the Mind: A Critical Study of Consciousness and the Human Brain, Princeton: Princeton University Press, 1975, p. 39.

  15. 15.

    See E. Shookman (ed.), The Faces of physiognomy interdisciplinary approaches to Johann Caspar Lavater. Columbia, SC: Camden House, 1993.

  16. 16.

    See M. S. Staum, Labeling People: French Scholars on Society, Race and Empire, 1815–1848. Montreal: McGill-Queen’s University Press, 2003.

  17. 17.

    See D. Dennett, Consciousness Explained. Boston: Little & Company 1991; A. Damasio, Descartes’ Error: Emotion, Reason, and the Human Brain, Putnam Publishing, reprinted in Penguin, New York 1994; A. Damasio, The Feeling of What Happens: Body and Emotion in the Making of Consciousness; New York: Harcourt Press 1999.

  18. 18.

    Quoted in W. Penfield The Mystery of the Mind: A Critical Study of Consciousness and the Human Brain, Princeton: Princeton University Press, 1975, p. 35.

  19. 19.

    W. Penfield, The Mystery of the Mind: A Critical Study of Consciousness and the Human Brain, Princeton: Princeton University Press, 1975, p. 111.

  20. 20.

    R. Sperry, Mind, Brain and Humanist Values, in J. R. Platt (ed.), New Views of the Nature of Man, Chicago: University of Chicago Press 1965; R. Sperry, Holding Course Amid Shifting Paradigms, in W. Harman, J. Clark, A Reexamination of the Meta Physical Foundations of Modern Science. Causality Issues in Contemporary Science, Sausalito: Institute of Noetic Science Press, 1994, pp. 99–124; see also T. J. Voineda, Sperry’s concept of mind as an emergent property of brain function and its implications for the future of humankind, in Neuropsychologia, 1998, 36, 10, pp. 1077–1082.

  21. 21.

    T. E. Feinberg, Why the Mind is Not a Radically Emergent Feature of the Brain, in Journal of Consciousness Study, Special Issue entitled The emergence of consciousness, 8, 9/10, 2001, pp. 123–146.

  22. 22.

    M. Boly, M. Massimini, N. Tsuchiya, B. R. Postle, C. Koch, G. Tononi, Are the Neural Correlates of Consciousness in the Front or in the Back of the Cerebral Cortex? Clinical and Neuroimaging Evidence, in The Journal of Neuroscience, October 4, 37(40), 2017, pp. 9603–9613.

  23. 23.

    C. Koch, M. Massimini, M. Boly, G. Tononi, Neural correlates of consciousness: progress and problems, in “Nature – Neuroscience”, 17, 2016, pp. 307–321.

  24. 24.

    K. Jaspers General psychopathology (trans: Hoenig, J., Hamilton, M. W.). Baltimore: Johns Hopkins University Press 1997.

  25. 25.

    K. Jaspers, General psychopathology, p. 493.

  26. 26.

    K. Jaspers, General psychopathology, p. 459.

  27. 27.

    K. Jaspers, General psychopathology, p. 496.

  28. 28.

    K. Jaspers, General psychopathology, p. 17.

  29. 29.

    F. Varela, E. Thompson, E. Rosch, The Embodied Mind, Cambridge, MA: The MIT Press 1991; S. Gallagher, How the Body Shapes the Mind, Oxford: Oxford University Press 2005; O. Sacks, The Mind’s eyes, Toronto: Knopf Publ. 2010; G. Colombetti, The Feeling Body. Affective Science Meets the Enactive Mind, Cambridge, MA: The MIT Press 2014; M. Tsakiris, H. D. Preester, The Interoceptive Mind: From Homeostasis to Awareness, Oxford: Oxford University Press 2018; T. Fuchs Ecology of the brain, Oxford: Oxford University Press 2017.

  30. 30.

    T. Fuchs, Brain Mythologies. Jaspers’ Critique of Reductionism from a Current Perspective, in T. Fuchs, T. Breyer, C. Mundt (eds.), Karl Jaspers’ Philosophy and Psychopathology, Springer 2014, DOI: https://doi.org/10.1007/978-1-4614-8878-1_5, p. 81.

  31. 31.

    See T. Fuchs, Ecology of the brain, Oxford University Press, Oxford, 2018.

  32. 32.

    T. Fuchs, Ecology of the brain, p. 67.

  33. 33.

    T. Fuchs, The Challenge of Neuroscience: Psychiatry and Phenomenology Today, in Psychopathology, 2002;35: 319–326, p. 319.

  34. 34.

    T. Fuchs, Ecology of the brain, pp. 67–68.

  35. 35.

    T. Fuchs, Brain Mythologies. Jaspers’ Critique of Reductionism from a Current Perspective, p. 83.

  36. 36.

    T. Fuchs, The Challenge of Neuroscience: Psychiatry and Phenomenology Today, in Psychopathology, 2002, 35, p. 319.

  37. 37.

    A. Noe, Out of our heads. Why You Are Not Your Brain, and Other Lessons from the Biology of Consciousness, Hill and Wang, New York 2010, p. XI.

  38. 38.

    G. Northoff, “Brain-Paradox” and “Embeddment” – Do We Need a “Philosophy of the Brain”?, in Brain and Mind 2: 195–211, 2001, p. 196.

  39. 39.

    See G. Northoff, “Brain-Paradox” and “Embeddment” – Do We Need a “Philosophy of the Brain”?, in Brain and Mind 2: 195–211, 2001.

  40. 40.

    See T. Fuchs, In Defence of the Human Being. Foundational Questions of an Embodied Anthropology, Oxford: Oxford University Press 2021.

  41. 41.

    H. Plessner, Levels of Organic Life and the Human: An Introduction to Philosophical Anthropology. New York: Fordham University Press, 2019.

  42. 42.

    T. Fuchs, In Defence of the Human Being, p. 75.

  43. 43.

    H. G. Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age., Wiley, Kindle edition pp. 98–99.

  44. 44.

    See F. Brencio, From words to worlds. How metaphors and language shape mental health, in S. Wuppuluri, A. C. Grayling (eds.), Metaphors and Analogies in Sciences and Humanities: Words and Worlds, Springer, 2022, pp. 233–250.

  45. 45.

    See T. Fuchs, H. De Jaegher, Understanding Intersubjectivity: Enactive and Embodied, in T. Fuchs, H. C. Sattel & P. Henningsen (Eds.), The Embodied Self: Dimensions, Coherence and Disorders, Stuttgart: Schattauer, 2010.

  46. 46.

    H. G. Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age., p. 113.

  47. 47.

    M. Merleau-Ponty, Phenomenology of Perception, New York: Routledge, 1981, p. 238.

  48. 48.

    See V. Bizzari, Absent Bodies: Psychotherapeutic Challenges during COVID-19, in Psychopathology, 2022, doi: 10.1159/000524711.

  49. 49.

    E. Husserl, Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy. Second Book, Studies in the Phenomenology of Constitution, Kluwer Academic Publishers, Dordrecht, 1989, p. 129.

  50. 50.

    E. Husserl, Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy. Second Book, p. 311.

  51. 51.

    V. E. Von Gebsattel, The meaning of medical practice, in Theoretical Medicine, 16, 1995 p. 63.

  52. 52.

    F. Brencio, (Dis)Embodied encounters. Deciphering intersubjectivity in the context of drugs’ prescription, in P. A. Gargiulo, H. L. Mesones Arroyo (eds.), Psychiatry and Neuroscience Update. From Translational Research to Drug Addictions and Psychoses, Volume V, Springer (forthcoming).

  53. 53.

    V. E. Von Gebsattel, The meaning of medical practice, p. 60.

  54. 54.

    T. Fuchs, In defence of the human being, p. 5.

  55. 55.

    “The revealing that rules in modern technology is a challenge. which puts onto nature the unreasonable demand that it supplies energy that can be extracted and stored as such. But does this not hold true for the old windmill as well? No. Its sails do indeed turn in the wind; they are left entirely to the wind’s blowing. But the windmill does not unlock energy from the air currents in order to store it. […] Agriculture is now mechanized food industry. Air is now set upon to yield nitrogen, the earth to yield ore, ore to yield uranium, for example; uranium is set upon to yield atomic energy, which can be released either for destruction or for peaceful use”, M. Heidegger, The Question Concerning Technology and Other Essays, Harper & Row, New York, 1977, p. 13 and following.

  56. 56.

    See H. Jonas, The Imperative of Responsibility: The Search of an Ethics for the Technological Age, University of Chicago Press, Chicago, 1985.

  57. 57.

    See S. Ferrarello (ed.) Phenomenology of Bioethics: Technoethics and Lived-Experience, Springer 2021.

  58. 58.

    D. Zahavi, Empathy, embodiment and interpersonal understanding: From Lipps to Schutz, in Inquiry, 53/3, 2010, p. 291.

  59. 59.

    M. Englander, Empathy Training from a Phenomenological Perspective, in Journal of Phenomenological Psychology 45, 2014, p. 12.

  60. 60.

    S. Gallagher, D. Zahavi, The Phenomenological Mind, Routledge, New York 2012, p. 203.

  61. 61.

    See M. Englander, Empathy in a Social Psychiatry, in M. Englander (ed.). Phenomenology and the Social Context of Psychiatry Social Relations, Psychopathology, and Husserl’s Philosophy, Bloomsbury, Indiana 2018, pp. 49–64.

  62. 62.

    See S. Wharne, Empathy in phenomenological research: Employing Edith Stein’s account of empathy as a practical and ethical guide, in Methods in Psychology Volume 5, December 2021, 100053, doi: https://doi.org/10.1016/j.metip.2021.100053

  63. 63.

    E. Stein, On the problem of empathy, ICS Publications, Washington 1989 p. 75.

  64. 64.

    H. G. Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age, p. 99.

  65. 65.

    T. Fuchs, In defence of the human being, p. 196.

  66. 66.

    P. C. Kontos, G. Naglie, Tacit knowledge of caring and embodied selfhood, in Sociology of Health & Illness, 2009, 31,5, doi: 10.1111/j.1467-9566.2009.01158.x, p. 696.

  67. 67.

    P. C. Kontos, G. Naglie, Tacit knowledge of caring and embodied selfhood, p. 697.

  68. 68.

    The literature on the theme of touching is extremely broad. For a general view I refer the reader to D. M. Armstrong, Bodily Sensations, Routledge & Kegan Paul, 1962, London; J. J. Gibson, The Senses Considered as Perceptual Systems, Houghton Mifflin Company, Boston 1966; A. D. Craig, How do you feel? Interoception: the sense of the physiological condition of the body, in Nature Reviews Neuroscience, 202, 3(8), pp. 655–666; M. Ratcliffe, Touch and Situatedness, in International Journal of Philosophical Studies, 2008, 16(3), pp. 299–322; M. Ratcliffe, What is Touch?, in Australasian Journal of Philosophy, 2012, 90(3), pp. 413–432.

  69. 69.

    K. Mononen, Embodied care: affective touch as a facilitating resource for interaction between caregivers and residents in a care home for older adults, in Linguistics Vanguard, 2019, doi: https://doi.org/10.1515/lingvan-2018-0036, p. 2.

  70. 70.

    E. Levinas, Ethics and Infinity, Duquesne University Press, Pittsburgh, 1985, p. 87.

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  1. Research Group “Filosofía Aplicada: Sujeto, Sufrimiento, Sociedad”, Andalusian Research Plan, Code: PADI-HUM-018, University of Seville, Seville, Spain

    Francesca Brencio

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  1. Faculty of Health/Faculty of Humanities (LIS EA 4395), UPEC (PARIS XII), Créteil, France

    Elodie Boublil

  2. Department of Philosophy, California State University, East Bay, Hayward, CA, USA

    Susi Ferrarello

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Brencio, F. (2023). From Digital Medicine to Embodied Care. In: Boublil, E., Ferrarello, S. (eds) The Vulnerability of the Human World. Philosophy and Medicine, vol 148. Springer, Cham. https://doi.org/10.1007/978-3-031-41824-2_11

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