THIS IS A BOOK about aging and medical technologies in the twenty-first century. It will follow a style that evolved in this now sixth of my books with “technics” in the title. On one side personal, it is also autobiographical in that it will be my own experience of aging that is being described; on the other side I am a philosopher of technology, a recently arrived type of philosophy that emphasizes the role of technologies in many dimensions of human life, both individual and social. And, finally, my approach is known today as postphenomenology, a modified type of phenomenological analysis specifically aimed at what is unique about technics, or the materiality of instruments and tools developed in medical science.
The origins of this inquiry are distinct to the twenty-first century, specifically 2008, which was a major turn in my own life, when aging became dramatic. I am now eighty-five years old; 2008 was my seventy-fourth year, and this book spans ten years of aging and the medical procedures that I underwent during that time. In some ways I was a typical aging male. In my role as a philosopher of technology, I had just completed three trips to China, a country that is intensely involved in what I will call a postmodern technological revolution. Today its ambitions include becoming the world leader in AI and many other fields. I had just made three lecture tours to China in 2004, 2006, and 2007, and while there, visiting ancient sites such as gardens up a steep mountain, the Great Wall, and ancient cities, I found myself panting, tiring, and having difficulty maneuvering for the first time in an active life. After my first bad short-breathed experience back in the United States in 2006, I went to see a cardiologist at my university hospital. His diagnosis, revealed in an angiogram, was cardiovascular disease. I underwent balloon angioplasty plus a stent in my most blocked artery. (I summarize all the medical procedures I experienced in “Aging: I Don’t Want to Be a Cyborg, I and II” and “Aging Cyborg, III, IV, V, VI, and VII.”)
Now for “Technics”: I borrowed this term from Lewis Mumford, whose Technics and Civilization (1934) was the best-known intellectual history of technology when I introduced a new course in philosophy at Stony Brook University shortly after my arrival in 1969. He was not at the time thought of as a philosopher, but the term “technics” seemed to nicely cover both the sense of technologies in use and the materiality of technologies, which I found helpful. The early seventies marked my first turn to philosophy of technology, and in background reading I became aware that many European technology theorists were using a vocabulary that included “technology” and “technique,” including early writers such as Foucault, Ellul, and Marcuse. In each case they seemed to turn everything into a technology that some regarded as a carryover from the materiality of technologies to analytic techniques such as language. I was skeptical of this expansion, although I could see how imaged techniques such as sports motility and even sexual praxis might indirectly reflect as “techniques” inspired by “technologies” without actually being technologies. I also became aware of how the tone of many early philosophers of technology, such as Heidegger, Ortega y Gasset, and Jaspers, often cast a dystopian shadow upon technologies viewed overall. And later Mumford also became critical in his Myth of the Machine (1970). His earlier Technics and Civilization, however, cast a more objective view upon the important role of technics in the history of civilization and recognized that the social impact of the clock paved the way for the Industrial Revolution. For me, technologies remain material while “hardware,” concrete, and technics resist totalization, a sense that I wish to continue in Medical Technics. I grew up on a Kansas farm, and its culture included lots of “junk” technologies. Every farmer had a discard pile of technology parts from worn-out, abandoned machines. These were often later used for invented “bricolage” machines that my brother, father, and I would invent once all of us developed the skill of welding. Much later, while first doing an MDiv and then a PhD in the Boston area from 1956 to 1964, I had become a chaplain at MIT (1958–1964) and spent most of my lunch hours in the faculty and graduate dining room just two doors away from my office. There I met many of MIT’s engineer-inventors only to find that many had midwestern heritages with the bricolage technologies I had known as a boy. This was in the late fifties, early sixties when “planned obsolescence” was popular in commerce, and many engineer-inventors admitted that their sponsoring companies often encouraged them to produce compound parts that, despite having shorter shelf lives, were much cheaper. I later wondered about the countermove with joint implants for which the problem was precisely shelf life. Early knee replacements lasted only about six to seven years, and thus an athletic person in his or her mid-thirties could have to undergo surgery again several times in later life. In this case the implant technologies had improved enough that when my own replacement knee implant was surgically placed in 2013, I, then seventy-nine, could expect at least fifteen or more years of shelf life. From all this it seemed to me that the technofantasies of technological eternal life simply missed the reality of technological finitude. (If Heidegger’s convincing “being toward death” underlined human contingency and finitude, should not technologies also be finite and contingent? Technologies, too, have a being toward death as shelf life.)
If my early experiences of medical technics again begin with my seventies, I sometimes think, what if I had been unlucky enough to have been born a century earlier? I think the answer would have to be I’d likely be dead. We now take careful note of how longevity has changed dramatically, at least in all industrialized countries. Human lifespans a century ago were forty-five or a little more. Today at least ten countries have about eighty-five as an average lifespan. How did this happen? First, a major factor is sanitation. Until national practices turned to sanitation, diseases like typhoid, the earlier plagues of the world, and other epidemics could kill vast proportions of societies. But, now obvious in retrospect, until we could recognize the microorganisms—germs, bacteria, and viruses—that caused diseases, there could be no informed therapies. Let me, somewhat oversimply, point out that the optical imaging of early modern science played a major role. Leeuwenhoek and many others, including Galileo, developed the microscope, which in turn revolutionized our view of a microworld, including reproduction, with the visual discovery of sperm and eggs and, later, disease-causing microorganisms. My own 2008 heart repair (not replacement) procedure could not have been diagnosed or surgically undergone a century ago. The wall of my surgeon’s imaging displays at my pre-surgical consultation, with his moving cursor to show what was broken, could not have existed until the twenty-first century.
So, if we return to our century, we see a postmodern world where we are undergoing what I sometimes call a “second scientific revolution,” very apparent in its medical dimension and led by a turn to laparo-, micro-, and nanoprocesses, especially in imaging technologies and surgical procedures. Let us look at some of the major changes even from the twentieth century. Surgery, for example, has clearly moved from very large processes—akin to butchering—to the laparoscopic processes of today. Even appendicitis once necessitated a major operation. Yet when my wife found she had bone spurs in her shoulders, inhibiting tennis playing, laparoscopic surgery left at most a half-inch scar that, when she added a few weeks of physical therapy, allowed play to resume; or, as will be discussed in “Aging Cyborg, III, IV, V, VI, and VII,” my cataract surgery was performed with a femtosecond laser process one million times more accurate than previous laser surgery technologies. It took fifteen minutes per eye and yielded what my ophthalmologist terms “perfect vision.” This was unheard of in the twentieth century. This procedure is performed on approximately 3.5 million patients per year in the United States.
I opened this entry with the revolution in longevity followed by the switch to microsurgery, which now is frequently performed robotically at a distance. I group these over yet another change from earlier medical technics in “Aging: I Don’t Want to Be a Cyborg, I and II” and “Aging Cyborg, III, IV, V, VI, and VII,” where I describe my own procedures. These chapter titles point to the growing capacity of medical technics to add permanent technologies to aging bodies. While tooth crowns have a relatively long history, implants constructed of metals and plastics in joints such as the knee, hip, and elbow are relatively new and common, again with close to millions of procedures per year in the United States. Stents and other permanent implants multiply regularly. I decided that it is better being a cyborg than disabled or worse, dead, after all. I chose Donna Haraway’s popularized notion of a cyborg as a hybrid mix of human, technology, plus sometimes animal parts over the more mechanized versions of earlier imagined cyborgs influenced by “cybernetics” models thought of by Norbert Wiener (whom I knew at MIT), since there is a clearly different pre- and postcyborg experience. So far, I have mentioned the well-known fact that early philosophy of technology was often dystopian. Yet its opposite exaggeration is often even earlier and hypes a utopian technofantasy. This technology will do marvelous things—perhaps even allow eternal life. The cyborg metaphor also includes dreams expressed in notions of the posthuman, or worse, transhuman fantasies. Posthumans are narrower: they fix upon genuine gains and project enhancement developments. Two common sensory prostheses are visual and auditory. When told by one of my ophthalmologists after cataract surgery that I now had “perfect” vision, I recalled what had been excellent vision that matched African Dogon vision, which was so sharp that the satellites of Jupiter could be seen with naked eye vision (a feat I used to match in my Vermont place). I recognized this result was a restoration to younger sharper vision, not an enhancement. And I wish my state-of-the-art digital hearing aids could do the same, but I continue to reject the possibility of a cochlear implant that does not restore hearing but allows a different hearing altogether, which is very difficult to learn as users testify. Transhumanists prone to many science fiction technofantasies imagine a self-guided human evolution that is bionic beyond default. As I point out later, all actual implants attract a biological film that can be “indolent,” as mine was fortunate enough to be, or bacteriologically toxic, even deadly. Transhuman, utopian technofantasies portrayed in film and television somehow ignore actual biofilms in transplants. Postphenomenology, respecting biological science, remains skeptical of such technofantasies.
Within the spectrum of praxis philosophies now at work on technics, postphenomenology often converges with critical theory, the current version of neo-Marxian philosophy. Many note how the work of Andrew Feenberg and my work converge, but Friedrich Kittler also has played a role. His Taking Care of Nietzsche shows how unexpected outcomes occurred when the typewriter was invented in 1878. Most secretaries were male, proud of their well-honed bodily skills using pens. The shocking invention of the typewriter provoked a “Luddite” reaction in the male secretaries, who thought typing “de-skilled” them and refused to adopt it. Instead, young women “pre-skilled” by piano training responded to an opening to escape the limits of domesticity, and within little more than a decade the vast majority of secretaries were female.
And now, I add a special and philosophical interest. On a philosophy of science side, I have long argued that science would be greatly enriched—in spite of its highly successful use of visualization from imaging technologies—were it to be multisensory, especially regarding auditory and acoustic imaging. I have long been known for this interest, and my Listening and Voice: A Phenomenology of Sound (1976), its second edition, Listening and Voice: Phenomenologies of Sound (2007), and Acoustic Technics (2015) are featured in an acoustic technologies in medicine follow-up, described in “Sonifying Science: Listening to Cancer.”
Indeed, in recent science publications there is evidence that sonification is being given as an alternative mode of science reporting. Those interested in the Cassini space probe’s last missions can hear dust particles hit the probe as it descends for its last travels that crash onto the Saturnian surface. Or, one can tune in to hear the sonic “moans” of glaciers melting; or follow the new “Superhenge” discovered by subsurface sounding in England, near Stonehenge but five times bigger; or, one of my favorites, learn about the 8,600 buried pyramids in Central Mexico discovered by airplane magnetometer in 1996.
Let’s turn back to philosophy of technology, particularly as related to medical technics. As previously noted, my own approach is called postphenomenology. Philosophy of technology, indeed like the timeframe for this book, is a relatively new interest of philosophy. It does have some notable nineteenth-century harbingers, both neo-Hegelians. After all, it was Hegel who got us to think of “philosophies of ____________.” He spoke of the philosophies of history, religion, and so on, so why not philosophy of technology? Two of his followers, Karl Marx and Ernst Kapp, did take technologies seriously. Kapp, indeed, was the first to title a book Philosophy of Technology in 1877. Kapp thought of technologies as analog organs. Far better known was Karl Marx, who inverted Hegel’s idealism into a kind of “dialectical materialism” that saw technologies whose change over time shaped the “means of production.” Like Mumford, Marx looked at how different technologies produced—in his case deterministically—different societies. But it was only after World War I, with the large military-industrial technologies of tanks, airplanes, and machine guns, that a whole generation of major philosophers began to take technologies seriously in philosophical concern. Of these, Martin Heidegger was—and is—thought of as philosophy of technology’s inventor, but Ortega y Gassett, Karl Jaspers, and many others of this first generation also shaped an opening to philosophy of technology, first taken mostly as transcendental or generic technology, often viewed with a dystopian evaluation. A second generation, mostly students of the first, continued the transcendental-dystopian views, now including many neo-Marxists centered in the Frankfurt School: Arendt, Marcuse, Adorno, Horkheimer, and Habermas. By my time, Hans Achterhuis noted in American Philosophy of Technology: The Empirical Turn (2001) that there had occurred a turn to the examination of concrete technologies. And while all three generations held, as I term it, a praxis or practices emphasis found in a limited number of philosophical traditions (Marxism, phenomenology, pragmatism, process philosophy), now both European and American, the dystopian tone had also changed, and an empirical turn had taken place.
Postphenomenology first took shape largely out of my technoscience research group at Stony Brook and is clearly a technology-focused version of phenomenology. Aided by the “case study” concreteness of STS (science technology studies) and presentation of postphenomenology research panels at all the major STS style conferences, this movement is a major presence in STS venues. My historical mentors were classical phenomenologists: Edmund Husserl, Martin Heidegger, and Maurice Merleau-Ponty, plus Paul Ricoeur with hermeneutics. I was later largely involved in the eighties discussion of “nonfoundational” philosophy stimulated by Richard Rorty and leading back to John Dewey, where I found much in pragmatism that helped enhance concern with technologies. I had long felt uncomfortable with the early modern subjectivist tone that Husserl maintained in his dominantly idealist adaptation of Descartes and with both Husserl’s and Merleau-Ponty’s claims that science was distant from the lifeworld, thus opening the way for the exaggeration that phenomenology was antiscientific. Postphenomenology emphasizes that the already interrelational analysis of human–world relations, which postphenomenology makes into a mutual co-constitutive relation, includes a mediating role for materiality, technics, and technology so that human–world interrelations become human–technics–world relations. The most easily emphasized and grasped version of this modification of phenomenology, I held, could be well illustrated in the case of imaging technologies. If one is familiar with the plethora of similar interrelationary analyses in the mid-twentieth-century arrival of science studies—the new sociologies of science, feminist critiques, and philosophies of technology—one can see that postphenomenology belongs to this intellectual milieu. Briefly put, postphenomenology joins the now widespread notion that human knowledge is perspectival, bodily located, and multisensory—or as I sometimes put it, praxis-perceptual. One can see there are many postmodern connections to this particular focus upon technics.
What I found, even from the early days of my turn to philosophy of technology—marked by the publication of my Technics and Praxis: A Philosophy of Technology (1979), cited as the first English language book in philosophy of technology—was that what I could do as a philosopher underwent deep changes. For example, with my first (and final career) move to Stony Brook University, I found myself working with the engineering college and collaborating with a wide regional “technological literacy” program supported by the Sloan Foundation. I soon found myself going around the entire state (New York and later New Jersey and Florida), often talking to groups of adults about computer education for very young children. Computer manufacturers were at that time mounting a serious advertising program aimed at stimulating laptop sales for young children. One theme was to claim that unless your child learns computer skills early, the child will “fall behind” and not do well in school. I was already doing heavy research in the history of technologies and their commercial propagation, often in collaboration with Ruth Cowan, a well-known historian of technology at Stony Brook. One of her examples echoed early successful sales campaigns that had to do with washing machine soaps: unless you have the proper washing machine soap, you will get germs and disease—so buy our soap. I found myself urging reasonable caution, telling worried parents that computer prices would come down, children would learn skills if interested anyway, and to not too easily rush into the latest thing. The same applied to worries about screen time: was playing computer games reductive? Was the reduction of gaming to eye–hand coordination bad? In this case, as I learned from so many of my late life doctors, this gaming has turned out to be a kind of pre-skilling for “Nintendo surgery” (see “From Embodiment Skills in Computer Games to Nintendo Surgery”) today widespread in medical technics, space exploration, and drone piloting. Pre-skilling turns out to be also related to convergent themes among postphenomenology and critical theory. Much of classical Marxian theory relies on notions of alienation in work, often called de-skilling as in my male secretary example. Pre-skilling, unpredicted in the secretary example, softens the notion of alienation. Another variant occurs in the development of early musical synthesizers. Trevor Pinch and Frank Trocco (Trevor a longtime collaborator) published Analogue Days (2004) showing that the Moog, by virtue of using a keyboard as its control device, vastly overcame the Buchla, which had a more complex control panel, another example of pre-skilling since many musicians were already familiar with keyboards.
Alongside my U.S. work with the Sloan Foundation and technological literacy, I was also working with Lego in Denmark in an interdisciplinary group worried about how computer games might encourage obesity for lack of bodily exercise. Our group imagined many “Wii-style” games like those that are now prominent, but this exercise also helped me understand more deeply the side issues of pre-skilling for Nintendo surgery and distant sensing noted in “From Embodiment Skills in Computer Games to Nintendo Surgery.”
“Postphenomenological Postscript: From Macro- to Microtechnics” returns to philosophical themes and “We Make Technology, Technology Makes Us” concludes with a postretirement interview with a story related to a change in postretirement life. Upon moving into a Manhattan apartment, I began to receive multiple requests for interviews, one of which came from an Israeli techie interested in AI, machine learning, and the like. He invited me to give a presentation on technics in his East Village workshop, and there I met Daisy Alioto, a freelance writer who in turn did the closing interview of how we humans invent technologies, which then also invent us.