Digital Health and the Gamification of Life: How Apps Can Promote a Positive Medicalization

In a world dominated by scores, ratings, and rankings, near-constant measurement can make one think, and in turn act, differently. Quantification is felt to be necessary. On a social level, the manufacturing of numbers paves the way for the politicization of numbers, which then allows the regulation of a person’s activities. The setting of seemingly unobjectionable thresholds and limits in fact contributes to the creation of government strategies that conceive of every citizen as a calculable thing. Further, assuming that these numbers are socially constructed elements, a numerical hegemony may develop in which those who do not possess the desired scores suffer social exclusion. The quantification of life has many implications in the realm of social justice. It is conceivable that, in the future, society could acquire some of the characteristics imagined by the writers of dystopian literature. Fourcade and Healy (2013) write that our society is experiencing a transition from distinct social classes to classification based on personal scores and ratings. Indeed, in the United States, the “credit score” is a number which is as important for the modern individual as titles were to medieval to nobility because they determine one’s access to credit. Personal scores and ratings – which could be not only financial but also social or political – could therefore exclude some sectors of society. In this case, too, a numerical indicator holds immense power, making this form of political violence appear as objective and even natural.

According to Barber (2007), the consumer society fosters the growth of an infantile ethos. This happens because infantilization of the consumer is the best way to create new needs that the market can then answer with new goods and services. Given that neoliberalism encourages individual consumers to remain, at least partially, infantile, what position can boring, difficult, “adult” activities occupy in a neoliberal society? Exertion and hard work are in fundamental opposition to infantilization. In a neoliberal culture, then, “serious” activities – like labor, hard work, and other boring things – must be dressed up as pleasant pastimes. Today, thanks to apps, it is possible to work, practice self-care, or study under the guise of playing a game. Clearly, then, gamification – the transformation of boring tasks into pleasurable activities – is consistent with and symptomatic of the broader infantilization promoted by consumeristic capitalism.

Gamification is a fundamental feature of several health apps. When using these apps, we earn rewards and points (depending on what we do). We thus engage in a pleasurable self-governance driven by our own aspirations and capacities. Gamified self-tracking is, then, the opposite of work and work activities. It increases our productivity without oppressing us – at least at first glance. This (apparent) self-governance is a funny and pleasurable taylorism of everyday life.

The biomedical paradigm enjoys growing importance in our society. Biomedicine (e.g., Genetics) seems to occupy the position once held by religion and politics. In this context, every trivial problem of daily life is thought to require an appropriate remedy, and perfect health becomes a paramount value, especially within the upper class.

Medicalization is not only promoted by doctors. Today, other engines of medicalization are also available. These include pharmaceutical companies through marketing, advertising, and disease mongering; active consumers who seek a pharmacological solution – a magic bullet – to solve non-organic problems; technology, because highly sensitive diagnostic tools can now detect potential abnormalities even in very low quantities; and the culture of risk, which is connected to the evolution of diagnostic tools, because it is now always possible to be at risk of something.

The parts of life today considered pathological or quasi-pathological are ever increasing shyness, sadness, imperfect blood pressure, or glucose levels. Progressing editions of the Diagnostic and Statistical Manual (DSM) – the text from which diagnoses of mental illnesses are made – reveal a growing number of syndromes. These “diseases” are diagnosed on the grounds of certain symptoms and the number of weeks they last (quantification). Smartphones, with their tremendous capacity for data collection, contribute to a growth in self-diagnoses. For example, invited to log our every moment of sadness through a “trustworthy” avatar from our app (gamification), we can easily make too much of normal moments of discomfort, immediately seeing them – with a simple computation – transformed into something pathological in need of a cure.

Contemporary society is characterized by extreme acceleration (Rosa, 2010). Time has become a scarce resource and individuals are forced to adhere to the demands of speediness. This condition is connected to the increased performance now required in many areas of daily life, an increase so profound that some authors refer to ours as a “doping society.”

This chapter argues that the practice of quantification exponentially increases the “managerializing” of the user. In this sense, the quantified-self (QS) can be thought of as something that helps people to organize their activities in the manner of the market. Individuals thus become self-entrepreneurs who, in keeping with the standard aims of neoliberalism, make use of their collected data in a fashion analogous to the way results are determined in a corporation’s Research & Development department. The self becomes an assortment of analyses by which measures of behaviors and habits are made, all in the name of producing an “objective report” on the user’s characteristics. The ultimate aim of all this is to improve certain parts of life so as to increase and optimize our productivity.

The chapter critically analyzes the concepts and the practices of surveillance in modern and postmodern societies along with their consequences. We show the changes in the systems, which are used to monitor individuals, and emphasize the transition toward soft surveillance systems, probably stimulated by digital technologies. This switch from top-down control to “lateral” monitoring systems encloses surveillance practices with suggestive names like interveillance, synopticon, and dataveillance. The dark side of digital health has a bright start. According to Topol’s (2016) vision of the future, we will soon be the “consumers,” the real protagonists, of the management of our health – thanks largely to the practically endless data about our bodies, behaviors, and lifestyles we will be able to collect and analyze. We will share our health information in real time with the doctors whom we will choose based on their score in clinical rankings (here, too, quantification rears its head). Yet, this simplified version of health makes it seem that there are always some solutions, which the algorithm can supply as long as it has enough information. Moreover, in the United States, some health-insurance companies have started to offer a discount on premiums to the members who agree to collect and share self-tracking data with them. Clearly, the discount is given only to the workers who have healthy habits. At first sight, this can seem as a win-win trade-off; however, what today is presented as an individual option can easily become a requirement tomorrow.

In this chapter, the authors discuss the results of research carried out on a sample of students at an elite university in the northeastern United States. The focus of the research was the interpretations that the students gave to a period of digital meditation. Meditation, yoga, and mindfulness have boomed in popularity over the past few years. Several factors are responsible of our “age of anxiety.” The de-standardization of life trajectories makes people freer (at least apparently) but requires more choices and, thus, reduces the sense of security. According to Rosa (2010), anxiety has intensified due to social acceleration. Therefore, it is not surprising that we sleep less than before. However, sleep loss is not just due to stress. According to Crary (2013), capitalism produces a consumer who should be able to buy “7/24.” Consequently, the chances of consumption should not have temporal boundaries. In sum, it is not surprising that there are numerous apps to cope with anxiety. Going back to the research, one result should be mentioned: several students have used biomedical jargon to describe the effects of meditation. Someone spoke of “digital therapy” referring to meditation. Moreover, some affirmed that the perception that they had of their own body had changed; thus, they were more keen on the quantifiable aspects of bodily health. In general, students found meditation as a very useful “therapy” for a quick fix for the many stresses of college. This is why we called it a “positive” medicalization.

In our society, there are some trends that are not exciting. We are living increasingly in an aging society and we are becoming fatter (globesity). Moreover, we are facing an alarming decline in physical activity (PA) worldwide. In this context, chronic diseases are booming and health expenditures are skyrocketing. Stimulating PA is likely the best way to reduce the burden of disease and increase the social, psychological, and economic well-being of a community. In this chapter, two projects aimed at increasing PA among individuals are presented. The key point of the two projects is that they medicalize PA. The first project was carried out in Italy. A series of doctors started to “prescribe” PA as if it were a medicine. Therefore, PA is presented as a real cure to treat diseases and pathologies. The other project was supported by a private enterprise. The “concept” of the project is summarized as follows: “The quantity and quality of the physical activity carried out by the patient should be considered by the general practitioner as a clinical parameter as well as other parameters, such as blood pressure, weight, and glucose level.” It is possible that the success of these two initiatives stems from the fact that the biomedical complex has a strong influence on the part of the population. It is very effective to use a reliable source to spread a health promotion message. It becomes a medicalization without pathologization and a form of medicalization without pharmacologicalization. In Conrad’s (2007) words, it becomes a conceptual medicalization.