A GoodTherapy.org Featured Column written by Greg Madison, Ph.D.

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In this article I would like to suggest that the time has come for psychotherapy to begin to contemplate the future. Not from the standpoint of current theory and contemporary debates regarding research and practice, arguments that are thickly stewed in mental health politics and the profit considerations of private health companies. Rather, I believe that psychotherapists may need to consider their professional role from a future point of view in order to contemplate what function, if any, we should have in the biotechnological revolution forecast to commence within the next few decades. If the futurists are correct, then ten years from now the most intractable issues that mental health professionals grapple with today will in retrospect be totally superfluous.

The world is bracing for an exponential advance in technologies that are predicted to fundamentally alter the very nature of human beings. If the profession of psychotherapy is to remain relevant, I think we must begin to prepare for this revolution. It is possible that in the not too distant future our clients will be presenting issues of deep unease and unbelievable excitement about the inscrutable new choices they will face in this post-human future. As therapists we have a responsibility, I believe, to hear these concerns within the context of their far-reaching psychological, ethical, and spiritual ramifications.

In May 2002 the Institute of Ideas, a public policy think-tank in London, hosted a debate entitled Post-Human Future. It offered a thought-provoking insight into the way that scientific ingenuity is likely to impact upon the fundamental givens of human nature. The exchange featured the philosopher Francis Fukuyama, author of Our Posthuman Future (2002), and the scientist Gregory Stock, author of Redesigning Humans (2002). Interestingly, the debate was not centred on whether or not foundational changes in the essence of humanity will occur, but whether those changes, considered inevitable, should be regulated according to ethical concerns. What safeguards, if any, should be in place when tinkering with the building blocks of human existence?

At that debate 5 years ago, Fukuyama, a typical philosopher, warned us to begin to think carefully about our technological advances before we find ourselves in a world we no longer recognise. He is certain that our future abilities will confront us with fundamental questions: What makes a human being ‘better’? Do we want to change human nature? If we alter the basis of human nature, what effect will this have on human rights? How do we balance what is beneficial for the individual (life extension, for example) with what is best for society (productive young work force)? Do we want a world where the genetically have-nations are populated with ‘enhanced humans’ while technologically poorer nations have ‘rudimentary humans’? For the first time in millions of years we could have more than one species of human walking the earth at the same time. According to Fukuyama, we need to face these fundamental questions now, and develop safeguards to maintain what we value most about ourselves.

As a scientist, Gregory Stock, on the other hand, while agreeing that the effect of biotechnology will be immense, displays a more laissez-faire attitude and cautions against regulating medical research. He says that we must be realistic. There is no way to slow down ‘progress’ in this area and it is inevitable that, for instance, human cloning will occur, and likely before it can be done safely. He believes that technology will address real suffering and that in one generation we will be able to retard aging and prolong vitality, manage emotions precisely, and test embryos for personality and temperament. He agrees that the interests of parents and individuals will need to be balanced with the interests of society but points out that this will be impossible to monitor, even with strict regulations. Parents will want their children to have the potential to compete and succeed as adults and if one country prohibits procedures to enhance children’s intelligence with memory chip implants for example, couples will likely travel around the world to avail themselves of the most advanced technologies elsewhere. Basically, Stock prioritises the clear benefits of future medical advances and downplays the dangers and utopian nightmares. And certainly there are clear and substantial benefits from such biotechnological research. We may be able to eradicate many if not all human disease and degeneration. We could, in principle, achieve open-ended lives, though we would still be mortal and able to die, just not condemned to it. For the first time in human history, death would in fact become a choice.

Three years after this debate in London, the futurist Ray Kurzweil wrote The Singularity is Near (2005), a book that advocates a major role for machines in the future of humanity. In addition to advances in genetics, Kurzweil sees human body and brain merging with robots so that we all become hybrids. According to Kurzweil, our intelligence will become non-biological and trillions of times more powerful than unaided human intelligence. He is certain that human aging will be reversed because nanotechnology will overcome the limitations of biology. Kurzweil is both radical and optimistic.

But in this flurry of ‘progress’ who is asking about the psychological impact of redesigning the human race? Will there be psychological and spiritual side effects to advances in genetic engineering? Perhaps technology will prolong and ‘enhance’ life, but can it answer the question of ‘how to live life’ or ‘what is a good life’? This of course brings us to therapy, which has always tried to deal with agonizing questions about how to live well.

The information from scientists and futurists makes it clear that it is not too soon for therapists to begin to contemplate the advent of this unrecognizable future. It is no longer science fiction. We need to ask what role does therapy have now in exploring the implications of such radical transformation in the essence of what it is to be human? If some philosophers, scientists, and theologians are beginning to embark upon cross-disciplinary dialogue regarding the new world ahead, shouldn’t we? Certainly as therapists we already deal with the everyday practical relevance of fundamental human questions, values, and assumptions. Perhaps it is time to begin to contemplate what impact genetic-cybernetic engineering will have on our understanding of our profession and our own personal concerns and how this contemplation may prepare us to open to the new range of questions, values, and assumptions that may soon be presented by our clients.

I suggest that we need to establish a kind of ‘Futurist Therapeutic Dialogue’, devoted to imaging the deeper impact of this prophesied revolution in human nature. First of all, we might explore what role psychotherapy could have now in preparation for the future. It may be useful to begin to consider what values will be challenged by some of the advances that scientists are anticipating. We could reconsider all of our current psychological theories in light of future humans who can perhaps live forever, who can change their hair and skin colour, alter their physiology at will, and change gender several times throughout ‘eternity’. Introduce such future possibilities as a topic of conversation to a group of friends and see how long it takes before you find yourselves facing profound questions, for example how we might begin to redefine ‘success’ and ‘failure’, how biotechnology will alter the future structure of families, create new forms of society, and force fundamental transformations in the meaning of relationships. Try to think of one psychological theory or therapeutic model that will not fragment when seen through the lens of this anticipated human future.

As professionals we might also want to try to predict what form our profession will take within this imagined future. I suspect that the onslaught of biotechnology and cybernetic enhancements will make psychotherapy as a ‘mental health profession’ redundant. There will be efficient technical responses to the difficulties of so-called ‘mental illness’, trauma, emotional stress, depression and anxiety etc. Our current range of psychopharmacological treatments will likely be a source of some embarrassment compared with the regulatory possibilities of future psycho-technology. Although many current technical-medical approaches to therapy leave me uneasy, the future ‘patient’ will likely be so malleable in terms of ‘nature’, ‘personality’ (an outmoded notion I’m sure) or physiology, that any concerns about intrusions into a person’s integral makeup may no longer even make sense. It is my guess that the more medical and ‘treatment’ forms of psychotherapy that are based upon alleviating symptoms, tempering pathology, and diagnosing ‘illness’ will be subsumed within genetic and cybernetic approaches, administered by psycho-technicians. However, it is my hope that the more relational, dialogical, spiritual and existential forms of therapy may have an increasingly crucial role in this brave new world and may become the essence of what remains of our profession. As the world becomes more focused on human technology, these forms of psychotherapy may play a part in sustaining what at least has been ‘authentic’ in human existence. For the sake of discussion I would like to outline some preliminary thoughts regarding possible issues we might face in the post-human profession of psychotherapy.

The heart of the misgivings regarding these profound changes is the way that they impinge upon our ideas about human nature. As therapists, we need to clarify what we mean by ‘human nature’. This clarification better positions us to help clients explore what they are protecting if they reject new ‘enhancements’ in an effort to remain ‘natural’. How will clients choose which advances are OK and which go too far in altering their sense of personal and species identity? For example, do human suffering, limitation, and death offer such pivotal meaning and value to life that some people will want to challenge attempts to eradicate them? As culture is man-made, man’s nature may also, at some future point, be man-made. And since each of these quandaries will affect us as much as our clients, therapy will potentially be based upon explorations that are entirely mutual in their impact and significance.

Psychotherapists, especially those working existentially, assume that many of our problems in living arise from the way we respond to, or deny, the givens of existence. But what if those givens themselves become choices rather than facts? For example, future therapists may be asked to explore with their clients a real choice between life and death, whether to die or not. But will our ability to understand such a choice evolve as quickly as our capability to technically generate it? We cannot comprehend the immense impact that ‘the dying of death’ may have on the human life-world. Our very language around death will have to be closely investigated before we can begin to use it to think clearly about what it would mean to ‘choose death’. At the moment we can only contemplate this fantastical future from our moribund worldview, tainted by death, but even now we can imagine how it would change attitudes toward suicide, the practice of bereavement counselling, and our understanding of grief, to list a few obvious examples. If a loved one chooses to die or is accidentally killed, the meaning of this death is certainly altered by the fact that the person could have, in principle, lived forever (or at least for hundreds of years). And what kind of relationships does a potentially immortal being have? Will the insecurities that prevent us from being open and caring towards each other been seen more clearly as unimportant or will we become less relational, lonely subjects drifting endlessly along our individual way, asking ‘what’s the meaning of it all’? The therapists of the future may be obliged to work phenomenologically, in a complete state of un-knowing with each client, discovering together, literally, who they want to-be, what they want to become, and whether there’s any meaning to it all.

All genetic counselling will become existential counselling (if it’s not already). Parents deciding to engineer their child’s emotional life will be expressing, quite explicitly, what they see as valuable in human existence and what they see as negative. Future therapists will also likely become genetic counsellors, assisting in the design of humans consistent with each individual’s values yet also challenging assumptions and biases regarding what is a desired attribute and what makes a person undesirable. Of course it would be arrogant to just assume that any form of therapy will still make sense after such a revolution in human being. But surely someone will have the role of seriously questioning the choices being made by individuals and human communities. Perhaps therapists will fall into the role of social critics, attempting to hold and support values and sensitivities that may easily be trampled in the rush of technological advance.

Can therapy become a profession that will help us think deeply about the implications of what we are doing as we do it; a hermeneutic practice that helps us contemplate the un-reflected assumptions we have about the meaning and purpose of human life on earth as that life itself is continually transformed? In the next twenty to thirty years, with the likely advent of ‘emotion technologies’, we will in all likelihood discard our identity as ‘health professionals’ and instead carve a niche alongside theologians, ethicists, and philosophers, with a common care for the Being of human souls: each of us trying to do our best, having to endure the necessity of making choices whose profound significance we will be unable to even partially fathom. At the very least, perhaps contemplating the future of our profession within such a changed world will give us insights into our current practice, revealing previously obscured assumptions about the way we live now, offering us new ways of interacting with the clients we are seeing today as well as tomorrow.

©Copyright 2007 Greg Madison, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see his GoodTherapy.org Profile.