An Old Mind in a New Body by Jean Marc Gulliet

Many books forecasting the advent of new technologies emphasize the apparent similitude between human mind and computer software. The mind is described as a peace of software hard-wired in the brain. According to this conception, the brain is just a physical device created by Mother Nature that contents the program representing an individual. Therefore, the whole body is perceived as a mere means to support the brain. In this context, the biological does not seem very important. The only thing of importance is the neural network, the interconnection of the neural cells, taking place in the brain. On this basis, some scientists go further and claim that if one can reproduce this network, whatever the medium used to do that, i.e. even non-organic, one will be able to replicate the mind of any individual (Kurzweil). In almost all of the literature published by information-technology experts, what might be more surprising than any speculations about new technological possibilities, is the absence of reflection about the relationship between mind and body. This relationship is not even questioned; it is merely forgotten. In so doing, these experts neglect the psychological relation that it is established between one’s self and one’s body. Sometimes relation of love, sometimes relation of hate, but it is always a relation that contributes to define one’s identity (Myers). Examining, by a case study, some of the psychological issues face during organ transplantations, I argue that most of the predictions of information-technology experts concerning body replacement, in part or in totality, whatever the medium used, are biased and incomplete.

To gain a better understanding of some of the psychological issues regarding organ transplantation, I have interviewed one person who has been transplanted recently. The interview was conducted in French and I have summarized and translated it in English. The person’s real name has been modified according to the person’s request. Marie-Christine Flores is a mother of two children. She is a computer scientist and lives in France. On January 30, 2000, her liver was replaced by a new one, during a fourteen hours operation. First, here is some historical background to understand the psychological process that drives her to ultimately undertaking such a surgery. Marie-Christine’s mother died of an unknown illness fifteen years ago. At that time, her mother suffered of many symptoms that could be attributed to a vast spectrum of diseases. For the physicists were unable to correctly diagnostic the real causes, all of the attempts to cure her mother failed. Six years after her mother’s death, one of Marie-Christine’s brothers started to show similar symptoms. At that time, medicine had made some progress, identifying this rare illness and naming it paramiloidose.

Paramiloidose is a genetic disease, which has its source in the liver. A kind of biological countdown is embedded in the affected genes, and the sickness usually reveals itself when the person is between thirty and forty-year old. The first symptom is a gradual lost of sensibility of the skin, starting with the hands and feet. For example, a person can easily burn itself with hot water while he or she washes the dishes. However, the lost of sensibility can be due to so many causes that the effects of paramiloidose where misinterpreting with many of other sicknesses for years. Then, a general degradation of health appears, which can be misdiagnosed as a generalized cancer.

Seven years ago, because paramiloidose is such a rare illness, only few physicists, specialized in liver diseases, were able to identify the disease. The only cure available is a liver transplantation. Unfortunately, for Marie-Christine’s brother it was too late to save him, because the illness had already caused to many damages in his body. One year after his death, some British and French physicists devised a test that allowed the diagnostic of the illness even before the beginning of the symptoms. The responsible genes were identified, indeed.

Marie-Christine decided to be tested, therefore to know if she had or had not the disease, less than three years ago. She says:

It was a tough decision. On the one hand, if the results were negative, I would be relieved for the rest of my life. I could also hope for my kids: they may be not affected. On the other hand, if the results were positive, I would have no other choice than to undertake a transplantation. That means to be stuck with any project for at least the following two or three years. And the success of the surgery was not guaranty. Looking back to this period, I realize that I really spent a lot of time weighting the pros and cons for such a decision.

Eventually, for the sake of her children, she decided to know and to undertake whatever was required according to the results of the test. After a week of anguish, she finally got the results. She had the paramiloidose and the illness had started its works. Therefore, she opted for the transplantation.

During the following year, she spent several weeks at the hospital. First, she had a comprehensive health check up. A heart weakness having been diagnosed, a first operation was done to support her heart with a pacemaker. A couple of months after that, time for the final decision came. She explained to me the process:

Basically, the decision I had to take was a matter of the schedule. Paramiloidose is a lethal illness. I was condemned in a window of five to eight years. I had witnessed already the slow death of my mother and brother. I was thinking of the sake of my kids... I had to be transplanted. It was the logical choice. However, that would mean that I have to refuse a business opportunity, which might secure my kids’ financial future. But I couldn’t start a new job with the forthcoming operation. Such a surgery implies that you can be called by the hospital at any time, day or night, week days or weekend. The hospital doesn’t master the organs’ supply. So, each patient is placed on a waiting list, and one waits usually between three months and one year for a liver. That means that I couldn’t go on vacation or business trip, that everything must have been ready for my kids in case of my hospitalization for the next three or for weeks. Organizing all these things was harder because I live alone with Stephanie and Michael. Finally, I decided to postpone my registration on the waiting list to the beginning of the year; so, I would have time for Christmas that I could spend with my family.

The hospital called Marie-Christine on January 30, 2001, in the middle of the afternoon. She had a couple of hours for finishing to prepare herself and to say good-bye to her children. The surgery started after midnight and lasted for fourteen hours. Then, she spent ten days in a sterile room with restricted access. Finally, she stayed for the following five weeks at the hospital. When she came back home, she was greatly relieved because the transplantation seemed to be successful.

Nevertheless, it was not the end of all the difficulties. She remembers:

The first few weeks, I was so weak that I could do almost nothing but heating my supper. My days were spent around taking my drugs according a strict schedule and sleeping. I was happy to see my kids and to have some guests, but I couldn’t really enjoy their presence because they exhausted me. I wasn’t in my best mood. Moreover, I have to go to the hospital every week to have check up. Working was forbidden for six months. Meanwhile, I gathered my strengths, gain some weight (I lost twelve pounds after the operation, and at that time I was already below the "normal" weight according to the physicist), and my mood was going better every day.

After that, going back to work, her life resumed nearly as if nothing happened, at least for the outside world. People who know nothing about her transplantation could see the appearance of a normal life. However, for Marie-Christine many things have changed. She must avoid sun exposition because of the fragility of the skin due to the post-surgery drugs. Moreover, she is not eager to wear a swimsuit, for she has to hide scar going side to side of his abdomen. She still has to go every month to the hospital for a one-day check up and every year for a one-week check up. She cannot eat whatever she wants. Obviously, alcohol is strictly forbidden, but also too much salt, fat, to name a few. For the rest of her life, she has to respect a strict schedule, take many drugs to avoid the rejection of the transplanted liver by her organism. Indeed, the new liver is perceived as a foreign-biological entity, and, consequently, the body fights as if any virus attacked it. Therefore, a delicate combination of drugs aiming to lower the defense mechanism of the body must be taken on a regular basis.

With all this constraints, Marie-Christine has developed a peculiar relation with her new liver. She explains:

Because I have to take many drugs to prevent the rejection of my liver, my body is not so strong. An illness that was cured in days before the transplantation, may take now weeks to be cure. For example, the last time I had a cold, it took almost three weeks for recovering. In this case, I cannot help myself not to speak to my liver, like if it were a buddy that I have to reprimand for its wrongdoing. "It’s because of you that I don’t feel well today," I say sometimes. I also may ask how it is doing today! I don’t become crazy. It is just that sometimes it is difficult not to perceive it as an independent thing, perhaps with its own will. It’s weird.

Marie-Christine does not have any specific religious beliefs. However, it was not the case for some people at the hospital, and this may be an issue for a transplantation. For example, she remembers one male Muslim, who was concerned to know if the liver he would receive may come from a woman. For a westerner, this kind of questions might seem useless and not appropriate. However, for someone who belongs to a culture where man is considered as highly superior to woman, being saved by a woman is a serious issue.

This case study, because it is about the experience of only one person, cannot pretend to be generalized to everybody. Nevertheless, it is quite representative of some of the psychological issues that may occur to anyone who has to be transplanted. Deciding to have such a major surgery seems to be not so easy, even if one’s life is concerned. The process lasts for year, that is one often anguishes while one waits for the operation, allowing plenty of time for doubting of the wisdom of one’s undertaking. The success is never guaranty, and, even though, it is always ephemeral, for the transplanted organ decays more rapidly than the original one. Finally, social and religious considerations may emerge, according to one’s culture and spiritual conceptions. For all of these reasons, and they are not exhaustive, if one wants to make seriously any prediction concerning body replacement, one cannot assume than body and mind are not related and interdependent. At least, if one claims that the mind is similar to a computer software, one must analyze the psychological, social, and cultural aspect of one’s claim and clearly show that theses aspect are not relevant. It is not a small thing to undertake; nevertheless, it is a necessary thing too often neglected, even by prominent scientists.

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