Nanomedicine, Volume I: Basic Capabilities
© 1999 Robert A. Freitas Jr. All Rights Reserved.
Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999
1.2.5 Changing View of the Human Body
How does a patient regard his or her own body, and how might this most intimate of all relationships change in the nanomedical era? The so-called dualist theory of the human compound, as originally developed by Descartes and widely accepted today by the ordinary person, holds that the human being consists of two separate kinds of thing: the body and the mind or soul. The body acts as a host or receptacle for the mind. The mind, often called "the ghost in the machine," is manifested by the brain, which it uses (via the bodily senses) to acquire and store information about the world and to integrate this with its genetically-driven imperative to live, thus resolving internal conflicts among action-choices and expressing these in what we (in our consciousness) experience as decisive action.
Scientific medicine has concentrated primarily on the body. The ancient Roman physician Galen first dissected and vivisected a variety of animals to increase his knowledge of anatomy and physiology, and dissection became increasingly important in the training of physicians and surgeons, and in painting and sculpture, during the Renaissance. By the late 20th century, dissection had reached the molecular level, with the insides of the human cell and nucleus being taken apart and examined by molecular biologists, literally receptor by receptor. Dissection and the mechanistic understanding it provides have led some to decry what they regard as the modern "soulless" view of the human body as a mere machine.
In the nanomedical era, even the most diehard reductionist must come to see the human body not merely as a heap of parts but rather as a finely tuned vehicle that is owned and piloted by a single human mind. As with automobiles, some body-owners will be more diligent about maintenance, regular tuneups, and paint jobs than other body-owners. Some will crave the latest upgrades, while others may prefer a more conservative model that reliably gets them around town. At either extreme, all human vices and virtues will be on full display, though one may perhaps anticipate an increasing pride of corporeal ownership if for no other reason than because maintenance and repair will become quick, convenient, and inexpensive.
From this simple analogy of body-and-mind to car-and-driver, it might at first appear that the advent of nanomedical technology will confirm and strengthen the traditional dualist conception of the body. But closer inspection reveals that the analogy is at best incomplete, and at worst deeply flawed. This is because mind, first being necessarily embedded in physical structure and relying upon that structure for its faithful execution, and second, this physical structure now being manipulable at the molecular level, enters also into the purview of our mechanic. Both car and driver may be modified in the shop. Speaking allegorically, it is as if the driver, after getting his car a tuneup, emerges from the shop no longer favoring chocolate but enjoying vanilla instead, or now preferring jazz over classical, the opposite of before. Such psychological changes may be either volitional or emergent.
Until the late 20th century, human progress was measured almost exclusively in terms of externalities. Food was gathered, then sown, then manufactured. Shelters had no running water, then gained outhouses, then indoor plumbing. Natural lighting and campfires gave way to candles, then oil lamps, then electric illumination. Finger-counting yielded first to the abacus, then the mechanical adding machine, and finally to the digital computer. But throughout all of history, the human body itself has remained largely untouched by progress. We have always regarded our bodies, evolved by natural selection, as fundamentally inviolate and immutable -- subject perhaps to various natural or traumatic degradations, but rarely to any significant intrinsic improvement on the timescale of human civilization.
Now we are set to embark upon an era in which our natural physiological equipment may for the first time in history become capable of being altered, improved, augmented, or rendered more comfortable or convenient, due to advances in medical technology. The physical human body may be one of the last bastions of "naturalness" (Section 1.3.4). It will also be one of the last elements in our common worldview to be modernized.
Our subjective experience of reality will shift by subtle degrees. For instance, all objective information about our physical surroundings has traditionally arrived in the conscious mind via the various natural senses such as hearing, sight, and smell. In the nanomedical era, machine-mediated sensory modalities may permit direct perception of physical phenomena well removed from our bodies in both time and space, or which are qualitatively or quantitatively inaccessible to our original natural senses. Perception will gradually expand to incorporate nonphysical phenomena including abstract models of mental software, purely artificial constructs of simulated or enhanced realities,2991 and even the mental states of others. Such new perceptions will inevitably alter the way our minds process information.
But the winds of change will sweep deeper still, into our very souls. Like ants oblivious to the collective purpose of their colony, the billions of neurons in the human brain are all busily buzzing, wholly ignorant of the emergent plan. This is the physical, mechanical world of our electrochemical hardware. People also have thoughts, feelings, emotions, and volitions, a higher level in the data processing hierarchy which in turn is equally oblivious of the brain cells. We can happily think while being totally unaware of any help from our neurons. But nanomedicine will give us unprecedented systemic multilevel access to our internal physical and mental states, including real-time operating parameters of our own organs, tissues, and cells, and, if desired, the activities of small groups of (or even individual) neurons. Diverse parts of our selves previously closed to our attention may slowly conjoin and enter our conscious awareness.
Will this access promote an integrated identity or lead to hopeless confusion, or worse? Marvin Minsky, in his collection of essays The Society of Mind,2982 persuasively argues that our selves or identities are in fact networks of semi-autonomous neurological "agencies" which sometimes cooperate and sometimes compete with one another. We think of ourselves as singular "persons," but we also experience "conflicting desires" and "differing viewpoints" within our minds that are, in Minsky's view, a direct experience of the multiplicity of our brain's neurostructures. Other models of the human mind2988-2990,3728 suggest that our internal mental states, prospectively transparent via nanomedical augmentation,2992,2993 are diverse and intricate; Julian Jaynes2983 is one of many writers who have drawn attention to profound dichotomies between the two cerebral hemispheres. The component-oriented personality models of Freud (e.g. ego/id/superego),2984 Jung (e.g. archetypes),2985 and Rank (e.g. will/counterwill),2986 and the identification of 4541 distinct personality traits by Allport and Odbert2987 warn us that full access to our brain's architecture could be perilous.
More seriously, most of us suppose that we are endowed with free will. But if choices by free will are simply the resolution of conflicts of neurological subsystems, and we become consciously aware of those subsystems and are able to intervene in their processes, do we run the risk of runaway instabilities at the deepest levels of what we presently call our "minds"? Will we find that these instabilities are profound counterparts to the maladies we currently designate as epilepsy, or psychosomatic illnesses? In any redesigns of our brains which would involve opening doors to, quite literally, the ultrastructure of our thoughts, we could become "naked to ourselves" in ways that we can only vaguely speculate about at present. Along with any other dangers we might encounter, this will raise entirely new issues of the proper role of psychotherapy and the sanctity of personal privacy.2996
Repairs to the brain may be carefully monitored to ensure quality control and to verify intended results, as already proposed in another context.3000 Major modifications might be strictly regulated, both to prevent abuse by unscrupulous third parties and also to forestall accidental or volitional alterations that could render the patient a significant threat to society. Nanomedical alterations to the brain and other physical systems may give us vastly expanded freedom to be who we choose to be (Section 1.3.4), along with increased responsibility to make wise and informed choices. The ethical and legal aspects of these questions, as well as the scientific and psychological ones, are extremely important and should be thoroughly debated in the years and decades that lie ahead.
Last updated on 5 February 2003