We have a tendency to separate structures from individuals, the ‘past’ from the present, the individual from their group, relationships and environment in ways that can be deeply unhelpful, arbitrary and consistent with Western individualism and modernist formations. White minds has sought to argue that psychological, social, spatial and temporal realities are co-constitutive, inseparable and arguably part of the same phenomena or communicational field.

Although this proposition challenges much of our worldview, being prepared to confront the disorientation it may produce is central to recognising patterns of harm and interrupting processes of repetition, continuation and maintenance that sustain whiteness across time and space.

I have attempted to present a psychosocial analysis of the same. That is to say, an analysis of whiteness grounded in these intersections. An analysis which sought to demonstrate that the internal– external binary, when it comes to race, and any other social phenomena for that matter, is hardly tenable.

My analysis has placed groups racialised as white under the microscope, in doing so subverting the white gaze and transgressing the direction of power. This oppositional gaze has invited us to explore the quotidian workings of whiteness and its everyday performances through personal reflections, stories and anecdotes, thus, through cultural, autoethnographic and historical material. A historicised approach which has provided, I have argued, ‘evidence’ of the production and reproduction, articulation and rearticulation of racialised violence.

‘Evidence’ that sameness and continuation can coexist with change, fragmentation and disruption has established the complex temporality of whiteness. A temporality which is embodied for the postcolonial subject and can be viscerally apprehended through recognisable patterns leading to a sense of knowing without knowing.

We have explored particular dysfunctions and disturbances in white minds resulting from the mobilisation of defences, fantasies and impulses which keep that white bubble intact in the midst of professed concerns for reason, justice and fairness in the white subject. We have sought to confront the psychosocial pathology of whiteness head on.

For the reader racialised as white, such a confrontation is likely to have given rise to difficult feelings, perhaps even some confusion. That disturbance, though, if felt, was already there. It exists within every single part of our society thus in the white body.

‘It’s because we fought for ARVs together’: HIV as a site of ongoing struggle

Miriam and I had spent the morning waiting in queues in Site C – a clinic in Khayelitsha, South Africa – as Miriam went through a series of checkups. On this visit, the check-ups extended beyond the usual monthly blood pressure and weight checks and included more detailed tests to make sure that her HIV medicines were not having adverse effects on her body. Miriam, who had first learnt of her HIV status in 1999, was concerned that the medicines were having seriously negative effects on her body. According to Miriam, these effects – including chronic backache and weight gain – were not taken seriously by the nurses and doctors and, instead, felt she was being blamed for these conditions rather than supported in addressing them. On this visit, she had resolved to speak to the nurse and ‘finally be taken seriously’. In this conversation, the nurse had told Miriam that the biomedical markers of her health – her CD41 count, viral load and blood pressure – indicated that the medicines were ‘doing their job’, and Miriam was advised to go on a stringent diet. I had waited on the bench outside the nurse’s office and when Miriam came to pick me up she explained that although she was frustrated with the nurse’s dismissal of her side effects, she was not surprised. With this sense of resignation, we walked across the clinic to collect her HIV medicines. While waiting in the very long queue snaking out from the three pharmacy counters to the general waiting area of Miriam’s clinic, we spent most of our time chatting to the many ‘comrades’, as Miriam referred to them, who came up to greet her. When I commented on Miriam’s active social life in the clinic, and particularly in the pharmacy queue, she smiled and said, ‘Sana, it’s because we fought [for ARVs] together’.

This chapter explores the ways that ARVs (antiretrovirals) are perceived and embodied by people like Miriam who had fought for the South African government to provide this treatment through the public health system.

A cultural note

It was on 20 April 1968 that Enoch Powell, the prominent member of the Conservative Party, made his now widely known and infamous speech, ‘The Rivers of Blood’ [2]. A speech which was so drenched in paranoia, racialised imaginary and hate that it would inscribe itself into British memory and remain the object of sustained political analysis. It provoked repulsion and fascination in equal measure for decades to come. Powell’s speech shook the nation largely because it employed discourses and devices which, until then, had been seen as the province of far-right politicians, white nationalists and extremists. The speech contained powerful imagery describing an apocalyptic Britain on the brink of black annihilation. Metaphors included, of course, the spreading of white natives’ blood, Britain ‘heaping up its own funeral pyre’ under the watchful eyes of ‘wide-grinning piccaninnies’.

The contents of the speech, which in many ways normalised within the UK mainstream the politics of racial paranoia, continue to make many of us recoil. I have attempted to fully re-read the entire text and considered incorporating larger extracts for a closer analysis in the present chapter. However, so strong and visceral was my response to the words I was reading, in the end, I simply was not able to. My will to read was overcome by a sense of repulsion which, no doubt, activated my own trauma-loaded response.

Another cultural note

On 17 June 2015, the same paranoia-filled ‘logics’ led to the mass shootings and murder of nine African American church-goers in Charleston by 22-year-old Dylann Roof. During his trial, it was found that Roof had wanted to start a ‘race war’ [3]. That he had dedicated hours to bemoaning and writing about how evil black people were. This belief in the threat posed by blackness was unshakeably held in the absence of evidence of him having been hurt by a single black person. In his own statement to the FBI, Roof confirmed he had never suffered harm at the hands of a person racialised as black.

In 2014, YouGov carried out a study on attitudes to the British empire in Britain [1]. It found that, generally, among the British public, feelings towards the empire tended to be both positive and nostalgic. Three to one, British people surveyed believed the British empire was something to be proud of rather than ashamed of. The same poll sought to discover whether the empire was viewed as a force for good or a force for bad; 43 per cent saw it as a force for good, only 19 per cent saw it as a source for bad. Twenty-five per cent responded that it was ‘neither’. Finally, the research also revealed that a third of participants wished the British empire still existed. The poll came about when then prime minister David Cameron paid a visit to the Punjabi city of Amritsar in India, the site of the 1919 Amritsar Massacre which saw hundreds of Sikh anti-colonialism protesters murdered by troops under British command. Of note, and consistent with the poll, Cameron declined to apologise for this colonial atrocity, instead he proposed: ‘there is an enormous amount to be proud of in what the British Empire did and was responsible for – but, of course, there were bad events as well as good. The bad events we should learn from – and the good events we should celebrate’. He never actually explained what ‘we’ had learnt from the massacre [2].

White narcissism, white shame

It takes a special kind of confidence to address descendants and relatives of the Amritsar Massacre and any other colonial atrocities, look them in the eyes and say, “The British Empire was both good and bad and it is important to celebrate the good.” All the while, survivors and their descendants continue to mourn the dead and remember the violence. This is the kind of confidence which is apparently averse to shame.

This collection began as a personal undertaking aimed at bringing together a diverse set of scholars whose work on health and technology converged on a shared objective: namely, to investigate a slice of our contemporary health-centric sociotechnical world using intersectional Science and Technology Studies (STS) methods in innovative ways. The first spark for this project came from my work on another book in which I examined the material-discursive construction of health and STS, titled Health Apps, Genetic Diets and Superfoods: When Biopolitics Meets Neoliberalism. In the course of writing that book, I discovered a flourishing ecosystem of new and exciting research examining what being in ‘good health’ means for individuals and communities and how this intersects with more contemporary notions of well-being in light of technological change, increasing medicalization and biomedicalization, and controversies around care, access, sovereignty and justice (Henry, Oliver and Winters, 2019; Hatch, 2020; Kolopenuk, 2020; Flore, 2021; Lupton and Willis, 2021).

Also of note was how health, under the conditions of a pandemic, had taken on a new valence – one that thematized the depths of our relations with other humans, non-humans and artefacts (inclusive of technologies). It also marked, as Moya Bailey and Whitney Peoples contend, a reconceptualization of health as ‘both a desired state of being and a social construct necessary of interrogation because race, gender, able-bodiedness, and other aspects of cultural production profoundly shape our notions of what is healthy’ (Baily and Peoples, 2017, p 3). While not all the chapters in this volume take on health as discourse and embodied state of being, each, in its own way, weaves together compelling narratives and performs agential cuts into our mutating techno-scientific and health assemblages in novel and exciting ways (Barad, 2007).

In light of these revelations, in drafting a proposal and sending out a call for submissions, I made it clear that my objective in inviting contributors and soliciting chapters was to use the book to engage in conversations with a diverse set of scholars whose commitment to heterogeneous scholarship was not only reflected in the thinkers they draw on, but also their methods, choice of case studies, writing styles and intentions.

Introduction

I contend that the future of healthcare lies in the advancement of digital health technologies. Digital technologies such artificial intelligence, robotics, nanotechnology, virtual reality and augmented reality systems are changing how we practise and experience healthcare delivery and will challenge the traditional system of medicine.

A new technology emerges every day and is having substantial impact on the workforce. Due to the contrast between the scarcity era in which we have lived and the coming era of abundance through new technology, it is important to pay attention to social contracts. Adapting healthcare systems and policies to the development, assessment and uptake of health technologies is discussed in this chapter. Furthermore, this chapter highlights new and emerging opportunities for policy makers, as well as current challenges. It has been observed that these technological advancements have not benefited all classes of society and thus there are economic and cultural inequalities (World Social Report 2020; UNCTAD 2021). In this chapter, the reasons for the gap between classes of Indian society will be discussed and evaluated, as well as gendered asymmetries in access to healthcare services and technology. My focus is to identify the gender inequalities, associated risks and the developmental interventions that can fill this wide gap. Although advancements have been made in STEM (science, technology, engineering, and mathematics) areas by women in the past decade that has shaped contemporary science and technology studies (STS), this arena has not been left untouched by the issue of gender bias.

Further, the chapter will engage with knowledge communication and try to assess how the scientific information route is being impacted upon by the gender issue. Transmission of healthcare information to requisite audiences occurs through mediated or unmediated modes of communication. Diverse methodologies employed for the internalization of healthcare information, including edutainment or civic journalism, for example (Dunwoody, 2014; Parvanta 2020). This scientific information has to penetrate to every level of society, including socially and economically excluded groups who have worse health outcomes (Tarango and Machin-Mastromatteo, 2017). Several areas of health information are relevant to health literacy, such as improving clinical relationships between healthcare professionals and patients, enhancing compliance with clinical recommendations, developing public health campaigns, communication about individual and population health risks through mass media, the image of health in popular culture, educating the public about how to utilize the healthcare system and the development of telehealth applications.

A cultural note

The year 2018 saw the release of the long-awaited superhero film based on the Marvel comic of the same name, Black Panther. Black Panther is the first film in the Marvel cinematic collection centred on a superhero of colour: black prince King T’Challa. The movie, which is set in the imaginary African location of Wakanda, also sees a virtually all-black cast defeat its enemy, avoid colonial invasion and successfully head a global technological revolution. Although the film can and has been astutely critiqued for its use of Western colonial motifs and significant capitalistic imaginary, its cultural significance is indisputable. Commensurate with this significance and the storyline which portrayed black subjects beautifully, and as agents of their own destiny, was the black joy that instantly erupted upon the release of the movie. By black joy here I simply mean a shared and collective sense of joy among groups racialised as black originating from the same event.

Black Panther brought a significant sense of euphoric pride in black groups across the diaspora, and although I focus here on the UK, videos of celebrations and joyful communication and dances shared on social media from across the world suggest that joy may have been global. With that joy came a significant backlash. I have observed it mainly online through the racist comments and abusive trolling of those seen to be happily tweeting about the movie or singing its praises. Anonymous social media accounts and identifiable figures came forth en masse as a reaction. Many, it appeared, worked hard to spoil the moment, deriding it, mocking the joy and even racially abusing those expressing it. It is clear that the hate-filled responses were not only acts of opposition to the quality of the movie, or forms of critiques, as it may be tempting to propose.

Introduction

This chapter provides a critical review of recent developments of science and technology, and scrutinizes the challenges of artificiality that we invent. Human existence and dignity continue to be challenged by advanced technologies such as AI and other innovations in the life sciences. As such, I argue that frameworks emerging out of science and technology studies (STS), ethics, philosophy and ELSI (ethical, legal and social implications) must be used to inform our perspectives.

I begin by focusing on the concept of the ‘artificial’. When one adds the prefix ‘artificial’ to any word, it introduces a level of discomfort, and it feels as if it conflicts with the values associated with life and human existence. As discussed further on, it carries with it some elements of the ‘uncanny valley’ or ‘numinose’. We should thus also feel a sense of latent warning rather than admiration for technological triumph, particularly when confronted with the nature of ‘artificiality’.

Second, based on the artificial as a concept, I argue that human existence and dignity are at risk, due to the development of specific forms of science and technology. Despite this, human beings and our societies still continue to pursue the mass production and purchase of these artefacts. What kind of society will we produce in the future? Will the end point of technological innovation mean the loss of human dignity and the value of life itself? Will humanity have the will to control the advanced technologies and artefacts we created?

This chapter aims to engage in a critical review of technological trends. It offers an overview of the values that really need to be protected and draws on a metaphysical perspective from which to maximize sustainability and existential survival into the future.

Problems with the ‘artificial’ concept

Humanity can be described, at least in part, as a population of mammals who produce their own technology and tools (for example, Homo faber (Scheler, 1961)). ‘Artificiality’, which is different from natural origin, can be generally defined as a something human-caused and human-made, and refers to those artefacts produced since the beginning of recorded civilization (Needham,1956; Jones and Taub, 2018).

Anyone racialised as white seeking to commit to anti-racism will at some point need to confront their relationship with whiteness, including their internalisation of white supremacy. Although we may often take this step for granted, the problematics and challenges of facing the reality of white supremacy and one’s complicity require some exploration. We know that human beings will go to extraordinary lengths to maintain their psychic equilibrium. We examined earlier in the book some of the physiological, psychic and social processes that help the white body flee the reality of white supremacy. When, a decade or two ago, I first encountered Black skin, white masks by Fanon, I had such a strong visceral response to it; I did not finish it [1]. I experienced an intense dislike for the words I was reading. I have not experienced this with any other book. I remember discarding the book, and did not touch it again for years. Such reactions always call for our attention. The reality is I was not ready. My mind refused to engage with the contents. My body put out a block. Perhaps this was to protect me from seeing part of myself or the world I was not prepared to see. Yet, Black skin, white masks is now one of my most cited texts. It took several painful encounters with whiteness for me to go back to Fanon’s words. My experience of the world drove my needing to understand this text.

This extract is from ‘Letter from Birmingham Jail’, an open letter written by Dr King on 16 April 1963 as a response to criticisms by clergymen calling for unity and condemning King’s involvement in direct action. The call for unity was based on the notion that racial injustices were best fought through legal means, in court rather than in the streets. That is to say, through civility and respectable means. King’s response, which became central to the civil rights struggle, defended his position on both religious and moral grounds. He stood by his actions and saw direct action as a legitimate means of achieving justice when diplomacy and dialogue fail, and when justice is not available through other means. The debate around which methods of protest for racial injustice may best suit white society and which timing will accord with its timetable is evergreen. The disapproval of black liberation methods is too often simply the disapproval of black liberation. This message from King at the height of the civil rights movement acts as a powerful reminder that white comfort has always been a significant blocker to justice and equality.

Today, this same preoccupation with (dis)order and ‘negative peace’ can be seen in the way Black Lives Matter protests and anti-racism actions such as ‘taking the knee’ continue to be ridiculed, maligned and fiercely opposed in the press and within most political parties. Hostility and opposition towards Black Lives Matter protests triggered by the murder of George Floyd have been widespread and explicitly expressed by those in high office.

Introduction

Towards the end of 2019, media reports emerged of a team of student researchers at the University of Copenhagen developing a chewing gum that helps women detect ovulation: when the ‘Ovulaid’ gum changes colour, women will know they’ve reached their ‘fertile window’, the days of the menstrual cycle when a woman can become pregnant (Russell, 2019). Ovulation, the releasing of an egg from the ovaries, is triggered by the rise and fall of the so-called ‘sex’ hormones, oestrogen, progesterone and luteinizing hormone. These hormonal changes can (sometimes) be detected through saliva, urine and temperature. Ovulation biosensors, like the chewing gum, claim to help women detect and predict their ovulation patterns and thus make conception easier by indicating the times at which they are most likely to conceive (Wilkinson, 2016). They can also, of course, be used to avoid conception.

Ovulation biosensors are located within a wider array of ‘FemTech’ devices/ products comprising an ever-increasing number of fertility-related apps and devices that have come onto the global market, each attempting to offer something new such as more in-depth data or greater levels of accuracy. Media stories, like the one cited, frequently accompany these developments, focusing not only on the increasing use of such devices (see, for example, Weigel, 2016) but also on the poor reliability of fertility tracking (see, for example, Kleinman, 2021). The FemTech industry (services, products and software designed to focus on women’s health) is increasingly subjected to public scrutiny. Many self-tracking apps and devices encourage women to collect and store large quantities of bodily data online, and controversies have arisen around companies’ capture and on-selling of this data (see, for example, Shadwell, 2019). In an important case, in 2021 Flo Health Inc, (owners of ‘Flo’, a period and ovulation tracking app with more than 100 million users), settled with the US Federal Trade Commission, who proved the company was sharing users’ data with third parties, including Google and Facebook, despite having promised to keep it secure (Federal Trade Commission, 2021).

FemTech is also increasingly the subject of social research, as we describe later in this chapter. A key strand of this work highlights issues of data privacy and the commercialization of women’s fertility. Science and technology studies (STS) and feminist technoscience studies (FTS) approaches are central to this field, and we situate our research in this space.

Introduction

The impact of digital technologies on labour has become in the past decade a focus of science and technologies studies (STS). The potential effects that a group of integrated technologies – connectivity, Big Data, the increase in computing capacity, forms of machine learning – could have on the quantity of employment and on the quality of working practices in most sectors generate widespread fears and, at times, hopes for profound social change. The rationale used to estimate these effects, in the first stage of research, was primarily based on utilitarian techno-economic categories, that is, oriented to assess (a) the technical feasibility of automation and (b) the cost and, therefore, any competitive advantage that could derive from implementation. Less attention was paid to other important non-techno-economic factors – sociotechnical, cognitive-behavioural, historical and cultural – that constitute the core of the interdisciplinary approach of STS.

In this context, the application of digital technologies and artificial intelligence to medical imaging constitutes an ideal case for this dominant cognitive approach. In a sector that has long been deeply invested in the use of digital technologies, first in preclinical research and then in the therapeutic field, medical imaging has been considered an activity inevitably destined to be improved by new technologies, in terms of the quantity and quality of diagnostic activities, while clinicians and technicians were seen as predestined to be sacrificed on the altar of progress.

Is this accurate? The first experiences of Computer Aided Diagnosis systems from the 1990s onwards showed that the unfolding of these implications is much more complex and multifaceted than the reductionism of rational economic models can represent. The first experiences based on the use of machine-learning systems in work processes that seem ideal for their application have led to interesting but limited results and, above all, these have not become fully institutionalized in healthcare systems.

This chapter intends to exemplify some non-techno-economic factors that could be at the basis of these contradictory results, in order to articulate analytical tools that can be used to study the effects of new technologies on work in healthcare and in other sectors.

Introduction

I begin this chapter with a brief overview of the state of play vis-a-vis immunity-boosting supplements and COVID-19, followed by an overview and analysis of my generative methodological framework. Note that I ground this study in an understanding of health that is based on my previous work and which I define as ‘a co-produced state of idealized expectations, performances, embodiments and patterns of consumption dominated by gendered and raced technophilic knowledge regimes that reproduce regimented and coercive Western standards of health and well-being’ or CICT (Sikka, 2022, 2023). Following a precis of this definition, I apply my ‘auto-ethnographic and rhizomatic socio-material feminist approach to science and technology’ method in four phases, via: (1) a case study-driven overview of Purearth, a UK-based wellness company; (2) a deeper discussion of method; (3) the application of new materialism to the company and its products through the use of an ‘agential cut’; and (4) an auto-ethnographic exegesis through which I chronicle and reflect on my consumption of Purearth’s ‘Immunity Drinks Pack’ over approximately ten days.

Case study: Purearth

Purearth is a London-based wellness company (incorporated in 2012) that sells vegan and organic ‘water kefirs, cleanses, juices, shots and broths’, in recyclable bottles, and whose ‘ostensible mission’ is to ‘help people live healthier lives by using what nature provides us in its most pure and organic form’ (Purearth, 2021). The company is funded primarily through Nexus Investment Ventures, a corporate, venture-capitalist seed fund whose latest funding round raised $447,000 for the company (Crunchbase, 2021; PitchBook, 2021). Its owners are two early to middle age White women, Tenna Anette and Angelina, who have been working in the health and wellness industry as practitioners for a number of years. The company has been written up, and its products reviewed, in such outlets as Country & Town House (Cox, 2020), which called its cleanse ‘one of the most enjoyable restrictive or preset diet plans out there’ Retail Times (Briggs, 2020), Wow Beauty, which invites readers to consume Purearth products and, in doing so, ‘drink their way to gut health’ (Wow Beauty, 2018) and The Telegraph (Howell, 2019), which, in a review, gave its kefir drink a 10/ 10.

‘When I first started my job, my manager told me in one of our first meetings that her family owned plantations in Kenya. For context, she is white South African and I am black British. I questioned why she felt the need to tell me this and felt very uncomfortable. Particularly as, after she told me this, she stared at me, awaiting a reaction. I just responded by saying “OK” and moved the conversation on. Subsequently I had numerous problems in my relationship with this manager, she would switch between appearing overly anxious/frightened in my presence to being very abrupt with me. She would frequently say things to me that were very clear dog whistles such as saying I was aggressive and needed to watch my tone and then would later deny having said these things when I reported them. I requested another manager but was denied and it got to the point where I refused to meet with her unless it was recorded.

Eventually I left the job, and I raised a formal complaint regarding her behaviour, namely gaslighting – the fact she would constantly say things to me and advise me to do things and then completely deny ever doing it which contributed to great difficulty in me doing my job. There were also several other issues in the department. When I went to the hearing for my complaint, the chairperson – a white male – confessed he had not read my complaint in full and so I had to explain again in detail the nature of my complaint and the racialised nature of it. I waited weeks for the outcome. The outcome of the complaint was that there was no evidence to support my claims even though I provided video footage as evidence. The thing that struck me the most was that he commented in a lot of detail about how polite my manager had been in communicating and how she appeared very good at listening and responding to me. This was not the complaint I had raised – it was about gaslighting and there was no evidence that he had paid any attention to what she had actually been saying in the videos and only the fact that she seemed nice as she was saying it.’