Plenary address – A year of living ‘dangerously’: Reflections on risk, trust, trauma and change

Emotion, Space and Society 18 (2016) 28e34

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Plenary address e A year of living ‘dangerously’: Reflections on risk, trust, trauma and change Joyce Davidson Department of Geography, Queen's University, Kingston, K7L 3N6 Canada

a r t i c l e i n f o

a b s t r a c t

Article history: Received 29 July 2015 Accepted 3 January 2016 Available online xxx

This paper examines the role of emotions in the construction and performance of mis/trustful relations; with medical professionals, their technologies, and ultimately, with oneself. Using personal experience of two common conditions as illustrative examples, it questions what it means and feels like to trust, and how, where and by whom such feelings can be enhanced or undermined. It explores some of the ways in which discourses of risk are mobilized and embodied to create a crisis of trust, asking; what kind of selves and emotionalities surface, and what are the health outcomes, when bodies are viewed as ‘at risk’? Visualizing technologies that probe the interior for data play an increasingly prominent role in healthcare, and are typically considered more trustworthy sources of knowledge about the body than anything that might be produced by the tech-free sensing self. However, not all (even ‘physical’) trauma can be seen or quantified, and not all information is equal. The paper reflects on the emotional dissonance that ensues when one's own perceptions and representations are at odds with those of medical experts for whom one is supposed to perform trust. It examines the feeling rules that are broken when we fail to appreciate our treatment at their hands, and asks: What happens when we resist expert author-ity by telling different stories about our embodied selves, ones that make space for emotions in contexts where they are rarely seen to count, and where only what can be measured matters? © 2016 Elsevier Ltd. All rights reserved.

Keywords: Concussion Medical technologies Multiple pregnancy Quantification Quantified self

Introduction In this paper, I draw on personal experience of a couple of fairly common health conditions encountered during my 42nd year to try and think about the conceptualization and embodiment of risk, and to a greater extent, trust. In particular, I want to question what it means and what it feels like to trust, and in what ways e for example, why, and where, and by whom e those feelings of trust might be built upon, or broken to produce a crisis of trust, in oneself and/or one's health care providers. I'll look at the kind of selves that are produced and performed as a result of such processes, and the associated emotions and feelings (as in bodily sensations) that may, or may not, constitute trustworthy sources of knowledge about our health and wellbeing. How do our own perceptions hold up when pitched against alternative informants, especially medical professionals, aided by imaging and other technological sources of insight? Contemporary medical practice tends to diagnose and display health information in ways that digitize bodies, and this has

E-mail address: [email protected]. http://dx.doi.org/10.1016/j.emospa.2016.01.002 1755-4586/© 2016 Elsevier Ltd. All rights reserved.

potentially significant consequences for emotional life, especially if we ourselves look to and even rely on such measures of our own health and worth. The two concepts are so often closely associated, and in this paper, I worry about the implications of these connections and developments for selves as forever fragile achievements. I want to suggest that increasing clinical tendencies to rely on data and ‘trust the numbers’ over the nuances of our own insight have a disturbingly logical extension in the Quantified Self Movement that views selves simply as ‘data emitting machines.’ In discussing my concerns, I'll be thinking through boundaries of various kinds, including those frequently placed between physical and emotional sources of trauma, and between visible and invisible health challenges and indicators. The distinctions between what can be seen and what can be felt can have profound implications for our experience and ‘treatment’, both clinically and culturally, and in my own case, can highlight discrepancies between theory and practice of emotional life. I've used autobiographical methods a lot in the past to think about other people's emotional lives (e.g. Davidson and Smith, 2009). However, I've never drawn explicitly on my own experience in anything I've written before, and I hope that some of the

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insights that emerge in what follows will have broader relevance for at least some of those working through emotional geographies, professionally as well as personally. Event horizon #1: on being concussed In attempts to write about what's happened over the last year, I've come to think of the significant moments in terms of ‘event horizons’, as involvements with something so massive, that no aspect of the life that surrounds the encounter can possibly escape its pull. The first point of no return came in the form of a concussion. It's a fairly pedestrian story e I wasn't engaging in any highrisk behaviour at the time e I just slipped, and lost consciousness, standing beside my car. It was just me and my daughter, January in Ontario, so minus 20 odd with wind-chill, and we live well out of town at a distance from potentially helpful neighbours. So I was out cold (pardon the pun) for I don't know how long, and came round to awareness of the world with my four year old asking, ‘why won't you get up?’ I spent more time than was healthy during the months of recovery that followed wondering what would have happened to her if I hadn't been able to get myself off the ground, but, in that moment, I thought I was okay, that I'd had a lucky escape. I wasn't even aware that I had lost consciousness, because however trustworthy we believe our own senses to be, it turns out they're not all that informative about an absence of input. To know you've been gone, you need to be able to recognize some change in your surroundings to indicate the passage of time, or have testimony from an observer,1 who's preferably more than four. Although I knew that I'd hit my head, hard, because it hurt like hell, and there was sound and light of a kind I'd never experienced before, I didn't recognize this as a sign that I'd lost touch with the world, and it was only later that others' questions brought the discontinuity to light, between my daughter's playing in a mound of snow before I went down, and being right by my side what seemed like a split second later. When I picked myself up, I felt a bit thrown, but I couldn't really see a problem with driving in for my intro-geography lecture. I called a friend for reassurance that I wasn't about to do anything crazy, but clearly, I was, and she was fairly persuasive about the need to get back into the house and cancel the lecture. My partner came home and took me to the hospital, which I thought was probably a waste of time, and it felt like the doctor thought so too. The examination was very brief. He checked for lumps and signs of bleeding, and did a few quick tests of cognitive function and eye movement, before saying I was fine, but should probably take the rest of the day off just in case. He said it wouldn't be a bad idea to avoid reading or watching television over the weekend e this happened on a Friday e but that I'd be good to go back to work as usual on Monday. This seemed reasonable, because I felt okay, though maybe a bit detached; I remember being only mildly concerned when I found myself standing right behind a car that was obviously about to reverse out of the hospital car park. I was holding my daughter's hand, and though I'd seen the driver get into the car and there was only one way for it to go, it didn't occur to me that we should move out of his way. I didn't feel any danger, or even any real sense of alarm about the signs I'd failed to interpret, but kind of knew, intellectually, that enough was out of the ordinary here about how I was thinking and feeling to suggest that my partner should keep an extra eye on our daughter. I did rest up for a couple of days, and felt like a bit of a slacker, so

1 Niall Smith (2013) offers valuable insights into the disturbing necessity of witness testimony in another context, involving epileptic seizure.

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went back to work on Monday as recommended. The headaches were pretty bad, but just about manageable with over the counter pain meds, and although I knew I was more tired than usual, I had been given the all clear, so just started going to bed a bit earlier, and then earlier, and earlier. For the next few weeks, I was aware that things were getting worse rather than better, and I was feeling overwhelmed, eventually doing very little beyond teaching my classes and going home to sleep until I had to get up and do the next one. I was having increasingly severe headaches too along with bone-crushing fatigue, and it was becoming unavoidably obvious that I had seriously reduced cognitive capacity. Which was a bit scary, to say the least. I started reducing the time I spent in front of the computer, because it hurt, and kept cutting back until I couldn't do 5 min worth of email without having to shut the curtains and crawl into bed. I was even struggling with hard copy readings for my grad class, and at this stage, had to start letting people know that I wasn't coping, and trying to come up with strategies to get me through the term. I asked my doctor for a note to legitimize a request for help, mostly with the online aspects of a course with 350 students. Accommodations were never formalized, and I looked for support in other ways, arranging guest lectures, and asking for extra time for journal reviews and so on. I used the phone rather than email whenever possible, and got used to explaining that I wasn't feeling great, and might have to leave meetings early, then letting colleagues know that I might have to avoid eye contact in meetings, and eventually, keep my eyes closed completely, because I couldn't deal with the sensory input. I'd started having bouts of vertigo too, and all of my social and spatial interactions were seriously messed up. The first doctor I saw after the initial hospital visit was sympathetic, but there was obviously nothing to see, and no offer of insight or follow up. I did go looking for help again, seeing different docs, sometimes in walk-in clinics when I was feeling desperate, and what was on offer were stronger painkillers. During one appointment I was told that I really should have recovered by now, and the fact that I hadn't suggested I must have suffered another concussion in the past. I supposed this was possible, maybe something that hadn't been noted as a child, but I didn't really think so, and it all contributed to the sense that I wasn't doing recovery quite right. In fact I kept getting it very wrong, staying in bed for a couple of days and thinking this time I'm all better, finally, only to find myself back where I started or worse, sometimes within minutes of beginning the performance of normality. I made it through two and a half months in this way, with a daily dismantling of trust in my judgement about my ability to do or be anything e there was less and less of the social and spatial selfmaking stuff I was used to going on every day e and on the last day of the teaching term, I pretty much collapsed, finally getting a referral for a concussion specialist who ordered immediate, complete and indefinite medical leave, along with an MRI scan. This was the first and only attempt to get beneath the surface in an attempt to see and measure the extent of this invisible disability; and I welcomed the intrusion. I was told, though, that concussion diagnoses were controversial. Scans were typically clear or inconclusive; when they didn't show anything, it meant that damage to the brain wasn't visible, not that it wasn't there, and where trauma was apparent, it wasn't always clear what it meant.2 In any case, it

2 My own research hasn't provided a great deal of enlightenment about many aspects of concussion. Further, although there has been much talk in recent years of a ‘concussion crisis’ or ‘epidemic’ (Ventresca, 2014), I have found surprisingly little social science research on the subject beyond the context of sports injuries (e.g., McGannon et al., 2013).

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seemed that therapeutic intervention was highly unlikely: I guess I'd hoped for more. From my admittedly sketchy sense of the theoretical landscape, I'd been taken to understand that we live in a ‘neurological age’, one populated by ‘synaptic’ or ‘neurochemical’ selves3; visualizing the brain and bringing its secrets to light has long seemed the next big thing, and neuroscientists like Antonio Damasio (1999, 2010) and Joseph LeDoux (2003) very publicly claim authority to solve brain mysteries of both a physical and emotional nature. More popular media accounts also blur Cartesian lines between material and mental trauma, and I'd been aware of local reports about the Royal Ottawa Mental Health Centre's attempts to acquire an MRI, dubbed the ‘mental health scanner’4 for its alleged ability to diagnose mental illness ‘objectively’, and then track whether and how drug therapies were working. Sociologist, Marit Solbjør (2008: 59) writes of medical imaging that: ‘As a culture, we place a great deal of trust in visual modes of representation, seen as instruments of truth and objectivity’, and although explicitly aligned with more critical approaches, like the neurosociology of Nikolas Rose (e.g., Rose and Abi-Rached, 2013), I was obviously not immune to such scientistic attractions. Apparently, it was the forbidden theoretical fruit that I craved; a kind of re-definition through supposedly ‘objective’ confirmation of my injury. Of course the scan revealed nothing, but I did obtain something valuable from the process, in the form of professional permission to do what I should have been doing from day one; i.e., nothing at all. While the scope of my involvement with the world beyond my home had been shrinking for some time, it was now at an absolute minimum. I only went out for the couple of concussion clinic appointments that were offered, had no email and minimal phone contact with anyone, and withdrew from all work commitments, initially for the next month. My days were spent travelling between my bed and a warm bath, filled with endless cups of herbal tea and very little else e no books, no DVDs, no running, no alcohol, nothing but staring out the window for hours at a time, feeling still and stolid, watching the green mist of spring spread through the garden, too depleted to go out and take part. And then I got pregnant. Event horizon #2: on being plural So, it's the month of May, 2014, I'm still 42, but apart from the concussion I'm healthy, and I'm happy about the pregnancy. Unlike the concussion, this was familiar territory and I felt like I could trust my body to know what it was doing. The docs I saw for this condition though were predictably less laissez faire, and in fact thoroughly interventionist from day one when an ultrasound was ordered, ostensibly to establish a due date. I didn't really think this was necessary e I could feel that I was pregnant in so many ways and wasn't looking for more objective confirmation e but I went along because … it was offered. I suppose I welcomed the attention in the beginning, and I guess I was curious. On the day, just a minute or so into the process, the sonographer pointed out the presence of not one but two embryos: To call it a shock doesn't begin to cover it. But, I still found myself happy e bewildered but happy e even when the sonographer stressed that twin pregnancy would involve at least twice the number of medical appointments, tests and scans, and carried at least twice the risk of complications, risks that were not exactly negligible given my age.

3 The BBC Radio 4 series ‘A History of the Brain’ provides fascinating insights into the impact of contemporary neuroscience on popular culture (Bunn, 2014). 4 http://www.cbc.ca/news/canada/ottawa/royal-gets-1m-donation-towardsmental-health-scanner-1.1254609.

(I did eventually ask him to just stop talking, but he was mostly helpful.) And so, at only six weeks, with embryos the size of lentils, my pregnancy was labelled ‘high risk’ e no travel insurance, for starters e and from that point on, my care was to be handled not by family doctor or midwife, but by high risk obstetrician gynecologist, during bi-weekly, then weekly hospital visits that took a couple of hours out of my day. I also had separate appointments for weekly tests to measure the free copper in my bloodstream because of one doc's new research obsession, and the constantly fluctuating results were used to recalculate the amount of zinc I should take on a daily basis to neutralize the copper that apparently put my pregnancy at exceptionally high risk. Ultrasounds were frequent too and could last up to 90 min, and although I welcomed some of the associated testing, I wasn't convinced the amount of imaging was strictly necessary.5 I know I sound a bit fickle here, given my stance on concussion care, but it seemed that everyone wanted to see so much more of this precious cargo than the one in my head, and it began to feel more like surveillance than care, of my life and theirs. It seemed though, that I was expected to enjoy all the increased attention, and sonographers invariably assumed I'd want lots of pictures, and to ‘see’ the babies as often, for as long, and in as much detail as possible. Of course you're not actually ‘seeing’ anything but a representation reconstructed from sound waves, and I usually wanted the process over as quickly as possible. More than once, though, I felt dismissed and maybe even ridiculed for my feeling that the babies didn't like the noisy intrusion into their personal space. These concerns were judged unreasonable e there was no supporting evidence after all e and sonographers insisted the fetuses were entirely oblivious, insensible to any changes in their environment. To suggest that they cared, that they had anything approaching an emotional life was surely laughable. Maybe they were right; how would I know? And this was the kind of self-doubt that became increasingly familiar during the regular and often more serious challenges to my sense of authority over, trust in and knowledge about my pregnant self. Mostly this friction emerged around numbers generated by these and other tests that were held up as a more reliable, trustworthy, objective and altogether better source of knowledge than anything my techfree, sensing self could possibly produce. Of course there has to be some Truth in that e despite the most powerful critiques of scientific knowledge production at our disposal6 e but it wasn't always clear in what sense (or even if) the data generated could be contextualized or rendered otherwise meaningful. Data were often assumed to be valuable simply in virtue of their existence, their even potential existence e as if it has to be ‘collected’ because we have the technology e and I think it's fair to say that how I felt was considered largely irrelevant as a source of even corroborative data. With each hospital visit, it seemed more and more as though the only thing that mattered was what they could measure. This included regular estimates of fetal weight, where data were plotted on growth curves used to establish whether I would be ‘allowed’ to go to full term e considered 36 rather than 40 weeks in twin pregnancy e or whether the team would ‘throw in the towel’ at an earlier date and ‘go in and get them’. The language used during appointments really was extraordinary, often incredibly paternalistic, and it didn't feel easy to question practitioners who were rarely equivocal in their opinions or advice, often dished up like horror

5 For further discussion of ultrasound experience, and from alternative perspectives, see Harris et al., 2004 and Lupton, 2013, 2013a. 6 Steven Shapin (1998) provides an interesting example of such work, particularly given his focus on the importance of trust.

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stories. The situation became increasingly difficult given I often didn't entirely trust what I was being told, and for what I saw as good reason as well as gut feeling. Fetal weight estimates are notoriously unreliable (Anderson et al., 2007), and there were many instances where communication about these and other data seemed to be meant to induce fear, to scare me into compliant submission. For example, I was repeatedly told there was a very high risk of delivery by caesarean section for twins, as I wouldn't be able to stand the pain if they had to go in and get them, i.e. manual extraction, ‘up to the elbow’. This was why I ‘needed’ to have an epidural, and why they ‘always’ give epidurals to women with multiple pregnancies. Because I wanted some basis on which to make a judgement about this, and about whether it might be possible to remain mobile or even give birth in a position other than the gravity-defying flat-backed one some of the docs insisted was the only option, I actually asked, in different ways, at different times, for numbers; what percentage of women declined the epidural, and of those, how many required emergency caesarian? Here, remarkably, it seemed there were no numbers, no research data they were able (or willing) to share, but in terms of this particular hospital I was told: ‘none’. I found this unbelievable, literally, and pressed for more detail after managing to find someone who had done the allegedly impossible in the self-same building. What I heard then, in contrast to earlier insistence on precision was, ‘well yeah, there's been a handful of women, but they'd all had five or six kids before and the babies practically fell out by themselves'. Practitioners worked hard here to dis-count alternative evidence and agency other than their own: they couldn't have portrayed these actively resistant women more passively if they'd tried. Thus did the climate of fear intensify, and though I really did feel ‘at risk’, it wasn't quite in the clinical sense docs intended; the hospital itself began to feel like a very unsafe place to be. This sense of mistrust was compounded by the handling of a glucose tolerance test. My ability to process 75 g of sugar within 1 h measured one measly point higher than the range of normal. Although the other (fasting and 2 h) readings were absolutely fine, I was suddenly and definitively declared diabetic, and thrown into a whole other set of clinic appointments. These turn out to be the most infantilizing experiences of my adult life, and along with a blood sugar testing kit, I was given nutritional fact sheets to make sure I knew the difference between an apple and a mars bar, and my very own journal, to record readings taken half an hour after every meal, with explanations for high numbers in the margins. My book was to be reviewed at each appointment, with the not-so-veiled threat of further intervention if the numbers weren't ‘good’.7 Although I didn't even trust the diagnosis e not least because proper testing protocol had been rushed e they wouldn't test again, and the label stayed with me for the duration, with all the associated risk of cascading interventions; one test almost always leading to another and another in the quest for absolute certainty and control. That I couldn't help wanting to be a ‘good’ patient and pass all of these tests was maddening, and though I know this must all sound like utter ingratitude in the face of such intensive (and costly) care, I did often feel obliged and of course I wanted the ‘best’ care for my babies. What this amounted to, though, was a feeling of constant tension, an emotional dissonance that became a kind of key-note of the pregnancy. Often, my feelings of appreciation conflicted with a longing to be left alone because I didn't feel like there was anything ‘wrong’ with me. What I did feel was considerable stress, frequent awareness of breaking a number of feeling rules guiding doctorepatient interactions, and the constant strain of keeping

7 For examples of recent work on the emotional geographies of (non-gestational) diabetes, see Hanks, 2013; Lucherini, 2015.

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‘inappropriate’ emotional responses under wraps. It didn't feel wise, for example, to voice questions or complaints that might reveal my profound sense that doctors didn't always know best. Because I wasn't expected to want to know ‘why’, I had to make decisions about compliance on the basis of trust, without access to key information. With blood copper treatment, this actually put my pregnancy at greater risk. Weekly tests used to calibrate my zinc intake called for the precise spacing of tablets six times a day, 2 h after and 1 h before eating. This felt like an impossible demand e pregnant women are rarely 3 h away from food once never mind six times a day e but no-one explained that ingesting zinc without an empty stomach flushed copper out of the tissues into the bloodstream where it posed an even higher risk to the pregnancy. It wasn't even possible to negotiate a more manageable treatment schedule because practitioners weren't dealing with me anymore, but with my numbers, with what digital sociologists have termed my ‘data double.’8 A quantified self I knew I wasn't supposed to feel quite so offended by the numbers that seemed to be ruling my life, and that some people actually want to be quantified in these ways, feeling reassured, perhaps even empowered, rather than reduced or disciplined by the process. It would be hard to avoid the cultural trend of lifelogging often referred to as the Quantified Self Movement e motto, ‘self-knowledge through numbers’ e and the growing academic as well as popular literature around it details the unimaginably many measurable aspects of our lives (e.g., ChamorroPremuzic, 2015; Nafus and Sherman, 2014; Swan, 2012, 2013). Most contemporary Quantified Selfers would no doubt consider my bio-metric data collection strategies decidedly old-school e my numbers were generated by ultrasound, glucose monitors and blood tests rather than wearable sensors and computers e but sociologist of emotion Deborah Lupton argues that there are clear connections between these various approaches to measuring, monitoring and visualizing the body.9 Current practice continues the attempt make a spectacle of ourselves and quantification taken to today's extremes can perhaps provide insights into more quotidian clinical practice. It might help us understand some of the motivations for, and implications of, treating ourselves in this way, as ‘data emitting machines’. For enthusiasts like movement founder Gary Wolf, there are many motivating factors for self-tracking that don't involve clinical coercion. Often, these relate to the achievement of desirable change. For Wolf, tracking helps by providing a trustworthy evidence-base on which to make decisions about how to change our behaviour and our bodies; it replaces ‘intuition’ with something much more reliable, i.e. numbers that provide greater insight into diet, exercise, sleep and just about every other activity you could think of.10 Some Quantified Selfers do describe tracking emotions or ‘moods’, using apps that enable them to account for how they feel more ‘accurately’. One is quoted in a recent paper (Lupton, 2014: 6) as saying ‘I can look down at my phone at any point in the day and

8 On the ‘data double’, see Haggerty and Ericson, 2006. For overviews of digital social research, see Hand, 2014; Lupton, 2015; Orton-Johnson and Prior, 2013. 9 Lupton writes that ‘the use of digital mobile technologies to record, measure and monitor bodily functions … is a logical extension of the employment of visualizing technologies in medicine … technologies … such as X-rays, ultrasound and MRI [that] have been used for some decades to monitor, record and interpret the body, to gaze into and produce images of its interior’ (2013a: 398). 10 According to Wolf (2010: npn): ‘If you want to replace the vagaries of intuitions with something more reliable, you first need to gather data. Once you know the facts, you can live by them.’

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see, kind of, how stressed I am’. However, emotion is often seen as having a different part to play, as product rather than focus of the process (see Lupton, 2014: 2). The idea is that tracking stimulates ‘useful’ emotions such as fear, guilt or shame that might motivate beneficial change. Lupton doesn't mention anxiety in this account, my own primary response to quantification e and I don't need an app to tell me this e but I know my experience isn't typical of those who track less reluctantly, and often less narrowly around health. Such calculated attempts to enhance well-being are often more about self-improvement, than health-improvement, with claims about ‘self-optimization’, or ‘self-actualization’ and about how to become e and I cringe as I say it e your ‘best self’. What this suggests (among other things) is a widespread recognition of insights found in psychoanalytic, feminist, and other post-structural theory that selves are inherently relational (e.g., Benjamin, 2013; and see Bondi, 2005), and that technological interactions are indeed productive of different, and quite particular kinds of subjectivities (Kember, 1998). There's a lot going on in such high-tech productions, and Lupton has written that self-tracking ‘represents the apotheosis of self-reflexivity’ (2013a: 397). I'm not sure that it does; I'd suggest tracking involves more self-inspection than self-reflection, that it's more about instrumental appraisal or audit than anything productive of genuinely meaningful selfunderstanding. Reflecting on the nature of self-hood, Wired contributor (and past editor) Mark McClusky writes: ‘We tend to think of our physical selves as a system that's simply too complex to comprehend. But what we've learned from companies like Google is that if you can collect enough data, there's no need for a grand theory to explain a phenomenon. You can observe it all through the numbers' (McClusky, 2015: npn, quoted in Lupton, 2016 forthcoming). There's an interesting slippage here between observation and explanation, information and meaning, in which everything worth knowing is presumed to leave self-evident physical traces. The data collected by Quantified Selfers is geared strongly towards enhancing predictability, enabling manipulation, and fostering (at least the illusion of) control. It seems, then, to be more concerned with self-governance than self-knowledge through numbers, as Costea et al. (2008) suggest, and so does indeed represent a clear and worryingly logical extension of the long-term twin projects of medicalization and technologization, which, as many feminist scholars have shown, play central roles in the marginalization of women's self-narratives by medical men and their expensive machines.11 Where emotions are included as part of the technologized clinical picture at all, they're there to be quickly dismissed, or, as in the account described above, to be put to particular and worrying use; they're given space merely in terms of ‘use-value’, framed by an instrumental rationality incapable of seeing emotionality as valuable on its own (or any Other) terms. For fully reflexive emotional selves, it surely doesn't feel good to be produced and reduced in this way, to something one-dimensional. As I've argued before (in Bondi and Davidson, 2011) emotions are wild, untameable by language (or code), and any static representation that can't make space for that wildness, that sees emotional selves as matters for management, isn't worth the paper e or program e it's written on. So how did we get here, to a point where the quantification project has been downloaded onto a willing, and relentlessly selfreporting laity? Why so many of us would choose to technologize ourselves in this way is a genuine mystery e it's like some kind of

11 See Woliver (2002) for a valuable overview of these issues, and Parry (2006) for some interestingly presented ‘insider’ perspectives. For further illumination, I recommend a visit to the Pythons' fetus frightening room; see ‘The Miracle of Birth: Part 1’, in Jones and Gilliam's (1983) The Meaning of Life.

post-humanist nightmare of self-objectification e but Heidegger warned many moons ago that ‘the technological framework is inherently expansionist and can reveal only by reduction. [It involves an] attempt to enclose all beings in a particular claim e utter availability and sheer manipulability’12; technology, here, represents a threat to ‘human spirit’ he calls Ge-stell or in translation ‘enframing’ (Heidegger, 1993). Although Heidegger does not privilege the visual, the term is evocative of high-tech society's ocularcentrism (e.g., Jenks, 1995), where even invisible interiors, including ‘landscapes’ of the unborn, are rendered otherwise frameable by ultrasound imaging. Some have characterised this visualizing imperative in terms of a cultural shift from the haptic to the optic (e.g., Draper, 2002). It seems we're quite literally losing touch with what matters, in ways that have significant implications for the production and performance of trustful relations. To quote Lupton (2012: npn) again: ‘As one's bodily states and functions become ever more recordable and visualized via data displays, it becomes easier to trust the ‘numbers’ over physical sensations. But what does this even mean, that it's possible to ‘trust’ numbers more than ourselves? What is trust, and how and where, exactly, does it take place? Trust and numbers A great deal has been written about trust in the context of healthcare in recent years, and while some scholars attempt to measure trust e in medical expertise or expert systems e others concur that it's messy, mysterious, and hardly quantifiable.13 Trust €llering (2008: ix) writes that trust is idiosyntheorist Guido Mo cratic, and that the ‘leaps of faith that enable trust are ultimately to be understood as emotional commitments and accomplishments’.14 Trust then is an emotional and so obviously relational achievement, an ‘emotional skill’, writes philosopher Robert Solomon (2000), and trustful relations involve this ‘leap of faith’ precisely because they are rarely based on or reducible to entirely logical processes. Writing in a broader sociological context, Anthony Giddens (1991: 19) claims that the ‘faith which trust implies tends to resist such calculative decision making’, and further, that ‘trust presumes the opening out of the individual to the other’ (1991: 96). This ‘opening out’ leaves us exposed, in various senses, and we take risks when we trust. We re-position ourselves as vulnerable by investing another with a degree of power over ourselves, and although it is often necessary to do so to facilitate the smooth running of everyday life (see Mechanic and Meyer, 2000: 657; Simmel, 1990: 178), when the stakes are higher, we take particular care not to misplace trust. We also revaluate these placings and our positioning on an ongoing basis, reflecting on the routine performances and affective competencies that can make or break trust in a heartbeat. More often though, trustful relations take time to change, and people themselves are transformed in the process. That is to say, trust and its absences are also productive of different subjectivities, intimately involved in the composition and de-composition of emotional selves.15 How, then, do we respond and re-form in relation to quantification? I would suggest that, whereas typical trustful relations work to strengthen our sense of connection with other people, and our feeling of ‘rightness’ in place, trust in numbers functions largely

12 This succinct account of Heidegger's ‘technological framework’ appears in David Farrell Krell's (1993: 309) ‘Introduction’ to Heidegger's essay, ‘The question concerning technology’. 13 See Brownlie, 2008; for discussion of the implications of ‘trust in numbers’ in cultural contexts beyond medicine (including business and government), see Porter, 1996. 14 €llering, 2001. This notion is discussed at greater length in Mo 15 These issues are discussed in more depth in Parr and Davidson, 2008.

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to isolate us. Arithmetical trust subtracts us from potentially meaningful contexts and relations, other than, perhaps, competitive ones, where we evaluate how we measure up against others. Such metrics are masculinizing in that they fail to account for intersubjectivities, emotional relations and mutual reliances. They operate in virtue of and intensify the illusion that selves operate atomistically, as singular, self-governing, systems. In effect, the only context that matters becomes internal, and the process inspires further self-absorption by placing another figure e number one e at its core. Heidegger refers to this single-mindedness as an inevitable consequence of enframing by technology, a delusional state whereby ‘man everywhere and always encounters only himself’ (1993: 332). Taken to an extreme, then e and I think self-quantifying practice is often pretty extreme, if now also utterly commonplace e trust in numbers makes selves that are worth-less in the relational contexts that count, or that should count as valuable in emotionally healthy lives. Conclusion In medical theory and practice, the turn towards quantification has had similarly enervating effects, involving the outsourcing of self-awareness to external indicators, and so promotion of detachment in various senses, none of which are healthy. To try and illustrate this, I've used two examples of health care, where trust e in medical professionals, their workplaces and technologies, and in myself e was complex and changing in ways powerfully impacted by numbers. With concussion, however, at least initially, there were no tests or numbers, beyond counting backwards from 100 in 7s and ‘how many fingers am I holding up?’ The MRI happened much later, but even then, attempts to see the problem were all so much less authoritative, despite a culture of quantification and popularized neuroscience that left me (the malcontent) craving re-cognition in the form of ‘objective’ assessment. I'd reached a crisis of trust in ‘subjective’ evaluation, and so it seemed bizarre that diagnosis and treatment of head trauma could involve taking the patient at their word. The practice requires trust in self-reporting at a time when the self is profoundly debilitated by the absence of perceptual intervolvement with other selves and spaces, the essential selfmaking stuff of everyday life. For me, then, a qualified, not ‘quantified’ self was the result of concussion and its mis/trustful relations; and I mean something akin to a qualified success here, a not-quite or partial self, one relatively ill-formed and infirm. I'm not entirely convinced the concussion is a thing of the past either e I sometimes wonder if the term post-concussion is as nonsensical as ‘post-feminism’ e but pregnancy tends to have a more predictable and decisive conclusion, if we're lucky; and I was. I want to return to the close of that story now. I'd got to the point where, with every hospital appointment or data collection session, my stress was up, and my confidence down e you could have graphed it I'm sure e and much of the time between was spent in attempts to reverse these trends, through my own research aimed at identifying and having conversations with mothers and midwives in other places with more positive experiences of twin pregnancy and birth.16 With hindsight, I was seeking

16 In Ontario, midwives are not certified to oversee multiple pregnancies, and although I'd been successful in my attempts to maintain access to their services, midwives were involved in a supportive capacity only, effectively positioned in terms of ‘non-clinical’ care (i.e., emotional rather than physical; they could do nothing with my body, and literally wouldn't touch it during regular appointments). This all changed during labour when the hospital team's apparent lack of familiarity with alternative birthing positions led the midwife to play a much more active role in the process.

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space that felt restorative rather than risky, and fostering interactions with others who'd experienced what they termed ‘natural’ multiple birth, without trauma. Towards the end of my pregnancy, it seemed like the lack of faith in the numbers that prompted these relations gave me something constructive to butt up against. An emotional stance of resistance in itself enabled alternatives, other framings that perhaps strengthened a sense of self that was obviously ill-served by metric configurations. In stark contrast with the untethered ‘self-lite’ of concussion, I was grounded and growing as a heavily pregnant, intensely emotional, and expansive embodied self, one that felt in the end, worth trusting. Being 42 offered precious few answers to the ultimate questions of life, the universe and everything e whatever Douglas Adams had to say about it17 e but it was starting to feel like a pretty good number to be. When I was 30 weeks pregnant, cramps from a stomach flu showed up on the fetal monitor as contractions 2 min apart, requiring hospitalization despite my suggestions that I wasn't actually in labour. Two weeks later, when I knew I had entered active labour, I managed to keep the monitors off me for the most part by staying as mobile as possible until my twin babies were ready to be born a few hours later. I found myself finally able to trust my feelings about what my body and the babies could do, and was able to claim space to labour in hope for the best, rather than fear for the worst. As I said, I was lucky, and the babies were healthy. They stayed in neonatal intensive care for a month though, for fattening up and of course monitoring, by machines that measured oxygen saturation, heart and respiration rates. While they were there, I developed an infuriating tendency to watch the machines instead of the babies, but I learned about trusting judgements in context from the nurses, whose care was definitely not reliant on the readings. Often, alarms would be switched off, because a nurse's glance or touch judged colour or tone to be healthy, despite flashing lights and plummeting figures on machines that go ping. Of course with twins, there's always the temptation to conduct scientific experiments, and there are fantastical resources available for the Quantified Baby at home18: I could continue the exact same monitoring with sensor-embedded baby clothing transmitting data to my phone, and use Naptracker and other apps to record and compare feeding times, nappy content, and moods, and export the data into spreadsheets to make baby care into experimental data management. Or … maybe it's time to move on, by letting go of my hold on those numbers, and even of their hold on me. Acknowledgements This paper was presented at the 5th International and Interdisciplinary Conference on Emotional Geographies (Edinburgh, June 10e12, 2015) and I would like to thank conference organizers - Liz Bondi, Caleb Johnston, Alette Willis and Jonathan Wyatt e for extending the invitation. Additional thanks are due to Lynn Jamieson for her generous introduction, and to members of the audience for extensive and insightful feedback. I am very grateful to editors of this journal for encouraging me to publish the talk in its original form. Much of the material discussed here deserves more in-depth treatment than it was possible to offer in the space of a 45 minute presentation, and there are no doubt numerous errors and in particular, omissions; I take full responsibility for the lot. Thanks to Mick Smith, Liz Bondi, Laura Cameron, Martin Hand, Katie Hemsworth, Eleanor MacDonald, Hester Parr, Emily Rain and

17 18

Adams, 1979; see Bignell, 2011. http://www.quantifiedbabies.com/. Also see Gaunt et al. (2014).

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Sophie Tamas for offering support of various kinds in relation to the writing of this paper as well as the events it describes. Above all, thanks to Robin and Jamie for making it all add up so perfectly, against the odds. References Adams, Douglas, 1979. The Hitchhiker's Guide to The Galaxy. Pan Books, London. Anderson, N.G., Jolley, I.J., Wells, J.E., 2007. Sonographic estimation of fetal weight: comparison of bias, precision and consistency using 12 different formulae. Ultrasound Obstet. Gynecol. 30 (2), 173e179. Benjamin, Jessica, 2013. Shadow of The Other: Intersubjectivity and Gender in Psychoanalysis. Routledge, London. Bondi, Liz, 2005. Making connections and thinking through emotions: between geography and psychotherapy. Trans. Inst. Br. Geogr. 30 (4), 433e448. Bondi, Liz, Davidson, Joyce, 2011. Lost in translation. Trans. Inst. Br. Geogr. 36 (4), 595e598. Bignell, Paul, 2011. ‘42: The Answer to Life, The Universe and Everything’, The Independent, February 6. http://www.independent.co.uk/life-style/history/42the-answer-to-life-the-universe-and-everything-2205734.html. Accessed July 26, 2015. Brownlie, Julie, 2008. Conceptualizing trust and health. In: Brownlie, Julie, Greene, Alexandra, Howson, Alexandra (Eds.), Researching Trust and Health. Routledge, London and New York, pp. 17e32. Bunn, Geoff, 2014. A History of the Brain. http://www.bbc.co.uk/programmes/ b017b1zd/episodes/player. Accessed July 20, 2015. Chamorro-Premuzic, Tomas, 2015. Wearable Devices: Tracking Your Every Step May Not Make You Happier, The Guardian, July 17. http://www.theguardian.com/ media-network/2015/jul/17/wearable-devices-technology-monitor-behaviourwellbeing. Accessed July 22, 2015. Costea, B., Crump, N., Amiridis, K., 2008. Managerialism, the therapeutic habitus and the self in contemporary organizing. Hum. Relat. 61 (5), 661e685. Damasio, A., 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Harcourt, New York. Damasio, A., 2010. Self Comes to Mind. Pantheon, New York. Davidson, Joyce, Smith, Mick, 2009. Autistic autobiographies and more-thanhuman emotional geographies. Environ. Plan. D Soc. Space 27 (5), 898e916. Draper, Jan, 2002. ‘It was a real good show’: the ultrasound scan, fathers and the power of visual knowledge. Sociol. Health Illn. 24 (6), 771e795. Gaunt, K., Nacsa, J., Penz, M., 2014. Baby lucent: pitfalls of applying quantified self to baby products. In: CHI’14 Extended Abstracts on Human Factors in Computing Systems, pp. 263e268 (ACM). Giddens, Amthony, 1991. Modernity and Self Identity: Self and Society in the Late Modern Age. Polity, Cambridge. Haggerty, K.D., Ericson, R.V., 2006. The new politics of surveillance and visibility. In: Ericson, R.V., Haggerty, K.D. (Eds.), The New Politics of Surveillance and Visibility. University of Toronto Press, Toronto, pp. 3e25. Hand, M., 2014. From cyberspace to the dataverse: trajectories in digital social research. In: Hand, M., Hillyard, S.H. (Eds.), Big Data: Qualitative Approaches to Digital Research. Emerald Books. Hanks, Gentry, 2013. An autoethnography of diabetes: exploring emotional geographies of (in)visible disabilities. In: Paper Presented at the Association of American Geographers Annual Conference, April 10, Los Angeles, CA. Harris, G., Connor, L., Bisits, A., Higginbotham, N., 2004. ‘Seeing the baby’: pleasures and dilemmas of ultrasound technologies for primiparous Australian women. Med. Anthropol. Q. 23e47. Heidegger, Martin, 1993. The question concerning technology. In: Krell, Farrell, David (Eds.), Martin Heidegger: Basic Writings, San Francisco. HarperSanFrancisco, pp. 311e341. Jenks, C., 1995. The centrality of the eye in western culture: an introduction. In: Jenks, C. (Ed.), Visual Culture. Routledge, London. Jones, Terry, Gilliam, Terry, 1983. The miracle of birth: part 1. In: The Meaning of Life. https://www.youtube.com/watch?v¼NcHdF1eHhgc. Kember, S., 1998. Virtual Anxiety: Photography, New Technologies and Subjectivity. Manchester University Press. LeDoux, J.E., 2003. Synaptic Self: How Our Brains Become Who We Are. Penguin, London. Lucherini, Mark, 2015. The Everyday Geographies of Living with Diabetes. PhD

thesis. University of Glasgow. Lupton, D., 2012. The quantified self movement: some sociological perspectives. In: This Sociological Life: a Blog by Sociologist Deborah Lupton, November 12. Accessed July 23, 2015. Lupton, D., 2013. The Social Worlds of the Unborn. Palgrave Macmillan. Lupton, D., 2013a. Quantifying the body: monitoring and measuring health in the age of mHealth technologies. Crit. Public Health 23 (4), 393e403. Lupton, Deborah, 2014. Self-tracking cultures: towards a sociology of personal informatics. In: Proceedings of the 26th Australian Computer-Human Interaction Conference on Designing Futures: the Future of Design available at. http:// www.academia.edu/8495888/Self-tracking_cultures_towards_a_sociology_of_ personal_informatics. Accessed July 22, 2015. Lupton, Deborah, 2015. Digital Sociology. Routledge, London. Lupton, Deborah, 2016. You are your data: self-tracking practices and concepts of data. In: Selke, Stefan (Ed.), Lifelogging: Theoretical Approaches and Case Studies About Self-tracking. Springer, Heidelberg, New York (forthcoming). McClusky, M., 2009. The Nike Experiment: How the Shoe Giant Unleashed the Power of Personal Metrics. Wired, June 22. http://archive.wired.com/medtech/ health/magazine/17-07/lbnp_nike. Accessed July 22, 2015. McGannon, K.R., Cunningham, S.M., Schinke, R.J., 2013. Understanding concussion in socio-cultural context: a media analysis of a national hockey league star's concussion. Psychol. Sport Exerc. 14 (6), 891e899. Mechanic, David, Meyer, Sharon, 2000. Concepts of trust among patients with serious illness. Soc. Sci. Med. 51, 657e668. €llering, G., 2001. The nature of trust: from Georg simmel to a theory of expecMo tation, interpretation and suspension. Sociology 35 (2), 403e420. €llering, Guido, 2008. Foreword. In: Brownlie, Julie, Greene, Alexandra, Mo Howson, Alexandra (Eds.), Researching Trust and Health. Routledge, London and New York, pp. viiex. Nafus, D., Sherman, J., 2014. Big data, big questionsj this one does not go up to 11: the quantified self movement as an alternative big data practice. Int. J. Commun. 8, 11. Orton-Johnson, K., Prior, N., 2013. Digital Sociology: Critical Perspectives. Palgrave Macmillan. Parr, Hester, Davidson, Joyce, 2008. ‘Virtual trust’: on-line emotional intimacies in mental health support. In: Brownlie, Julie, Greene, Alexandra, Howson, Alexandra (Eds.), Researching Trust and Health. Routledge, London and New York, pp. 33e53. Parry, D.C., 2006. Women's lived experiences with pregnancy and midwifery in a medicalized and fetocentric context: six short stories. Qual. Inq. 12 (3), 459e471. Porter, T.M., 1996. Trust in Numbers: The Pursuit of Objectivity in Science and Public Life. Princeton University Press. Rose, N.S., Abi-Rached, J.M., 2013. Neuro: The New Brain Sciences and the Management of the Mind. Princeton University Press. Shapin, S., 1998. Placing the view from nowhere: historical and sociological problems in the location of science. Trans. Inst. Br. Geogr. 5e12. Simmel, G., 1990. The Philosophy of Money. Routledge, London. Smith, Niall D., 2013. The Everyday Social Geographies of Living with Epilepsy. PhD thesis. University of Glasgow. Solbjør, Marit, 2008. You have to trust in those pictures: a perspective on women's experience of mammography screening. In: Brownlie, Julie, Greene, Alexandra, Howson, Alexandra (Eds.), Researching Trust and Health. Routledge, London and New York, pp. 54e71. Solomon, Robert C., 2000. Trusting. In: Wrathall, M., Malpas, J. (Eds.), Heidegger, Coping and Cognitive Science. MIT Press, Cambridge, MA. Swan, M., 2012. Sensor mania! the internet of things, wearable computing, objective metrics, and the quantified self 2.0. J. Sens. Actuator Netw. 1 (3), 217e253. Swan, M., 2013. The quantified self: fundamental disruption in big data science and biological discovery. Big Data 1 (2), 85e99. Ventresca, M., 2014. Putting the ‘head’ in head games: representing the brain within a concussion ‘crisis’. In: Sport, Society and Technology Session, 25th Annual Conference of the North American Society for the Sociology of Sport, Portland, OR (November). Wolf, Gary, 2010. The Data-Driven Life. The New York Times, April 28. http://www. nytimes.com/2010/05/02/magazine/02self-measurement-t.html?_r¼0. Accessed July 22, 2015. Woliver, L.R., 2002. The Political Geographies of Pregnancy. University of Illinois Press, Illinois.