European School of Governance, position paper #101 by Jochen Büchel.
In this era of Big Data, there is an increasing demand for technologies to monitor and evaluate complex and chronic diseases of patients, as well as those who are seeking to stay healthy.
The fervent drive by health market innovators to digitalize as many body-related signals as possible neglects the widespread work and progress being made by the humanities to improve healthcare and wellbeing through a deeper understanding of the complexity of human body and soul relations.
At such a time it is even more important that we create bridges of understanding and synergetic work between the arts and humanities and the life sciences. Big Data-oriented medicine doesn’t have enough individualized tools and time to become aware of the many complex and interactive dimensions that influence a person’s wellbeing, and therefore can`t characterize illnesses and states of health or emotions.
Systems, or 4P (Predictive, Participatory, Preventive and Personalised) Medicine aims to develop techniques to translate and validate huge amounts of data with the help of so-called -omics measuring method. These efforts go far and are important.
However, more can be done to strengthen and improve the bridges of understanding and synergetic work between the arts and humanities and the biological and technological sciences. Some of the more exciting efforts can be found in trends on the front edges of museums, cinema and this work that point to the high potential in this intersection for crossing the barriers between the cultures of bioinformatics, clinical medicine, the arts, and patient`s needs.
Insights from imagery: A lively map
Images and diagrams offer innovative and contemporary forms of holistic insight into the patient as a cultural being. The development of new symbolic methods will provide molecular-oriented approaches a bridge to understand the cultural dimensions of patients’ needs.
For example, efforts to monitor the resonances of the different scales of human body directly connects the use of images, diagrams and graphics to alternative or ancient knowledge and approaches to health and medicine from diverse cultures like Paracelsism in Europe or Chinese medicine. This connection also helps increase the quality of therapist- patient interaction.
The sociological concept of agency provides a new frame for understanding organismic processes and challenges the mechanistic medical concept of causality. Agency stresses the interactive aspects of all effects. In a holistic sense, all processes are seen as communication – as exchanges of information. However, we have to learn to see them not just in data packages but by using them to create a lively map that shows the relation of the organisms’ different scales and their environments.
Biochemistry provides the vocabulary to assist molecular medicine in developing a cultural understanding of patients´ needs. Therapists and researchers need to apply methods that draw from ancient knowledge, sociology, agency-oriented image analysis, and future-oriented medical history for dialogues, advanced education and creative collaboration.
Along with Big Data, a cultural and holistic approach to health requires that the complex Organism-Environment Interaction has to be represented and mapped in a biographic-narrative and innovative way in order to contribute the benefit of the patient’s needs.
Using aesthetic methods
Interactions, information, and communication can give us more than data or feedback about our physical, emotional, and social wellbeing or disease – if we learn to decipher their relational codes. There are two broad concepts and categories of tools that can be used to develop cultural-based insights that would be useful for clinical experts and patients: Arts-based monitoring and Dynamic-Systems Theory for medical needs.
Arts-based monitoring includes images, videos, virtual reality, augmented reality, personalized sound, and more. To improve top-down approaches, these are used to improve narration typologies of and for the patient.
Applied aesthetic methods that draw from the humanities, such as Video-Reflexive Ethnography, bring about innovative changes to medical practices in hospitals, enhancing therapist-patient communication and care.
There is an opportunity to apply VRE to molecular medicine. It can be even used to generate manageable implicit knowledge which is crucial to make use of the subtle therapist – patient communications. Particularly the zooming in – zooming out tool should be added to analyse graphics in a way allowing the monitoring psychological aspects in an unknown way. The research group “Picture act and Embodiment (Humboldt University Berlin)” has pioneered studies with VRE and is planning to start a project cooperation between Steinbeis Institute Berlin and Zentral Institute of Kunstgeschichte München.
One of the first highly personalized and successful efforts to combine digital and aesthetic tools is the Synergetic Navigation System developed by Günter Schiepek from the psychiatric and psychotherapeutic department at Paracelsus Medical University Salzburg. This Internet-based tool for monitoring several essential internal psychic states is able to combine years of successful psychotherapeutic experience with the expertise of chaos research for mapping dynamical changes in the so-called Synergetic.
This Navigation System also offers a personalized Idiographic Systems modeling deriving from a long talk between therapist and patient and uses afterwards 7 diagrams types to illustrate or map the changes of different parameters of mental states of the patient during the time after the patient left the hospital and thus telemedicine begins.
In the development of these instruments that will gather data in a way to monitor and reflect personalities, it is important to consider field-oriented and holistic tools, drawing from the concept of agency from Actor Network Theory (ANT), as well as microcosmic graphics, in addition to Kurt Lewin’s ideas and Gestalt-Theories. We can learn much from media-oriented expositions like the Globale series (Exo-Evolution, New Sensorium and Infosphere from ZKM Karlsruhe) to develop new cultural perspectives on understanding causalities and dynamics in complex illnesses like cancer and psychic blockades.
Trendspotting: The cutting edge of art, medicine, and technology
The most important developments to cultural and holistic approaches to monitoring, sustaining, treating and understanding health and patient care are being developed within the innovative intersection between the arts, medicine, technology, and culture.
For example, the exhibition, “TheThinking Machine: Ramon Llull <<ars combinatoria>>”, began at CCCB Barcelona 2016 and explored the impact of the visionary – and controversial — 13th century philosopher Ramon Llull on the arts, literature, science and technology. The exhibition provides insights into Llull’s thinking and his astoundingly futuristic ars combinatoria, the method of knowledge that Llull invented to establish a complex model of reality that linked all the branches of knowledge and viewed the world as a vast web.
Llull lived 200 years before da Vinci and is considered by some to be the predecessor of computational logics and tools and probably with this are compendious medicine even biomathematics. What more can be mined and combined with artificial intelligence, visual technologies, and more to become newly applicable in the 21st century to enhance our holistic, cultural and scientific understandings of health, disease, the person, and society?
Process-revealing visualization methods are needed for integrating translational, systems, and holistic medicine. This is new to most medical research debates, and will, as a first aim, improve validation of experimental data and its relation to the therapist. To extend the perspective of database-oriented molecular medicine, the design of patient-oriented diagnostic environments should integrate virtual and augmented reality to combine digital and aesthetic tools in medical methods.