Technical Nemesis
A Guest Post on metricizing your health
On June 26th, the fitness tracker company Oura announced an integration with Slack, allowing users of the tracker to link their Oura Readiness and Sleep Scores for their colleagues to see. The integration is billed as a tool to help remote team members “communicate with empathy,” by signaling when your colleague may be tired or stressed. But it can also be read as a metricization of health that alienates users from their bodies, rather than further integrating the mind and body.
Here at Regress Studies we’re excited to publish our first guest essay, from Paige Brann, on what the modern transformation of medicine does to our feelings of embodiment. I purchased an Oura Ring for Nicole a few months ago, so Paige and I disagree somewhat on how to engage with the biotech metricization complex. But it’s a sharp, provocative essay worth chewing on.
Going forward, Regress Studies will publish occasional guest essays like this one. If you’re interested in contributing, please reach out via email. We’re interested in essays that treat the past seriously, and essays about things which persevere.
We use the words that are presently available to us in our culture to signify basic human realities. In a technological age, the words available to us are technological: “let me double click on that,” “I’m wired that way,” “he scanned the room,” “I’m monitoring it.” But the words we use also have the power to shape our understandings of the things we mean by them.
This process is not a new one. Methodist preacher John Wesley complained about the use of the word reproduction to mean sexual generation: “Buffon substitutes for the plain word Generation, a quaint word of his own, Reproduction, in order to level man not only with the beasts that perish, but with nettles and onions.” Nettles and onions reproduce, but generation is sexual.
For Wesley, this was a theological and political issue. Kinship with God, who generates, elevates man above other biological organisms, and using a desexed term like “reproduction” would level out all creatures. Now, I’m a vegan, so I depart from Wesley in thinking that humans are far closer to God than any other living thing. But I’m struck by the small but real sense of loss he conveys: that the move from the language of the human to the language of the machine process, or the vegetative, abstracts us from our bodies.
The term “reproduction” in the eighteenth century entered the broader lexicon as a product of changes in the organization of work as well as science. As work shifted toward mechanized and standardized procedures, the language of reproducing emerged. Changes in science mirrored those in work: birth had been left to midwives and non-professionals in a community, only unprofessional in the sense that they were untrained and uncertified, but reproduction became a scientific, professional matter that could be explained and broken down into trimesters and medical terms. This is what Jacques Ellul calls technique: the essence of technique is to compel the qualitative to become quantitative.1
Technique is essential to the process of medicalizing behaviors and experiences, since redefining a human condition as a medical condition makes it something that can be concretely described, diagnosed, and treated. Ancient visions of health ranged from the humors of Greece to the elements in Ayurveda, but they all treated health as a virtue, because it required harmony with a particular community and environment.
Health science has allowed us all to replace vague complaints of malaise with a clear checklist of symptoms, potential sites of infection, and tests that run the gamut to find out precisely what the problem is. But as more complete technical knowledge of man is developed, promising efficiency and control over our body, the reality of this technique is turning our bodies over to a certified professional for maintenance. Relying on scientific metrics of health encourages us to divide ourselves into discrete fragments, we see different specialists for each problem, and erodes our ability to be conscious of our own “living presence.” Embodied and sensorial knowledge is at odds with mechanical, technical development since it is much harder to sort qualitative experience into precise categories. This is most apparent in the current growth of biotechnology.
The transformation in medicine that defines our current era is one where health is an individual responsibility, and in which health is increasingly understood quantitatively. The Oura Ring, a wearable gaining traction in the women’s health market, describes its mission as nothing less than to improve the way we live our lives.
Nowadays, health care is sick care. People are feeling worse, not better. Ultimately, we want everyone to realize health as a daily practice. We are creating a future where people have the understanding and tools to practice their health through continuous access to accurate information and personalized guidance wrapped around their finger.
That's why we exist: to empower every person to own their inner potential.
The ring gives you daily scores based on the measurements of things like basal body temperature, sleep quality, and heart rate, and informs you whether today is a day to push yourself or take it easy. Despite its use of phrases like “tune in” or “inner potential,” Oura’s app is designed so that those inner processes become external. Rather than returning health to something unprofessional and qualitative, the Oura Ring has made all aspects of an individual body’s health quantifiable – and scorable – so that you actually don’t need anyone but the numbers to truly unlock your “inner potential.”
The Ring is just one of a bevy of wearables designed to translate the internal, qualitative experience of the body into data which is external and metricized. At Apple’s WWDC 23 keynote, VP of Health Dr. Sumbul Desai announced new features to track physical and mental health on the Apple Watch and Health app. She wrote in her announcement that the goal is to empower people to take charge of their own health. This vision of people taking responsibility for their own health is one Dr. Desai has been promoting, believing that “if [users] take action using science-based data and insights… there’s nothing more powerful. Because you’re tapping yourself as a motivator.” Once users generate enough data about their biological processes, the Apple Watch can identify problems before users even see a doctor.
New features promoted at WWDC 23 included adding mental health data to the Health and Mindfulness app that will allow users to log emotions and moods daily across devices. Scrolling through amoebic shapes in soothing pastel colors, users can choose a shape that represents their mental state on a scale of “Very Unpleasant” to “Very Pleasant” and log what might be causing those feelings to give insights into their mood. As users log their moods and listen to music, Apple will identify what daily habits are affecting the user’s state of mind. Funky shapes come to symbolize certain moods, and Apple is positioned as a therapist capable of providing insights.
These models and numbers seem at first like a tool to understand the body, but tools are like sacraments: what they symbolize is inevitably what they do. Wearables symbolize the return of health to laypeople, in a manner that suggests you really can be in charge of your own health. Rather than dismantle the doctor/patient dyad that exists in professionalized healthcare, the devices make an individual a permanent patient.
In a 1990 speech, social critic and priest Ivan Illich predicted the effects of an increasing technicization of health:
It would be politically naive, after health and responsibility have been made technically impossible, to somehow resurrect them through inclusion into a personal project; some kind of resistance is demanded.
Ivan Illich gave the speech years after he wrote the controversial Medical Nemesis. At the time of the book’s publication, he later said, he did not know how little power individuals would have over the conditions they live in, and it would be foolish to implore readers to be responsible for their own health in a world of environmental destruction and pollution.
In turning back health to the individual, wearable biotech is perfecting technique as Ellul saw it: the aim to resolve all problems that might impede the functioning of an organization in advance. Instead of health that addressed conditions beyond one individual, biotech builds on the prior procedures set up by the medical profession to predict and resolve problems. Codifying a therapist, a role invented when community ties became so severed that people needed someone with a certificate to talk with about their problems, the Apple Watch can make sure you don’t need anyone but your Apple devices to get along.
In this way, it seems like feeling healthy as an internal state is no longer possible. The way health has been quantified, coded, and meticulously modeled has turned “feeling healthy” into the same enjoyment one gets from getting code to work instead of something sensorial. Being sick, tired, in pain, bored, lonely, anxious, are all unavoidable aspects of being alive. But by medicalizing expectations, more misery and obsession is produced as people demand more data about their bodies, more models to understand how they can avoid feeling even slightly unwell.
These wearables may symbolize independence and reclaiming of medical tools, but really they draw us further away from the sensory world. What could health actually look like when abstraction and technique permeates our daily habits? Is it simply adapting to the chemical, environmental, and cultural consequences of industrial expansion?
I don’t really believe that more tech and more science can remediate the ills they have caused, and I think the daily task of accepting human fragility and contingency is something we can’t displace onto pastel shapes or work through via prompts from our Apple Journal.
Importantly, people don’t just metabolize and secrete serotonin. We celebrate, laugh, eat together, and care for one another. It’s been shown, many times over, that being happy and cultivating lasting connections matters way more than almost any other biological “risk factor” for health. Why flatten out these experiences into averages of data points?
Elsewhere Ellul describes technique as "the totality of methods rationally arrived at and having absolute efficiency in every field of human activity."