Jun Ng
Healthcare for Humanness
Summary
This research began as a speculative design inquiry into the future of ageing. It found that asking people to imagine beyond their current notion of ageing is a tall order. How can we imagine a reality that is liberated from the limitations of our physical body, while we still reside in it? The premise of this research was that technology and advances in medicine were steaming ahead towards immortality, while we hadn't stopped to ask what people would do with their forever youth.
It was through a search for new methods to help people imagine, and a concurrent collaboration with geriatric medicine, that a substantial gap was realised - a lack of consideration for the metaphysical.
In this case, metaphysics entails subjective quality-of-life, compared to a medicalised and objective view. Our relationship to healthcare causes us to see the body as an entity to be fixed, and that fixing it leads to happiness. This presents a problem when body function declines or it is no longer 'fixable'. What then? We feel our quality-of-life decreases. However, there are numerous cases where 'imperfect' bodies go on to live with great purpose. The danger with our current ageing futures trajectory, is that this important factor of life is starting to be sidelined, even worse - forgotten.
This research was interested in understanding the mental models reinforcing our paradigm of ageing. This allows us to improve the way we conduct speculative design by liberating the imagination. Equally, it opens the door to new ways of designing for what it is to be human. This work proposes a form of design that centres on human purpose, it calls this humanness-centred design.
Additional info
Key acknowledgements
Design supervisors: Professor Ashley Hall and Anna Wojdecka from the Royal College of Art.
Clinical supervisor: Dr. Melanie Dani - Consultant Geriatrician for Imperial College Healthcare NHS Trust.
Designing for humans, but not through human-centred design
Human-centred design is a fundamental approach in the design community. However, in speculative design, we need to be aware that this may tie us to our current reality. This is exactly what we are trying to break free from. Thus, this research proposes to design for humanness - the level below expressed or expressible needs. The goal is to design for people to achieve inner-congruence (alignment between internal story, beliefs, virtues, and outer impression management) which is often subconscious and illogical in terms of observed behaviour.
Methods
In order to study these mechanisms, psychology, philosophy and design were combined using Owen's Circular Process along with autoethnography with a therapist to improve self-reflection. This allowed patterns in interviews and transcript analysis to be identified that otherwise would go unseen and unaddressed.
Owen's Circular Process in action
Limitations for speculative design method and design practice
This research heavily utilised Frayling's Research Through Design approach. However, it realised that even though we can view, and sit with, and be in the system from multiple angles, we are still viewing through the lens of our current paradigm. In ageing, that is the notion that the body is declining, and our ability to be functionally useful is therefore also diminishing in potential. It was no wonder that speculative design participants so often mentioned the desire to not become a burden. Regardless of imagination or ideation technique, if we do not shift this starting point, our efforts will be limited. This is what shapes our views of reality.
Shifting the paradigm could be a useful starting point for other speculative design applications. Furthermore, design also falls trap to this limitation, illustrated in the image below.
Illustration of Research Through Design. Black borders represent the boundaries of the paradigm, outside which sit alternative futures.
Shifting the paradigm of ageing
Current interventions mainly attempt to shift the future of ageing by changing language and imagery. This research argues that it will only lead to more vocabulary attached to the same rudimentary meaning; we need to change the paradigm. It proposes we can do this by shifting our perspective of meaning and time; where meaning is not one big life purpose to be found, but rather meaning can be created out of our today, tomorrow, and yesterday. Meaning is no longer 'what did that mean' or 'what does my life mean', but becomes 'what makes this worthwhile'. In this way, people have endless potential to create meaning, regardless of body or time.
The reinforcing healthcare narrative
All our lives, we are taught to fight for the physical body. This makes sense, since in younger age, fighting bought us time to figure out our existential needs. However, as we mature, physical wellbeing is less related to perceived and subjective ‘quality-of-life’. Many stories, from Viktor Frankl and Elizabeth Kubler-Ross included, highlight that lacking a sense of purpose can lead to much more distress than one’s physical woes. For healthcare, this means we need to design for perception and meaning. This is arguably as important as the physical interventions themselves.
Is our suffering the issue? Or is it that our suffering has no meaning? - Nietzsche
Maslow's Hierarchy of Needs adapted for illustration
People want to align to the story they tell themselves and others
Two projects were developed to test ways in which we can ‘transcend our paradigm’ (Donella Meadows) and change the narrative; Hey Hero and Caring Curiously.
Hey Hero: a self-reflection and self-discovery activity to help people re-examine what they find worthwhile in times of health transition. It starts by reframing concepts such as time, meaning and responsibility. People can lose a sense a purpose when their body does not allow them to achieve it in the same way they used to. This design leverages the idea that every hero has a core they fight for, and even die for - which gives people a sense of purpose. It centres on re-finding this, but rather than starting with activities or hobbies that people pursue, it aims to surface the core virtue that it is tied to. This is a universal human driver which we we might not be aware of, or may not have articulated before. As a result, we chase superficial remedies for unexplained dissatisfaction in life.
Caring Curiously: acknowledging that heroes are supported by comrades, this was an experiment in shifting the culture of how we care for others. The aim was to counter over-protective behaviour that reinforces fighting for physical existence at the expense of subjective quality-of-life. It works by shifting our perspective, which then alters behaviour, that subsequently changes attitude. By caring through a posture of curiosity and wonder, we prime ourselves to be open to be surprised. Surprised by someone we may know very well. It breaks habits and holding patterns. It urges us to see the essence of who someone is, at their core, and encourages us to be comrades for their unique potentialities in life.
For updates, visit: HealthcareForHumanness.com
The vision for this work is designing healthcare for humanness - our sense of purpose and inner peace in the midst of medical dilemmas. It is especially interested in the area of decision making, where both options are equally bad. The working theory is that if we can design for the perception of ‘having made the right decision’ (between all parties: patient-family-doctor), we will be able to improve subjective quality-of-life. This is critical work to the area of shared decision-making, advance care planning, and end-of-life care, but arguably all of life.
It explores design as a way to surface the invisible and often subconscious, so that we can better navigate through these difficult and complicated scenarios more intentionally. It is currently exploring how humanistic psychology and principles that are well known in organisational psychology including self-narrative, self-identity concept, congruence, cognitive dissonance and authenticity can be combined with spatial and experience design to achieve this goal.
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Profile
Jun Ng completed her undergraduate degree in Biomedicine Neuroscience at The University of Auckland in New Zealand. She worked in the field of life science data acquisition used for medical research and education for 5 years. Concurrently, she studied Instructional Design while working out of Oxford, leading to several years practicing and then managing a team of creative learning designers and developers at KPMG London.
She is now in her second year of the MRes Healthcare and Design programme through the School of Design at the Royal College of Art and Imperial College Medical School with an expected completion date of May 2021. Her approach combines psychology, design and strategic thinking with the goal to reimagine and redesign relationships between people, the environment, and life situations.
