ROBERT S. MORISON

Perhaps the most embarrassing issue to be raised by technology is also the most obvious, at least to the naive. The same youngster who noticed that the emperor had no clothes may now be asking, "What is all your technology for?" The question is embarrassing on several counts, but the most pervasive stems from the very origin of modern science and technology. Rightly or wrongly, for better or for worse, modern science and technology are regarded as having originated in Galileo's establishment of the primacy of efficient causes. Since that time no self-respecting scientist-except for an occasional embryologist and an even more occasional and deviant evolution-ist--would allow himself to talk seriously in terms of final cause or purpose.

Casual conversation might loosen the rule, especially for biologists, who often found themselves surreptitiously asking what a newly discovered organ or secretion might be for. In any serious discourse, however, all science confined itself rigorously to the interpretation of current events in terms of previous ones. The future might thus be predicted, but in no way could it influence the course of events.

Not only was it regarded as philosophically unsound to invoke the future and its purposes, but there was a widespread feeling that it was rather crass or insensitive to do so. Science, like art, was pursued for its own sake, and even such advocates as Francis Bacon were at least slightly suspect for their utilitarian emphasis on relieving man's estate. Even the practically minded Faraday, who is remembered as much for the technical neatness of his experiments as for the penetration of his scientific ideas, found it necessary to turn away a philistine inquiry with his famous wisecrack about the potential taxability of one of his findings.

There was also the pervasive worry that premature interest in the purpose of inquiry or its "value" in terms of human needs or desires might contaminate the objectivity considered essential for unbiased scientific work.

In recognition of these limitations of method, and possibly with the hope of avoiding an onerous responsibility, the scientific community was only too glad to leave the value choices to those who professed to know how to make them.

For various reasons that have been widely discussed elsewhere, every one of these barriers, or self-denying ordinances, except perhaps the metaphysical one, has been eroded in recent years. Nevertheless, your average scientists and perhaps an even larger majority of professional technologists, whether engineers, physicists, or agricultural experts, feel uneasy when asked to discuss the purpose of what they are doing. In the event, it has been easier to begin by discussing negative purposes or costs. Positive purposes, which once seemed so obvious as to scarcely merit discussion, turn out in fact to be very difficult to characterize precisely or measure quantitatively.

Systematic discussion of particular purposes of particular technologies began in a serious way only a few years ago with the increasing consciousness that technology has undesirable its well as desirable results. This fact had always been known in a general way. Complaints about air pollution from the burning of coal go back to the Middle Ages. The undesirable side effects of new drugs were recognized by Hippocrates when he warned that, even though the occasion may be instant, the art is long, experiment perilous, and decision difficult. More recently, the notorious Luddites appeared as pioneer worriers over the effects of mechanization on job opportunities and the alienation of the worker from his work. Only in the last two decades, however, have men thought seriously about weighing the pluses and minuses of a technology in advance of actually using it. The first formal account of the need for a general procedure named technology assessment, and an account of how it might be carried on, were promulgated in l969 in a report from a committee of the National Academy of Sciences-National Research Council.1 Shortly thereafter the Congress responded with the establishment of an actual Office of Technology Assessment. So far it has not assessed a great deal of technology, but its history does provide it a lively and instructive view of the difficulties involved.

As is so often [the case with new technologies, it was the military that first opened (the road to technology assessment, with a set of procedures known then as operations analysis, (or, more crudely, target selection. The criterion of choice was cost/effectiveness, which in peacetime has, with some loss of self-restraint, been converted into cost/benefit.

So far so good; all is very tidy, linear, and algebraic. But anyone even casually familiar with the literature finds that the better papers end on a plaintive note. When all the numbers are added, sub-tracted, correlated, chi-squared, and otherwise processed, there comes the inevitable moment of truth when someone must make some value judgments about the purposes to be fulfilled. What, after all, is a benefit? Who gets it? Is the same event beneficial to some and harmful to others? Are all lives equally enjoyable? Whether they are or not, are they all equally valuable-in the sight of God perhaps, or, more often, in the sight of an insurance adjuster or a sympathetic jury? Does the $50,000 spent in keeping a leukemia patient uncomfortably alive for a year add as much to the sum total of human happiness as if it had been spent by twenty taxpayers taking their wives to Bermuda? Is, in fact, the sum total of human happiness the item to be maximized, or should we first make sure that the least advantaged are raised to some acceptable standard before we ask for algebraic sums? Is happiness, perhaps, not the point at all? In the long history of hominids, the possibility of happiness has been perceived but fitfully and realized even more rarely. Yet the modern world seems unprepared to give preemptive status to a Romanesque cultivation of duty, an Augustinian glorification of God, a Confucian veneration of one's ancestors, or, least of all perhaps, to a Pre-Raphaelite dedication to art for art's sake.

Until recently it would have been easy for most of us to dismiss all of this as a bundle of pseudo-questions unworthy of the attention of the tough-minded. Common sense would tell us that knowledge is better than ignorance, food better than famine, health better than illness, life better than death, mobility better than stagnation, automobiles better than horses, electric lights better than tallow candles, and so on. How could we go wrong if we simply dedicated ourselves and our technology to meeting obvious human needs?

My own hope of ending my days in this kind of blissful ignorance fell away abruptly when my brother Elting Morison wrote a deceptive little book that purported to be a brief everyman's history of American engineering.2 The simplicity of the occasion was uncomfortably complicated by the fact that the account began with a quotation from A. N. Whitehead and ended with "Some Notes on Visions" by the author. The essence of the quotation from White-head may be conveyed by the following excerpt: "The business of philosophers, students and practical men today [is] to recreate and reenact a vision of the world ... either we succeed in providing a rational coordination of impulses and thoughts, or for centuries civilization will sink into a mere welter of minor excitements." The "notes on visions" give a brief review of past visions and the chances for finding one that will keep us from sinking deeper into the welter of minor excitements in the future. The main point for our purposes is that it does not make long-term sense to assess technology merely in terms of its short-term costs and benefits. We must attempt instead to see where it fits in some much larger framework of the future, and it is just this lack of a larger frame that modern technologists find so embarrassing. They are so very good at getting you to Paris in three hours but so very poor at telling you what to do when you get there.

Indeed, it sometimes seems that society as a whole, and, surprisingly enough, a high proportion of its young people, are unable to conceive of any vision other than the welter of minor excitements. A couple of years ago, for example, I found myself teaching a section in a course that employed my brother's book as one of its texts. Somewhat unexpectedly, my principal task turned out to be an elaborate explanation of the very possibility of a vision different from, let alone larger than, our present one. No passions were aroused, scarcely one drooping eyelid was raised at Henry Adams's speculation about the meaning of the impending substitution of the dynamo for the Virgin. Worse than that, it seemed impossible to explain what Matthew Arnold felt he had lost as he listened to the melancholy, long-withdrawing roar of the waves that once rolled from the Aegean to Dover Beach. On other occasions, I have been equally unsuccessful in getting a class to grasp what Plato and Bacon and More, or even H. G. Wells, thought they were doing in their speculative writings about Utopias.

In groping for an explanation for this curious insensitivity to things as they might be, one is forced to wonder whether the technical preoccupation with efficient causes has infatuated a whole generation. If everything is determined by preceding events, they seem to be saying, what point is there in speculating about a different kind of future?

But the picture is not all of one color. As usual, there are internal contradictions. At the same time that we lose any clear vision of the long-term future, we become increasingly, even uncomfortably aware of, our power of choice over the short term. Technology has not only greatly widened the span of our options, it has made choosing a necessity. Faced with declining reserves of oil and gas, we can choose coal at the risk of living in a greenhouse, or go nuclear and risk a meltdown (or two or three--the figures are not yet precise), or go directly to the sun and bear enormous capital costs.

Nowhere, perhaps, are the choices more numerous, novel, and insistent than in the field of medicine, where almost every week we hear of a new way of prolonging life or of identifying some genetic defect in time to destroy life before we become too squeamish about its personhood. For most of us, the power to choose implies the obligation to do so. Science and technology not only give us the possibility of choice, they also can tell us a good deal about the results of alternate choices. But they must always stop short of telling us what it is we really want. That is the real paradox of our time-- an enormous increase in power and an almost equivalent increase in the ability to foresee the effects of power in objective terms, but a decrease in our ability subjectively to decide what we want. The pressure generated by this contradiction becomes every day more difficult to ignore.

Nowhere, perhaps, is the paradox more binding than in the area quaintly known as "national defense." Science has given us the power to destroy our enemies with unparalleled efficiency. We can pretty well demonstrate that the results will be devastating to both sides, but we remain oddly paralyzed and unable to choose between making a first strike and being the first struck. One of the difficulties apparent in both the medical and national defense examples is what might be called the seductiveness of technological detail. Peace studies and arms control groups in and out of the universities have spent endless person hours estimating megatons, defining the probable precision of multiple warheads, and defining the relative hardness of various kinds of missile sites. Fo a certain kind of mind, the possibilities for calculation and countercalculation are endlessly fascinating, but they may also keep us from the more important effort to analyze just what it is that separates us from the Russians or to develop a cost/benefit analysis of coexistence.

The foregoing and other possible examples seem to show that as we grow microscopically more precise, we become macroscopically more confused. In Whitehead's terms, the minor excitements seem to crowd out the possibility of a "vision of the world [to provide] a rational coordination of impulses and thoughts." It seems just possible, however, that we have begun to grope our way toward the larger questions. Although the energy problem is still largely discussed in terms of drilling more wells, stripping more seams, and "synthesizing" more petroleum substitutes, every now and then a voice may be heard asking the larger questions and seeking a different vision. Why must per capita consumption of power always increase? What do we get for it? Are we happier, healthier, or closer to some other ideal state than the Swedes, who use about half as much energy as we do, or the !Kung Bushmen, who use scarcely any nonrenewable energy at all?

It may be worth spending a moment on the !Kung, because they actually tell us a good deal about the vision of human existence that endured for a much longer time than any other. From the seventeenth century onward it has been customary to pounce on any romantic speculations about a golden age and destroy them with one stroke of Hobbes' famous aphorism about the life of man in a state of nature. It did not matter that Hobbes had no empirical evidence, or that he was primarily concerned, not with the actual conditions of life but with elaborating a speculative political theory on the basis of s hypothetical condition of early man. However it may have arisen, the famous phrase provided an all too nasty, brutish, and short way of dismissing all those who questioned current definitions of progress. Recent work, not only with the !Kung, but also with other remnants of Mesolithic man, supplemented by studies of artifacts from Paleolithic and Mesolithic times, suggests that the life of hunters and gatherers may have been quite healthy and happy, especially in comparison to that of the settled agricultural and technologically more advanced societies that came later. Many of the early societies seem to have remained in a balanced relationship with the environment for hundreds of thousands of years. Population growth was limited not so much by the natural checks of the four horsemen as by other more subtle, possibly self-conscious means.3

Social life was highly organized and rewarding, and above all, there was a lot of leisure time to devote to conversation, mythmaking, and other primitive arts. This last observation reminds us that the designers of modern science-based Utopias, like the archetypical H. G. Wells, stressed the role of modern technology in freeing men and women from drudgery and enlarging opportunities for more cultivated, enjoyable, and creative pursuits. The reality, of course, has turned out to be quite different. More efficient production has been used to produce more things rather than more free time. As Kenneth Galbraith and many others delight in pointing out, additional effort must then be spent in getting people to want the things produced. The result is that almost all adults must work almost continuously to maintain the normal American standard of living. The fact that a higher percentage of women than ever before are in the labor force should not be taken as triumphant evidence of woman's liberation. On the contrary, even a casual survey will show that most of these women work outside the home because they need the money to buy some new thing.

The vision that has kept us going during most of the modern technological age is the one formulated in the eighteenth century by the men of reason, and expressed most articulately by Condorcet. It is, of course, an aggressively secular vision, and hinges on the proposition that man's spiritual welfare is closely linked to his material circumstances. Perfect his circumstances and you perfect man himself. The material emphasis was certainly justified in the beginning, since most things were in short supply for all except the very rich. For a considerable period, material and spiritual conditions seemed to go forward together, and in the memory of those of us who are now retired, many people believed that Western man was actually improving morally as well as physically. Indeed, I can remember reading as a boy of the rackings and sackings of the Thirty Years War, and rejoicing that I lived at a time when men had clearly progressed beyond the very possibility of such cruelties.

If the sack of Magdeburg and the devastation of the Palatinate have their modern counterparts in the bombing of Dresden and Hiroshima, and if the crematories of Auschwitz have outshone the crackling fires of the Grand Inquisitor, there is at least one respect in which man has made striking, almost unbe1ievable progress. His physical health is much better than it was in 1789, and it continues to get better all the time. Undeniably, and just as Bacon and Condorcet would have predicted, this improvement has been due to progress in technology, though much less to specifically medical technology than is usually believed. In advanced countries scarcely anybody dies from the conditions that swept away half the population before puberty in Condorcet's day, Those few who now die before passing the prime of life do so for interesting reasons, which suggest that physical perfectability does not lead inevitably to spiritual peace of mind. Accidents, homicides, and suicides are now the "captains of the men of death" in the younger decades, while the results of dietary indiscretion and addiction to nicotine and alcohol dominate the forties and fifties. These by now well-known facts are particularly curious when juxtaposed with other evidence that modern man has adopted physical health as his paramount value.

It is worth pausing a moment to consider the current worship of Hygeia, since it may come as close to a universal value or Whiteheadian vision as we have been able to get. Contemplation of its obvious limitations as an organizing human purpose may help us understand how far we are from Whitehead's requirement.

Roughly 10 percent of our national income goes to support the medical establishment, replacing the tithe that in a good society of the past went to the church that in turn took responsibility for a wider range of social and spiritual activities (including many of what we now characterize as health services). In most communities of moderate size, the local hospital or medical center outclasses the structures that house the local library, the art gallery, or the church, just as in our national capital, the National Institutes of Health outspread the National Cathedral, the National Gallery, and the Library of Congress combined. Even in our greatest institutions of learning, the medical center towers above everything else, just as the budget of the medical school dwarfs that of the other arts and sciences.

A case can be made that this primacy of health in our value system was far from accidental or simply selected for want of something better. The man who, as advisor to the senior Rockefeller, was more responsible than any other for the shape of modern medical philanthropy, the ordained Baptist minister Frederick T. Gates, had this to say at the tenth anniversary of the founding of the Rockefeller Institute for Medical Research:

I said it [medical research] is as universal in its scope as the love of God, and I now add it as beneficient in its purpose. It goes to the fountains of life itself. It deals with what is innermost in every man. For what is health? Health is happiness; mere health itself is happiness.

And on the other hand. . . disease . . . with its attendant evils is undoubtedly the main single source of human misery.... In the Rockefeller Institute we have a great organization, nobly housed, suitably equipped, splendidly endowed, inspired with the most intelligent zeal and the noblest enthusiasm to prevent and to destroy the chief source of human disqualification and misery.

For what is human progress? Ultimately it is this, just this, and nothing else-an ever closer approach to the facts, the laws, the forces of nature, considered of course in its largest meaning. Nothing else is progress and nothing else will prove to be permanent among men....

Do not smile if I say that I often think of the Institute as a sort of Theological Seminary. But if there be over us all the Sum of All, and the Sum Conscious-a Conscious, Intelligent Being, and that Being has any favorites on this little planet I must believe that those favorites are made up of that ever enlarging group of men and women who are most intimately and in very truth studying Him and His ways with men. That is the work of the Institute. In these sacred rooms He is whispering His secrets. To these men He is opening up the mysterious depths of His Being....

As medical research goes on, therefore, it will find out and promulgate, as an unforeseen byproduct of its work, new moral laws and new social laws--new definitions of what is right and wrong in our relations with each other. Medical research will educate the human conscience in new directions and point out new duties. It will make us sensitive to new moral distinctions.

It will teach nobler conceptions of our social relations and of the God who is over us all.

There is, of course, something admirable in all this. There may the even something magnificent about the resolve to learn God's laws and then to use them to reverse that part of the order of nature that dooms most men to less than optimal performance, if not to a lifetime of physical suffering. But there is also something almost desperate about this preoccupation with the elimination of physical distress. It suggests that having discovered no real reason for any existence, we will devote all our efforts to making that existence at least as painless as possible. For, like it or not, health is at base a negative concept. In the optimistic reaction that followed the horrors of World War II, the World Health Organization tried hard to promulgate a positive definition of health as a "state of complete physical, mental, and social well-being" much more than the mere absence of disease, but the idea never caught on. The most obvious reason was purely technical. Doctors are trained in terms of disease, and the elaborate machinery at their command is designed to Uncover the abnormal. Health is thus usually defined as that state in which all the pointer readings fall within the normal range. In practice, that range can be very broad, and most medical people become confused and embarrassed if called upon to define a scale for measuring degrees of health. Instead, they are content to define health as all absence of obvious disease.

The second reason For the failure of positive definitions of health is more subtle and more germane to our present concern. When called upon to speak about health in positive terms, the sensitive physician suddenly finds himself struggling to define the good life, and this he feels ill equipped to do. Certainly before World War 1, and even perhaps until World War II, it was possible to believe that other members of the learned world had this task reasonably well in hand.

Now one is not so sure. Certainly the secularization of life in the twentieth century explains some of the difficulty. Shorn of its traditional religious metaphors, Gates's vision simply doesn't shine as effulgently as he hoped, and it comes as something of a shock to discover that the only alternative to seeking a divine purpose is to live in such a way that all one's organ systems function according to accepted norms. If he were to return to us today, Gates might well ask if there is no way of being secular without being exclusively corporeal. Must those who followed the gleam of the Grail now content themselves with a bottle of Natural Lite?

All this is not to say that health is not a desirable stale nor that it is a mistake to include it among the three wishes placed before the good fairy, but its proper status is that of a means, not an end itself. Just as there is something a little sad about a man who buys a new car simply because he wants to wash and polish it every Saturday morning, there is something quite wrong about a man who jogs five miles before breakfast, eschews bacon and eggs, and turns down a stressful but interesting job, all because he is obsessed by the need to remain in "good health." Actually, good health is not even an indispensable means, as the lives of many poets, musicians, and even soldiers remind us. One might even ask if a Dostoevsky who enjoyed good health could possibly have written The Brothers Karamazov.

Perhaps the most uncomfortable aspect of health as an end is the way it substitutes or obscures the need for more mature approaches. Thus it has come to dominate many aspects of our national life where in other cultures it might seem only distantly related.

The health theme is central to much of our advertising, some of it directed at specific aches and pains or the suppression of odors, but a considerable proportion directed at establishing less well defined states of well-being, like the mystical unions cemented by daily libations of Geritol. Medical research has long been recognized as the keystone to health, and the budget for health-related research is second only to that for research related to national defense, which many of its proponents may think of as health-related also. Indeed, ever since the Rockefeller boards decided to concentrate on health as the root of most of man's evils, a major part of private philanthropy has been channeled into the improvement of health in various ways.

Perhaps most revealing of the way in which health has taken over or underlies the whole contemporary value system is best seen in the way the health theme is used to justify other values and purposes. Thus most of the standards set for cleaning up the environment are related to real or fancied effects of pollution on human health. True enough, many environmentalists have their own quite different sets of values that prompt them to take an interest in returning the environment back to its pristine condition. Some of them are doubtless moved by aesthetic considerations: the San Bernardino mountains do look better on clear days, and salmon leaping in uncontaminated rapids are a more cheerful sight than the green scum floating on a stagnant, eutrophic pool.

Others are consciously, or perhaps unconsciously, embarrassed by the primacy God is said to have given Western man in the Book of Genesis. As a result, they feel a moral urge to come to the defense of more endangered species. Some of the most ardent are certainly closet pantheists, possibly unaware of their addiction to an outmoded heresy and unwilling or unable to expose it to public view. All too rarely but significantly, courage and wit may sometimes combine to ask such questions as "Should trees have standing?"4

All these alternative attitudes and values have a need to be explored and considered in their own right. In practice they are all subordinated to the health theme, because in our present state of grace this is short route to the most votes.

Even the values attached to nature by former generations of religious and literary figures must now be interpreted in terms of the health needs of some people for solitude, fresh air, or the tonic effect on the heart of a rainbow in the sky.

Perhaps the most serious result is the way the preoccupation with health occludes the search for other ends. Even though one suspects that other ends may never be found, the renunciation of the search leaves us with nothing to do but order up another angiogram to assess the heart's desire, or to prescribe the most recent tranquilizer to still the remnants of existential angst.

It remains only to mention some of the other and perhaps more serious external costs of placing a disproportionate value oil health. These have been most comprehensively and unrestrainedly dealt with by Ivan Illich. Unfortunately, the richness of his rhetoric, the radical conservatism of his distorted remembrance of things past, and the often flagrant misinterpretation of the numerous citations with which the text is so proudly burdened have served to turn attention away from the important core of truth in Medical Nemesis.5 As I understand it, and stripped of its distracting conspiratorial interpretation of the medical profession, an account of his position might run something like this:

For various reasons, not the least of which is its apparent success in reaching limited objectives, modern medical technology has achieved enormous prestige and influence in our society. This has led, among other things, to a vast erosion of the individual's responsibility for his own health and welfare and to its transfer to health professionals. Thus the professionals originally charged with the prevention and control of disease become increasingly responsible for new types of illness and disorders. Of the three classes of iatrogenic sicknesses Illich describes, the social illness is perhaps the most interesting and relevant to our present concern.

The point here seems to be that the human community lost a good deal of what made social life worth while, or warm or rich or human, when it adopted a very limited definition of normal behavior and regarded all departures from this norm as illnesses to be cared for by professionals. Prominent among his examples are aging and death and certainly there is now a very rich literature describing the need to deprofessionalize the care of these two inevitable parts of natural man's existence. Psychiatrists like Szasz and Laing have extended the same sort of thinking into the realm of so-called mental illness, and there is a growing effort to reduce the number not only of the mentally ill, but also of the mentally retarded that must now be cared for by professionals in institutions. But here again we encounter a difficulty. Wise though it may be to give up measuring some of these people on the sickness-health continuum, the unhappy fact of the matter is that many do not adjust easily and well to twentieth-century urban living.

What is clearly needed is a system of social values that includes a place for those different, but not necessarily unhealthy, people. Our present tendency to overemphasize health as a value and at the same time to define the unusual as pathological may thus unduly restrict the scope of our social arrangements.

In conclusion, it appears that technology assessment is even harder than we thought. It is not enough to judge a given technology in terms of how effectively it realizes its stated objective and how well it avoids undesirable side effects and external costs. The very value system or "vision of the world" within which the technology is to function must also be taken into account.

The relationship is a reciprocal one. A comprehensive, satisfying vision of the future, it we had one, would provide an overall standard by which to judge the more obvious and immediate purposes of our technological advances. It would give substance to such currently nebulous concepts as the "quality of life" or the "integrity of the environment" that we now call upon as substitutes

It is this function that I believe Whitehead had in mind when he wrote the sentences that constitute the theme of this paper.

As we also have tried to show, a particularly brilliant technology may give a spurious brilliance to an inadequate vision. Means tend to become ends in themselves, and the search for a more enduring purpose is slowed down or forgotten. At its worst the inadequate substitute value system may tempt us into superficially satisfying, but in the long run deleterious, solutions to social problems. Indeed, as we have tried to show, there is some evidence that the primacy currently given to health as a value has unduly limited our sense of responsibility for the environment. Similarly, in our relationships with one another, the tendency to regard deviations from accepted behavioral norms as deviations from health may set too narrow a limit to our social arrangements and responsibilities.

To take a perhaps more familiar but quite different example, that of a premature satisfaction with inadequate visions, one may speculate that our society might be in better shape today if it had not been too ready to believe that the early material successes of the spirit of capitalism were the outward and visible signs of inward and spiritual grace.

NOTES

1 National Academy of Sciences, Technology: Processes of Assessment and Choice (Washington, D.C.: U.S. Government Printing Office, 1969).

2 Elting E. Morison, From Knowhow to Nowhere: The Development of American Technology (New York: Basic Books, 1974).

3 Richard Lee and 1. DeVore (eds.), Man, the Hunter (Chicago: Aldine Press, 1968); Brian Spooner (ed.), Population Growth.- Anthropological Implications (Cambridge, Mass: M.I.T. Press, 1972); James V. Neel, "Lessons from a Primitive People," Science, 170 (November 1970): 815-822.

4 Christopher D. Stone, "Should Trees Have Standing?-Toward Legal Rights for Natural Objects," Southern California Law Review, 45 (7): 450.

5 Ivan Illich, Medical Nemesis: The Expropriation of Health (London: Calder and Boyars, 1975).