Aging: I Don’t Want to Be a Cyborg, I and II

ALTHOUGH DONNA HARAWAY did not invent the term cyborg, she did help make it a term of popular culture. Her cyborg is a hybrid that can include human, animal, and machinic or technological parts. Haraway’s cyborg is simply a mixture. This, in turn, may combine with various human fantasies, including what I call technofantasies. Haraway herself was also well aware that the cyborg could stimulate imaginative fantasies. In popular culture, these fantasies include utopic-bionic science fiction variants that in film and television include all sorts of prostheses that make mere human limbs, organs, and the like superpowerful and better than the originals. Terminator, RoboCop, and The Six Million Dollar Man / The Bionic Woman, have all had their plays upon this theme. And each is a variant of what I claimed was a deep-rooted technofantasy in Technology and the Lifeworld (1990):

There is a . . . deeper desire which can arise from the experience of embodiment relations. It is the doubled desire that, on the one side, is a wish for total transparency, total embodiment, for the technology to truly “become me.” Were this possible, it would be equivalent to there being no technology, for total transparency would be my body and senses; I desire the face-to-face that I would experience without the technology. But that is only one side of the desire. The other side is the desire to have the power, the transformation that the technology makes available. Only by using the technology is my bodily power enhanced and magnified by speed, through distance, or by any of the other ways in which technologies change my capacities. These capacities are always different from my naked capacities. The desire is, at best, contradictory. I want the transformation that the technology allows, but I want it in such a way that I am basically unaware of its presence. I want it in such a way that it becomes me. Such a desire secretly rejects what technologies are and overlooks the transformational effects which are necessarily tied to human–technology relations.1

In that earlier context I was describing what I have called embodiment relations, which were experienced uses of technologies that remain detachable but that in use are quasi-transparent and not literally taken into or inside my body. Yet, I will maintain that the desire remains applicable to cyborg technologies. To make the case, I will need to account for several historical as well as contemporary variations upon technologies used both in detachable and nondetachable, internalized forms.

One of the oldest such anticipations of cyborgization are prosthetic devices. False teeth, peg legs, arm hooks, and various other devices to replace lost teeth, limbs, and such are very ancient. These prosthetic devices, substitutes for lost body parts, remain detachable and thus fall under the earlier descriptions I have made concerning embodiment relations—one experiences one’s surroundings through the quasi-transparency of such devices but always with a detectable difference that magnifies some and reduces other features of one’s experienced environment. The peg leg can never “feel” the hot, sunbaked sidewalk that the bare foot would feel—but slid along the rough texture, one might even better than with toes “feel” the rough textural features of the surface. Nor would I expect that the users of such ancient devices could easily fall into the slippery slope and utopian fantasies that so frequently dominate science fiction and virtual-reality hype contexts and that describe these devices as “better” than the lost body part—or am I wrong? Pinocchio, after all, capitalizes on a fantasy of a dummy-become-alive! The desire remains, but the device remains “dumb.” No one in a right mind would likely seek an amputation that would replace one’s healthy limb with a wooden one. But most people would choose to have a prosthesis once the limb is gone in order to restore some semblance of motility and capacity. The proto-cyborg is thus a compromise.

Vivian Sobchack, a phenomenologically trained scholar with a high-tech prosthesis, brings us up to date in a specific response to the quotation above:

Obviously, transparency is what I wish—and strive—for in relation to my prosthetic leg. I want to embody it subjectively. I do not want to regard it as an object or to think about it as I use it to walk. Indeed, in learning to use the prosthesis, I found that looking objectively at my leg in the mirror as an exteriorized thing—a piece of technology—to be thought about and manipulated did not help me to improve my balance and gait so much as did subjectively feeling through all of my body the weight and rhythm of the leg in a gestalt of intentional motor activity. So, of course, I want the leg to become totally transparent. However, the desired transparency here involves my incorporation of the prosthetic—and not the prosthetic’s incorporation of me. This is to say that although my enabling technology is made of titanium and fiberglass, I do not really or literally perceive myself as a hard body—even after a good workout at the gym, when, in fact, it is my union with weight machines (not my prosthetic leg) that momentarily reifies that metaphor.2

This is a good description of, precisely, an embodiment relation, of quasi-transparency. Sobchack, however, is not tempted by the slippery-slope utopic slide:

Nor do I think that because my prosthetic will, in all likelihood, outlast me, it confers on me invincibility or immortality. Technologically enabled in the most intimate way, I am, nonetheless, not a cyborg. Unlike Baudrillard, I have not forgotten the limitations and finitude and naked capacities of my flesh—nor, more important, do I desire to disavow or escape them.3

Even more high-tech prostheses built with springs for below-the-knee amputations have allowed highly motivated and skilled athletic persons to actually achieve high running speeds, such as those demonstrated by Jami Goldman, amputee sprinter. Perhaps the most famous model-athlete is Aimee Mullins who, with her spring legs, played Cheetah Woman in Matthew Barney’s Cremaster 3 movie series. Mullins turns in highly respectable records running but also alternates her spring legs with other prosthetic legs, including a pair of glass limbs, for other purposes. She has had prostheses since learning to walk because she was born with fibular hemimelia (born without fibula bones) and underwent amputation at age one. Growing up with prostheses is probably as close as one can get to minimal quasi-transparency. Prostheses with spring components have become more common with the large numbers of Iraq War amputees as well, yet all remain within the noted degrees of limitation cited for detachable devices.

Before leaving limb prostheses, I should mention their internal and permanent counterparts—knee, hip joint, and other implants—substituting for bone and cartilage damage. Stainless steel and Teflon restore the motility lost to damaged joints or arthritic deterioration to a degree. But while the metal and plastic implants, insofar as the materials are concerned, might “outlive” the patient, in practice the stress and strain usually call for replacement on a seven- to ten-year basis. (Newer prostheses are said to last for up to thirty years.) And since more bone has to be removed for situating each new replacement, diminishing numbers of such replacements are possible for finite human lifespans. (All prostheses, older or newer, have finite shelf lives.) Thus one must hope for late life rather than midlife cyborg parts!

Much more common, but still detachable, are sensory prostheses such as optics and audio technologies (eyeglasses, contact lenses, hearing aids). Again, there has been a long history to such body-related, sensory-correcting technologies. Eyeglasses were already common in Europe by the thirteenth century, and one noted social effect was to prolong careers for scribes and accountants beyond the age when one normally needed reading glasses, thus closing off what had been in pre-eyeglass eras jobs for younger scribes and accountants. One could continue to read into old age. Contemporary contact lenses, while still detachable, are much closer to quasi-permanent cyborg capacity. And while I have no experience of contacts, my family members do, and it is clear to me that the occasional dust or eyelash occurrence, torn lenses, and the like retain the sense of compromise I suggest belongs to these technologies in use. In my own case, I did not need reading glasses until age fifty-eight when the New York Times and telephone directories became unreadable. These I still must use for fine print, but my distance sight remains such that no other optics are needed. (As noted later, cataract surgery has allowed me to abandon reading glasses!)

In the case of loss of hearing, hearing horns have been depicted in treatises on the senses for several centuries. But hearing horns are simply amplification devices, and in most loss of hearing, more is needed than mere amplification. With normal aging, most people began to lose certain—usually high—frequencies. These cannot be restored with amplification. In my late sixties I, too, began to notice some hearing problems and noted difficulty hearing questions from the back of lecture halls and found cocktail party conversation hard to manage. Taking a frequency range test during a conference in Boston at the Museum of Science, I found that my hearing was considerably short of the 20,000 cycles per second younger, better hearing could detect. Today, I wear state-of-the-art digital hearing aids, and I could echo Sobchack’s desire for transparency of hearing, which remains much more difficult to attain with hearing technologies than in seeing technologies. I have described in detail the comparative embodiment processes in the second edition of Listening and Voice: Phenomenologies of Sound (2007). Two of the points made in such a phenomenology are the far greater difficulty learning to rehear and the far greater complexity in the technologies between optics and audio devices. For example, whenever an optical prescription is changed, the user experiences very subtle changes in motility and spatiality when walking for example, but it is but a matter of days at most before the quasi-transparency is “fully embodied” and no longer occupies any significant role in daily life. Contrarily, the auditory embodiment in using hearing devices is much slower and more difficult to attain, so much so that many individuals give up or reject using hearing aids entirely—a fact well known to audiologists. And, even with the best and most expensive devices, feedback at certain frequencies, the impossibility to match normal hearing’s capacity to sensorially inhibit background sounds (as in a cocktail party situation), and full auditory transparency remain noticeable long after one becomes accommodated to the devices. Even one’s musical memory reminds one that music no longer “sounds the same.” Frequencies lost remain lost, but high-tech digital devices can partially compensate for the loss of consonant sounds—which are more often lost to those with hearing disabilities compared to vowel sounds, which are more easily amplified—thus making speech more available than would be the case without the prostheses. They remain worthwhile trade-offs, but they also remain short of full transparency in user experience.

Closer to a cyborg body notion, implantable devices display somewhat different characteristics, and it is at this point that I shall begin with some self-reference related to “my case” and my reluctance for cyborg status:

• It began quite a long time ago with dental technologies—tooth crowns—of which I now have five, plus a root canal (living tooth nerve replaced with a filler). The first broken tooth was due to a piece of sand in a Maine mussel. The silicone of the sand proved harder than my tooth enamel, and so while still a graduate student, I got my first taste(!) of cyborghood. Interestingly, I can still detect the differences experienced with crowns. They “feel” different to the tongue: they lack the striated texture of an original tooth, they can cause chewing gum to stick, and the shape is never quite the same as the original tooth. While feeling-through-the-tooth as with eating has become indiscernible from the original teeth, feeling the crowned tooth with my tongue retains a discernibly different feel. Thus, though permanent, the crown retains a marginal self-difference. But, given the choice of either a missing tooth or an aesthetically odd-shaped one, I would willingly choose the cyborg crown.
• Making a vast leap into animal or other human transplants (heart, heart valves, lungs, kidneys, etc.), I feel fortunate enough to have so far avoided this degree of cyborghood [see follow-up below]. Yet, one interesting study just now getting underway at the University of Toronto, in the Health Care Professional Training group, has noted anecdotal evidence from heart transplant patients that indicates that such a major transplant trauma often leads to an experienced personality change. Patients claim to feel as if they were “another person” or are incorporating another person after the procedure. A carefully designed study is planned to investigate this phenomenon.
• An electronic transplant is yet another variant—pacemakers and defibrillators, for example. Pacemakers are devices either implanted under the skin or worn on belts with only wires implanted, which electronically pace heartbeats for patients whose beats are irregular or too slow. Today, some are even equipped with radios to signal to a central medical facility should trouble occur. As with many contemporary procedures, the implantation can be performed and the patient released the following day. Most felt responses are not so much related to the experience of a more regular or faster heartbeat—although this is experienced—as much as hoped for more indirect results, such as greater energy levels and less fatigue with daily activity. Some minimal training for what to be aware of is taken before hospital release. Patients describe less light-headedness, incremental energy improvement, and less “stuffiness” in their chests. Most agree that the implantation was positive enough to confirm a right choice for the procedure.
• This brings me to my own next stage cyborg addition—a medicated stent in one of my heart arteries. I had long delayed having a recommended colonoscopy but finally agreed to undergo the procedure. My physician, upon doing a pre-procedure check, detected—with a stethoscope—a slight heart murmur. It is worth noting that the stethoscope, although now an ancient device mostly used as a symbol of practicing medicine as per television commercials, in skilled practice can reveal very nuanced internal phenomena. Auscultation, or listening-to-interiors, was a favored diagnostic art at the end of the nineteenth and on into the twentieth century. But, as articles concerning medical education have pointed out, it is for the most part a lost skill amongst many contemporary physicians. So then, following the dominant visualist and instrumental practices of contemporary medicine, a series of tests was ordered: EKG, or the electrical graphing of heart motions; echocardiogram, a multimedia visualization imaging that produces dynamic images of heart motion with added graphing of the beats; and an audio counterpart as well. I have been researching imaging technologies for more than a decade now, and when I inform my physicians of my interest, I almost always get a detailed and interested response with demonstrations of how the imaging is interpreted. I also collect copies of the actual imaging performed! More then followed, with stress tests and before-and-after imaging and finally a recommendation to undergo an angiogram. This procedure entails a small incision in one’s femoral artery (in one’s leg alongside the groin), insertion of a catheter with fiber-optic lights and internal instruments for further interventions, and movement of the catheter Nintendo surgery–style (guided by imaging on a screen and manipulated by a set of “joystick-like” controls) up into the arteries of the heart itself. A radioactive dye is used to show any obstructions, which when found may be forced open by balloon angioplasty, that is, the obstruction is shoved aside by an inflated mini-balloon or, if necessary, the insertion of a stent. The stent is a small wire mesh tube, often impregnated with a slow-acting drug to prevent clotting. And, in my case, one balloon procedure was performed and one stent inserted. As with pacemaker implantation, I was released the next day and while rest was prescribed for a limited period of time, I was soon back at work.
• A phenomenology of this event is relatively simple. I was kept awake so as to move as directed. I could see the screen, which was also moved repeatedly to the advantage of the operating surgeon, and feel the warming infusion of the dye but very little pain or sensation of the catheter in motion. It seemed a quite minor interruption of life, and the result was, indeed, an incremental improvement in energy levels following. I, again, have the entire procedure recorded on a DVD that I now use as a demonstration of a medical imaging technology on the road. Admittedly, it was somewhat disturbing to find—only a few weeks after my operation—that drug-embedded stents were found not to be as dramatically effective as first thought. Some patients were found to develop clots long—several years—after the operation, and thus while stenting remains more common than arterial bypass surgery, its effects are more parallel to bypass than previously thought. Nevertheless, had I to do it over, I would still choose the stent rather than the much more intrusive bypass open-heart surgery! Interestingly, I have no direct bodily awareness of the stent at all—unlike my tooth crowns, it remains totally “invisible,” although the indirect awareness of energy levels may be noted. I am thus a limited or partial cyborg.

By now it should be obvious that the gradual accumulation of human–technology hybridization, or the cyborg process, often relates to effects of contemporary aging. One’s eyes gradually lose the flexibility of younger pupils, lenses, and orbs; the cilia in one’s inner ears deteriorate with age (in my case the “boilermaker” sounds of a John Deere tractor may have been my equivalent of the rock band sounds of my children’s generation); and plaque in one’s arteries tends to build up with age. Thus, as illustrated above, cyborg strategies are often technological attempts to thwart even more severe effects of aging. I have not dealt with animal transplant strategies as fully here, but such transplantation strategies also have their associated problems, such as transplant rejection. Furthermore, the cyborg strategies show that such delaying tactics remain trade-offs, compromises. It is better to have a pacemaker than to have life-threatening arrhythmia; it is better to be able to walk with either a steel-Teflon implant or a prosthesis than not to walk at all; it is better to have digital hearing aids that allow seminar participation and exchange than not to be able to hear speech sufficiently to understand. Yet all these trade-offs fall far short of the bionic technofantasies so often projected in popular culture or post- and transhumanism.

What, then, motivates the continuance of technofantasies, the unrealistic imaginations of utopic cyborg solutions to our existential woes? At the popular level, the sheer entertainment value mixed with the contradictory desires we have concerning our technologies may provide some of the answer. “Explosion movies” remain popular—the quasi- or even superpowers of a Terminator or a RoboCop indulge wish fulfillments and even revenge fantasies. But they also reverberate with our secret desires to be bionic technology plus human, equaling superpowerfulness. Such fantasies are, of course, ancient, but in other cultures and times they did not always take technological form. To be godlike, to have animal powers, and to be more-than-finite human are desires reflected in literatures and magical practices on a wide scale. Ours, reflecting the highly saturated technological texture of contemporary life, more often take technological or cyborg forms. Not satisfied with quasi-transparency, we seek the organic cyborg solution that does not happen in actuality or mundane life.

There may also exist as a motivation a social or even industrial desire to keep utopic hopes stimulated as possible sources for technological development itself. Could, for example, technoscience development remain well funded were all utopic fantasies to disappear? I suspect that it is not accidental that Stephen Hawking urges humankind to think about escape to other planets. He is convinced that we will end up destroying ourselves and thus need to plan for extrasolar life. Yet, as a physicist, he must be aware that so far the only possible life-supporting planet recently discovered lies some twenty light-years away. No existent technology can even approach the speed of light, and thus such a journey seems close to yet another technofantasy. I am suggesting that there may be a subterranean link between the wildest science fiction fantasies and our current technological culture. Do the desires, dreams, and fantasies indirectly support financing of research and development?

Or, is it that the deepest desires and fantasies are simply our wishes to avoid mortality and contingency? And if so, is my own reluctance to cyborghood part of this same phenomenon? Should I not, contrarily, argue that precisely to accept finitude and contingency applies equally to cyborg technologies? That is, to accept the cyborg destiny is also to accept the trade-off compromise that all our actual technologies display, and this, in turn, is existentially tied to the human process of aging.

Epilogue: Aging Cyborg II, More Cyborg than Ever—Open-Heart Surgery

My stent was implanted in 2006, just before I completed this article on aging for its first appearance. It is now 2008, and I have become more cyborg than ever. Once one enters today’s high tech medical system, the monitoring, even surveillance, process continues. By the end of 2007 I found myself often feeling highly fatigued and short of breath. My cardiologist ordered stress tests and more echocardiograms, and later another angiogram. All revealed more obstruction to my heart arteries—again, odds are that approximately half the arteries cleared by angioplasty can again close within six months to a year—and imaging showed a severe “regurgitation” with my mitral valve. My cardiologist recommended that I consider surgery and recommended a mitral valve specialist. So, by watching my imaging CD, turning to research on the internet, and above all investigating the specialist who was recommended by my doctor as the “rock star” of mitral valve surgery, I ended up scheduling a consultation with David Adams at Mount Sinai Hospital’s famed cardiovascular clinic. From his many entries on the internet, which included video clips from actual operations, reprints of his articles, but above all his fervent philosophy that argued that repair—retaining one’s own flesh rather than replacing it with pig or cow parts or even a metal valve—was far superior and, where possible, yielded better results. The only machinic artifact to be involved was a plastic ring that would “reseat” the valve (a description that reminded me of automobile repair). Here my desire to be less rather than more cyborg kicked in.

Upon arrival at David Adam’s office, I felt almost as I did when I played with the cybertoys in Umea University’s Humlab a couple of years before. There were plenty of cybertoys here as well. Adams, along with several of his team members, awaited in a large office with a contemporary array of visual display screens. Upon these, of which there were many in the multiscreen equivalent of a newsroom, he played different takes on my latest echocardiogram and TEE imaging, all in dynamic, colored imaging. With his cursor, he showed me that two of the cords attaching the valve to my heart were broken. He showed the backward flow of the regurgitation and many other clearly imaged features. He confidently noted that this made me a qualified patient and that for him this would be a routine surgery (not for me since it would be my second surgery ever). We concluded with a good discussion of the progress in imaging that characterized such high tech surgery in the twenty-first century. As for risk, mortality was significantly below 1 percent, but with full success, quality of life could be considerably better than before or without surgery.

A bit over a month later, I entered the hospital, somewhat shocked to see that the protocol called for a triple bypass in addition to the mitral valve repair! I was to receive a major reconstruction. Here any first-person phenomenology became disrupted—I had no experience from the time going into surgery until waking up in the intensive care unit, now hooked up to a large array of machines and monitors, including an external pacemaker, electrodes from my chest, a quite large leg drain from the area where my vein had been “harvested” for the bypasses, and another drain from my chest. I shall cut short more details, but by the end of a week I was ready to be discharged and returned to Long Island. I was optimistic; I had had none of the frequent complications such as stoke, dizzy and disorienting experiences, lung congestion, or severe pain. I had only a bit of atrial defibrillation said to be common right after such a surgery. And I was so relieved to have my electrodes removed, the pacemaker taken away, and to head home to my first decent meal in a week. A follow-up with my cardiologist on Long Island and another echocardiogram showed that the repair had been successful and my heart functions were excellent.

However, just in case, my cardiologist recommended I wear an “event monitor” to record any unusual rhythms from my heart. Unfortunately for me, the arrhythmia had not disappeared, and a search of earlier EKGs indicated that there had been signs of preexisting irregularities. Note here again the role of consistent monitoring and surveillance. I had escaped major cyborgization with repair and no installed defibrillator or pacemaker only to wonder if I was fated to have one of these installed later—I definitely did not want to be the first philosopher Dick Cheney! I felt lucky, then, when first my cardiologist, Michael Matilsky, and later Jeffrey Mattos confirmed the earlier opinions of experts in Mount Sinai Hospital, all concurring that a pacemaker seemed unnecessary, recommending instead a heartbeat regularizing medication. There was a catch—one must initiate the prescription only while in a forty-eight-hour, full monitoring situation in a hospital. There was a risk of a side effect that occurs in less than 1 percent of patients: a worsening of the symptom or even a heart attack. Back to both monitoring and risk-taking. Fortunately, for me, nothing happened, and my heart is currently very regular.

And now, the good news. Although it has only been three months since my surgery, my old energies have returned; I am back to my strenuous travel schedule and in fact feel better than I have for several years—this had been the good prognosis from such surgeries, which could include a prolonged lifespan in an era in which lifespans are considerably longer than a century ago. Am I more cyborgian than before? Yes, and again related to the aging process, but also minimally more cyborg than could have been the case.

Here, again, one discerns the role of high-tech processes ranging from the improved imaging devices used for the monitoring and diagnosis to the chemical technologies of medications to the complex medical care system but also including all the risks, assessments thereon, and trade-offs entailed with all technologies. In this case, I do not feel so bad about this particular increase in my cyborg identity. Better to be partially cyborg than dead.