10.6092/issn.2038-3460/17489
application/pdf
2038-3460
17489
2
en
Veronica Moretti
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
Nelly Oudshoorn, Resilient Cyborgs. Living and Dying with Pacemakers and Defibrillators, Palgrave Macmillan, 2020
Text.Serial.Journal
https://tecnoscienza.unibo.it/
11
Book Reviews
2021-03-09
2023-06-27
2021-03-09
2023-10-16
162-166
TS
Veronica Moretti
2020
10.6092/issn.2038-3460/17489
162
Università di Bologna
2038-3460
2
en
166
Nelly Oudshoorn, Resilient Cyborgs. Living and Dying with Pacemakers and Defibrillators, Palgrave Macmillan, 2020
https://tecnoscienza.unibo.it/article/download/17489/16336
11
162                                                             Tecnoscienza – 11 (2)

References
Bijker, W., Bal, R. and Hendriks, R. (2009) The Paradox of Scientific Authority:
    The Role of Scientific Advice in Democracies, Cambridge MA, MIT Press.
Collins, H. and Evans, R. (2007) Rethinking Expertise, Chicago, University of Chi-
   cago Press.
Eyal, G. (2019) The Crisis of Expertise, Cambridge, Polity Press.
Harsin, J. (2015) Regimes of Post-truth, Post-politics, and Attention Economies, in
   “Communication, Culture and Critique”, 8, pp. 327-333.
Keyes, R. (2004) The Post-Truth Era. Dishonesty and Deception in Contemporary
   Life, New York, St. Martin’s Press.



                                       ***
   N. Oudshoorn
Resilient Cyborgs. Living and Dying with Pacemakers and Defibrillators,
London, Palgrave Macmillan, 2020, pp. 350

Veronica Moretti Università di Bologna

    Providing an autonomous review of a medical book during a moment
in history when the ubiquitous COVID-19 pandemic progressively has re-
shaped the imagined future of health and illness has been a challenging
task. Other diseases look anachronistic. Nelly Oudshoorn's book Resilient
Cyborg is a strong call to the “COVID-aside reality”, telling us how some
people are living and dying with pacemakers and defibrillators, which are
intrusive technologies surgically implanted in patients’ bodies. Pacemakers
and defibrillators have changed radically over the past few decades (the
first prototype for a pacemaker was introduced in 1985), considering that
at the beginning, they were used only for patients who had survived cardiac
arrest. Nowadays, these medical devices transform subjects into “mundane
cyborgs”.
    The book’s core argument is that people living with defibrillators and
pacemakers are far from being passive entities. With a strong empirical fo-
cus, the volume takes the reader on a journey inside and outside what the
author calls “everyday cyborg bodies” (p. 17).
    Oudshoorn’s book is structured around four main parts (“Introduc-
tion: theorising the resilience of hybrid bodies”; “Technogeographies of
resilience”; “Resilience and difference”; and “How hybrid bodies fall
apart”).
    The first part (Chapters 1-2) theorises on the resilience of hybrid bod-
ies, a concept that has inspired many STS scholars (but not exclusively) to
Book Review                                                               163
address human-technology relations, resulting in extensive cyborg litera-
ture (Haraway 1991; Mol 2002). Everyday cyborgs must live persistently
and inseparably with technology implanted inside their bodies – but with
an expiration date. Considering that these devices’ batteries last approxi-
mately 5-10 years, many people must undergo several implantations
throughout their lives. Controlling the battery’s lifetime is “crucial because
heart devices fail to work when the battery is weak or empty” (p. 69).
Therefore, battery life also must be taken into account.
    Like bodies, technologies can fail. This topic is examined to illustrate
how pacemakers and defibrillators not only can save lives, but also intro-
duce new vulnerabilities. The vulnerability of an everyday cyborgs is not
something isolated. On the contrary, it is embedded in a network of rela-
tions of human and non-human actors, including relatives, healthcare pro-
fessionals, biomedical technologies and socio-technical environments. Vul-
nerability should not be considered only through its negative connotations,
as it can create awareness of technological systems’ fragility and contribute
to learning and coping with potential technological risks. This is how Nelly
Oudshoorn adopts the resilience perspective – something that is not given
(far from being static) and always a “work in progress” (p. 44).
    The second part of the book (Chapters 3-5) provides the reader with
variety of sources through which to follow the author in her narrative. The
empirical data are derived from observations of 10 pacemaker/ICD (Inter-
nal Cardioverter Defibrillator) control visits, semi-structured interviews
with patients and healthcare professionals, analysis on different online
communities and articles on the security problems of pacemakers.
    Oudshoorn presents the concept of techno-geographies of resilience to
explain how responsibilities – in terms of equity in the dominant Western
health care system – are distributed differently between actors and spaces.
They are geographically situated. Pacemakers and defibrillators might ap-
pear to be isolated pieces of equipment that work automatically, but they
cannot be separated from local infrastructures because technologies par-
ticipate in redefining the meaning and practices of the spaces in which they
are used. At the same time, people somatically wearing these devices are
not invisible and inactive. More specifically, this part of the book describes
the monitoring and surveillance trajectory, including follow-up visits, and
it opens up the discussion to a major topic: vulnerabilities of patients who
must learn how to cope with different aspects of the implants. As men-
tioned above, despite its promises, technology can arise and introduce new
vulnerabilities that make some ordinary activities difficult or even imprac-
tical, such as air travel, working in a context full of machinery or simply
using everyday consumer electrical devices. Even the intimate sphere with
a partner can require alterations. Basically, a traditional safe place (home)
or a leisure activity can endanger these patients. Such vulnerabilities can
lead to a particular kind of ‘existential uncertainty’ in the (re)construction
164                                                         Tecnoscienza – 11 (2)

of a new identity because of this double fragility of the body and the tech-
nology.
    In the third part (Chapters 6-7), Oudshoorn demonstrates socio-demo-
graphic variables’ pivotal role in becoming a resilient cyborg. In particular,
the author adopts an intersectional approach – that is the combination of
a person’s multiple characteristics to explain discrimination and forms of
oppression – to uncover dynamics that can shape vulnerability and resili-
ence. Unflinchingly, the author discloses how gender and age matter in the
world of heart-wired cyborgs. Bearing in mind that most people who re-
ceive these devices are white adult men, pacemakers and defibrillators may
not fit other bodies easily. Gender is involved when the author describes
mismatches between devices and bodies in the Western cultural ideal of
femininity and beauty. Surgical scars make the disease visible, but these
scars imply much more than an aesthetic defect; they imply a “drastic
change in the ways in which women relate to their bodies and to others (p.
156)”. The “gaze of others” (p. 155 and p. 178) matters even more for
women because their bodies are more subject to inspecting gazes than male
bodies. However, some women may resist these cultural norms by showing
off their scars publicly and articulating new forms of normalcy.
    Age is another crucial variable, as these medical devices can affect
younger and elderly people’s lives differently. Young people may receive
these implants because of genetic predisposition for life-threatening heart-
rhythm disturbances. In this sense, the genetic diagnosis of a predisposi-
tion might become a family-disease, i.e. the person is a sort of cyborg-in
waiting. However, older people are more likely to receive these implanta-
tions to prevent sudden cardiac arrest or to treat heart failure.
    In this regard, anxiety is knowledgeable in different forms of emotional
work. Because they have not experienced any prior cardiac problems, chil-
dren or young adults have the dilemma of deciding whether or not to con-
tinue using these medical devices, balancing the “risk of lifelong implant
against the consequences of not putting in a new defibrillator, which can
be more devastating, particularly if the medication fails to work” (p. 199).
Cardiac arrest survivors, who often are elderly, experience high stress, anx-
iety and depression levels, especially during the first six months after being
discharged from the hospital.
    The last part of the book (Chapters 8-10) takes a strong stance, high-
lighting the ambivalent and intricate life cycle of wired-heart cyborgs, with
a specific focus on what actually happens when they face end of life. In this
sense, it is significant to examine how technologies affect how people cope
with dying and death. To keep these hybrid bodies alive, it is important
that patients with these implants feel the active presence of and engage
with their close relatives, technicians, nurses and other professionals. Just
as an everyday wired cyborg’s life differs from those who do not use these
devices, in the same way, the passage from life to death is not the same for
wired-heart cyborgs as it is for people living without internal heart devices.
Book Review                                                                 165
The widespread use of life-extending technologies has created several eth-
ical dilemmas, as they generate responsibilities (“Will a medical interven-
tion prolong the life of a patient or contribute to a prolonged, unwanted
way of living and dying?” p. 232) that did not exist before the surgical im-
plantation. Basically, pacemakers and defibrillators orient “dying trajecto-
ries” (p. 230), influencing the perception of and expectations tied to dying.
    This book can act as a thought-provoking work for different scholars
in getting closer to a complex theme. The merging of humans with tech-
nology is a classical topic supported by a rich STS vocabulary, including
words as cyborgs, entanglement, human-machine unions and incorpora-
tion.
    Following recent STS scholars (Pinch and Bujstervard 2012), it is rele-
vant to ask how people living with internal heart devices use their sensory
experiences as a new resource to make sense of their transformed bodies.
Patients play an active role in managing and shaping the care they receive,
doing many tasks that actually are not seen, a sort of “invisible work”
(Strauss et al. 1997). Additionally, this book sheds light on the full circle of
hybrid bodies, from how technologies transform human life, to contribute
to postpone death and fall apart. The death of technologies largely is ne-
glected in the sociology of technology, as studies focus more on how tech-
nology exists and shapes our lives, not how it ends.
    Future studies possibly could broaden research on disparities in access-
ing to these medical devices, as well as expand understanding on how to
become a resilient cyborg. Additionally, the book does not address other
differences, such as ethnicity and disability – an aspect that the author ad-
mits. More emphasis on other variables that are strong predictors of health
outcomes, e.g., education level and income – which are actually part of the
intersectional approach (Kaufman 2010) – could have grounded
Oudshoorn’s analysis on a more solid basis. The intersectional approach
may provide an important heuristic for grasping the multiple differences
on building resilience.
    At the end of the book, the author proposes a sociology of resilient cy-
borgs. Like all lay people, resilient cyborgs gain knowledge and skills in
different ways through a constant process. They learn what it means to live
with their implants in their daily lives, including monitoring practices
within the clinical environment.
    To paraphrase Simone de Beauvoir: one is not born, but rather be-
comes a cyborg.

References
Haraway, D. (1991) Simians, Cyborg and Women. The Reinvention of Nature,
      London, Free Association Books.
Kaufman, S.R. (2010) Time, Clinic Technologies, and the Making of Reflexive Lon-
      gevity: The Cultural Work of Time Left in an Ageing Society, in “Sociology
166                                                            Tecnoscienza – 11 (2)

       of Health and Illness”, 32 (2), pp. 225-237.
Mol, A. (2002) The Body Multiple. Ontology in Medical Practice, Durham, Duke
       University Press.
Pinch, T. and Bijsterveld, K. (eds.) (2002) The Oxford Handbook of Sound Stud-
       ies, Oxford, Oxford University Press.
Strauss, A.L., Fagerhaugh, S., Suczek, B. and Wiener, C. (1997), Social Organiza-
        tion of Medical Work, New Brunswick/London, Transaction Publisher.



                                      ***
   G. Tipaldo
La societa’ della pseudoscienza. Orientarsi tra buone e cattive spiegazioni
[The Pseudo-Science Society. How to navigate among good and bad
explanations], Bologna, il Mulino, 2019, pp. 311

Maria Carmela Agodi Univesità degli Studi di Napoli Federico II

    The red thread running through this book is the idea that sociotech-
nical controversies – where scientific and pseudoscientific knowledge
claims are clashing in the public sphere – follow a typical causal structure.
Such a structure makes recent oppositions to vaccines or beliefs in alterna-
tive cancer therapies very similar to local conflicts against big infrastruc-
tures – those well-known as exemplars of the so-called NIMBY (Not In
My Back Yard) or BANANA (Build Absolutely Nothing Anywhere Near
Anything – or Anybody) syndromes.
    According to Tipaldo, while commonalities prevail, two features distin-
guish more recent controversies from NIMBY and BANANA conflicts.
The first distinguishing feature concerns the issues at stake. Issues at stake
in NIMBY used to be undesired land uses (LULU, Locally Undesired
Land Uses, is actually a more neutral acronym than NIMBY to identify
them); recent controversies are mainly focused on collective decisions af-
fecting individual personal bodies – through public regulation/interven-
tion about health, food, personal habits. “Not in my body” (NIMBO) is
the best-suited synthesis for them.
    The second distinguishing feature concerns the role played by science.
In NIMBY or BANANA controversies, scientists used to play a secondary
role and they only came on stage when called by public administrators and
politicians to support their own decisions. In recent technoscientific con-
troversies, instead, scientific experts are positioned at the center of the
stage – as sharing with governmental bodies the responsibility of public
decisions – while opponents support the so-called fake scientific
