Abstract
In many popular and medical accounts, pacemakers and internal cardioverter defibrillators (ICDs) are often portrayed as almost magical technologies. Once implanted in bodies, they will work automatically by themselves and don’t require any agency of their ‘users.’ As I argue in this book, any discourse or policy that assumes a passive role of people living with technologies inside their bodies silences the fact that keeping cyborg bodies alive involves their active engagement. To understand the agency of ‘wired heart cyborgs,’ as I call them, this first introductory chapter provides a critical intervention in dominant discourses that conceptualize cyborgs as passive or merely as a linguistic or metaphorical entity. These approaches are problematic because they silence the lived experiences and voices of cyborgs, adopt a narrow focus on cyborgs as individuals, and neglect the materiality of hybrid bodies. Inspired by recent feminist post-humanist studies on the intimate relationships between bodies and technologies, this chapter argues that it is important to re-materialize the cyborg. The chapter describes conceptual tools used in the book in order to account for the ways in which wired heart cyborgs sense and make sense of their materially transformed bodies.
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Notes
- 1.
This story is based on the interview with Joan (52) on 15 August 2012.
- 2.
An average pacemaker is two inches (51 mm) long and two inches wide (www.pacemakerclub.com), Accessed 8 November 2018.
- 3.
Implantable defibrillators are a bit larger than pacemakers. The average ICD is 2.5 inches high, 2 inches wide and 0.5 inch deep (or 64 × 51 × 13 mm). http://www.asktheicd.com. Accessed 8 November 2018.
- 4.
Pacemaker/implantable cardioverter defibrillator (ICD) insertion. Procedure overview as presented at the website of the Stanford Hospitals & Clinics in the US. Accessed 14 February 2014. http://stanfordhealthcare.org/medical-treatments/i/icd/procedures.html
- 5.
- 6.
Remote monitoring was introduced in the early 2000s by Biotronik and Medtronic (www.biotronik.de; www.medtronic.com) and has become integrated in ICD care in the US and some European countries, including Denmark and the Netherlands (interview de Cock 2012; Dam Nielsen 2015, 20).
- 7.
The companies in the US include Medtronic, Boston Scientific, Abbot (t. Jude Medical), and the German company is Biotronik. Smaller companies include ZOLL Medical Corporation, MEDICO S.p.A and Pacetronix (Anonymous 2017).
- 8.
- 9.
The ICD has been approved by the US Food and Drug Administration (FDA) in 1985 and framed by Medicare (the US government program that covers the costs of acute medical treatment for people older than 65) as a last resort treatment for patients who had experienced episodes of life-threatening heart rhythm disturbances or cardiac arrest (de Lissovoy 2007).
- 10.
- 11.
Old age alone is not considered as a relevant criterion for the implantation of ICDs. In Swedish law, for example, guidelines have been developed that explicitly prohibit any age discrimination in clinical decision-making (Sager and Zuiderent-Jerak 2016). American and European guidelines for primary prevention with ICDs don’t include any age limits, although complications caused by implantations are considered to increase with age (Bracke et al. 2009). Because older people often suffer from other serious, potentially life-threatening diseases as well, these guidelines advice cardiologists to take into account these co-morbidities as important consideration in decisions on the implantation of defibrillators in old people (Epstein et al. 2013; Priori et al. 2015).
- 12.
See Chap. 6 for a further analysis of how the implantation of ICDs affects young people.
- 13.
- 14.
In line with postcolonial and transnational researchers, I use the term Global South to refer to what may also be called the Third World or developing countries, (i.e., Africa, Latin America, and the developing countries in Asia, including the Middle East). The term Global North will be used to refer to wealthy industrialized countries, including the US, Canada, Western Europe, wealthy parts of Asia, Israel, Australia, and New Zealand (https://en.wikipedia.org/wiki/Global_South; https://en.wikipedia.org/wiki/North-South_divide; Accessed 20 August 2018).
- 15.
The cost of an ICD implantation ranges from US$30,000 to US$50,000, although this may vary depending on insurance arrangements and financial assistance. www.asktheicd.com and www.healthusnews.com, 26 November 2014, both accessed 8 November 2018.
- 16.
The number of diagnoses for which they are recommended has grown as well (Butler 2013).
- 17.
- 18.
Mond and Proclemer 2011 as cited in Runge et al. (2017, 297). In the Netherlands, approximately 80,000 people were living with pacemakers in 2013, and the implantation rate has increased since then with 11,850 annually.
- 19.
Although there exist major differences in access to pacemakers and ICDs between the Global North and the Global South, there is considerable heterogeneity within the Global South as well. Whereas some middle-income countries do have the required infrastructure for pacemaker and ICD implantation, other countries have no infrastructure to support these implants at all. Equally important, rich people from the Global South can travel to countries in the Global North to have an implantation of these devices. Similarly, there exists a huge variety of experiences within the Global North as well, where people who live in countries that don’t provide sufficient health-care insurance coverage don’t have access to high-tech procedures such as pacemaker and ICD implantations. Nevertheless, the sharpest contrast in access to internal heart devices emerges at the global level.
- 20.
Throughout the book, I use the terms ‘cyborgs’ and ‘hybrid bodies’ as synonyms to refer to the fusion of bodies and technologies, particularly medical implants.
- 21.
- 22.
- 23.
This approach to technologies has been developed by STS scholars such as Singleton (2005) and Moser (2008), who argued that whether technologies work or not depends on a process in which they are continually used and remade in different locations rather than being developed in laboratories and implemented in contexts of use.
- 24.
As in Don Ihde’s earlier work, Bodies in Technology (2001), in which he discusses how virtual technologies such as computer simulations and scientific research instruments extend the senses and one’s orientation in the world, Ihde focuses exclusively on technologies external to bodies. Similarly, Embodied Technics (2010), which explores how new technologies extend and transform one’s experience of embodiment, also excludes technologies implanted in bodies. Interestingly, implants are mentioned briefly in his 2011 essay in which he criticizes transhumanism. Based on the example of artificial legs, which are partly internal, partly external, he describes how these technologies change one’s perceptions of the environment and introduce different capacities than before. Moreover, he emphasizes the importance of critically examining the materiality of cyborgs, although he does not further explore this suggestion. Ihde does not conclude that the presence of cyborg bodies requires a rethinking or extension of his typology of human-technology relations. Other scholars, including myself, have taken up this challenge by introducing a new human-technology relation to Ihde’s typology by adding cyborg relations (Verbeek 2008) or fusion relations (Kiran et al. 2015) to refer to embodiment relations in which bodies merge with technologies. However, the major interest of the post-phenomenology approaches of Don Ihde and Peter Paul Verbeek concerns how people having implants perceive the world and how this is transformed by these technical devices. As Lucy Dalibert has argued already, this scholarship “still blackboxes both technologies and bodies” (Dalibert 2014, 180).
- 25.
Some of the more recently introduced implants delegate some agency to their users. Deep brain stimulation implants introduced for the treatment of Parkinson and spinal cord stimulation implants, developed for the treatment of chronic pain, allow patients to interact with the device in order to raise or lower stimulation levels (Morrison and Bliton 2011; Dalibert 2014).
- 26.
- 27.
The term ‘wearers’ is, for example, frequently used by the Dutch Stichting ICD dragers Nederland (STIN) (www.sidned.nl), whereas the term ‘recipients’ is frequently used in the medical literature.
- 28.
In this respect, people with pacemakers and ICDs in their bodies show a dependency on health-care professionals similar to that of women using hormonal contraceptives inserted under their skin. See Mintzes et al. (1993) for detailed accounts of these dependency relations.
- 29.
As patients, cardiologists are often not able to freely choose the type and brand of implant they prefer. In the Dutch context, health insurers allow hospitals to purchase only a limited number of brands to reduce the costs of devices and personnel because each brand requires different software programs and skills required for the control of the implanted devices (Split 2012, 3).
- 30.
- 31.
See Chap. 7 for a detailed analysis of the policies and practices of decisions concerning the de-activation of internal heart devices before dying.
- 32.
- 33.
Although their implants worked in mice, Clyne and Kline did not succeed in modifying the human body to survive in space (Kline 2009).
- 34.
Exemplary studies include Balsamo (1996), Gray (2001), Fukuyama (2002), and Hughes (2004). Interestingly, many cyborg studies, including the work of Donna Haraway herself, have not been restricted to technologies implanted in bodies. In the Cyborg Database (Gray et al. 2010), for example, Chris Hables Gray and his colleagues describe many different types of what they call cyborgization. Their typology includes the incorporation of living elements (such as bacterial, plant, insect, and mammal) and technological interventions in the body (such as machine prosthesis, genetic engineering, vaccination, and xeno-transplants). Because the level of integration of non-human elements may vary as well from mega to mundane, Gray argues that “basically an infinite number of possible cyborgs exist, life multiplied by human invention and intervention” (Gray 2011, 88).
- 35.
- 36.
Criticizing approaches in the cyborg literature that only focus on “the extreme versions of human-machine integration and hybridity” in popular culture, Steven Mentor has introduced the term ‘mundane cyborg’ that reflects some of the concerns addressed in the everyday cyborg concept as well, particularly the fact that cyborgs are not just fictional but ‘all around us’ (Mentor 2011, 54). However, Mentor focuses merely on technologies external to the body such as cell phones, laptops, remote controls, automobiles, and exoskeletons. His preference for studying technologies external to the body reflects a much broader trend in cyborg studies. In the past decades, the notion of cyborg has become an umbrella term to include almost all human-technology relations. The concept of ‘everyday cyborg ’ is therefore important as well because it may help to make the debates on cyborgs more focused and differentiated.
- 37.
A few notable exceptions to the masculinization of the cyborg in popular media include Six Million Dollar Woman and “Seven of Nine” in Star Trek, in which female cyborgs are introduced. Like male cyborgs, female human-machine hybrids also reflect dominant gendered characteristics of the body where the technological modifications focus on the female reproduction anatomy (Haddow et al. 2015, 503).
- 38.
See Chap. 5 for a more detailed account of how gender matters in the world of pacemakers and ICDs.
- 39.
The term prosthetic is frequently used in cyborg anthropology, philosophy of technology, and disability studies to think beyond binaries of body/technology, male/female, and normal/disabled. This scholarship aims to investigate the relationships between bodies, technologies, and subjectivities that go “far beyond the medical definition of material replacement of a missing body part” (Jain 1999). Although the prosthetic literature focuses on many themes addresses in the cyborg literature, it also includes topics such as ‘prosthetic consciousness’ and ‘prosthetic aesthetics’ (Sobchack 2006, 19). Sarah Jain (1999) has criticized early studies on prosthetics for neglecting the differences between various technologies where “metaphors of prosthetic extension are presented as if they were equivalent in some way, from typewriters to […] silicone implants. Both the prosthesis and the body are generalized in a form that denies how bodies can and do ‘take up’ technologies of all kinds.” Remarkably, cyborg studies tend to fall in the same pitfall by neglecting the differences between implants and technologies external to the body.
- 40.
“Anatomy and Function of the Heart’s Electrical System.” www.hopkinsmedicine, accessed 14 June 2019. Since the early twentieth century, the electrical activity of the heart has been mapped and monitored using electrocardiograms (ECGs) that produce graphical waves that subsequently came to be considered as signs of life and death (Rodgers 2011). Ever since then, ECGs have become important medical tools in the diagnosis and treatment of heart diseases and constitute a crucial component of pacemakers and ICDs to monitor heart rhythm irregularities.
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Oudshoorn, N. (2020). Rematerializing the Cyborg: Understanding the Agency of People Living with Technologies Inside Their Bodies. In: Resilient Cyborgs. Health, Technology and Society. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-15-2529-2_1
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Publisher Name: Palgrave Macmillan, Singapore
Print ISBN: 978-981-15-2528-5
Online ISBN: 978-981-15-2529-2
eBook Packages: Social SciencesSocial Sciences (R0)