The divided self: "Portrait in Ruby and Blue" (2012) by Daniel Gordon. Image: Daniel Gordon Studio
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The agony and the ecstasy

The creative power of illness.

The first time I experienced severe physical pain, I was 13 years old. It was a new sensation: nauseating, deep and gnawing; centred in my abdomen and the base of my spine, it also radiated down both legs. I lay on the floor of the lounge, one moment curled on my side like a comma, my knees pulled up to my chest; the next on my back; the next on my front with my legs spread as wide as they would go. None of these positions brought relief. I was vaguely aware of shaking and of being unable to talk. My skin, I learned later, was so unnaturally pale that had I not been moving, I might have been taken for dead.

More than a decade of similar episodes followed, until, aged 26, I was diagnosed with endometriosis. I still have the condition today, and sometimes, in the middle of a bad episode, I have longed not to exist. But always after the pain comes the gradual, miraculous release from pain, and with it the sense that my stay in that other strange realm to which illness transports us is by no means over. It seems to me that these periods are vacations, in the truest sense of the word – intermissions, voids, times in which my normal life has in effect been emptied of my presence.

Most people have never seen me suffering: a few (ambulance staff, doctors, night cleaners) have never seen me well. It is as if, since the age of 13, a secret self has existed alongside my everyday self; one for whom, from time to time, the so-called real world, with all its duties and dreary preoccupations, ceases to be. It’s striking how often the notion of the divided self crops up in relation to physical illness. Sometimes the division is literal, as described here by Dorothy Molloy in the title poem of her collection Gethsemane Day:

They’ve taken my liver down to the lab,
left the rest of me here on the bed;
the blood I am sweating rubs off on the sheet,
but I’m still holding on to my head.

Sylvia Plath also presents an account of the self splitting into two while undergoing medical treatment. In December 1952, she found herself in hospital after breaking her leg in a skiing accident. Her response, “In Plaster”, details a struggle between two different selves:

I shall never get out of this! There are two of me now:
This new absolutely white person and the old yellow one,
And the white person is certainly the superior one.

Superior, it transpires, only inasmuch as the plaster self doesn’t need food to sustain it and is “whiter and unbreakable and with no complaints”. But it is the old, yellow self that plays host to this gleaming other. Clearly, we’re in the realms of metaphor: Plath believed that a life lived by a false self or selves was both cowardly and senseless; time and again her poems propound the wisdom of shedding false identities.

Much has been made of the link between creativity and mental illness, but the link between physical illness and the creative life, though less discussed, is just as significant. For some artists, it led directly to a choice of career. Matisse – famous for his intense, saturated colours that seem to blaze with life – initially studied law and had begun work as a court administrator when an attack of appendicitis forced him to take time out. His mother bought him art supplies to keep him occupied during his convalescence and it was only then that he made his first paintings. His subsequent decision to quit law and become a painter was, it is said, the cause of deep disappointment for his father.

Hilary Mantel, a fellow endometriosis sufferer, believes the disease was at least partly responsible for her choice to become a writer, as she explains in an interview at the back of her memoir, Giving Up the Ghost: “A lot of people know they’re going to be writers when they’re children, but I made a conscious decision to become one when I was 22, when, because of my poor health, I saw other career prospects slipping away from me.”

Like Matisse, Mantel read law at university but her studies were interrupted by severe episodes of pain that resulted in a succession of inappropriate medication. She explains, “It was in the nature of educated young women, it was believed, to be hysterical, neurotic, difficult, and out of control, and the object was to get them back under control . . . by giving them drugs which make them indifferent to their mental pain – and, in my case, indifferent to physical pain too.”

Baffled by the symptoms, Mantel’s doctors seem to have resorted to a sort of annihilation of the self. Though the circumstances aren’t usually so extreme, the sensation of surrendered identity is a common reaction to medical intervention – as the bed-ridden speaker in Sylvia Plath’s “Tulips” describes:

I have given my name and my day-clothes up to the nurses
And my history to the an aesthetist and my body to surgeons.
They have propped my head between the pillow and the sheet-cuff

Like an eye between two white lids that will not shut.

This feeling is by no means the preserve of female writers. In 2006, in County Donegal, the Nobel laureate Seamus Heaney suffered a stroke that he wrote about in his most tender collection, Human Chain. In conversation with the Observer, he explained, “The trip in the ambulance I always remember because Marie [Heaney’s wife] was in the back with me . . . To me, that was one of the actual beauties of the stroke, that renewal of love in the ambulance. One of the strongest, sweetest memories I have.” In “Chanson d’Aventure”, he describes that same journey: here, the speaker’s sense of powerlessness is powerfully expressed in a series of passive verbs, as he finds himself

Strapped on, wheeled out, forklifted, locked
In position for the drive
Bone-shaken, bumped at speed

Later in the same poem, Heaney finds himself reflecting on the word bell:

. . . the one I tolled in Derry in my turn
As college bellman, the haul of it there still
In the heel of my once capable

Warm hand, hand that I could not feel you lift
And lag in yours throughout that journey
When it lay flop-heavy as a bellpull.

The merging of present and past that Heaney articulates here is another familiar feature of illness. In the midst of severe pain it is difficult to be anywhere except the present, but at times of injury or shock it is common for different time phases to merge.

Disease can open up unique perspectives for the sufferer and a surprising amount of the work that makes up our artistic canon has emerged from it – work that would otherwise never have existed. An obvious example is Paradise Lost, dictated by Milton after he had lost his sight completely.

More poignant still is the story of Mahler’s Ninth Symphony. In middle age, and shortly after the death of his young daughter, Mahler learned that his heart was defective. The first movement of the symphony opens with a tentative, syncopated rhythm that many, including Leonard Bernstein, have suggested echoes the composer’s irregular heartbeat. The motif returns seven times over the course of the movement until, at its climax, it arrives as a sudden intrusion, as Bernstein put it, of “death in the midst of life”. This time it is announced by trombones, underpinned by a booming bass drum and marked in the score mit höchster Gewalt (“with the greatest violence”) – as if death must finally have its say.

My latest poetry collection, The World’s Two Smallest Humans, concludes with an assertion of life – a sequence of poems based on the IVF treatment I received for fertility problems related to endometriosis. The sequence is fictional but the two smallest humans of the title are real enough: there is an extraordinary moment during the IVF process when the embryologist walks into the treatment room with your live embryos attached to the end of a pipette. In she walks, in a little scrub cap and tunic, looking more like a bakery worker than someone who is carrying in her latex-gloved hands the smallest human beings possible. Moments later, those same beings are transferred to the patient’s womb to do their best.

After three operations, my worst pain episodes are few and far between, but they still occur. The most recent happened a few months ago. The two-person ambulance crew that arrived at my cottage door in the dead of night was led by a woman called Jo, for whose professionalism and compassion I shall be eternally grateful.

Philip Larkin said of ambulances, “They come to rest at any kerb:/All streets in time are visited.” According to the poem, a journey in an ambulance signals the end, first of our identity and then our existence: such a trip, the poem concludes, “Brings closer what is left to come,/And dulls to distance all we are.”

That may be true but more often than not it is a temporary truth: Larkin’s poem wilfully disregards the possibility of recovery. In some ancient cultures there is a deity for illness, which strikes me as refreshingly clear sighted. If such a god existed for us today, I would be glad of the chance to offer up a prayer of thanks for the rich crop of art he has nurtured into being.

Julia Copus’s recent collection, “The World’s Two Smallest Humans”, was shortlisted for the T S Eliot Prize and the Costa Book Awards

This article first appeared in the 28 January 2013 issue of the New Statesman, After Chavez

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Fitter, dumber, more productive

How the craze for Apple Watches, Fitbits and other wearable tech devices revives the old and discredited science of behaviourism.

When Tim Cook unveiled the latest operating system for the Apple Watch in June, he described the product in a remarkable way. This is no longer just a wrist-mounted gadget for checking your email and social media notifications; it is now “the ultimate device for a healthy life”.

With the watch’s fitness-tracking and heart rate-sensor features to the fore, Cook explained how its Activity and Workout apps have been retooled to provide greater “motivation”. A new Breathe app encourages the user to take time out during the day for deep breathing sessions. Oh yes, this watch has an app that notifies you when it’s time to breathe. The paradox is that if you have zero motivation and don’t know when to breathe in the first place, you probably won’t survive long enough to buy an Apple Watch.

The watch and its marketing are emblematic of how the tech trend is moving beyond mere fitness tracking into what might one call quality-of-life tracking and algorithmic hacking of the quality of consciousness. A couple of years ago I road-tested a brainwave-sensing headband, called the Muse, which promises to help you quiet your mind and achieve “focus” by concentrating on your breathing as it provides aural feedback over earphones, in the form of the sound of wind at a beach. I found it turned me, for a while, into a kind of placid zombie with no useful “focus” at all.

A newer product even aims to hack sleep – that productivity wasteland, which, according to the art historian and essayist Jonathan Crary’s book 24/7: Late Capitalism and the Ends of Sleep, is an affront to the foundations of capitalism. So buy an “intelligent sleep mask” called the Neuroon to analyse the quality of your sleep at night and help you perform more productively come morning. “Knowledge is power!” it promises. “Sleep analytics gathers your body’s sleep data and uses it to help you sleep smarter!” (But isn’t one of the great things about sleep that, while you’re asleep, you are perfectly stupid?)

The Neuroon will also help you enjoy technologically assisted “power naps” during the day to combat “lack of energy”, “fatigue”, “mental exhaustion” and “insomnia”. When it comes to quality of sleep, of course, numerous studies suggest that late-night smartphone use is very bad, but if you can’t stop yourself using your phone, at least you can now connect it to a sleep-enhancing gadget.

So comes a brand new wave of devices that encourage users to outsource not only their basic bodily functions but – as with the Apple Watch’s emphasis on providing “motivation” – their very willpower.  These are thrillingly innovative technologies and yet, in the way they encourage us to think about ourselves, they implicitly revive an old and discarded school of ­thinking in psychology. Are we all neo-­behaviourists now?

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The school of behaviourism arose in the early 20th century out of a virtuous scientific caution. Experimenters wished to avoid anthropomorphising animals such as rats and pigeons by attributing to them mental capacities for belief, reasoning, and so forth. This kind of description seemed woolly and impossible to verify.

The behaviourists discovered that the actions of laboratory animals could, in effect, be predicted and guided by careful “conditioning”, involving stimulus and reinforcement. They then applied Ockham’s razor: there was no reason, they argued, to believe in elaborate mental equipment in a small mammal or bird; at bottom, all behaviour was just a response to external stimulus. The idea that a rat had a complex mentality was an unnecessary hypothesis and so could be discarded. The psychologist John B Watson declared in 1913 that behaviour, and behaviour alone, should be the whole subject matter of psychology: to project “psychical” attributes on to animals, he and his followers thought, was not permissible.

The problem with Ockham’s razor, though, is that sometimes it is difficult to know when to stop cutting. And so more radical behaviourists sought to apply the same lesson to human beings. What you and I think of as thinking was, for radical behaviourists such as the Yale psychologist Clark L Hull, just another pattern of conditioned reflexes. A human being was merely a more complex knot of stimulus responses than a pigeon. Once perfected, some scientists believed, behaviourist science would supply a reliable method to “predict and control” the behaviour of human beings, and thus all social problems would be overcome.

It was a kind of optimistic, progressive version of Nineteen Eighty-Four. But it fell sharply from favour after the 1960s, and the subsequent “cognitive revolution” in psychology emphasised the causal role of conscious thinking. What became cognitive behavioural therapy, for instance, owed its impressive clinical success to focusing on a person’s cognition – the thoughts and the beliefs that radical behaviourism treated as mythical. As CBT’s name suggests, however, it mixes cognitive strategies (analyse one’s thoughts in order to break destructive patterns) with behavioural techniques (act a certain way so as to affect one’s feelings). And the deliberate conditioning of behaviour is still a valuable technique outside the therapy room.

The effective “behavioural modification programme” first publicised by Weight Watchers in the 1970s is based on reinforcement and support techniques suggested by the behaviourist school. Recent research suggests that clever conditioning – associating the taking of a medicine with a certain smell – can boost the body’s immune response later when a patient detects the smell, even without a dose of medicine.

Radical behaviourism that denies a subject’s consciousness and agency, however, is now completely dead as a science. Yet it is being smuggled back into the mainstream by the latest life-enhancing gadgets from Silicon Valley. The difference is that, now, we are encouraged to outsource the “prediction and control” of our own behaviour not to a benign team of psychological experts, but to algorithms.

It begins with measurement and analysis of bodily data using wearable instruments such as Fitbit wristbands, the first wave of which came under the rubric of the “quantified self”. (The Victorian polymath and founder of eugenics, Francis Galton, asked: “When shall we have anthropometric laboratories, where a man may, when he pleases, get himself and his children weighed, measured, and rightly photographed, and have their bodily faculties tested by the best methods known to modern science?” He has his answer: one may now wear such laboratories about one’s person.) But simply recording and hoarding data is of limited use. To adapt what Marx said about philosophers: the sensors only interpret the body, in various ways; the point is to change it.

And the new technology offers to help with precisely that, offering such externally applied “motivation” as the Apple Watch. So the reasoning, striving mind is vacated (perhaps with the help of a mindfulness app) and usurped by a cybernetic system to optimise the organism’s functioning. Electronic stimulus produces a physiological response, as in the behaviourist laboratory. The human being herself just needs to get out of the way. The customer of such devices is merely an opaquely functioning machine to be tinkered with. The desired outputs can be invoked by the correct inputs from a technological prosthesis. Our physical behaviour and even our moods are manipulated by algorithmic number-crunching in corporate data farms, and, as a result, we may dream of becoming fitter, happier and more productive.

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The broad current of behaviourism was not homogeneous in its theories, and nor are its modern technological avatars. The physiologist Ivan Pavlov induced dogs to salivate at the sound of a bell, which they had learned to associate with food. Here, stimulus (the bell) produces an involuntary response (salivation). This is called “classical conditioning”, and it is advertised as the scientific mechanism behind a new device called the Pavlok, a wristband that delivers mild electric shocks to the user in order, so it promises, to help break bad habits such as overeating or smoking.

The explicit behaviourist-revival sell here is interesting, though it is arguably predicated on the wrong kind of conditioning. In classical conditioning, the stimulus evokes the response; but the Pavlok’s painful electric shock is a stimulus that comes after a (voluntary) action. This is what the psychologist who became the best-known behaviourist theoretician, B F Skinner, called “operant conditioning”.

By associating certain actions with positive or negative reinforcement, an animal is led to change its behaviour. The user of a Pavlok treats herself, too, just like an animal, helplessly suffering the gadget’s painful negative reinforcement. “Pavlok associates a mild zap with your bad habit,” its marketing material promises, “training your brain to stop liking the habit.” The use of the word “brain” instead of “mind” here is revealing. The Pavlok user is encouraged to bypass her reflective faculties and perform pain-led conditioning directly on her grey matter, in order to get from it the behaviour that she prefers. And so modern behaviourist technologies act as though the cognitive revolution in psychology never happened, encouraging us to believe that thinking just gets in the way.

Technologically assisted attempts to defeat weakness of will or concentration are not new. In 1925 the inventor Hugo Gernsback announced, in the pages of his magazine Science and Invention, an invention called the Isolator. It was a metal, full-face hood, somewhat like a diving helmet, connected by a rubber hose to an oxygen tank. The Isolator, too, was designed to defeat distractions and assist mental focus.

The problem with modern life, Gernsback wrote, was that the ringing of a telephone or a doorbell “is sufficient, in nearly all cases, to stop the flow of thoughts”. Inside the Isolator, however, sounds are muffled, and the small eyeholes prevent you from seeing anything except what is directly in front of you. Gernsback provided a salutary photograph of himself wearing the Isolator while sitting at his desk, looking like one of the Cybermen from Doctor Who. “The author at work in his private study aided by the Isolator,” the caption reads. “Outside noises being eliminated, the worker can concentrate with ease upon the subject at hand.”

Modern anti-distraction tools such as computer software that disables your internet connection, or word processors that imitate an old-fashioned DOS screen, with nothing but green text on a black background, as well as the brain-measuring Muse headband – these are just the latest versions of what seems an age-old desire for technologically imposed calm. But what do we lose if we come to rely on such gadgets, unable to impose calm on ourselves? What do we become when we need machines to motivate us?

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It was B F Skinner who supplied what became the paradigmatic image of ­behaviourist science with his “Skinner Box”, formally known as an “operant conditioning chamber”. Skinner Boxes come in different flavours but a classic example is a box with an electrified floor and two levers. A rat is trapped in the box and must press the correct lever when a certain light comes on. If the rat gets it right, food is delivered. If the rat presses the wrong lever, it receives a painful electric shock through the booby-trapped floor. The rat soon learns to press the right lever all the time. But if the levers’ functions are changed unpredictably by the experimenters, the rat becomes confused, withdrawn and depressed.

Skinner Boxes have been used with success not only on rats but on birds and primates, too. So what, after all, are we doing if we sign up to technologically enhanced self-improvement through gadgets and apps? As we manipulate our screens for ­reassurance and encouragement, or wince at a painful failure to be better today than we were yesterday, we are treating ourselves similarly as objects to be improved through operant conditioning. We are climbing willingly into a virtual Skinner Box.

As Carl Cederström and André Spicer point out in their book The Wellness Syndrome, published last year: “Surrendering to an authoritarian agency, which is not just telling you what to do, but also handing out rewards and punishments to shape your behaviour more effectively, seems like undermining your own agency and autonomy.” What’s worse is that, increasingly, we will have no choice in the matter anyway. Gernsback’s Isolator was explicitly designed to improve the concentration of the “worker”, and so are its digital-age descendants. Corporate employee “wellness” programmes increasingly encourage or even mandate the use of fitness trackers and other behavioural gadgets in order to ensure an ideally efficient and compliant workforce.

There are many political reasons to resist the pitiless transfer of responsibility for well-being on to the individual in this way. And, in such cases, it is important to point out that the new idea is a repackaging of a controversial old idea, because that challenges its proponents to defend it explicitly. The Apple Watch and its cousins promise an utterly novel form of technologically enhanced self-mastery. But it is also merely the latest way in which modernity invites us to perform operant conditioning on ourselves, to cleanse away anxiety and dissatisfaction and become more streamlined citizen-consumers. Perhaps we will decide, after all, that tech-powered behaviourism is good. But we should know what we are arguing about. The rethinking should take place out in the open.

In 1987, three years before he died, B F Skinner published a scholarly paper entitled Whatever Happened to Psychology as the Science of Behaviour?, reiterating his now-unfashionable arguments against psychological talk about states of mind. For him, the “prediction and control” of behaviour was not merely a theoretical preference; it was a necessity for global social justice. “To feed the hungry and clothe the naked are ­remedial acts,” he wrote. “We can easily see what is wrong and what needs to be done. It is much harder to see and do something about the fact that world agriculture must feed and clothe billions of people, most of them yet unborn. It is not enough to advise people how to behave in ways that will make a future possible; they must be given effective reasons for behaving in those ways, and that means effective contingencies of reinforcement now.” In other words, mere arguments won’t equip the world to support an increasing population; strategies of behavioural control must be designed for the good of all.

Arguably, this authoritarian strand of behaviourist thinking is what morphed into the subtly reinforcing “choice architecture” of nudge politics, which seeks gently to compel citizens to do the right thing (eat healthy foods, sign up for pension plans) by altering the ways in which such alternatives are presented.

By contrast, the Apple Watch, the Pavlok and their ilk revive a behaviourism evacuated of all social concern and designed solely to optimise the individual customer. By ­using such devices, we voluntarily offer ourselves up to a denial of our voluntary selves, becoming atomised lab rats, to be manipulated electronically through the corporate cloud. It is perhaps no surprise that when the founder of American behaviourism, John B Watson, left academia in 1920, he went into a field that would come to profit very handsomely indeed from his skills of manipulation – advertising. Today’s neo-behaviourist technologies promise to usher in a world that is one giant Skinner Box in its own right: a world where thinking just gets in the way, and we all mechanically press levers for food pellets.

This article first appeared in the 18 August 2016 issue of the New Statesman, Corbyn’s revenge