Dr. James Beckerman is a cardiologist with the Providence Heart and Vascular Institute in Portland, Oregon.
And he’s also a jock. He serves as the Vice-Chair of the Oregon Governor’s Council on Physical Fitness and Sports, as well as the team cardiologist for the Portland Timbers major league soccer team.
In a recent article, he tells the sad story of the time the running watch that tracked his regular runs stopped connecting to his computer.
As Dr. Beckerman points out, the earliest studies of pedometers demonstrated that the mindfulness afforded by documenting simple activities like walking or running tends to increase those overall activity levels. But when, he wonders, does mindfulness actually become mind-numbing?
When his own running watch stopped working, he was suddenly unable to upload the data collected on his runs for a few weeks. And in the self-tracking world of connectivity, he explained that this meant only one thing:
“My runs never happened!
“Because one thing I’ve learned about the Quantified Self is that if you can’t document it, then you can’t prove you did it.
“It bothered me that I even cared. But I recognize this phenomenon as ‘The Dark Side of the Quantified Self’ — there is a tendency to become so dependent on the secondary gain experienced by documenting our activities that our experience of the activity itself is tied to its documentation.”
The Quantified Self movement that Dr. Beckerman mentions promises “self knowledge through numbers” for those people interested in – some might say obsessed with – keeping careful track of things like their sleep, exercise, diet, mood, sweat, caffeine, work patterns, dreams, memories, sexual activity, social habits and pretty well anything else that’s even remotely trackable in life.
But that’s only half the fun for Quantified Selfers. There’s also the appeal of documenting, charting or graphing data about yourself, as well as sharing your personal numbers with other people.
For some, tracking may not so much be about “fun” as it is about dependence, according to Milwaukee’s Michelle Jackson. The 39-year old has lost over 100 pounds since March with the help of a diet and fitness tracking app called SparkPeople. Described in a CNN Health interview in September as “data-obsessed”, she reports that, during the few times when this app malfunctions because of an update:
“I feel really almost debilitated. I’m very dependent on it.”
Dr. B. further explains that there is a tendency to become so dependent on the secondary gain experienced by documenting activities that our experience of the activity itself is tied to its documentation.
He invites his readers to consider, for example, their Facebook accounts:
“You and your friends are posting updates, photos, links, and check-ins. Why? Because you really care if the kid who used to pick on you in high school reads some random blog post, knows that you’re killing time at the Gas N’ Sip, and sifts through the fifty photos you posted from dinner last night?
“Nope. It’s because with status updates, there are ‘likes.’ There are comments. There are shares.
“It’s because we are, unfortunately, judging our own tastes, experiences, and even (gulp) the cuteness of our kids based on whether our questionably curated group of friends thinks that they are as awesome as we do.
“As we use similar technology to quantify ourselves, let’s be careful that we don’t fall into the same traps. Quantity doesn’t always mean quality, especially when it comes to the self.”
Even as an early adopter of social media, and especially as an advocate of mindfulness as a technique to improve health outcomes, Dr. Beckerman warns his readers about the collective tendency to lose the joy of a tasty meal in the hurry to input calories on a tracking device.
With small, affordable tracking sensors, we can can now log all sorts of human metrics: brain wave patterns during sleep, heart rates during exercise, leg power exerted on bike rides – but also our experiences like places visited or sounds heard. So instead of just enjoying ambient sounds out in real-time nature while being outdoors, for example, we are documenting, graphing and sharing information about those sounds we hear.
Dr. B. also warns Quantified Selfers not to mistake gamification for a true runner’s high.
Gamification in self-tracking technology means using game mechanics in non-game contexts in order to engage users. These can include the use of achievement badges, leaderboards, progress bars or challenges between users to encourage greater participation. Gamification may be important to the future of self-tracking apps because we know that only 5% of apps (including health apps) are still in use 30 days after download.
It may well be that only 5% of apps are worth using.
As Paul Cerrato, editor of InformationWeek Healthcare, wrote recently in his column about what he calls “digital snake oil”:
“Testimonials from famous athletes and actors turn heads, but they rarely prove that a treatment protocol – or an app – can cure your baldness or lift your depression.
“The vast majority of apps that find their way onto your radar screen call for a healthy dose of skepticism.”
Technologies that are used to keep track of all this personal information include cameras, phones, tablets, GPS devices, accelerometers and wearable wristbands, headbands or patches with embedded technologies able to measure bodily functions or movement. Some committed self-trackers even regularly send stool and blood samples for analysis and use commercial genetic tests in order to construct a detailed map of their bodily functions and wellbeing. And then they can tell their online friends all about it. . .
A MedCityNews article called Are We Headed Toward The Over-Quantified Self? examines when self-tracking crosses the line from enabling and empowering people to bombarding them with data, including this Tweet from California cardiologist and author of The Creative Destruction of Medicine, Dr. Eric Topol:
Sociologist Dr. Deborah Lupton has looked at the QS movement through an academic lens in her blog, The Sociological Life:
“In a world in which risks and threats appear to be ever-present, the certainties promised by the intense self-monitoring of the ‘self-tracker’ may be interpreted as a means of attempting to contain risk, to control the vagaries of fate to some extent.
“Self-tracking represents an intense focus on the self, and using data about the self to make choices about future behaviours.
“In relation to health matters, self-tracking offers users of such technologies a strategy by which they feel as if they can gather data upon their health indicators as a means of avoiding illness and disease. The self-knowledge that is viewed as emerging from the minutiae of data recording a myriad of aspects of the body is a psychological salve to the fear of bodily degeneration.”
Dr. Lupton also describes how this kind of self-surveillance has shifted from an inner-directed preoccupation with the body/self to what sociologists call a performative mode: inviting further scrutiny from one’s friends and followers on social media, just as Dr. Beckerman suggests we already do with those frequent social media updates.
The thrill is gone for some former Quantified Selfers, however.
Consider, for example, Alexandra Carmichael who, after 18 months of tracking 40 measurements every single day, decided to just quit, as she so eloquently described in this excerpt from her popular poem published in Quantified Self called Why I Stopped Tracking – ©2010 Alexandra Carmichael:
“Each day
My self-worth was tied to the data.
One pound heavier this morning?
You’re fat.
2 g too much fat ingested?
You’re out of control.
Skipped a day of running?
You’re lazy.
Didn’t help 10 people today?
You’re selfish.
It felt like being back in school
Less than 100% on an exam?
You’re dumb.
I’m starting to realize
That I need to
Trust
Listen
Accept myself
That I’m more than the numbers
That I’m beautiful, strong, and super smart
I don’t need data to tell me that.”
Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, and the author of the book, Overdiagnosed: Making People Sick in the Pursuit of Health, might agree with Alexandra’s conclusions. He believes that individuals who monitor themselves closely are pretty much guaranteed to find something “wrong.”
Contradictory as it sounds, he says abnormality is normal. And as he was quoted in The Atlantic last summer:
“Data is not information. Information is not knowledge. And knowledge is certainly not wisdom.
“It brings to mind the fad a few years ago with getting full-body CT scans. Something like 80 percent of those who did it found something abnormal about themselves.
“The essence of life is variability. Constant monitoring is a recipe for all of us to be judged ‘sick.’ Judging ourselves sick, we seek intervention. And intervention, usually with drugs or surgery, is never risk-free. Doing no harm often demands doing nothing. The human body is, after all, remarkably sturdy and self-healing.
“Arming ourselves with more data is guaranteed to unleash a lot of intervention on people who are basically healthy.
“Frankly, I’d rather go river rafting.”
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Q: Is Dr. Beckerman right in worrying that we risk losing “the joy of a tasty meal in the hurry to input calories” on our self-tracking devices?
See also:
Self-tracking tech revolution? Not so fast…
How we got sucked into live-tweeting at conferences
Dr. Sherry Turkle: “I share, therefore I am”
Is your life as awesome as you pretend it is on Facebook?
“Distracted Doctoring” – updating your Facebook status in the O.R.
News flash: smartphone users obsessively check their devices
Why you should put the damned phone away
When the elephant in the room has no smartphone *
How a heart attack turned me into an “Information Flâneuse”*
* (from my other site, Heart Sisters
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The Ethical Nag 
I couldn’t agree more, Carolyn.
I am heartily sick of the non-stop deployment of advice on how to live, how to minutely monitor health and how to avoid the ultimately unavoidable.
The latest salvo came from the Heart and Stroke Foundation, which sent me an email and video warning of the pitfalls of not following a healthy lifestyle. You can read my reaction in this post.
Lovely to hear from you again, Kate, and thanks for the link to your post. The Heart and Stroke Foundation has never been shy about their IN YOUR FACE awareness campaigns (remember the grim “Make Death Wait” ads?) Trouble is, when you spend your time watching people smoking, eating and lazing themselves to death, it must be hard to keep coming up with attention-getting ways to say “Hey you! Yes, you! Lying there on the couch with the cigarettes and that tub of Cheezies!” The quantified-selfers of the world do not need to be reminded about how to spend those last 10 years of life, however. They’re already obsessing over every possible trackable health indicator.
Hi Carolyn,
Great to see you’re continuing to write about the Quantified Self movement.
I find it amusing (and discouraging) that QS’ers use the word “mindfulness”. What they do is the *opposite* of true (Buddhist) mindfulness, which is about remaining in the moment and learning to manage the “monkey mind” that creates distractions and races into the past or the future.
Obsessive QS’ers have monkey minds in overdrive.
I’ll admit, though, that I also fall into these traps from time to time. I recently bought a new home BP monitor which can connect directly to Microsoft’s HealthVault (which is not a bad app for keeping all your records in one place, though there are of course privacy issues). Suddenly I found myself thinking about getting a new Windows machine so I can upload my data, despite having a perfectly good lightweight app on my Mac for doing just that.
I recently bought a pedometer, with the goal of getting up to 10,000 steps a day. (Not hard, given that I walk about 5 miles to and from the train I take from work). I recently forgot the pedometer at home and had the feeling you describe in your piece: I didn’t walk today.
How could I have walked, when the pedometer, forlorn on my desk, reads zero?
It’s lunacy. And all too tempting. The cure is true mindfulness: ease with what is, ease with what might be.
We are not our data.
–Ed
Well said, Ed! I take the word “mindfulness” in this health-tracking context as a reminder to take the stairs instead of the elevator, for example, or to be more aware of avoidable stressors, or even as just the opposite of mindless eating/drinking/smoking or other unhealthy habits we might want to change. But the question is: do we need self-tracking data for that?
As someone who likes his Fitbit, I nevertheless recognize the risk of focusing on the data, not the experience.
Where I think these devices can help, if used wisely, is for incremental change (which is hard) or to provide focus given all the other distractions. I find that it has made a difference at the margins (if I am close to my daily goal of 10000 steps I will walk a few minutes longer).
But it is a fine line between being mindful (good) and being obsessed (bad). And I suspect most of us who use these devices are probably already active and healthy. 🙂
Thanks Andrew – I do use an old-fashioned pedometer to track steps during my daily walks, but I have found that I already have a remarkably accurate idea of my distance based on how long I’m out, often guessing pretty close before I even check the pedometer at the end of a long walk. And I don’t count total daily steps (like grocery shopping as some do – since stop-and-go slow strolling down a grocery aisle hardly counts as the exercise I need, and only serves to artificially boost my daily steps total, which is NOT THE POINT!) I agree with your last comment; as health economist Jane Sarasohn-Kahn explained recently, 2/3 of those who track exercise already consider themselves to be in “good or excellent” physical health.
This is a compelling summary of interesting research and [other] observations … though perhaps I’m easily swayed.
I’m reminded of a slogan I first heard in a 12-step program: “When you are what you do, when you don’t, you’re not” and thinking how some of the behaviors described in this post might reflect a slightly reworded perspective: “When you are what you track, when you don’t, you’re not”.
Thanks so much for that perspective here, Joe. This reminds me in turn of the saying: “We are human beings, not human doings”.
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That poem really is on the mark. About 10 years ago I went on a calorie counting diet, weighing everything I ate. I even started to avoid social occasions where I would be obliged to consume things I couldn’t measure.
Counting my running times, weighing myself everyday, etc. It all just became more sticks to beat myself with. I used to think those kinds of diet were better than ones which cut out certain foods but now I think these are the worst. There was a calculator in my head in the background all of the time, constantly planning how I was going to balance my exercise/calories throughout the day. A phenomenal waste of mental energy that just sucked the joy out of life.
Thanks for your comment here. Even the most ardent self-tracker should agree that the process isn’t meant to be a stick to beat oneself with. I hope you’re no longer using that stick . . .
Oh I don’t know. I think there’s an element of stick-beating inherent in it. Why obsessively measure if you aren’t obsessed with targets for self-improvement, and motivating yourself to achieve them? For example – you can take up running but not be interested in measuring your times or distances, but simply on how you feel and how much you enjoy it. It will still improve your fitness, but it’s an entirely different way of going about it.
Say you go for a run, it’s really enjoyable. Then you see your time and realize it was a lot slower than you thought. Shouldn’t matter for your pleasure, but it invariably does, because when you measure, you’ve already made that a more important goal. And if you aren’t measuring to pursue an improvement in the measurements, then I don’t really see the point. Even in those cases, I think it’s a natural tendency to become more focused on the measurement, probably unavoidable.
also, if that’s your opinion, why did you quote that poem in your article, as it’s clearly agreeing with what I’m saying…?
Simple. Because Alexandra represents a now former Quantified Selfer.
well she still felt like that even when she was doing it, clearly. don’t really see how you can make a statement that
“Even the most ardent self-tracker should agree that the process isn’t meant to be a stick to beat oneself with” and then give that poem as an illustration of what’s wrong with it for some people. Clearly, this person felt the stick-beating was intrinsic to it, or she would have just changed the way she approached it rather than giving up.
To say ‘the thrill is gone’ as you did seems a pretty inaccurate descriptor of what her process was all about. She felt that measurement itself created a constant sense of not measuring up.
The main underlying problem as she said it, was that her self-worth was tied to the data. And, as others have said in the comments here, not only this, but it feels like the things they do aren’t even real if they are not measured. The focus isn’t on yourself, on what you are doing, but whether you can live up to something external to yourself – some idea of what the data is supposed to be. There is more alienation from self than self-knowledge going on there – if what isn’t measured, isn’t real, then your own experience of life becomes less and less real; and you become dependent on the data to have some sense of existing. So it is not only self-worth but a sense of even existing that becomes dependent on the data.
I know these aren’t quite the same thing, but it does seem a similar form of self-alienation – one which will vary depending on what your goals are – simply tracking for the sake of tracking or whether you have any targets you wish to change.
And really, I don’t think you have to subscribe to any kind of “extreme behaviour-change-through-public-humiliation” to use self-measurement in a was that is somewhat self-punishing, creating a sense of not measuring up. This has existed long before the quantified self movement – standardized school testing, weight watchers, you name it (just as the former QS said, made her feel she was failing at school exams). I find it odd that you would even seek to deny this, it seems quite obvious this is the purpose.
Many of the Quantified Selfers I know report that their keen (some might say ‘obsessive’) interest in tracking every possible trackable activity, mood, calorie, mile, etc is just all part of ‘self-knowledge through numbers’. There are other QSers out there who clearly subscribe to the extreme behaviour-change-through-public-humiliation school of thought (requires not only a stick for self-flagellation, but apparently the sticks of other people, too).