The Quantification of Bodies in Health: Multidisciplinary Perspectives

‘What is the meaning of the process of body quantification?’ – This is the central question of this chapter. With it, the author intends to question and analyse the way the body relates to new technologies and new technical procedures, and how these depend on the body itself to constitute themselves as mediating cultural forms. To make this enquiry feasible, the author shall critically examine the status of ‘object’ to which the body has been relegated by the myths of quantification, notably those concerning the universal symbolic character of numbers and measurement techniques. If the body is considered as a mere ‘quantified object’, then it is unlikely to be distinguished from other objects subjected to the same process. Consequently, it will easily tend to support the imaginary of technological determinism that prevails in our societies. Health trackers for personal use are, today, a good example of how the body is a fundamental element of such imaginary, since the feeling of control that they nurture in their users is also connected with the possibility of sharing information about the body itself. Given all these factors, the author intends to argue that, instead of being a simple quantified object, the body is, for new quantification technologies (namely those related to self-care), a ‘medium of the media’, insofar as it reinforces the effects of technological mediation processes, and potentialises the increased digital convergence of media. Recognising this means, finally, that the imaginary of quantification and associated techno-myths are also stimulated and reproduced by an extra-discursive somatic level inherent in the empirical use we make of technological devices.

This chapter explores to what extent the Quantified Self, and in general the self-tracking culture, could be considered as a ‘technology of the self’: hermeneutical apparatuses generating new processes of subjectivation. Quantified Self, described by Wolf as a ‘self-consciousness through numbers’ (Wolf, 2010), refers both to the cultural phenomenon of self-tracking with devices and to a community of creators and users of self-tracking technologies. In this context, the author considers mainly the first aspect of this phenomenon and examines how its uses are diffused throughout the social mainstream. The author begins with the author’s own personal experience using self-tracking devices, then the author considers the phenomenon of self-tracking in relation to its historical context described by Floridi as the era of the ‘4^th Revolution’ (Floridi, 2014). The second part of the chapter deals with the theoretical framework. The author discusses the Quantified Self from the perspective of the Material Engagement Theory (Malafouris, 2013) in order to outline the genealogical and anthropological perspectives of the relationship between man and technology. The author concludes that man and technology have always had a biunivocal relation; man shapes technologies that shape man, both materially and cognitively. In the final part of the essay and through the lens of Foucault’s and Agamben’s theories, the author discusses the Quantified Self as a ‘technology of self’ to underline the ambiguous nature of the phenomenon and its social and biopolitical implication in the age of transparency (Han, 2015) and surveillance capitalism (Zuboff, 2019).

The debate concerning the Quantified-Self Movement (QS) has been extremely polarised. As Tamar Sharon has pointed out, each aspect of the lifestyle promoted by Gary Wolf and Kevin Kelly has provoked opposite reactions, generating a debate that revolves around some basic conceptual dichotomies: empowerment versus surveillance, self-awareness versus reductionism, and personalised healthcare versus disintegration of public assistance (Sharon, 2017). The aim of this chapter is to provide a critique of QS, namely an assessment of its limits and its (technological and social) conditions of possibility. In particular, the author’s analysis will focus on the relationship between technology and subjectivity, and its main theoretical framework will be Michel Foucault’s research on the notion of ‘care for the self’ (Foucault, 1986, 2005). Quantification is an essential and unescapable aspect of our present technological environment. The devices that make our onlife (Floridi, 2014) possible are connected with a complex technological system made of GPSs, satellites, computers, and networks. Health is no longer managed through a distinct set of practices within the limits of a well-defined space (the hospital or the ambulatory), but it rather becomes a dataset integrated into a system where all aspects of life (health, law, leisure, work, social relations) are treated and managed simultaneously. This technological condition implies a new form of cognitive and practical delegation (Ippolita, 2016; Morozov, 2013), which makes the very notion of ‘self-tracking’ at least problematic. Individuals do not track themselves anymore: on the contrary, they are tracked by prosthetic extensions of their own bodies. This, however, does not mean that they do nothing. Our digital devices require a specific set of practices, a determinate way of life. The author will argue that these practices are the product of design, understood as a specific way of conceiving and organising the interaction between subject and technical object (Flusser, 1999). Through our technological environment, design reshapes the social and political function of bodies, their interaction and the set of practices connected to them (Bratton, 2015; Dyer, 2016; Vial, 2014). Automated quantification is an aspect of our designed user experience. As such, this chapter discusses design as a key element to understand the role of quantification in our digital milieu. It analyses the QS movement as a specific way of responding to our new technological condition. The main research question will be the following: is QS to be regarded as a simple acceptance of a new form of delegated – and thus alienated – subjectivity, or is it a kind of practice that allows the subject to overcome his passivity, and to take part in the process through which quantification is designed and managed? Is it possible to understand QS as a technology of the self (Foucault, 1988, 2005)?

This chapter provides a historical contextualisation of health tracking and public health communication from the post-World War Two development of the welfare state, through the birth of neoliberalism, until today’s individualising practices of digital health tracking and quantification of bodies. Through an examination of these three phases of public health quantification of bodies, encompassing the socio-economic, cultural and political shifts since 1948, combined with the development and wide adoption of digital health and self-quantifying technologies, this chapter traces the changing landscape and the dramatic implications this has had for shifting who is responsible for maintaining ‘good’ health. This chapter illustrates how neoliberal free market principles have reigned over UK public health discourse for many decades, seeing health as no longer binary to illness, but as a practice of individual self-quantification and self-care. In turn, the chapter explores how the quantification and health tracking of bodies has become a dominant discourse in public health promotion, as well as individual citizenship and patient practices. This discourse still exists pervasively as we move into the digital society of the 2020s, through the Covid-19 pandemic and beyond; with public health strategies internationally promoting the use of digital health tools in our everyday, further positioning citizens as entrepreneurial subjects, adopting extensive technological measures in an attempt to measure and ‘optimise’ health, normalising the everyday quantification of bodies.

Self-tracking is becoming a prominent and ubiquitous feature in contemporary practices of health and wellness management. Over the last few years, we have witnessed a rapid development in digital tracking devices, apps and platforms, together with the emergence of health movements such as the Quantified Self. As the world is becoming increasingly ruled by metrics and data, we are becoming ever more reliant on technologies of tracking and measurement to manage and evaluate various spheres of our lives including work, leisure, performance, and health. This chapter begins with a brief outline of some of the key theoretical approaches that have been informing the scholarly debates on the rise of self-tracking. The chapter then moves on to discuss at length the findings of an international survey study conducted by the author with users of self-tracking technologies to discuss the ways in which they perceive and experience these practices, and the various rationales behind their adoption of self-tracking in the first place. The chapter also addresses participants’ attitudes towards issues of privacy and data sharing and protection which seem to be dominated by a lack of concern regarding the use and sharing of self-tracking data with third parties. Some of the overarching sentiments vis-à-vis these issues can be roughly categorised according to feelings of ‘trust’ towards companies and how they handle data, a sense of ‘resignation’ in the face of what is perceived as an all-encompassing and ubiquitous data use, feelings of ‘self-insignificance’ which translates into the belief that one’s data is of no value to others, and the familiar expression of ‘the innocent have nothing to hide’. Overall, this chapter highlights the benefits and risks of self-tracking practices as experienced and articulated by the participants, while providing a critical reflection on the rise of personal metrics and the culture of measurement and quantification.

Studies on the socio-technical relations between bodies and self-tracking apps have become more relevant as the number of digital solutions for monitoring our bodies are increasing and becoming even more embedded in our everyday lives. While a strong body of literature within the fields of self-tracking and the quantified self has evolved during the recent years, the author suggests it is time we (once again) start paying attention to the specific bodies in question when we look into the quantification of bodies, particularly about the question as to whose bodies are we talking about when we say, ‘quantified bodies’. The author also proposes that, when discussing the quantification of bodies, we take interest in the bodies designing, producing, and guiding the logic behind the algorithms embedded in the technological solutions in question. By suggesting this focus on bodies as knowledge producing, the author draws from a feminist perspective of situated knowledges (Haraway 1988; Harding, 1986, 2004) with a particular interest in knowledge production and the understanding of bodies as active, epistemological objects. Feminist theory of science replaces, so to speak, the idea of a universal human identity with a knowing subject who can occupy many different positions – in co-creative and transforming constellations. Following this line of thought, all kinds of knowledge production must be bodily anchored and situated. However, knowledge production always takes place in relation to or with something/someone else/other. As explained by philosopher Rosi Braidotti ‘[t]he post-human knowing subject has to be understood as a relational embodied and embedded, affective and accountable entity and not only as a transcendental consciousness’ (Braidotti, 2018, p. 1). Thus, the bodies in this chapter are the bodies who menstruate. The author wishes to discuss a particular socio-technical relation between smartphone applications (apps) to track and monitor the female cycle; period-apps, and the menstruating bodies engaging with these apps. Building on early feminist thoughts from the science and technology studies (STS), the author seeks to move beyond the algorithmic quantification of bodies to study the network of knowledge production formed by bodies, materialities, technology and history with all its reminiscence of stigma and taboo surrounding these leaking bodies (Shildrich, 1999). These inquiries are not only theoretical accounts but are also rooted in empirical soil. Based on a feminist ethnography of Danish women’s everyday engagement with period-apps, the female developers from the Femtech-industry and the women-only groups within the quantified self-movement, the author aims to provide a broad perspective on what the author defines as the gendered data body. The author argues for a feminist approach to better understand the socio-technical relations and the socio-cultural discourses the menstruating body is situated in, as well as to better understand the unique relation between knowledge production and technology as being constitutional for the gendered data body.

The classification of psychological suffering stumbles on the challenge of quantifying the ‘un-quantifiable’ upon the systematic categorising and description of affective and mental states and their transformation into illnesses and disorders. In this chapter, the author will explore the affect of anxiety through a critical recent history of its diagnosis and treatment in the context of psychological care. By unpacking the strategies employed by mainstream psychiatry in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association since the mid-twentieth century, it is possible to unveil the dynamics of a reduction of the subject to a productive-biological body in the last decades. This chapter thinks through what happens to the equation ‘body-world’ through the critical genealogy of affect and its relation to diagnoses and treatments of anxiety and depression. It grapples with the ethics of techno-scientific global financial capitalism – heralded by pharmacological corporations and governmentality – which replicates a modern scientific view of the body, affect and suffering in a world of renewed paradigmatic demands. The author argues that by consistently pathologizing and working towards the elimination of anxiety, the hegemonic clinic erases the possibility of such ‘subjective truth’, reducing the subject to the status of ‘dividual’.

This chapter considers how mental health care is done in and by digital culture in the UK. The author examines how treatments for anxiety and depression operate in today’s technosocial age of smartphone hegemony. Smartphones, the author argues, offer valuable insight into contemporary health and wellbeing precisely because they are emblematic of the neoliberal production logics, knowledge claims and modes of address that structure this moment in digital culture history. The author also shows how this moment is the outcome of key shifts in computing hardware, software, and content. Empirically, this research focusses on mapping Britain’s terrain of smartphone interventions for anxiety and depression. Working from a dataset of 635 apps, the author develops a four-part framework for understanding products and services in this crowded marketplace relative to an app’s (1) intended audience; (2) communicative affordances; (3) business model; and (4) therapeutic approach. Through this framework, the author proposes the notion of me apps to codify the individualised, commercialised, and desocialised mode of address enacted by most of the apps in the dataset. The author shows that the ideology of me apps, and the modes of address they employ, frame mental illness as an individual problem and regard treatment as an individual endeavour. The end of the chapter considers the possibility of an alternative vision for designing technologies of mental wellbeing.

Most scholarly and governmental discussions about artificial intelligence (AI) today focus on a country’s technological competitiveness and try to identify how this supposedly new technological capability will improve productivity. Some discussions look at AI ethics. But AI is more than a technological advancement. It is a social question and requires philosophical inquiry. The producers of AI who are software engineers and designers, and software users who are human resource professionals and managers, unconsciously as well as consciously project direct forms of intelligence onto machines themselves, without considering in any depth the practical implications of this when weighed against human actual or perceived intelligences. Neither do they think about the relations of production that are required for the development and production of AI and its capabilities, where data-producing human workers are expected not only to accept the intelligences of machines, now called ‘smart machines’, but also to endure particularly difficult working conditions for bodies and minds in the process of creating and expanding the datasets that are required for the development of AI itself. This chapter asks, who is the smart worker today and how does she contribute to AI through her quantified, but embodied labour?

This chapter investigates the need to focus on the gap between the pure quantification of the body, expressed by robotic implants, and recent research aiming to recover qualitative aspects of touch, such as sensation. The solution proposed is to analyse new implant technologies with a stereoscopic vision that is able to consider sensation both as intensity of neural signals and as something that we feel. The central question is: what is the value of introducing qualitative analysis into typically quantified robotics research, governed by data?