New project on fitness self-tracking apps and websites

My colleague Glen Fuller and I have started a new project on people’s use of fitness self-tracking apps and platforms (such as Strava and RunKeeper). We are interviewing people who are active users of these devices, seeking to identify why they have chosen to take up these practices, what apps and platforms they use, how they use them and what they do with the personal data that are generated from these technologies. We are interested in exploring issues around identity and self-representation, concepts of health, fitness and the body, privacy, surveillance and data practices and cultures.

The city in which we live and work, Canberra, is an ideal place to conduct this project, as there are many ardent cyclists and runners living here.

See here for our project’s website and further details of the study.

Thinking about the ethics and politics of public health campaigns

Over the past few years one of my research foci has been that of fat embodiment and obesity politics. This interest builds on my longstanding research on the sociocultural dimensions of health, medicine and public health, as well as the sociology of food and eating and the sociology of the body.

In July 2012 I wrote a piece for The Conversation critiquing a new Australian anti-obesity campaign, LiveLighter. The campaign included visual material and text that sought to evoke disgust (the ‘yuck factor’) about body fat in audiences. I argued in my piece that such strategies need to be examined for the ethical and moral issues they raise. Should health promotion campaigners be attempting to make people feel hatred and revulsion about their own bodies? To what extent are certain individuals and social groups identified by others as disgusting via such campaigns, and as a result subjected to social discrimination and stigma? How do such campaigns reproduce and exacerbate existing social disadvantage?

These questions have been addressed in several other publications of mine since then. In 2013 my book Fat appeared, in which I investigated the historical, social and cultural underpinnings of the disgust and revulsion that fat bodies tend to evoke in contemporary western culture. And I followed up my interest in public health campaigns and their use of strategies that attempt to arouse negative emotions such as disgust, shame and fear in two journal articles that were published recently.

One of these articles, published last week in Critical Public Health, builds on the piece I wrote for The Conversation by exploring the reasons why disgust is used in public health campaigns directed not only at obesity but also other issues, such as tobacco, excessive drinking and illicit drugs. It is entitled ‘The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns’. Here is the abstract:

The developers of public health campaigns have often attempted to elicit disgust to persuade members of their target audiences to change their behaviour in the interests of their health. In this critical essay, I seek to problematise this taken-for-granted and unquestioned tactic. I assert that the pedagogy of disgust in public health campaigns has significant ethical, moral and political implications. In outlining my argument, the literature on the social, cultural and political elements of disgust is drawn upon. I also draw more specifically on scholarship demonstrating the ways in which disgust has operated in relation to health and medical issues to reinforce stigmatisation and discrimination against individuals and groups who are positioned as disgusting. It is concluded that advocates of using such tactics should be aware of the challenge they pose to human dignity and their perpetuation of the Self and Other binary opposition that reinforces negative attitudes towards already disadvantaged and marginalised individuals and social groups.

The other article was published last month in Fat Studies and is entitled ‘How do you measure up?’ Assumptions about ‘obesity’ and health-related behaviors and beliefs in two Australian ‘obesity’ prevention campaigns’. This article was based on research I undertook using documents reporting on the formative and evaluation research by market research companies that was undertaken for two other Australian anti-obesity campaigns: the ‘Measure Up’ and the ‘Swap It, Don’t Stop It’ campaigns. Analysing these types of documents provides an interesting insight into the mentalities and rationales that underpin their development on the part of public health authorities and the people they employ to develop the content and strategies of their social marketing efforts. This is the abstract:

This article presents an analysis of two related Australian government-sponsored ‘obesity’ prevention campaigns, including documents produced by commercial social research companies reporting the formative research and evaluation of these campaigns. This material is critically analyzed for its underlying assumptions about weight, ‘obesity’ and the public’s health-related behaviors and beliefs. These include the following: the concept of ‘good health’ has meaning and value that is universally shared; to be ‘overweight’ or ‘obese’ is to be physically unfit and at risk of higher levels of disease and early death; individuals are responsible for their own health status; individuals lack appropriate information about health risks and providing this information leads to behavior change; and information should be provided in a way that arouses concern and a belief that individuals should make a change. These assumptions are challenged from a critical sociological perspective.

Anyone who would like a copy of these articles can contact me on deborah.lupton@gmail.com.

The body-being-born: how women conceptualise and experience the moment of birth

Newborn child, seconds after birth. The umbili...

Newborn child, seconds after birth. The umbilical cord has not yet been cut. (Photo credit: Wikipedia)

Although there is a large body of literature about labour and childbirth in the social sciences, surprising few researchers have sought to investigate women’s experiences of the moment of birth.

Virginia Schmied and I recently published an article in the Sociology of Health & Illness that drew on interview data with Australian women who had recently given birth. We asked women to recount their birth stories to us, and the data that eventuated gave interesting insights into women’s perceptions and experiences of what we call ‘the body-being-born’. We use this term to refer to the foetus/infant, an ambiguous body at the moment of birth because it is not quite inside but not quite outside the maternal body. When inside the maternal body, this body is technically a foetus; once expelled from the maternal body, it is called an infant. But in the process of vaginal labour and birth itself, when the body-being-born is passing through the cervix, parts of this body (most commonly its head) slip inside and outside the maternal body, moving back and forth as the woman works to deliver the body.

This stage of labour, therefore, is a highly liminal one, involving the two-in-one foetal/maternal body in the process of individuating to become two separate bodies over a period of time.  Women who gave birth vaginally without anaesthetic often described this process as a ‘splitting’ of their bodies, a sensation of their bodies ‘opening to the world’ over which they had no control.

We found that most of the women we interviewed struggled to conceptualise this process, as it was so foreign to their embodied experiences. They also needed to take some time following the birth to come to terms with the idea that the foetus was now ‘my baby’: a body/self that was physically separate from their own, now foreign and strange as it was outside their bodies. As one of our interviewees put it:

The midwife handed her straight to me and I held her, but I had held her for a while, I just was — it was like looking at her and wondering ‘Where did this baby came from?’ You know, despite what I’d gone through, it was hard to associate that she was actually mine and she was out of my stomach … Even holding her for the first few minutes — just, it wasn’t like she was mine, my kid, which is weird …when you think of what you went through, it was really quite strange.

This is a time in which women have to deal physically and emotionally with the disrupted boundaries of their bodies, the significant distortion and opening that has occurred with the birth and the splitting of body/self. There is a sense of disbelief, of wonder that this amazing, unique and strange process has happened to them.

An important finding from our study was that women who had undergone a caesarean section had even greater difficulties coming to terms emotionally and conceptually with the notion that their infant was now separate from them; that they had, indeed, ‘had a baby’. Because they did not undergo the physical rigours and often intense pain of prolonged labour and the experience of actually expelling the body-being-born from their own bodies, and because their bodies were numbed to surgically deliver, women who had had a caesarean took longer to accept the fact that the infant was now out of their bodies. They talked about feeling alienated from their infants and struggling to come to terms that it was actually ‘my baby’. In the words of another of our interviewees:

It was very hard to think that she was my daughter after she was born, because I had a caesarean under general anaesthetic and all of a sudden I’m not pregnant any more. And I wake up a few hours later and you’re presented with a baby. You think, ‘Oh, why isn’t this, why aren’t I feeling any kicks in my abdomen anymore?’ — you know. And there’s the baby and it’s very hard to relate to it.

Virginia and I conclude our article by arguing that the circumstances in which women give birth are pivotal to how they experience the process of coming to terms with the body that was once inside them emerging to the outside. Our findings suggest that health professionals and attendants working with women in labour and childbirth need to allow not only for the physical and the emotional but also the ontological dimensions of how a woman experiences both her own body and that of the body-being-born, and the significant difference that undergoing a caesarean section can make to the woman being able to achieve the transition from two bodies in one to two separate bodies successfully.

The rise of the quantified self as a cultural phenomenon

The Quantified Self movement was first developed in 2007 by two Wired Magazine editors, Gary Wolf and Kevin Kelly, who set up a website devoted to the movement in 2008. Interest in the concept and the associated movement has developed rapidly from there. According to The Quantified Self website, there are now over 130 quantified self groups in 34 countries around the world, many of which have regular meetings involving ‘show-and-tell’ discussions of how members have been engaging in self-tracking activities.

As part of investigating the ways in which the quantified self as a new term and practice has developed, I conducted a search for the term as it has appeared in English-language news media articles in the Factiva database, which archives newspaper and magazine articles (including digital and print articles) from over 8,000 sources from the world’s press.

Not surprisingly, given that the Quantified Self website was only established in 2008, the first news article to appear using this term was not until September of that year, just prior to the group’s first-ever meetup. The Washington Post (9 September 2008) noted the establishment of the group and interviewed Gary Wolf and several other people who were engaging in self-tracking.

In 2009 only two news articles appeared mentioning the quantified self: one in the American Life Science Weekly that reported a study on the relevance to healthcare of self-tracking, and the other in the Canadian Globe and Mail that discussed The Quantified Self movement and people involved in it. But the number of articles rose to 21 in 2010 and 33 in 2011 and by 2012 148 articles had been published that used the term. 2013 has witnessed even greater interest: by the end of July 2013, 188 news articles discussing the quantified self had already been published.

While these are not particularly high numbers relative to the thousands of topics that were reported in the news outlets included in Factiva, they do demonstrate evidence of growing and continuing interest in the quantified self which has gathered momentum each year since 2010.

The tenor of news reporting on the quantified self has changed over time. Early reports focused on its innovative aspects and debated whether such close attention to the details of one’s life and bodily functions would extend beyond ‘uber geeks’ or those ‘weirdly narcissistic’ few who are interested in ‘extreme naval gazing’ to the general population (Forbes magazine [USA], 25 April 2011). By 2012, news articles represented the quantified self as growing in popularity and becoming not only an important feature of health promotion but part of everyday life, as a way of maximising productivity and happiness as well as health. The term ‘quantified self’ was now frequently used not only in relation to members of the Quantified Self movement itself, but more generally to refer to the practices of self-tracking or life-logging.

Bearing headlines such as ‘Apps that will help you keep your resolve’ (Sydney Morning Herald, 30 December 2012), these news reports normalised the practice as applicable to everyone interested in improving their bodies or the selves. As the British Sunday Telegraph Magazine (2 December 2012) put it: ‘It began with a small group of digital obsessives recording their every heartbeat. Today the “quantified self” movement is a gadget-filled fitness craze.’ By June 2013, The Guardian (UK) was contending that ‘the “Quantified Self” movement (is) all the rage for people tracking their physical activity, food intake, vital signs and even their personal genome through digital services’.

News articles also increasingly referred to the plethora of new devices that were being released onto the market to support self-tracking efforts, involving major corporations such as Nike, Apple and Qualcomm, demonstrating a growing interest in the business world in taking advantage of the phenomenon. As 2012 drew to a close, several news reports noted how self-tracking devices could help people achieve their New Year’s resolutions. These technologies were also frequently mentioned in lists of innovations that would attract significant attention in the new year to come from those seeking to develop and sell products for quantified selfers.

News articles in 2013 appearing thus far demonstrate the growing dimensions of this potential market for wearable digital self-tracking devices, with many articles reporting new devices that are in development or that have been released, including ‘digital diapers’, wearable devices as fashion accessories, the use of self-tracking by elite athletes to improve their performances and devices for the ‘quantified pet’. There has been a focus on big data as well, with articles noting the power not only of individualised data in contributing valuable knowledge to self-trackers, but also that of the aggregated big data accumulated across many users uploading their data to websites.

However there is also evidence in recent news reports of the growing realisation of privacy concerns in relation to these data collected with these devices. Questions were raised about who should own these very personal data and how self-trackers can protect their rights to access their own data, as in The Guardian’s (26 June 2013) article headlined: ‘Wearable tech: why Intel thinks we should own our data.’

To establish further how general interest in the quantified self is developing, I used the Google Trends1 tool to see how often the ‘quantified self’ was used as search term for the same time period. The resultant graph showed that searches for the term ‘quantified self’ have risen steadily since early 2009, reaching its peak in April 2013. The regional interest figure, which highlights which areas of the world have used the search term comparatively the most, demonstrates that the USA has by far the greatest interest (top of the scale on 100), followed by Germany (60) and the UK (52). No other countries register on this scale, demonstrating far lower interest2.

I am using these analyses in a current article* that I am preparing on the critical sociology of the quantified self. For previous blog posts on the quantified self in relation to digital health, see here and here.

* Update: This article has now been published as ‘Understanding the human machine’ in IEEE Technology and Society, and can be accessed here.

Footnotes

  1. Google Trends analyses a portion of worldwide Google searches to compute how many searches have been conducted for the terms entered relative to all Google searches over that time period. This indicates the likelihood of a random user to search for the search term from a certain location at a certain time. The tool draws a graph showing interest over time plotted on a scale from 0 to 100 (100 representing the relative peak of interest, not the absolute numbers of searches).
  2. This does not mean that no searches for quantified self were initiated from these countries, but rather that the numbers did not reach the threshold set by Google for registering on the scale.

My two new books on unborn humans

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Last month both my new books on the topic of the unborn (human embryos and foetuses) were published. One is an authored book, part of the Palgrave Pivot series, entitled The Social Worlds of the Unborn. The other, The Unborn Human, is an open access book that I edited as part of the Living Books about Life series published by the Open Humanities Press.

Both books deal with very similar issues and theoretical perspectives, and therefore complement each other nicely. The Social Worlds of the Unborn has five substantive chapters. The first chapter examines what I call ‘contingencies of the unborn’, drawing on sociological, anthropological, bioethical, philosophical and historical perspectives to highlight the dynamic nature of the ways we think about foetuses and embryos and the debates over the extent of their humanness and personhood. I then go on in the next chapter to discuss technologies for visualising the unborn, such as foetal photography and computer imaging and obstetric ultrasound. These have been particularly important technologies in opening up the uterus to the gaze so that we can see the previously mysterious entities that inhabit this space. I argue that visualising technologies have worked to represent unborn entities as already persons in their own right, autonomous from the maternal body, and indeed as already infants. These images also represent the unborn as beautiful, fragile and vulnerable entities requiring our utmost love and protection, and thus are powerful agents in anti-abortion politics.

In the third chapter of this book I focus on pregnant women’s perspectives on the unborn entities growing within their own bodies. I highlight the ambivalence that pregnant women often feel about this Other body inhabiting their own, as well as their difficulty in coming to terms with their ‘two-in-one’ bodies that depart so radically from the contained, unitary bodily norm. The concept of the ‘good mother’ often precludes acknowledgement that pregnant women may sometimes feel as if their unborn is antagonistic and even parasitic. Yet these feelings are not uncommon in pregnant women, in addition to the more culturally accepted notions of the unborn as precious proto-infants.

The next chapter goes on to examine the dead unborn, including discussion of abortion practices, policies and politics, decisions about the disposal of surplus IVF embryos and the mourning and memorialisation of unborn entities lost in miscarriage or stillbirth. It also looks at bioscientific definitions of the unborn and how working practices in the medical clinic or stem cell laboratory operate to deal with using matter from dead unborn entities. Here again issues concerning judgements about the humanness and status of personhood of various unborn entities are to the fore. I demonstrated that the context in which these entities are created and grow (or fail to develop) is vital to concepts of their value and vitality.

The final substantive chapter examines the concept of the endangered unborn, particularly in relation to how pregnant women are represented as posing a threat to their unborn through ignorance or deliberate negligence. I argue that the increasing humanisation and personalising of the unborn and their representation as precious, vulnerable and as already infants with full human privileges work to position them as more important than the women who bear them, who increasingly as positioned as vessels rather than as individuals with their own rights and needs that may differ from those of their unborn.

The edited book, The Unborn Human, takes up many of these issues. I review the contents of the book in my Introduction (‘Conceptualising and configuring the unborn human‘), showing how each item in the collection contributes to various ways of thinking about, treating, representing, creating or destroying unborn entities. Like the other books in the Living Books about Life series, The Unborn Human is a curated collection of material that is available as open access publications. Some of this material can be viewed via links to the website embedded in the book, while others can be directly accessed under the Creative Commons Attribution licence. This means that all of the articles and other materials included in the book, which range from historical documents to scientific, medical, bioethical, policy, sociological, anthropological and cultural studies articles as well as social and other digital media material such as websites, blog posts and YouTube videos, can be accessed for free (including my introduction using the link supplied above).

Towards a critical sociology of digital health technologies

A recent research interest of mine is the emergence of ‘digital health’ (otherwise known as Health 2.0, Medicine 2.0, eHealth or mHealth) as central to healthcare and public health policies in developed countries. Digital health technologies include using mobile wireless devices and social media to gather data on health-related behaviours or to encourage people to take up health promoting behaviours, using Web 2.0 devices to seek out information on health-related matters and to contribute to this information, telemedicine, digital medical records and disease-monitoring systems.

There are now many articles in the news media and medical and public health literature that enthusiastically promote digital health as ‘revolutionary’ and ‘disruptive’ to traditional approaches to healthcare and public health. As a sociologist, I have sought to interrogate the assumptions underlying discourses on digital health technologies and to identify the social, cultural and political dimensions of the digital health phenomenon. I have recently written several academic pieces about digital health technologies, as well as a number of blog posts.

Two articles have focused on their use as part of health promotion, quantifying the body and self-tracking (see here and here). Another article looks at the concept of what I have termed ‘the digitally engaged patient’ in relation to the employment of digital technologies in recent telemedicine initiatives . I have also written about the commodification of patient experience data uploaded to patient support websites and the use of Donna Haraway’s cyborg theory to theorise digital health. The most recent piece returns to the subject of what I call ‘digitised health promotion’.

One of my central arguments is that despite the representation of technologies as inert, neutral objects participating in the collection of data in the interests of health promotion and medical self-care, from a critical perspective such objects may be viewed as actively shaping the subjects/bodies of those who use them. Technologies discipline and order bodies in certain ways, just as bodies discipline and order technologies. They are not politically neutral, but rather are implicated in a dense web of power relations. Using medical and other technologies to peer inside the body is part of a mentality that assumes that more information about the body is always better.

There are a number of central themes that come together in the critical sociology of digital health phenomenon. These include examination of the technologies themselves that are part of Web 2.0 and the Internet of Things, including ubiquitous computing (devices that are mobile and wireless), wearable devices and embedded sensors in devices, as well as the ‘big data’ that are produced from digital technologies. Other themes are the emphasis on personal responsibility for self-care and self-monitoring in telemedical and health promotion programs, the withdrawal of the state from alleviating socioeconomic disadvantage and the promise of control over the body, disease and expenditure that is regularly articulated in discourses on digital technologies. Also important are the contributions of the discourse of ‘healthism’, or the assumption that good health should be privileged over other priorities in people’s lives, and the lure of techno-utopian and data-utopian discourses generally that promote digital technologies as the means by which good health and financial savings may be achieved. Surveillance, whether voluntary, imposed or coercive, is another central dimension of using the new digital health technologies.

Now that computers are wearable upon and can even be inserted into the body or ingested as pills, and are used as part of medical care and preventive health strategies, a new set of possibilities and limitations have been generated in relation to the ways that we think about and use these technologies. I argue that digital health discourses work to draw attention from the social determinants of health and support victim-blaming of those who are ill or viewed as not successfully managing health risks. They promote the myth that ‘clean’, ‘controlled’ technologies allow containment of the ‘messiness’ of human disease and bodily disorder.

Furthermore, digital health technologies discipline bodies in certain ways and configure a set of obligations concerning acting upon the data that they generate. Privacy and discrimination issues also need to be identified and acknowledged, given that digital monitoring devices potentially allow healthcare providers, health promoters, employers and health insurance companies to gain access to data on users’ bodily functions and activities in fine-grained detail. Greater attention needs to be paid to the moral, political and ethical dimensions of the digital health phenomenon.

Cashing in on patients’ experiences: the commodification of patient support and opinion websites

English: The PatientsLikeMe Profile of Stephen...

English: The PatientsLikeMe Profile of Stephen Heywood, brother of the co-founders of the company, who was diagnosed with ALS when he was 29 years old. This profile describes his experience with the disease including his functional rating scale, treatments, symptoms, breathing capacity, and weight. (Photo credit: Wikipedia)

As part of the digital health phenomenon, a plethora of interactive digital platforms have been established in recent years to elicit lay people’s experiences of illness, medical treatments and healthcare. These include such sites as PatientsLikeMe, Smart Patients, Health Unlocked, CarePages and Cure Together, as well as many condition-specific sites.

The function of these platforms, as expressed on the main pages of their websites, is to provide the tools and forums whereby patients and caregivers, and in cases medical practitioners, can share their experiences with others, benefit from the support and knowledge of other contributors, comment on healthcare providers and contribute to large aggregated data archives as part of developing better medical treatments and services and conducting medical research. However what may not always be readily apparent to the users of these platforms are the growing commercial uses by some of the platforms’ owners of the archives of the data they contribute.

I have just published a working paper (available here) in which I discuss what I term ‘the digital patient experience economy’. This term relates to patients’ online accounts and details of their medical conditions and their ratings and opinions of healthcare providers and institutions having become valued not only for the support and information they offer to other patients but also for the increasing commercial value they have for other actors. These data have become treated as another form of digital intellectual property, owned not by the patients themselves but by the companies that encourage patients to upload their experiences that accumulate in the data archives they own and over which they have control. While some of these platforms are not-for-profit and operate solely as forums for patients to interact with each other or to report their experiences with healthcare providers (for example, Patient Opinion), a growing number have been established by companies seeking to profit from the harvesting of these data and on-selling them to their clients.

Lay people’s experiences and opinions as they are expressed in digital media forums, with all the suffering, hope, despair, frustration, anger and joy that are often integral aspects of coping or living with a medical condition or surgical procedures, have become commercial properties for market exchange. They are not offered and nor do they receive financial compensation for providing their experiences. The value they derive is non-commercial, while the exchange value of the data they upload is accumulated by the for-profit companies that provide the platforms for patients to share their experiences or trawl the web to harvest the data and render it into a form that is valuable for commercial entities.

As I argue in the working paper, patients may benefit in many ways from the affective labour in which they engage as part of contributing to these websites. Research suggests that many patients appreciate the greater access to information about their conditions and the emotional support, opportunity to express themselves, feeling part of a community and greater sense of control over their illness that they may gain from their participation in such forums. They may further gain satisfaction from contributing to scientific research, the production of better understanding of their condition or the provision of facilities or improved healthcare that may benefit themselves or others with their condition.

However many contributors may not be aware of the ways in which the data they upload may be harvested for commercial purposes. The overt rhetoric of the for-profit platforms on their main pages emphasises patient support and the democratic sharing of data for the good of all. The information about how these data are monetised for the benefit of the platforms’ owners is often buried in ‘terms and conditions’ or ‘privacy policy’ pages that people who join as members may not bother to read or may not fully understand.

The use value of the data produced by contributors is restricted by the limits imposed by the platform they are using. Indeed it can be extremely difficult for people to retrieve for their own purposes the data they upload to patient experience platforms, enter as part of their electronic medical records or that are generated as part of their participation in clinical trials. Contributors’ efforts to collate their own small data aggregates may be frustrated in the face of the interests of commercialised big data: hence the recent development of the Small Data website, designed to assist them to gain access to their data.

We know little about to what extent the people who contribute to these sites are aware of how their data are used by third parties, commercially or otherwise; how they feel about this use if they are aware of it; how they experience the sites as users; and to what extent they may wish to gain access to their own data for their own purposes. I argue, therefore, that patients’ opinions and illness narratives may be expressed in more diverse and accessible forums than ever before, but simultaneously they have become exploited in novel ways in the era of digital health.

Theorising mHealth and the quantified self

I have published several posts on this blog now about mHealth and the quantified self (see them here). I have also written two scholarly publications that have been published in academic journals discussing this topic in greater depth. In the first article I looked at how theories of surveillance society and the cyborg body could be applied to understanding the use of digital health technologies as they are used for health promotion, and also discussed privacy, intimacy and ethical issues (see here for details of the first article, the full version of which is open access).

The latest article is entitled ‘Quantifying the body: monitoring, performing and measuring health in the age of mHealth technologies’, published in Critical Public Health (see here for details). It builds upon the previous article by bringing in discussion of the quantified self movement. Here is the abstract:

Mobile and wearable digital devices and related Web 2.0 apps and social media tools offer new ways of monitoring, measuring and representing the human body. They are capable of producing detailed biometric data that may be collected by individuals and then shared with others. Health promoters, like many medical and public health professionals, have been eager to seize the opportunities they perceive for using what have been dubbed ‘mHealth’ (‘mobile health’) technologies to promote the public’s health. These technologies are also increasingly used by lay people outside the professional sphere of health promotion as part of voluntary self-tracking strategies (referred to by some as ‘the quantified self’). In response to the overwhelmingly positive approach evident in the health promotion and self-tracking literature, this article adopts a critical sociological perspective to identify some of the social and cultural meanings of self-tracking practices via digital devices. Following an overview of the technologies currently available for such purposes I move on to discuss how they may contribute to concepts of health, embodiment and identity. The discussion focuses particularly on how these technologies promote techno-utopian, enhancement and healthist discourses and the privileging of the visual and the metric in representing the body via these devices.

My current research is moving from a focus on health promotion to the construction of patienthood in digital health discourses. I’m looking at how patients are being encouraged to engage in self-monitoring and self-care activities to reduce healthcare costs, and the commodification of patients’ accounts of their experiences of illness and healthcare on social media platforms designed to elicit patient opinion.

Moving attachments: our emotional relationship with mobile digital media technologies

I recently read an article by Dave Beer in which he discussed the current lack of academic research and theorising about the emotional attachments users of the new mobile media develop with their devices. I agree that there is rather a dearth of writing about the ways in which we use and relate to new mobile media. I was frustrated, for example, to read a new edited book recently entitled Digital Cultures and the Politics of Emotion that focused on the topic of affect and digital technologies and to find that none of the contributions dealt with the affective dimensions of the technologies themselves. The focus, instead, was on the content produced via the technologies (their texts and images) and how affective states were reproduced and circulated online: for example, racist, violent and misogynistic material shared via social networks. While this book certainly provided interesting material on ‘digital structures of feeling’ there was little discussion of the ways in which digital technologies themselves as material objects and their embodied use are part of these structures.

This is a subject in which I have long had an interest. I have written extensively both on the topic of emotions, selfhood and embodiment (published in my book The Emotional Self ) and on the sociology of computer technologies. In the 1990s, I penned some articles on various aspects of the affective relationship we have with what were then emphatically ‘non-mobile’ digital technologies: the chunky desktop personal computer (PC). My argument was that using these PCs we developed a relationship with them that borders on the anthropomorphic.

One such piece was an essay entitled ‘The embodied computer/user’ (Lupton, 1995), where I explored the emotions that may be evoked by the PC not working or taking over one’s life, including  frustration, hostility and fear, and the tendency for users to describe their PCs as ‘friends’, ‘work companions’ or even ‘lovers’. With Greg Noble (Lupton and Noble, 1997) I then conducted some empirical research using interviews to address the ways in which the users of desktop computers incorporated their technologies in the context of the academic workplace. Our findings showed that PC users tended to evince an ambivalent position between seeing their PCs as humanoid and resisting this. Some people gave their PCs human names, or ascribed a gender or personality to them, describing them as spiteful, sexy, grumpy, intelligent or stupid. One person remarked that she saw her PC as ‘part of me’, ‘an extension of myself’.

I am still very interested in these dimensions of digital technology use (see here for a recent journal article and here, here and here for my blog posts on mHealth technologies and the quantified self). Digital technologies now have far more of a capacity to be intimately involved in our lives. Now, more than ever, as the new digital technologies become ever more mobile and wearable, as we carry them on our bodies throughout the day or even wear them at night (in the case of self-tracking headbands with embedded sensors designed to monitor sleep patterns): indeed as some can now be swallowed or stuck upon the skin as paper-thin patches to measure bodily functions, they are becoming even more a part of us, part of our bodies as prosthetics of the self, part of our identities as they store more data about our experiences, our social relationships and encounters and our bodily functioning.

There are moments when we become aware of our dependence on technologies, or find them annoying or difficult to use, or lose interest in them. As I have remarked in an earlier post on self-tracking technologies for health purposes, some people find wearable self-tracking devices not fashionable enough, or not water-proof enough, or too clunky or heavy, or not comfortable enough to wear, or find that they get destroyed in the washing machine when the user forgets to remove them from their clothing.

A blog post by designer Jennifer Darmour made similar observations, arguing that the aesthetic dimensions of wearable technologies have been little addressed. If these technologies remain too obvious, she argues, ‘bolting’ these devices to our bodies (an unlikely Frankenstein metaphor) and therefore obviously proclaiming ourselves as cyborgs will ‘distract, disrupt, and ultimately disengage us from others, ultimately degrading our human experience’. Darmour asserts that these objects need to be designed more carefully so that they may be ‘seamlessly’ integrated into the ‘fabric of our lives’. Her suggested ways of doing this include making them look more beautiful, like jewellery (broaches, necklaces, bracelets, rings), incorporating them into fashionable garments, making them peripheral and making them meaningful: using colours or vibrations rather than numbers to display data readings from these devices.

Another blogger has remarked upon the emotions that wearing digital self-tracking devices may provoke in people. Putting on a self-tracking device makes some people feel athletic, some fashionable, others fat and self-conscious about their bodies. Others feel safer and develop a greater sense of security about having their health monitored by these devices. Here again it was noted that the design of the device – its ‘look’, its conspicuousness or lack thereof  – may be integral to how people feel when they wear it.

Researching and theorising the affective dimensions of the configuration of user/mobile device potentially brings together the literatures on affect and emotion, embodiment, actor-network theory, media and cultural studies, the anthropology of material culture, digital cultures, digital sociology, digital anthropology and social computing. One way forward is to tap into the literature on the domestication of technologies emerging from media and cultural studies. This perspective is interested in how we ‘domesticate’ or ‘appropriate’ the technologies we use: that is, incorporate them into our everyday lives. I drew upon some of this work in my earlier research described above, and think that it still has much to offer in relation to understanding our affective attachments to our new digital technologies.

The material culture literature is also relevant to understanding how things in our lives are appropriated, incorporated and domesticated, how meaning and significance is invested in objects, and what the affective dimensions of this may be (see, for example, Miller’s The Comfort of Things and Turkle’s Evocative Objects, and my chapter on ‘emotion, things and places’ in The Emotional Self). So too, the work of Bourdieu, particularly his writings on the habitus, or the habitual practices of everyday life as they contribute to embodiment and subjectivity, may usefully be applied to understanding the interaction of bodies/selves with technologies. The actor-network approach to theorising the ways in which material objects join with fleshly bodies, other people’s bodies, other living things, ideas and practices to configure dynamic assemblages can potentially contribute to theorising and researching the affective dimensions of digital object use.

Computer science is well ahead of sociology when it comes to exploring what is termed in that field ‘social computing’ or ‘human-computer interaction’. The focus for computer scientists is in recognising that users interact with computerised technologies in often emotional ways (sometimes described as the subfield of ‘affective computing’), and to incorporate that recognition into designing systems and technologies that are accepted by users as useful, meaningful and a positive rather than frustrating experience.

Much remains to be explored, including the following questions: What does it feel like to carry, wear and use a mobile digital device? How much does their appearance and size matter? How are these devices incorporated into the habits and practices of everyday life (the habitus)? What are the practices of appropriation? How are they resisted? How do these devices configure users’ bodies and sense of selfhood and what are the emotional dimensions of this? What are the enabling and constraining aspects of their use? How do users adjust to giving up one device for another? How do they feel if the technology stops working? What are the interactions between the feelings configured and circulated via the texts and images produced by these devices and the physical material objects themselves?

References

Lupton, D. (1995) The embodied computer/user. Body & Society, 1(3/4), 97—112.

Lupton, D. and Noble, G. (1997) Just a machine? Dehumanizing strategies in personal computer use. Body & Society, 3(2), 83—101.

Living the quantified self: the realities of self-tracking for health

The end of 2012 and the dawning of a new year brought with it a multitude of news reports and blogs on the phenomenon of the quantified self or using self-tracking tools for health promoting purposes. Much hype has been generated around ‘digital health’ or ‘mHealth’ technologies, or mobile digital devices such as smartphones and wearable materials with embedded sensors that are able to connect to device apps or websites and download the data collected. These technologies include thousands of health-related apps for smartphones, tablet computers and iPods that can keep track of the user’s food and alcohol consumption, physical activity, body weight, ovulation cycle, stress levels, mood, sexual activity and many other physical functions and habits. It has been argued that by using such apps the smartphone can become a ‘”soulmate device” that knows your body better than you know it yourself’.

There are also an increasing number of specifically designed devices such as the Fitbit, Jawbone’s Up, Nike Fuelband and Zeo headband and various brands of adhesive patches that are available for self-tracking. All of these are designed to be worn upon the body to automatically collect data on bodily functions such as physical activity, pulse, heart rate, body temperature, calories burned and sleep patterns. Some can be worn 24 hours a day to provide constant readings of biometrics. Digital body weight scales, blood oxygen saturation monitors and blood pressure monitors that link to smartphones are also on the market. To motivate users, some devices include ‘gamification’ strategies. These use built-in reward or docking systems so that points or real money can be collected or paid if various commitments (to regular exercise or weight loss goals, for example) are either met or unmet, as well as websites where one’s metrics can be compared competitively against those uploaded by other users.

Nike+ FuelBand

Nike+ FuelBand (Photo credit: LoKan Sardari)

The combination of New Year resolutions season, predictions for digital innovation in 2013 and the reporting of the new technologies that were showcased at the 2013 Consumer Electronics Show in Las Vegas has contributed to the recent intensified focus on self-tracking for health reasons. Self-tracking mobile devices, apps and gadgets were reported as the new way of ensuring resolutions to lose weight or engage in more exercise would be accomplished (see here and here). They were frequently mentioned in lists of trends to watch in digital health technologies in 2013 (see here and here). Weird and wonderful devices such as self-tracking devices for dogs to wear to monitor their exercise levels, smartphones that could detect bad breath and other odours and a ‘smart fork’ embedded with sensors that could warn people they were eating too fast all received media attention in the early days of 2013.

I have written elsewhere about the ways in which self-tracking for health and the quantified self movement may be theorised sociologically, drawing attention to some of the ethical, moral and political issues (see here and here for previous blog posts on the topic and here for a lengthy academic article). Little academic research has yet been published on how people are taking up this approach to health promotion as part of their everyday lives. But accounts are beginning to appear in news stories and blog posts that have begun to explore the lived experience of self-tracking.

On the positive side, several self-trackers have reported that they feel more in control of their health using digital devices and have argued that there are many benefits to quantifying the self. Many people have discovered that tracking of their food intake and body weight has allowed them to achieve weight-loss goals. One success story is that of Dan Hon, who has type 2 diabetes and uses the Nike Fuelband and the Fitbit to monitor his physical activity levels as well as a digital blood glucose meter and weight scales. He reported that the combination of these technologies had allowed him to reduce his blood sugar levels to normal and that he had ‘healed myself through data’ (see here for his story). Another user experiencing problems with sleep used a Zeo headband to track his sleep patterns and experimented with taking magnesium supplements, giving up caffeine and changing the lighting in his room to see which of these factors affected his sleep. Using the data downloaded from the headband he eventually worked out how to best achieve a good night’s sleep. Other people with a diverse range of health problems have used self-tracking devices to monitor medical treatments for acute diseases or chronic conditions, evaluate the moods created by eating certain foods, track their alcohol consumption  and many more aspects of their bodily functions, health and illness states. Patients have also been able to ‘crowdsource’ the data they have collected on websites such as PatientsLikeMe and CureTogether, allowing the massing of data for a better understanding of what treatments are effective (see here and here for overviews).

Image representing PatientsLikeMe as depicted ...

Image via CrunchBase

Also beginning to emerge are accounts by people who have tried self-tracking for health reasons but have become disenchanted with the practice. As these stories demonstrate, the realities of quantifying the self do not always meet expectations. The devices do not share data with each other, so it is impossible to track different activities using more than one device and then produce statistics that combine the data collected. Some users find them inconvenient or uncomfortable to wear. Some people quickly become bored with the effort involved in self-tracking. It has been reported that the devices are often not compatible with some types of smartphones.

Other users who have tried self-tracking for health have suggested that the intense focus on the body that these devices encourage may place too much pressure on oneself, leading to feelings of failure and self-hatred. It has been argued that intense self-tracking may cause ‘cyberchondria’, leading to people becoming unduly anxious about their health state based on the data they collect. Devices may be used by people such as anorexics to facilitate health-destructive behaviours by engaging in too much obsessive self-tracking. Activities such as walking may become viewed through the lens of the self-tracking device rather than for the other pleasures they may bring, as one commentator wrote of his experiences using a Fitbit while visiting Paris. As he noted, ‘the data mind is hard to shake’, even while immersed in the sights and sounds of one of the most celebrated cities in the world.

Privacy issues are a concern as more and more data are collected by self-trackers. The manufacturers of self-tracking devices are beginning to approach workplaces as a site for encouraging people to use them and compete against each other. There are concerns that people may feel pressured into using them to meet employers’ expectations and that employers may use the data. Other critics have questioned what may happen if health insurance companies begin to expect their clients to use the devices if they wish to avoid higher premiums (see here for an account of these issues). The quality and efficacy of health apps and their potential for harming rather than promoting users’ health have also been questioned, given that they are currently not regulated (see here).

Using digital devices to self-track for health reasons is a very new phenomenon. While stories such as those referred to above are beginning to identify both positive and negative dimensions, it is a practice that still requires much more investigation and analysis in the face of all the hype.