Science & Technology Studies 2/2013 Cyborg Heart: The A! ective Apparatus of Bodily Production of ICD Patients Pernille Bjørn and Randi Markussen We argue that a cyborg approach both emphasizes the complexity in treating patients with implantable cardioverter de" brillators (ICDs) attached to home monitoring devices, and makes it possible to decipher modern perspectives in the notion of ‘Patient 2.0’ and other representations of patients. We attempt to open up the notion of Patient 2.0 exempli" ed by ICD patients by drawing on the cyborg idea as developed by Donna Haraway as well as her understanding of science and the body as an apparatus of bodily production. We include the feminists Rosi Braidotti, Anne Balsamo, Geo! Bowker, and Leigh Star in discussing the cyborg, its infrastructures and a! ective potentials. We analyse modern imaginaries of remote monitoring as they are portrayed on the websites of the two largest manufacturers of ICD technologies, and based on an analysis of the apparatus of bodily production involved when patients visit a hospital to have their illness monitored we propose the analytical device cyborg heart to capture an a! ective apparatus of bodily production in the clinic and the idea of an enlarged sense of community as opposed to modern imaginaries of patient empowerment. Finally we discuss how the device cyborg heart di! ers from the notion logic of care. Keywords: cyborg, patient, healthcare Life is beyond pleasure and pain – it is Introduction a process of becoming, of stretching the boundaries of endurance. ! ere is noth- In 1982 Ridley Scott released his " lm Blade ing self-evident or automatic about life. Runner, based on Philip K. Dick’s book Do It is not a habit, though it can become Androids Dream of Electric Sheep? (Dick, an addiction. One has to ‘jump-start’ 1968). ! e " lm’s futuristic image suggests into life each and every day; the electro- that androids are stronger and more capable magnetic charge needs to be renewed than humans. Androids could only be told constantly. ! ere is nothing natural or apart from humans by the use of advanced given about it. (Braidotti, 2006: 211) equipment to detect feelings and emotions through their eyes, and the most advanced Science14 & Technology Studies, Vol. 26 (2013) No. 2, 14-28 Science & Technology Studies 2/2013 androids were not even aware that they starting point in her cyborg con" guration. were not human, since they were given false (Haraway, 1991: 150). ! e ICD device is a memories of non-existent childhoods. ! e small, battery-powered electrical impulse portrayal of androids in Blade Runner calls generator programmed to detect cardiac into question what it means to be human arrhythmia and correct it by delivering a or machine. ! e ambiguity of several chock of electricity. It is implanted under characters urges us to ask, what does it mean the skin. ! e device appeared in the US in to live in a time dominated by scienti" c and 1980 and in Denmark in 1989. More and technological imaginaries (Balsamo, 1997)? more people are under treatment, both Although the characters in Blade Runner are those surviving severe heart problems and science " ction, the question remains highly heart attacks. Increasingly ICD are also relevant in order to appreciate what ‘Patient used prophylactic (Køber et al., 2006). ICD 2.0’ is about? patients appear as any human in the society, ‘Patient 2.0’ is a modern term. ‘Patient’ as it is invisible for others how they embody literally means su# ering, and refers to complex contemporary human-machine people who are a# ected by the action of relations. One needs ‘blade runners’ so to others, i.e. medical institutions, doctors speak, doctors with advanced equipment to etc. ! e digits ‘2.0’ refer to a new version tell the di# erence. of a web-based information infrastructure. Haraway’s cyborg " guration (1991: Following the modern idea of progress 149) builds on a blurring of key modern the implied suggestion seems to be that distinctions, such as human versus machine, ‘2.0’ possesses the potential to empower/ organic versus inorganic, and natural emancipate patients by o# ering them more versus arti" cial, which contemporary opportunities of participating in their own scienti" c approaches in biology as treatment. Emancipation literally means, ‘to well as communication sciences have come out from under the hand of’ (Lerner, brought about (Haraway, 1991: 149). ! e 1986: 237). ! us ‘2.0’ denotes not only new, approach di# ers from sciences operating but better than ‘1.0’ in the sense that the on essential categories of the human, the patient potentially becomes less dependent organism, the machine etc. and challenges on other people and gain more freedom. distinctions between what belongs to ! e idea is not that the patient becomes nature and what belongs to culture. ! ose ‘more patient’ as the numbers go up, or distinctions ‘implode’ when sciences work ‘more entangled’ in the infrastructure as the by ‘translating the world into a problem of science " ction imaginary suggests. It reads coding and information processing,’ relying as a modern human centred term rather on command, control, and communication than a post human term. mechanisms that connect humans and We investigate controversies machines. Mind, body, and technologies regarding human versus post-human are ‘on very intimate terms’ (Haraway, 1991: perspectives through a cyborg lens and 165). focus on patients with an implantable Looking into the ICD device cardioverter de" brillator (ICD) hooked infrastructures, we are curious to learn up to a remote monitoring system. ! ese how sciences and stakeholders imagine patients are literally cyborgs as beings and manage ICD patients and what kind of relying on a cybernetic ‘command, realities they help bring about. ! e cyborg control and communication’ mechanism approach invites us to include popular the phenomenon that Haraway took as 15 Science & Technology Studies 2/2013 images of ICD patients, as well as the by biological feedback and monitored the practices implicated in their treatment. e# ects. In what follows, we explore how ICD ! e goal was to develop drugs and patients are imagined in the public space of devices that would make it possible for the Internet from the perspectives of two of a human to adapt to an extraterrestrial the largest ICD technology manufacturers. environment through what they called a In addition, we move to a heart clinic ‘participant evolution’. ! ey imagined that at a university hospital to decipher the scientists had a great role to play in making knowledge production in the treatment evolution progress much quicker than a of the patients, the infrastructures and ‘natural evolution’ was able to bring about. the involvement of the patients in the Paradoxically, the idea was to free astronauts collaboration. Subsequently, we bring the from a cumbersome arti" cial environment various theoretical as well as empirical that imitated worldly conditions in order for images together to discuss di# erences them to survive in outer space. According between modern and cyborg approaches to the historian Ronald Kline (2009), even in understanding patients and their ethical though those cyborg ideas involved serious implications. interventions into the human body, such We embark on this journey, by going as arti" cial organs, hypothermia, drugs, " fty years back in history and look at the sensory deprivation, and cardiovascular genealogy of the term cyborg in order models, Clynes and Kline thought of the to emphasize Haraway’s vision and its changes as strictly related to extraterrestrial implication for making sense of ICD patients survival conditions, without impinging on and open up the notion ‘Patient 2.0’. the human in his or her earthly habitat: ‘Cyborgs would be humans with some Cyborgs for Earthly Survival organs only temporarily altered or replaced by mechanical devices. On returning to When Donna Haraway coined the term earth, the devices would be removed and cyborg in the early 1980s, she was unaware normal body functions restored’ (Kline, of its former use in another " eld (Markussen 2009: 342). et al., 2000: 10). ! e term " rst appeared in Haraway’s cyborg vision in ‘Cyborg 1960 in connection to experiments in the Manifesto’ (Haraway, 1990) di# ers radically " eld of medical cybernetics (Kline, 2009: from those ideas, both in terms of the 333). Engaged in bioastronautics, Manfred perception of the body and of the authority Clynes and Nathan Kline introduced the of science. Despite their ambitions about term as an abbreviation for ‘cybernetic fusions of human and machine, Clynes organism’ (Clynes & Kline, 1960). ! ey and Kline’s cyborg imagery implies that built on Norbert Wiener’s de" nition of an ‘organic’ body can be extraordinarily cybernetics as the entire " eld of control manipulated without losing its and communication theory, whether in the characteristics or being marked. Haraway’s machine or the animal. ! e term was meant vision is cleared of the innocence as well as to indicate a literal fusion of human/animal the anthropocentrism that characterizes the and machine, as in the laboratory mouse early cyborg imagery. A distinction between they experimented with by implanting an a natural and a participant evolution is osmotic pump. ! e researchers used the irrelevant when it no longer makes sense pump to inject drugs at a rate controlled to speak of nature in the singular and as a base on which cultures build. In addition, 16 Pernille Bjørn and Randi Markussen her vision of science is very di# erent from implying immediate presence of such the heroic and anthropocentric idea of a objects or, what is the same thing, their science and scientists who transcend earthly " nal or unique determination of what conditions. Haraway’s slogan ‘Cyborgs can count as objective knowledge at a for earthly survival’ does away with the particular historical juncture.