Prosthetics & Selves: PTSD in virtual worlds, Lock In, & psychological health in space

This has been a great couple weeks for thinking about cyborgs, which is one of my favorite things to do :)

This week Popular Science put out an interesting short piece on the question of whether people can get post-traumatic stress disorder from interactions in virtual environments, such as video games and virtual worlds. It’s an intriguing question, because at the base of it is the issue of what constitutes a self. Where does the “self” end and the prosthetic begin? The weight of this issue is bound up the with the definition of PTSD itself: according to the American Psychiatric Association, in order to be diagnosed with PTSD, one needs to experience or witness a life-threatening event.

One of the leading clinical psychology researchers investigating the application of virtual technologies for mental health care, Dr. Skip Rizzo (misidentified as a psychiatrist in the article) discounts the possibility of experiencing such an event in a virtual environment. He argues that for someone to get PTSD in a virtual environment, they would need to already be psychologically compromised. After all, no matter how dedicated we may be to our online lives and avatars, if they die our physical well-being is not endangered. Right?

This reminds me of John Scalzi’s Lock In, a very smart novel on the future of prosthetics. The story takes place in a not-too-distant US, in which a epidemic of meningitis has left millions with lock-in, the condition where they are conscious but cannot move their bodies. With the help of copious government funding, numerous tech companies build both virtual worlds and prosthetic robot bodies called “threeps” (for C-3PO)  that those who have been locked-in can access via “neural networks,” implanted brain-mind machines. While a threep is experienced as the user’s body, and can even be set to feel pain, the main characters in the book feel no more trauma at the loss of good threep through violence than they do the loss of a good car in an auto accident. The prosthetic extends the self, but it is not the self. Therefore, its loss does not constitute trauma. But is this always the case? These characters are also independently wealthy. Losing a threep sucks, but they can afford a new one. Could the loss be traumatic if the hardware that allows you to live in the world were not replaceable?

Another fascinating article I read this week is the The Guardian’s piece on the mental health of astronauts. People who spend long periods of time in outer space often start experiencing psychosis and hallucinations and this presents a major challenge to our long-term space exploration ambitions. I would have liked the article to have said a bit more about the specific kinds of interventions that are being explored to maintain sanity among those who explore the stars. Friends of mine at the Los Angeles-based company All These Worlds have been working with NASA to develop virtual environments that can provide entertainment and emotional support to astronauts on long-term missions. This work carries on a long tradition of cybernetics research. You may have heard that the term “cyborg”—so prominent in both science fiction and feminist theory—was originally a term for an astronaut. The term actually originates from a 1960 article written by engineer Manfred Clynes and psychiatrist Nathan Kline for Aeronautics magazine about the ways that the space ship would need to serve as a prosthetic for the space traveler. But a few years later Clynes wrote a follow-up piece, Cyborg II, in which he argued that astronauts needed not only physical but emotional and psychological support in space. In engineering fashion, he imagined a set of tape recordings that could take the astronaut through a set of emotional calisthenics that he called “sentics.” Though Aeronautics didn’t take Clynes seriously and refused to publish the piece, in many ways NASA’s investment in virtual worlds and other media technologies to support astronauts’ mental well-being are bringing Clynes’ dream to fruition.

The research to explore the benefits of virtual worlds for helping astronauts maintain their sanity is still underway. But one has to wonder: if virtual worlds can provide us social and emotional support while floating in a tin can in outer space, couldn’t there loss also be traumatic? Perhaps there is nothing a priori about virtual worlds that makes them peripheral. It is only a matter of dependence. As we become increasingly invested in our prosthetics, why shouldn’t  violence to them be traumatic?

Set-back in marijuana PTSD research for veterans

Important news in PTSD research: University of Arizona assistant prof of clinical psychiatry Dr. Suzanne Sisley was fired without reason, shortly after winning a rare FDA approval to study the clinical effects of marijuana use among war veterans.

An article on the story in the LA Times suggests that the termination may be the outcome of political retaliation for Sisley’s association with pro-marijuana activists who had–independent of her own involvement—lobbied against senator on behalf of her research:

Sisley’s study was designed to involve veterans who would use marijuana in an observation facility on campus. She had lobbied state lawmakers for approval to use state funds collected at medical marijuana dispensaries to help pay for the work. When a powerful Republican senator maneuvered to block that money, some of Sisley’s allies launched an unsuccessful recall effort.

Sisley said she did not get involved, but that university officials were irate when some activists she described as “overzealous” put the university logo on one of their political flyers. Sisley said a university vice president ordered her to draft a statement outlining all her political activism, which she did.

“I didn’t even support the recall,” Sisley said. “I thought it was a waste of energy.”

Interestingly, I just procured a brochure from the VA here in SD all about why marijuana is not a legitimate treatment for PTSD. One major reason is the lack of available data, though clinical researchers also worry from a theoretical standpoint that the drug encourages patients to avoid confronting their trauma, which ultimately ingrains it more deeply rather than helping them overcome it. My personal opinion is that drugs are tools, and prima facie don’t see any reason why pot couldn’t be part of the healing process. However, it will be pretty difficult to find out whether this is the case if our universities don’t support this research. I hope a university with a strong affiliation with the VA located in a place with a large veteran population—such as UC San Diego—decides to hire Sisley so she can continue her important work.

What next? Thinking about Therapy and Politics

As of Friday, May 17th, I possess a Ph.D. in Communication and Science Studies. I defended my dissertation War, Trauma, and Technology: The Making of Virtual Reality Exposure Therapy in front of my committee: Chandra Mukerji, David Serlin, Kelly Gates, Charlie Thorpe, and Joe Dumit.

While the defense went smoothly overall, it became clear to both me and Chandra (my adviser) that I had not done enough in the dissertation to take a clear stance on the politics of therapy in situating my project. My data about the development and promotion of VRET was interesting, but the bigger picture was somehow missing.

At various points in writing, I found myself working with questions of Foucauldian ideas, such as biopolitics, governmentality, and discipline. I asked what kind of power was being created through the development of virtual reality systems promoted as doing part of the work of remembering a traumatic event for a military service member in therapy. I thought about Donna Haraway’s concept of the Informatics of Domination and Gilles Deleuze’s proposal of the Society of Control as ways of thinking about information technologies as post- (or better yet, neo-) biopolitical forms of power over populations and bodies. I thought a lot about cyborgs and their subjectivity.

But none of this made it into the thesis because every time I went down that path, I lost site of what my data really showed me. Now that the data is written up into some 280 pages, it’s apparent that these are topics I’m going to need to address again.

Here are a few thoughts:

  • Many people have criticized the medicalization of PTSD because it makes a disorder out of a “natural” or “normal” experience. I’m not sure I buy this. Not everyone who experiences trauma has long-term, debilitating suffering. This is not to say that PTSD should be considered an abnormality or weakness, only that it truly represents a kind of suffering that is worthy of intervention. The question is whether therapy or other forms of medical intervention are appropriate ones.
  • We don’t have a great system, currently, for evaluating therapies. All we have is “empirical support” data based on short questionnaires that suggest that someone’s symptoms have remitted over the course of therapy, but these cannot really tell us if someone has healed–only that they have changed their answers to the questions.
  • How could we evaluate therapy, including that for PTSD, based on ethical criteria? Are medical interventions inherently problematic in their conceptualization of disorder and healing and if so, why? Is there a way to have interventions within medical/therapeutic frameworks that also adhere to particular ethical criteria? In order to answer these questions, I need to be explicit about what I believe is ethical, what is problematic in medicalization, and whether the medical and the ethical are inherently mutually exclusive. I really don’t think they are, but I need to be able to explain why this is.
  • In fact, I think therapy can be a very good thing. Unlike someone like Thomas Szasz I don’t just think it’s an instrument of the state to keep folks in line. Rather, I believe that mental illness can actually be a major source of suffering in and of itself (not just because of stigma or social exclusion) and that therapy can be an important part of a journey towards regaining well-being and even agency. People who hide away to save themselves from painful stimuli are not merely socially oppressed subjects.
  • However, I must also address the question is therapy can be ethical when administered in the service of an ethically problematic institution, such as the military. Would I really agree that all therapies are unethical when used in the service of healing combat-related PTSD? Not at all. But then, what would it mean, especially in this context, for a therapy to be ethical? Would it necessarily have to conflict with militaristic goals, or is there a way to conduct healing that is good for the individual without taking an explicit stance towards war itself?

Well, these are all questions I’m going to need to think about seriously as I move forward towards making a book manuscript. I plan to make more use of this blog as a space for thinking through these ideas in the coming months. Stay tuned for elaborations on my thinking about Foucault, cyborgs, and therapy, among other things.