The Thinker, the Maker, and the Machine: Revisiting 3D Printing Eleven Years Later
I recently revisited a post I wrote in March 2015 titled “On 3D printing technologies and The Nature of Gothic.” Because I am now helping to build an occupational therapy program where digital fabrication is one of its defining capabilities, there is a reasonable possibility that one of my students will eventually find it too. I figured I had better clean up the mess on aisle three before a student or collaborator asks why the person promoting Measure. Design. Make. once dismissed 3D printing as a fad.
The original post isn't entirely a mess - actually, I still believe its central warning was correct. But some of my claims were overstated, some of my rhetoric deserves reconsideration, and my sharpest criticism was not accompanied by enough solution (that happened a little too much in previous writing. I was better at expressing critique than at expressing solution). Eleven years later, I can see more clearly what I got right, what I got wrong, and how the work we are now developing at RIT provides a better answer to the problem I was trying to identify.
What I got right
The most important thing that I got right was that a device is not an intervention.
Printing an object is pretty easy. Determining whether a person needs it and whether it is designed appropriately and safe and integrated for function is a lot harder. And it is even harder to revise and fix something when you learn that it is not good enough. A successful print is not the same thing as a successful outcome, just like a compelling video posted in Instagram is not evidence of sustained use. Also, the price of the filament is not the cost of delivering a responsible service.
Those distinctions remain essential. The hidden costs I questioned in 2015 have not disappeared - things like equipment, software, training, calibration, failed prints, design time, fitting, maintenance, technical support, and follow-up. More importantly, they include the clinical knowledge required to decide what should be made in the first place.
I was also right to be suspicious of technological spectacle. New technologies invite exaggerated claims because the visible act of production is so compelling (and gets clicks, let's be honest). A printer constructing an object layer by layer looks like progress. A brightly colored prosthetic hand placed on a child makes an emotionally powerful image. What we never really see behind the social media post is whether the object is comfortable, durable, maintainable, developmentally appropriate, or useful six months later. We are easily persuaded by the moment of delivery because it is more visually satisfying than the slow work of evaluation and follow-up.
Occupational therapy should be especially resistant to that confusion. We know that the meaning and usefulness of an object cannot be separated from the person, the occupation, and the environment. We know that assistive technologies are often abandoned even when they appear technically sound. Every Level II student learns that when they eagerly go to see their patient who is recovering from a hip fracture only to learn that all of the adaptive equipment went straight into the garbage. We know that performance in a demonstration does not necessarily translate into participation in ordinary life. Those were legitimate concerns in 2015, and they remain legitimate now.
I also continue to believe that function alone is not enough. A device can perform its mechanical task and still be rejected because it is uncomfortable, or stigmatizing, or just inconsistent with the person’s identity and incompatible with the routines and environments where it must be used. Human beings do not experience objects as collections of engineering specifications. We experience them through appearance, touch, effort, identity, meaning, and use.
A final point that I think I got right was to return to Ruskin. The separation of thinking from making remains a danger. When designers do not understand bodies, when clinicians do not understand materials and fabrication, when makers never meet users, or when users are treated merely as recipients of other people’s ingenuity, the resulting objects may be technically impressive and humanly inadequate and even unimpressive. Thought and labor still cannot be separated without consequence.
What I got wrong
I called 3D printing a fad. That was wrong.
Some of the publicity surrounding it was faddish, and many of the claims were inflated. But I allowed my irritation with the hype to narrow my view of the technology itself. Additive manufacturing has become a sophisticated method of production. It does more than click-bait claims of inexpensive plastic prosthetic hands. It can support rapid prototyping, anatomical models, adaptive equipment, orthotic components, and highly individualized solutions that would be difficult or expensive to produce through conventional manufacturing. I didn't consider that deeply enough in the original post.
I also created too sharp a division between the machine and the artisan. I treated 3D printing primarily as an extension of industrial production and therefore as a potential threat to craftsmanship. I understand that differently now. Digital fabrication can itself be a form of craftsmanship - and I think I was stuck in a binary at the time.
What I now understand better is that the craft may involve a scanner, computer-aided design software, and a printer (rather than only hand tools and low temperature thermoplastics), but it remains craft when the maker understands both the materials and the person for whom the object is being made.
In fact, digital fabrication can restore some of the connection between thinking and making that Ruskin valued. A clinician or student can identify a problem, measure it, develop a design, fabricate a prototype, place it into use, observe its failure, and revise it. The feedback between conception and physical production can be immediate. The person who thinks does not have to hand the idea to a distant manufacturing system and wait for a standardized product to return. Properly taught, the technology can reunite thought and labor rather than separate them.
My criticism of aesthetics was also underdeveloped. In the original post, the brightly colored plastic hand appeared to me as evidence of something inhuman and now I think that judgment was too easy. A device does not have to imitate the body or conceal its technology to have aesthetic value. A child may prefer neon pink, or even something made out of legos. A visible mechanical form may express playfulness, individuality, or pride (I have seen some OTs reflect that in low temperature thermoplastics too - their splints look like fancy layered fondent on a custom cake)! What matters is not whether the object conforms to my idea of beauty, but whether the person using it has meaningful influence over how it looks and what it communicates.
That is an important correction. Aesthetics still matter, but they cannot be imposed by the clinician, engineer, or critic. They belong within the user’s experience of the object.
I would also change the rhetoric of the original post. My reference to an “outsider technophile” delivering a prosthesis to a child injured by a landmine was intended to criticize sentimental publicity and poorly supported humanitarian intervention. But the language was kind of dismissive and used the child as an abstraction inside my own argument. I was criticizing the reduction of a human being to a technological success story while engaging in a different kind of reduction myself. The ethical concern was valid but I think that my framing deserved more care. Mea Culpa.
The student who commented on the original post may have seen the solution more clearly than I did. She agreed with many of my concerns but argued that occupational therapists should become involved in the development process. Rather than standing outside the technology and criticizing what engineers and enthusiasts failed to understand, occupational therapists could contribute knowledge about hand function, context, individual meaning, technology abandonment, and daily use.
She was right. It is kind of a shame that the adoption of this technology and following that kind of suggestion has not progressed.
What still hasn’t happened
So that student was right about what occupational therapy should do. What is striking, eleven years later, is how little of it the profession appears to have done.
Although additive manufacturing continued to develop, it never penetrated occupational therapy practice or education to the degree that the early excitement seemed to predict. There are certainly occupational therapists doing excellent work with 3D printing, scanning, customized orthoses, assistive devices, and rapid prototyping. But these remain niche activities rather than broadly established components of occupational therapy practice. The technology survived. Much of occupational therapy’s enthusiasm for it did not mature into sustained adoption.
That makes my original description of 3D printing as a fad both wrong and, in a narrower sense, partly correct. Additive manufacturing was not a technological fad. It became a sophisticated and durable form of production. But within occupational therapy, the burst of attention may have followed the familiar pattern of a fad: intense initial enthusiasm, exaggerated expectations, and limited long-term integration.
Perhaps we focused too much on the printer and too little on the capabilities needed around it. Owning a machine does not create a meaningful fabrication program. Clinicians and students also need opportunities to measure accurately, understand materials, develop designs, test prototypes, work with users, and evaluate what happens after an object is placed into use. Without that larger process, 3D printing remains an interesting piece of equipment rather than an occupational therapy capability.
That unrealized promise is part of what we are trying to address at RIT through Measure. Design. Make.
Measure. Design. Make.
So my answer today is Measure. Design. Make. It is a practical response to the problems I identified in 2015, but it is also a philosophy for how occupational therapy should approach technology.
Measure means beginning with disciplined attention and not just enthusiasm for a tool. We can measure movement, force, muscle activity, visual attention, temperature, dimensions, task performance, and characteristics of the environment. At RIT, our developing capacity in movement analysis, eye tracking, wearable sensing, and 3D scanning creates extraordinary possibilities for understanding human performance.
But measurement has to be more than just accumulating data. Before measuring, we have to ask what is worth knowing and why. A precise measurement of the wrong variable does not move us closer to a meaningful solution. I also know that any given instrument can't tell us what an activity means to a person, what tradeoffs that person is willing to make, or whether the identified problem is the one the person actually wants solved. Measurement has to discipline clinical reasoning, and not displace it.
Design is the interpretive center of the process. It is where information about the body, occupation, environment, materials, technology, and personal preference must be brought together. Design has to be more than drawing the object in software. It involves framing the problem, recognizing constraints, generating alternatives, anticipating consequences, and deciding whether fabrication is even the appropriate response.
Design also must be participatory. The end-user of an object should not enter the process only after the important decisions have already been made. This is one place where occupational therapy can make a distinctive contribution. We are trained to understand that usefulness is situated/contextual and that people are experts in the occupations and environments of their own lives. My favorite ethical principle: Autonomy.
Make means bringing an idea into material form and accepting responsibility for what happens next. Making includes choosing materials, calibrating equipment, fabricating, finishing, fitting, testing, and revising. It also includes leaving room to discover that an elegant design does not always work as expected. The failed prototype is not wasted effort if it exposes an incorrect assumption and leads to a better understanding of the problem.
Making has to be connected to use. Our goal should not be shelves filled with clever objects and social media feeds filled with successful prints. The relevant question is what happens when the object leaves the Fab Lab. Does it support occupation? Does the person choose to use it? Can it be repaired or reproduced? Does it solve one problem by creating another? What did we fail to understand?
Those three terms are a total and iterative process. Making frequently reveals that we measured the wrong thing or designed around a false assumption. We return to the person, measure again, revise the design, and make another version. Measure. Design. Make. is a cycle of inquiry.
It also provides a way to reunite the thinker and the worker. Students should not learn clinical reasoning in one room and fabrication in another as unrelated activities. They should not be taught to generate ideas that someone else will translate into objects (and that they order from a catalog), nor should they learn to operate equipment without understanding the people and occupations that give its use purpose. They should move repeatedly between observation, interpretation, design, physical production, and evaluation.
That is the educational opportunity I did not fully appreciate in 2015.
What has not changed
I no longer believe that 3D printing is a fad, and I no longer believe that machine production necessarily stands in opposition to craftsmanship. I have become more cautious about imposing my own aesthetic judgments, and more aware that criticism from outside the design process is not sufficient.
But I have not changed my mind about the central danger.
Technology becomes dehumanizing when it encourages us to mistake production for care, or novelty for evidence, or low material cost for accessibility. Most importantly, none of it equates to a functional product. It becomes dehumanizing when the people who design an object are separated from the people who make it, and both are separated from the person who must incorporate it into a life.
The machine cannot replace the human judgment required to recognize what should be made, how it should be made, and whether it has actually helped. Eleven years of technological development have made that point more apparent to me.
Rereading the original post, I don't think its deepest mistake was excessive skepticism. Its mistake was failing to imagine sufficiently how occupational therapists might respond. We do not have to choose between rejecting digital fabrication and surrendering to its spectacle. We can enter the process with a distinct set of obligations: to measure carefully, design collaboratively, make skillfully, and evaluate honestly. Kind of what that student said, interestingly.
That is what Measure. Design. Make. means to me now.
I am still a little skeptical about how much utility we can squeeze out of additive manufacturing - but I am moderating and trying to be more thoughtful. It is a commitment to keep thought and labor, technology and occupation, maker and user, together. That was Ruskin’s warning. It remains the right one.
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