Mind Over Machine
This article originally appeared in the August 2017 issue of FOCUS magazine.
We now live in a digital age: a treasure chest of useful information has been opened to us. Computers have dramatically changed the practice of medicine and as physicians we need to adapt and embrace aspects of this change. However, as philosopher Neil Postman says, “Technology giveth and technology taketh away.” This treasure chest of information can often be a Pandora’s box of confusion and error. Also, if “the medium is the message”, then how is the medium changing us as we increasingly rely on it? Is this change to be completely accepted? What exactly are we losing by relying more on computers and the internet as physicians, patients, and generally as members of society?
We are certainly gaining a whole lot of information. In this age of information, physician and patient have access to a huge amount of data – some of it good, well researched and current, some pure fiction, and everything in between. In fact, patients now have access to most, if not all, of the information that physicians do. So why do patients and physicians come to a different understanding of what that information means? Some of this we can blame on unscientific, poor quality data. Yet, even when a patient has access to Dr. Google’s best, it is surprising how often there can be a difference of opinion with the physician. Information is critical to understanding, yet there is something in addition which makes a physician. It is the purpose of this article to describe what that something is, and show why it is important to both medicine and faith that we understand it correctly.
How is it that a physician makes a correct diagnosis? Undoubtedly, having a lot of information on various disease states is important. The vast amount of information that needs to be absorbed in medical school, residency and beyond can be overwhelming. Could a computer be programmed to take over the job? Perhaps there is a decision tree analysis that could be used for every constellation of symptoms that could remove the subjective bias of the diagnostician. This would then, in theory, make the diagnosis more certain. As the surgeon and author Atul Gawande has pointed out in the book Complications: “Medicine’s ground state is uncertainty. And wisdom – for both patients and doctors – is defined by how one copes with it.” (Atul Gawande, ““Complications: A Surgeon’s Notes on an Imperfect Science” in Medical Liability and Treatment Relationships, eds. Mark A. Hall & Mary Anne Bobinsky (Wolters Kluwer Law & Business: 2014). In making a diagnosis there is an element of logic at play, and we could in theory benefit from our mental powers being formulated and systematized by a machine. Is this the wisdom we are looking for: eliminating the merely intuitive element in medicine? Are we basically flawed machines, in need of more data and logic? Just input the data, and out comes the diagnosis and treatment.
Philosophers of the mind are divided on how much the mind resembles a computer. Certainly, the current trend is to think of the mind as some sort of incredibly complex machine, inspiring much philosophical and scientific debate and interesting science fiction. Although this is a controversial area, I do not agree that a computer “thinks” or even that it has been programmed to “think”. Deep Blue may have been programmed to beat a grandmaster, but it did not even know it was playing chess. In fact, it did not “know” at all! A computer algorithm follows rules which programmers decide are good to follow; they systematize certain aspects of human thought process. However, there is an organic, intuitive aspect of intelligence that is not so much a logical deduction as the grasping of a relation or an integration of parts into a whole, which we experience at the moment of an insight.
Most of the foundational knowledge we have is tacit, implicit, ingrained into the habitual texture of our minds. In coming to an understanding, we do not focus on the knowledge we have, so much as rely on it to focus on what we do not yet know. As the philosopher of science Michael Polanyi has demonstrated, in solving a problem we do not focus on the details focally so much as subsidiarily. We “indwell” the particulars of a problem while our attention is focused on the new insight lying “beyond” the data. Think of the way we read a book. When we read, we do not normally focus on each word in the sentence, but instead we rely on the word and look beyond the word to its meaning within the sentence. We could focus on a word, and lose the train of thought that the sentence was evoking in us. Polanyi in the book Personal Knowledge describes this phenomenon:
My correspondence arrives at my breakfast table in various languages, but my son understands only English. Having just finished reading a letter I may wish to pass it on to him, but must check myself and look again to see in what language it was written. I am vividly aware of the meaning conveyed by the letter, yet know nothing whatever of its words. I have attended to them closely but only for what they mean and not for what they are as objects. If my understanding of the text were halting, or its expressions or its spelling were faulty, its words would arrest my attention. They would become slightly opaque and prevent my thought from passing through them unhindered to the things they signify. (Michael Polanyi, Personal Knowledge (Routledge: 2012), pg 59)
Just as we go beyond the word as object to its meaning in the sentence, an insight is not a logical deduction within a particular system of thought, but involves crossing a logical gap, which is a miraculous achievement of the mind: a “leap of faith” in the midst of reason. This is a skill which is not reproducible by any deterministic machine. Furthermore, the particular insights which we discover are made more likely in minds steeped in a particular tradition, such as the tradition of medicine, which becomes part of who we are – a part of the subject of consciousness, the tacit or implicit not the focal or explicit: that which we rely on for engaging the world.
In medical school, there is certainly a focus on amassing vast amounts of information – what philosophers call propositional knowledge. True learning involves taking that knowledge and making it our own. This involves integrating what we learn into a meaningful whole, seeing the point, grasping the relations between merely given data. The real test that a learner has grasped a concept is that they can take that concept and transfer it into another context: another patient, another situation. It is theirs. It becomes a part of them as if a part of their body – they don’t even normally notice they have this knowledge, they are too busy relying on it tacitly to find new patterns, seek new insights, courageously charge into the unknown.
Let us assume then, that the mind does not resemble a computer: some would say so much the worse for the mind! They would suggest we should strive to be less like Dr. McCoy, and more like Mr. Spock. Yet, there is a type of knowledge that resides primarily in the body, and it is difficult if not impossible to translate this knowledge into propositional form and submit it to logic. As an example, think of a child learning to ride a bicycle. Once he grasps the practical insight into how to shift his weight to balance he gets it – the type of knowledge felt in the body. If we were to tell a child that “for a given angle of unbalance the curvature of each turn is inversely proportional to the square of the speed at which you are moving” … that would not be very helpful! Certainly, there are encouragements and hints we can give, but nothing replaces the practicing (and falling) which we all need to get through until we get it. Even were we to completely understand the physics behind riding a bicycle, this doesn’t mean we can ride a bicycle! “Know how” is not the same as “know what” or “know why”.
Learning to be a doctor involves much know how that cannot be completely formalized, such as properly reading a chest x-ray. A physician can program a computer to “notice” the patterns that they tell it are important to notice in order to systematize the process, but the root of this noticing grows by first looking at chest x-rays with teachers, and then looking at a lot of chest x-rays and making mistakes, until finding even a tiny pneumothorax can be quite straightforward. With every chest x-ray we read, in our minds there are the thousand x-rays which have come before, which are present with us, a part of who we are. Knowledge is transformation, not just information. I like to think of pattern recognition software as a fancy pair of glasses: they have been designed by a human mind to help us to see things better, but it is not the glasses that see.
The philosopher Herbert Dreyfus provides a concise summary of why computers will never “think” the way that people do:
There is now general agreement that . . . intelligence requires understanding, and understanding requires giving the computer the background of common sense that adult human beings have by virtue of having bodies, interacting skillfully in the material world, and being trained into a culture. (Herbert Dreyfus, What Computers Still Can’t Do: A Critique of Artificial Reason, (MIT Press: 1992) pg. 3)
To most in the Protestant faith community, one is defined as a Christian by the propositions which one believes. For example, that Jesus Christ is divine, that he died for our sins, and that we are justified by faith in his atoning work on the cross. (Of course, it must be said that how we are to understand some of these beliefs is hotly contested!) Certainly, our faith includes assenting to doctrines, and it is good to be clear about what it is that one believes. The history of the Reformation shows that the Protestant church is deeply concerned with repudiating the superstitious practices of medieval Christianity and placing faith solidly in the word of God. Yet, when faith is defined solely by assent to propositions, rather than being foundationally rooted in a way of life whose very possibility is drawn from a deep identification with the crucified, risen and ascended Christ, we risk losing much of the richness and depth of what it means to follow Jesus in the world.
In a recent article in Comment Magazine, Canadian philosopher James K. A. Smith comments: “While never intended as such, you can see how this thinning out of Christianity from an embodied, sacramental way of life to a mere set of beliefs can then slide into a mere identity, sort of a badge of belief one wears to claim affiliation with a team.” (James K. A. Smith, “Our Protestant Problem”, Comment Magazine https://www.cardus.ca/comment/article/4873/world-view/.)
It is this thinning out of Christianity which I contend is leading to a loss of mission in the world. We are losing our saltiness, and then complain when the Church is being trampled underfoot (Matt 5:13).
What if we understand faith not so much as a set of propositions to be believed, but as a way of life based on an identification with the person of Jesus Christ? In other words, faith as a know-how based on a know-who, rather than a know-what! Or, faith as transformation not just information! What if we saw God not as an object of thought out there to be systematized and proved, but as the one from whom we draw our very sense of self, whom we rely on to know anything at all? I contend that this has far reaching implications both for how we understand our faith and how we live it out: theology and mission.
I began this piece by discussing how the practice of medicine is being shaped by the digital age, and have tried to show why a computer can never replace a person as physician. To do this, I drew out the importance of the tacit powers of a mind steeped in the tradition of medicine. I then went on to describe the issues with a potentially fault Christian epistemology (theory of knowledge); therefore, instead of seeing faith as merely propositional knowledge, we should also see faith as lived knowledge – a know-how, which has as its foundation a tradition marked by its identification with the death and resurrection of Christ. To be a Christian is to be a follower of Jesus Christ, identifying in his death and resurrection, in a sense “dwelling in” this reality to affect how one sees the world. As C.S. Lewis said: “I believe in Christianity as I believe that the sun has risen: not only because I see it, but because by it I see everything else.” (C.S. Lewis, “They Asked For A Paper,” in Is Theology Poetry? (London: Geoffrey Bless, 1962) pg. 165.)
Have you reached the understanding I have been striving to evoke in you? Have you found the intelligible pattern in what I am saying? Has this article become a unified whole, not just a collection of unrelated rantings? Furthermore, if you get it, and judge it to be true (another personal insight which cannot be systematized I might add), then how should that affect both how you learn and practice medicine, and how you understand and practice your faith? Perhaps you understand what I’m saying but disagree, because you have further questions that need answers: questions that I’ve avoided. As you seek out the truth, my contention is that you will be trusting mental abilities immersed in a particular tradition, which arise before and go beyond a hollow deductive logic. It is by relying on these faculties of the mind that philosophers reject those same faculties, and subscribe to mere mechanistic determinism or empty empiricism. Yet it is here that faith and reason collide, and ultimately the exigence of the human spirit demands that we say, together with Luther: “Here I stand, I cannot do otherwise.”