Ex Machina (2015)
They say things happen in threes.
One, I watch a movie, Ex Machina, which poses provocative questions about how real an artificially intelligent human can be.
Two, I am in the middle of Neurosurgery research and come across some of the latest applications of Virtual Reality to navigate around the brain as if you were inside it.
Three, I get an email from my medical school about a new project in which students can practice difficult conversations with patients by speaking with virtual humans.
I like toys, but I do not consider myself a techie. Yet, I find myself fascinated by the concept of Virtual Reality. Why?
Then it hits me. I am trained in Theatre. Theatre is, by definition, Virtual Reality! You create a 3-D space with objects that look real but aren’t (as any actor who has had to eat cold mashed potatoes as if it were delicious ice-cream will tell you!). You surround yourself with people who are supposed to be real people with whom you have real relationships. But of course, the whole thing is made up. The curtain will come down (the “console” will switch off). And just like that, Richard III becomes your cast mate and you go get a drink, no longer having to worry about being impaled on a sword (unless you gave a terrible performance . . .). And yet, your imaginary creation sent a room full of people home feeling new emotions and thinking new thoughts.
And so, the question becomes if the “Virtual Reality” of Theatre can provoke an emotional response, could the computerized Virtual Reality do the same, and perhaps even trigger the crucial emotion of empathy? That question must have occurred to journalist Nony Lapena when she teamed up with technologist Palmer Luckey to create a virtual world to portray the devastating reality of war-torn Syria http://techcrunch.com/2015/02/01/what-it-feels-like/
Her work was presented at this year’s Sundance Festival. So why does Ms. Lapena do it?
“Syria is so far away from most Americans. How do you attract a younger audience who might not pick up the newspaper to think about these important issues? That’s the point of all good journalism.”
Project Syria
All of which takes us back to the medical school project. Can interacting with virtual humans really help me prepare for such conversations with real patients? That depends, I imagine, on how “real” they are. And how do you know that? At what point does a computerized human cross that threshold? The movie Ex Machina proposed The Turing Test in which a human interacts with a machine that she is blinded to. If the responses of the machine convince the interrogator that she is speaking to a human, the machine has passed the test. In developing this test, Alan Turing raised an interesting point. The question, he said, is not can a machine think, but can it imitate human thought?
I have heard this line of reasoning used before in terms of empathy. Do we need to feel empathy to show it? Or is empathy a skill, a craft that should be learned like any other part of the physician’s arsenal?
The neurosurgeon uses Virtual Reality to master the architecture of the brain, through relentless repetition and adjustment. Can empathy be achieved in the same way? Is it trainable?
Virtual Reality Surgery
And, ultimately, when the headset is removed, the electronics shut down, and I am sitting in front of a patient with all our histories, biases and experiences present, but invisible and we begin to talk, into what reality have we just entered?
Have an existential weekend!
Acting Doctor 
As I was reading this post, I immediately thought of Alan Turing in the Imitation Game. Very thought-provoking post JB!
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On one level I think people can be trained to become more empathic – skill building not unlike the “dry runs” of simulation labs for surgeons, innumerable hours on the basketball course or in the pool for professional atheletes. That is similar to your reference of placing people on stage, creating the illusion of something else and uttering words not usually orginating from their own lips. But this still misses the mark of an elusive quality which separates those who truly have that sixth sense which makes them empathic. What is it about a Marlon Brando, Lawrence Olivier, Helen Mirren or Maggie Smith that makes us call them “great actors” and be more moved by their performances than those of a Grade B actor? Is it an innate sense of empathy, of understanding the human condition that they can fuse with that and then project it in their characters? I applaud the efforts to enhance this ability for those who may be lacking in this area. Do not be disappointed if they still fall a little short of the mark you hope to achieve. Beside the ability to project the words of empathy there has to be the ability to project an authenticity to this emotion. People know when they are getting “the real thing”: they feel it to their core and are moved by the efforts of another human being trying to connect on a far deeper level than superficial talk. Continue in your efforts of getting “left brainers” to hop their corpus callosums and extract some of those more “right brain” features. You know how important this has been to me over the years in caring for patients. Lucky are the patients who will have you as their physician.
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I have revisited your thoughts here since we had the chance to discuss them in person and I am struck again by your wisdom and insight . . . I completely agree that there is a component to empathy that may be beyond instruction-perhaps must be self sought and require significant internal transformation? Thank you for the kind words about my relationship with future patients. As a dear friend and doctor of your caliber, that affirmation is very meaningful!
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