"The Ghost in the Machine"

I just finished Atul Gawande’s book Complications: A surgeon’s notes on and imperfect science. Gawande highlights the very human nature of medical care and its influence on both the good and the bad outcomes of medical practice.  In vivid detail he describes cases that highlight the intended very mechanical and scientific nature of surgery and medicine in its practice, but inevitably calls attention to the role that “the ghost in the machine” (Gilbet Ryle, 1949) plays in influencing outcomes below the level of consciousness, the role of insights that come without conscious thought.  It was just a hunch given a 5% chance that Eleanor was infected with a deathly antibiotic-resistant, flesh eating bacteria that called for biopsy and immediate surgery, but it was this hunch that lead to saving her foot and leg, and perhaps her life.

While it may be an apparent “ghost in the machine,” Gawande’s work indicates that this ghost is not beyond influence and it becomes very clear that our ghost is largely trained by practice, experience and reflection that build neural maps to guide future automatic thought patterns and behaviors.  In Gawande’s case, if you want to be a great surgeon, do a lot of surgery and have a way of reflecting upon your work so that strengths are reinforced and shortfalls avoided; I would suggest that this rule applies to all endeavors to include psychotherapy.  It all comes back to knowing what we want to become and acting it out long before we get there; our humanity and the art always remain key to both science and practice.