Originally authored by E. Fuller Torrey and published in Synapse on March 31, 1969.
Machines are even making inroads into psychiatry and the human mind. A psychiatrist at Stanford, Kenneth Colby, is trying to program a computer to do therapy; he calls it “the mad doctor.” Conditioning by an electric shock was recently done in England to cure an unfaithful husband of his illicit desires. And two psychiatrists in New York demonstrated that previously hypnotized subjects could be re-hypnotized via television.
Signals
The possible uses of machines to control the mind are well illustrated by the work of Dr. Delgado at Yale. He has implanted electrodes in the brains of monkeys and caused them to reject their offspring when stimulated by a remote control radio signal. He also implanted electrodes into the brains of bulls and was able to stop their charge toward a matador in mid-flight by activating the signal.
The list of technological developments in medicine stretches on, but the point has been made. Heart transplants and the synthesis of active viral DNA are not the only developments bringing profound ethical and social problems. Nor are they even the most awesome.
Invasion of Privacy
Let it not be thought that it is only the medical machines that are running away from their creators. Disturbing effects of the technological revolution may be felt in all fields. Oil tankers with unlimited capacities are built without considering the consequences of a wreck. Detergents foam on our streams and lakes. Automobiles outrace safety standards.
Urban noises challenge our eardrums. Hidden eyes and ears Invade our privacy. Before answers can be found it is necessary to understand two characteristics of the technological revolution — that it is mindless and that it is neutral. It is mindless because pure science Is simply a desire to know, to uncover the facts, to unlock the secrets. A mind must be superimposed onto it If it Is to have any limitations.
The technological developments described above are inevitable unless man actively decides to stop their development. Scientists will continue learning how to unwind the Intricacies of DNA; transplant organs, and implant electrodes in the brain as long as there are areas of unknown and unless they are specifically told not to.
Good and Evil
It is neutral because the changes wrought by the technological revolution in themselves are neither good nor bad. They acquire a value only by the way in which they are used. Science can tell us what we can do but not what we should do. It can tell us how to do something but not if we should do it. The potentials for good and evil of many of the developments described above stagger the imagination and recall the harnessing of atomic power.
Mindless Technology
Because the revolution challenging medicine and mankind is mindless and because it is neutral, then mind must be imposed on it to control it and determine its values. The present failure to do this has created a wide gap between man’s technological and his humanistic imagination. Mindless technology threatens to become a Frankenstein, destroying its creator.
The visions of the future would become specters. It is a warning being sounded increasingly often by thoughtful men, the warning asked editorially by The New York Times on the morning after Hiroshima had been bombed: “Can mankind grow up quickly enough to win the race between civilization and disaster?”
So far the revolution has been, In the words of Michael Harrington, accidental. It has evolved episodically and randomly, following the whims of chance rather than the dictates of reason. The technological revolution has solved many problems, but left untended it has created many others.
What remains to be done is to climb astride the machine and begin to truly direct its course. Only then with science and technology become a tool of man rather than enslaving him.
Battle With a God
When one sets out to find avenues to explore to bring the machine under control, many impediments are encountered. One of the biggest of these is the deification of the scientist and his tools by the public at large. Certainly, this is true in medicine.
The medical scientist and his test tubes are accorded almost supernatural power by most people. As long as this deification continues it will be difficult to objectively evaluate and control the developments of technology — man is reluctant to do battle with a god.
The Power of Religion
Another impediment to solving problems wrought by technology Is the decline of religious Influence. Whether you consider this an actual Impediment or the removal of an impediment depends upon your frame of reference; all I mean here is that the quick, easy answers formerly supplied by a theological framework are no longer readily available.
In the past religion and medicine were wedded, and philosophical problems encountered in medicine were answered theologically. Religion and medicine have now parted, though they remain friends. This has been accompanied by a decline in religious influence in general and by technology reaching out to capture ever more of God’s power, including the power over life and death.
The net result of all this is to leave man free but free-floating, with the barriers that religion had erected beyond which technology could not pass but also without any limit to the horizon. One Catholic scholar sums it up accordingly: “The scientific humanist may be as much repelled by the prospect of the replacement of the family by the stud farms of artificial insemination as the Christian, but unlike the latter he has no final argument against it. If the power is there, why should it not be used?”
Dehumanization
A third impediment to clear thinking toward answers to these problems Is the increasing dehumanization of our society. It is not possible to accurately identify and solve the problems discussed above unless man is identified as man.
This is a well-worn theme and will not be replayed here except to note it. Eric Fromm has summarized it as an era “in which men build machines which act like men and develop men to act like machines ... an era of dehumanization and alienation in which men are transformed into things and become appendices to the process of production and consumption.”
Public Policy
In spite of these Impediments to bringing technology under control, ways must be found to do it. Who is to provide the answers? What role should the doctor play?
Regarding the first, public policy should determine the ultimate answers. The social and philosophical problems of medicine do not belong to doctors alone, nor do theologians, nor do lawyers, nor do any other single group. They are problems that belong to everybody. Abortion is not exclusively a problem of doctors because they wield the curette any more than chemical warfare is exclusively a problem of pilots because they push the release lever.
But in order for public opinion to be operative and effective it must be informed. This is where the doctor’s role begins. The medical profession should play a major role in outlining the facts, clarifying the alternatives, and establishing the limits within medical possibilities. Only with this perspective can intelligent discussion take place, and only thus will society know what it Is choosing.
Law?
But doctors have an obligation to society beyond simply outlining the facts on these complex ethical and social questions. Their obligation extends to providing leadership. The issues should be raised by the medical profession itself; it should not be In the position of waiting until others raise them.
If the profession fails to accept the leadership In promoting discussion of these problems then its prerogative will be usurped by others such as the legal profession. But since law is a reflection of customs of the community, then It is less appropriate for law to assume leadership on these issues. Law enters to codify after the discussion has taken place.
Gun-Runner Mentality
Physicians generally fear playing god. What should be feared equally as much is a failure to play even man. Frequently in the past, medicine has been accused of adopting an ostrich-like posture on social Issues, an accusation not without foundation. What medicine definitely does not need is the gun-runner mentality of simply supplying services to those who request it.
Frightening Power
A doctor can no longer afford the luxury of sitting on the sidelines and watching. He now has power — real power. Increasing power. Whereas fifty years ago he had to rely on digitalis leaves and a steady look in the eye, he now implants an electronic pacemaker for the former and shines a laser beam in the latter. Doctors now have power to do things, and this power is growing every day.
It is a frightening power. Whether he wants it or not doctors are going to have to accepting responsibility for how this power is used. If these problems are going to be discussed they will require forums. What forums are appropriate? What forums are already being used? What forums should be developed?
Listings
Popular periodicals are one forum that are already in use. A look at them reflects the rapidly increasing public interest in and awareness of some of the issues. For instance, in the Readers’ Guide to Periodical Literature. Between 1951 and 1953 there were only 18 articles on birth control whereas between 1963 and 1965 there were 120. Headings such as euthanasia, vasectomy, and artificial insemination were not even listed in the early period but are included in the latter.
“Science Writers”
Doctors should not hesitate to contribute to this body of literature. The traditional hypersensitivity of the medical profession to publicity and advertising has led to a vacuum of reliable information for popular consumption.
The vacuum gets filled by flashy “science writers” whose facts are less accurate than their prose may be more palatable. The same may be said of books for popular consumption. Certain non-medical institutions lend themselves well to being forums for discussion of these questions.
An example is the Center for the Study of Democratic Institutions, “a non-profit, independent educational institution devoted to clarifying basic issues confronting a democratic society.” So far the Center has not dealt with any of the problems outlined above in any detail, but a model such as this could be developed and would be ideal for developing the dialogue that is needed.
An example of what can be done along these lines was the excellent symposium in 1963 sponsored by the CIBA Foundation in England, “Man and his Future”. Other non-medical technology into the future are the Rand Corporation, the Hudson Institute, and the Commission on the Year 2000 of the American Academy of Arts and Sciences.
Interested Industry
Private industry has also taken an interest in some of these questions. At a recent insurance convention, for instance, the companies were urged to prepare new kinds of insurance to cover people who wish to be frozen at death, and later, hopefully, revived. A rubber company is exploring artificial organs as a possible new market. The suitability of industry as a forum for discussion of these issues is sharply limited by their monetary involvement, as can be readily seen.
Religions’ Influence in Medicine
The churches are another possible forum. In the past it has often been them who have taken the initiative in discussing these issues. With technology moving as fast as it is, however, organized religion must strive harder if it hopes to keep abreast of developments. Galileo proposed the Copernican Solar System in 1611, but it was not accepted by the Catholic Church until 1820. The challenge to religions to understand and respond is obvious; failure to do this may well result in a further reduction of their sphere of influence in medicine.
