Ancient instincts, modern hardware: paranoia and medical imaging and surveillance technics

Abstract

Purveyor of paranoiac science fiction, Philip K. Dick, once characterised paranoia as “a modern-day development of an ancient, archaic sense that animals still have…a lingering sense that we had long ago, when we were—our ancestors were—very vulnerable to predators…” Commenting on the paranoiac lives of the characters in his novels, Dick then observed that “[t]hey’re living like our ancestors did. I mean, the hardware is in the future, the scenery’s in the future, but the situations are really from the past.” Viewing Dick’s remarks as an opportunity to examine the deeply historical— even biological—origins of paranoia, this paper proposes paranoia not as a psychopathological reaction to contemporary surveillance technics, but as an ancient surveillance technic in its own right. It will examine Dick’s implicit claim that paranoia might be viewed as a kind of parachronism whose uneasy ‘situation’ in the present—and whose proximity with futuristic hardware—might be characterised, across time, by its vestigiality.

In this context, this paper examines the interrelation of biological models of self-surveillance (such as the ‘immunosurveillance’ mechanism of the immune system), the powerful visual technics of contemporary biological surveillance (X-rays, PET scans, diffraction photography, bio and other close-monitoring procedures) and their relations to paranoia. In doing so, it will offer an alternative theory of paranoia in which it is understood to (re)animate the unseen—and thus to identify the predatory—even in the context of those medical technics that profess, by ‘revealing all’, to exhaust the possibility of any such an identification.

Conference Paper

1. PARANOIA, EVOLUTION AND SURVEILLANCE

This quotation from a 1974 interview with Philip K Dick suggests not only that paranoia connects us, as primates, with other paranoid species on the planet, but also that paranoia is an advantageous phenotypic trait: something that may have evolved or mutated in order to assist us in survival; to guide us away from predation or as against negative events more generally. I open up my talk with this quote, and I make this same claim as Dick, not simply as a humanities student reading science fiction, but as someone that is for some probably a lot worse: a postmodern humanities student that dabbles in reading science itself.

To justify this position, and to clarify the way in which I approach literary texts and science, I repeat –but slightly alter—what Raymond Chandler once said about fairy tales, which are a bit like science fiction texts. He said that “[t]he spirit of an age is more essentially recorded in its fairy tales than in its most painstaking chronicles”. PKD’s texts are insightful fairytales about medical and biotechnological developments that began in and around the time of his science fiction writing in the 70s. It is arguable that his works more essentially record the spirit of his time than any later histories of those technological, scientific and medical developments do themselves. Dick’s paranoia, for example— like that which may be identified and is also described in the writing of Deleuze and Guattari in the first half of the 70s—especially in Anti-Oedipus—is interesting and worth reexamining precisely because his represents a vision of technological surveillance that is on the hand thematically and narrationally very disturbing—and indeed, it has been mined by Hollywood for such films like Blade Runner, Total Recall, Minority Report, and the Adjustment Bureau, all PKD adaptations—but on the other hand, Dick’s vision of technological objects (or technics) has largely materialised and quite closely, albeit rather grandiosely, represents the reality in which we now, and will, live. While we do not yet, other than rather theoretically, understand ourselves to be cyborgs that dream of electric sheep, many of the ideas PKD had about the nature of time—for instance that in an evolutionary sense our bodily and psychological reactions to technology stem from both an ancient and a futuristic ontology or ontologic—or about medical technics and objects—that their behaviour or misbehaviour has become more threatening and more disturbing to us, at least psychologically, than other humans—these are ideas with which we are increasingly familiar. Dick’s novels are also a way in which we can reconnect with that spirit of the 70s and to speculate as to whether we have simply become acclimatised to objects and technics, and to the way in which we interact with them psychologically and bodily—or whether, on the other hand, it is simply the case that PKD was overparanoid and should have sought treatment.

In this sense, like the worlds that his novels animate are atavistic, reading Dick is an atavistic practice and a Jamesonian retrogression into the pre-history of many of our current technologies. In reading PKD we thus step into the past and into the future in this double sense: his works are atavistic, and so is our reading of them. In Dick’s novel, A Scanner Darkly, the protagonist, an undercover police operative known as known as ‘Bob Arctor’ – real name Fred— reflects on whether the ‘scanners’ that monitor his undercover drug-bust might assist him in regaining control of his life. Bob/Fred has become increasingly paranoid and disassociated under the influence of a psychotomimetic drug known as Substance-D; in the context of maintaining two personalities, Bob and Fred; and in wearing, when not undercover, a so-called scramble suit that serves to disguise his body to human eyes, as a scrambled multiplicity of bodies. The holo-scanners that watch Bob/Fred can see through scramble suits, and see directly into the reality that lies beneath. In his state of disassociation, Bob/Fred is lead to ask what a scanner sees, and to anxiously question whether it might see into himself, since he no longer can do so. The love-hate relationship that Bob/Fred has with the holoscanners in A Scanner Darkly prompts us to consider how surveillance through scanning technics and medical and scientific imaging might engender security and trust in the clinic, but also, albeit in a less obvious sense, the same feelings of paranoia, loss of identity, and hostility, as arise in Dick’s novels.

Before I move on to the scientific aspects of paranoia, I will talk about paranoia in surveillance studies. Paranoia, as Nicholas Holme writes—is a much vexed term in surveillance studies and, which “haunts the academic study of surveillance.” Its significations in the academic setting are only ever generally identified. In the academic setting, as David Harper points out, we can understand paranoia as productive in some ways in that it may be seen to engender critical thinking and specialist research on a given subject. However, as Harper also notes, the work that surveillance researchers do—and her refers to one particular researcher who tried to count in a single day of their life all of the devices that recorded her—is often criticised as paranoid and delusional scholarly activity in itself, dismissed as “unwarranted and meaningless suspicion…”

In another, even more theoretical way, we might think of surveillance and paranoia studies in evolutionary terms as the very means by which vigilance is exercised against an otherwise invisible threat to our independent subjective, conscious and intellectual experience of the world so that, like meerkats that are visually impaired—that is, who cannot possibly, despite their vigilance, see all of the possible threats against them—and who use quiet surveillance vocalisations to alert their peers to possible predators–surveillance researchers, undertake a sentinel duty in carefully and intellectually identifying the  range of threats to our subjective positions and freedoms as individuals. The task is inevitably cross-disciplinary and also involves questions related to public ethics.

The discreditability of some  sureveillance research is also perhaps linked to the cultural imaginary that surrounds paranoia, and the fact that beliefs associated with conspiracy theorising and paranoid thinking, far from rare, are actually very common within the population; as Harper argues, it is only the preoccupation and distress associated with these beliefs varies between clinical and everyday kinds of paranoia. Paranoia studies and paranoia more generally thus needs to be reimagined in the popular imaginary as something, like language itself, that may be positively utilised as much as it may become dysfunctional.

In the context of a hospital, extreme paranoid and delusional reactions to medical intervention and scanning and radiation technics, are treated very seriously, and often discussed as unusual responses to the empirical logic of science, medicine, and the technologies that facilitate their pathologies and diagnostics. However, if one understands the clinic in the way Foucault describes it in The Birth of The Clinic, also written in the early 70s, in 1973 —as a power structure in which the medical gaze and the enforcement of bio-power attempts not only to make the invisible pathological body visible and readable, but also to treat the body and disease as an object that transcends time, as it is linguistically converted into lesional signs (which we now would understand as genetics), from whence these symptoms emerged. Treating a disease could now be seen in terms of a ‘history’ and a ‘case’ rather than simply as a symptomatology. In this context of increasing surveillance of the body as an object, it is perhaps not so surprising that extreme paranoia in the form of, for example, Intensive Care Unit psychosis—or ICU psychosis—sometimes occurs whereby delusions that one is being victimised takes place.

Nevertheless, a review in the Neuroscience and Biobehavioural Reviews entitled ‘Social threat perception and the volution of paranoia’ from 2004 analyses the array of varied tests undertaken to determine the detection of threats by humans in the social environment, and, as the authors claim “The neurocognitive mechanisms responsible for fast and efficient threat detection may…have survived as an adaptive advantage in accord with Darwinian evolutionary theory.”[1] While we may think of other species when considering potential predators, and when thinking of Dick’s remarks, which seem to suggest the threat of another species obliterating humans, it is interesting to consider the extent to which paranoia functions as a means of protecting us against the actions undertaken and the actants created by agents within our species: by other humans. This is especially interesting when we put paranoia into the context of surveillance, and immunosurveillance technologies. It is all the more interesting to consider how the battery of tests created by the humans and life sciences themselves to measure illness – for example PET and CT scans—may in fact serve as examples of cases in which paranoia is increased by those undergoing such tests. The paradox, predictably, is whether the tests that make us better, and that survey our bodies at extremely close-ranges, also play a role in activating vestigial paranoiac anxieties, not simply because we are consciously fearful of the results, or of even these medical technics or technologies themselves, but because, rather, of something other, and something prior to our conscious recognition of our own impulse or compulsion to be paranoid, and perhaps the impulse to respond to social, as well as physical, threats.

I claim that paranoia—a much vexed term in surveillance studies and, as Nicholas Holm suggests, “a theme, an undefined noun [and] a vague proposition [that] haunts the academic study of surveillance”—can be seen to signify, in all of its academic and non-academic valencies, and in its meta-signification, so to speak, a hyper-rumination or an excess of mental activity on precisely that which we do not know, and that this activity is often framed in a negative, fearful, or anxious narrative. If we put paranoia into the Hegelian dialectical terms (thesis, negative, and synthesis) then paranoia might be seen as useful for developing the negative—for making a very strong case for the negative—but it might also postpone the development of a synthesis since it would resist the thesis, which, in everyday life, might compare to the resistance by the paranoid person of logical explanations, or rational hypotheses, for certain events they perceive as negative or certain actions they regard as persecutory or predatory.

It follows from this proposition that paranoia might possibly arise in a patient undergoing surgery involving close-range body surveillance technics—for instance, there is a syndrome called ICU delusional syndrome wherein a patient in an intensive care unit begins to fear the medical clinic, and which is characterised by delusions and hallucinations within the clinic. Of course, ICU is just as likely to arise because the patient is fearful of their medical diagnosis, or of the surgical procedure itself, or of their ability to recover from the surgery, and they may experience these feelings either before or after any surgery or diagnosis has taken place. My interests in these close-range surveillance technics, however, relates to the point I flagged earlier about our increasing knowledge of that which we have hitherto not known. While medical technologies offer us the opportunity to know and to see that which we could not normally know or see—there remains a crucial gap—always—in knowledge about the self, and that this fear of the gap, of the unknown, is the domain of paranoia. The paradox I want to underline here is that while we are fearful of that which is unknown, and which may in fact be made known, now, by these surveillance technics—Does the cancer exist or not? Is my child healthy and well?—there is perhaps another way in which these technics engender paranoia: they remind us of all we do not know.

One qualification I wish to cite is that I am thinking of paranoia, in a rather Freudian way, as a psychopathology in ‘everyday life.’ Just as surveillance may exist in everyday life as well as in prisons and high-security offices, and so on, so it is with paranoia. While, of course, medical scanning technologies are not part of our everyday, this may not be the case for long. And as many studies of paranoia in non-clinical populations note, most people handle paranoia, notwithstanding its constant presence: most of us do not catastrophise, and are able to gain emotional distance from paranoid feelings or ideations. Those, however, who become susceptible to paranoia, both clinically and non-clinically, are said to “perceive themselves, whether accurately or not, as having inferior social standing”, and by bottling-up such feelings, “maintain a state in which external attributions and anomalous experiences are more likely, thus leading to the persistence of persecutory ideation.”[2]

In instances of conventional surveillance paranoia, in the face of something like the increasing abundance of CCTV cameras, or the fear of being monitored via social networks, and so on, arguably, the paranoia that one might feel arises as a result of a number of relatively explicable instances of non-knowledge—what might be described as imagined threats—including: Who is he or she that surveils me? Why is he or she surveilling me? How might their knowing about my private life, or the lives of my online avatars, be used against me, or for another’s benefit? In contrast, these non-knowledges or questions seem well-explained by the circumstances of the medical setting: the answers are, respectively: he or she is a doctor; they are surveilling my body because I am pregnant, or because I am suspected of having a disease; and the knowledge attained by the surveyors will be used for my benefit. In the medical setting, however, it is arguable that, for some, certain paranoid questions begin to arise at an interpersonal level about the nature of the medical surveillance regime itself: Does this technology have any negative side-effects or risks? Is the conclusion the doctor may draw in respect of her examination of this medical imaging an appropriate and medically sensible conclusion? Like Dick says, the hardware and scenery’s in the future—for it is now a medical age—but the situations are really in the past—for this situation, as Foucault’s argument in The Birth of the Clinic attests, are thoroughly political, and are governed by relations of power, which are designed to overcome bodily threats, and often, the threat of death itself. These questions are wotrth asking because it gets to the heart of what it means to be paranoid in the face of all surveillance regimes, be they understood, by cultural theorists, as positive or negative.

2. COGNITIVE BEHAVIOURAL STUDIES OF PARANOIA

As a slightly more recent study argues, “the perception of threat is a central feature of paranoia almost by definition.” However, this more recent study, when considering a range of empirical tests undertaken in relation to paranoia that are similar to the aforementioned word and story tests, suggests that “there is considerable evidence that paranoid patients have indeed actually experienced an abnormal frequency of adverse events such as discrimination and victimisation.”[6] In other words, paranoid patients may indeed be expressing a conditioned avoidance response (or ‘CAN’) in relation to experiences quite realistically and actually already had by them previously. As the study explains,

Not only does this [past experience and memory of past experiences] affect evaluations of the past, but also, because there is a tendency to rely on recollection of past events when making predictions about the future (called the availability heuristic….) it also tends to inflate estimates of future negative events.[7]

In addition to this, there is evidence that paranoid patients have a tendency to preferentially recall threat-related, as opposed to simply neutral, information[8] and that, finally, paranoid patients make inflated or exaggerated assessments or estimates about future negative events even after controlling for the above events (or for the availability heuristic), as well as for the effects of comorbidity—that is, the possibility that these memory-based influences may coexist with another syndrome or syndromes, such as depression or anxiety. As this later study claims, it is the somewhat inexplicable origin of the inability of the paranoid patient to desist in making inflated assessments about the immediate threat-quotient in relation to future and current events, notwithstanding his or her apparently fully conscious psychical resolution of past-threats, that is suggestive, for neuroscientists, that a “specific abnormality in the mechanism responsible for aversive processing” exists in paranoid patients which makes a “large contribution to the formation of paranoid delusions.”[9]

Of course, before we speak of the abonormalities that characterise paranoia—in terms of biochemical or physiognomic abnormalities—it is worth considering the behavioural and psychological habits that are facilitative of the same. For example, attribution theory considers how events are explained—or to what causes paranoid and other so-called normal people attribute them. Since most normal people are thought to attribute negative events to external causes—a phenomenon known as the self-serving bias, which is said to buffer against self-esteem loss in the face of failure and other threats to the self—there is thought to be a natural tendency to regulate or self-serve qua self-surveil one’s levels of paranoia. Some studies have suggested that paranoid patients tend to attribute negative events to excessively external causes[10] and especially external personal causes.[11] However, because of the inconsistency across paranoid people in relation to self-esteem, models of paranoia have linked inconsistent or unstable self-esteem itself to paranoia—paranoid patients are not excessively low or high in self-esteem, and in most instances there is no bearing of self-esteem on the existence of paranoia.[12]

Studies involving humans and rats in relation to avoidance conditioning have shown that once successful avoidance of, for example, an electric shock, has been achieved, the avoidance response – for instance, this may involve pulling a lever to avoid the electric shock—becomes “resistant to extinction”:[13] that is, when the aversive stimulus—the electric shock—is magnified, repeated more often, or otherwise made prevalent—the avoidance response becomes less likely to discontinue. In this context, I would like to charecertise surveillance – and, first of all, standard CV surveillance as a kind of aversive stimulus – but, more than this, I would like to suggest that in our increasingly medicalised world, and with the increase of devices and instruments suited for surveillance of our bodies—consider those medical technics with which we are familiar: scanners of all kinds, including x-rays, functional imagery with positron emission topography, in which a radionuclide is introduced into the body, and traced throughout it to produce an image of a functionality, notwithstanding a small risk of radiation poisoning, as well as FMRI scans, and so on. There is a sense in which these technologies might also be regarded as surveilling technologies—quite easily—but also in which they might be considered as aversive stimuluses to which we might develop psychological responses, or avoidance conditions. It is not simply because these devices are misread as predators, either, although this might be the case; but, moreover, because, in a very real sense—and in the sense that Dick’s remark implies—these technologies might be repurposed as instruments of the state, as well as by the medical profession, as instruments of oppression and of exclusion. This is what Foucault, in The Birth of the Clinic, described as the medical gaze, which separated the patient’s identity from the medical body he or she inhabited.[14] It is a scopic regime whose purpose, while putatively for the good, is arguably as much liable to mistake, accident, exclusion, oppression, and to depersonalising or identity-shifting effects—some of which result in paranoia. However, how might this be said to occur?

3. PARANOIA IN SOCIETY AND PHILOSOPHY

While I have thought of paranoia as a vestigial trait that might be reactivated or reanimated by medical technics in the case of ICU, philosophical understanding of paranoia regard it more as an ideological position or reaction to an historical situation or episteme. Deleuze and Guattari, for instance, describe paranoia in Anti-Oedipus or A Thousand Plateaus as a ‘reactionary arrest’ by which the ‘deteritorializations’ of identity and subjectivity brought about within capitalist societies are ‘reterritorialized’, or are resisted by a paranoiac.[15] As they suggest, recalling Dick’s thinking on the atavistic societies that his characters inhabit, and the distinction between the archaic and the futuristic—the ancient and the modern (their book was written two years before the interview—1972):

modern societies…are caught between the Urstaat that they would like to resuscitate as an overcoding and reterritorializing unity, and the unfettered flows that carry them towards an absolute threshold. They recode with all their might, with world-wide dictatorship…[and] they are torn in two directions: archaism and futurism, neoarchaism and ex-futurism, paranoia and schizophrenia.[16]

It is interesting to consider the way Deleuze and Guattari contrast the symptoms of schizophrenia and paranoia as different logical responses—or causes and effects— of capitalistic territorializations in modern society whereas the DSM-IV-TR, regards paranoia as a subtype of schizophrenia[17], as well as a separate disorder, namely, Paranoid Personality Disorder[18], both of which are relatively uncommon among the general population, and have, as a two-part classification, developed out of Emil Kraeplin’s nineteenth century textbook of psychiatry, in which “dementia paranoides” (qua paranoia) and “dementia praecox” (qua schizophrenia) were distinguished.

Notwithstanding contrasting classifications, the most salient difference between the diagnostic or clinical understanding of paranoia, and the philosophical and cultural studies understanding, is the extent to which the phenomenon is linked to modern societies, as opposed to an archaic, special or phenotypic trait. As Kenneth Paradis writes,

As an epistemological rather than nosological descriptor paranoia is a term that participates in the discursive management of the individual’s tendency to remythologize modernity’s disenchanted cosmos; it is a wrong way to find personal meaning in a seemingly indifferent universe. Paranoia is a modern grotesque: it reveals the modern ideal of objective knowledge as shot through with desire, and the modern ideal of effective, even-handed administration as shot-through with presumptions of hierarchy, privilege and exclusion…[19]

As a response to this, I would argue that the paranoia is activated by medical technics with which we have been made to become very quickly familiar, and which we have perhaps misperceived as threats, not directly, but because of the range of social meanings that accrue around these technics, and a desire to avoid these threats.  As an Christine Hassenstab’s consideration of the ultrasound as a

“technological nexus where visibility could join with some form of subjectification or end in actual subjectification.”

As she suggests,

“we need to understand how patients, especially women, negotiate medical images. We need to remember that while images are dependent on culture and society for their meanings, these images can have multiple meanings.”[20]

Given the multiplicity of meanings engendered by medical and other close-range surveillance technics, how one negotiates these meanings epistemologically is not as clear-cut or as stable a task as Paradis suggests. Indeed, the remythologising of modernity’s so-called disenchanted cosmos seems often already to have taken place; both the popular media and even the medical literature, which, for legal reasons among others, conveys and discloses the full range of possible side-effects, risks, and other threats in relation to almost all medical procedures and operations. Far from an individualist modern grotesque, then, paranoia seems, in this medico-legal context, to be a mythology that is generated in the form of a collective unconscious about the nature of medicine and of public health more generally.