Posts tagged ‘Technology’

It’s Just Like You’re One of Us (But With a Steel Strap and a GPS).

So this is what it’s come to? We’re willing to tag and track people based on a diagnosis? Oh that’s right, we’re not doing it to each other, only those sick ones we’ve so self assuredly separated out.

South London and Maudsley Hospital is trialling tracking of mental health patients. The tracker system involves fitting patients with a steel ankle strap linked to a GPS tracking system that can then monitor the location of the person.

As Gianna Kali of Beyond Meds wrote, “If you don’t automatically think ‘civil and human right violation’ there is something wrong with you.” I couldn’t agree more and would go so far as to say that you are part of the problem. There are two reasons these things happen — people in power are willing to disregard our rights and  the public is willing to allow it.

In response, a Department of Health spokesperson said;

‘This is a locally led initiative, not a national pilot.

“Patient rehabilitation into a community is an important part of recovery, but it relies on good risk assessment, trust between the patient and the service and patient responsibility. There can be no substitute for staff knowledge of patients to properly assess risk and to make the right decisions to ensure safety”.

Trust between the patient and the service? Is this what trust looks like — a steel strap with a tracking device? Maybe I’m reading this all wrong and they just mean the patient should trust the system. Personally, I have a problem trusting anyone with more power than regard for my interest. Similarly, rehabilitation only calls for patient responsibility. If it called for responsibility on the part of the system, we’d need a new one, rebuilt from the ground up.

What do you think this does for the idea of inclusion, by the way? I can’t imagine that a person wearing a device that advertises their private struggles and places them socially between a criminal and an animal to be studied is very well received in public situations. Perhaps we could forego the cost and complication of these devices and just go ahead with a ball and chain and scarlet letter…oh yeah, rights. We better keep it digital.

August 29, 2010 at 10:30 am

iTherapy 2.0

Welcome to the future of reductionist psychiatry. You can now be diagnosed, labeled and treated without a doctor ever having to even look you in the eye or hear the stories that make you tick. Just click the boxes for your symptoms, fill out the questionnaire and the complexities of the human psyche can be unraveled as quickly as e-filing your taxes in the last hour of tax day. Never mind the subtle differences that define us or the experiences that got us here.

This is not some luddite rant about the technology takeover, though to some extent there is a worthwhile wariness in that discussion. I’m talking about the power of the DSM, which was never meant to be a stand-alone collection of boxes to check off in diagnosing, now essentially uploaded and online to be used in just that fashion.

From Australia’s The Age:

MENTALLY ill Australians are increasingly being diagnosed and treated online in virtual psychiatric clinics, without ever seeing a doctor.

Patients suffering from depression, anxiety and post-traumatic stress disorder are being assessed by computer and given ”e-prescriptions” for online counselling courses instead of medication or treatment sessions with a psychologist or psychiatrist…

With e-therapy, patients are clinically diagnosed after completing psychiatric reviews by answering online questions

“Assessed by computer”? It makes you wonder what we need all these psychiatrists for? Apparently all we really need are the DSM committee and a handful of tech guys to work out the interface and we’ll be well on our way to solving those pesky problems that keep cropping up and reminding us how hopelessly human we all are.

One positive point is that it presents a shift from medicine and toward some sort of counseling but I see that aspect of it as short lived. It seems likely to follow the trend of “real life” psychiatry and revert to drug based care, printing out its e-prescriptions for the latest in pharmaceuticals. Also, it makes you wonder — if these kinds of treatments are so effective, why do we need a computer to veer away from drugs? I can see computer based communication and the easy transfer of information as useful but only as a supplement to truly involved care from a living, breathing human – not a replacement. I question the quality of online counseling when compared to real counseling. Of course it’s limited to relatively minor difficulties like depression, anxiety and PTSD. They wouldn’t dare try to treat the as yet uncharted depths of serious mental illness — would they?

In Melbourne, David Austin, the co-director of the National eTherapy Centre’s Anxiety Online program, which is run from Swinburne University of Technology, said the service did not attempt to treat people with more serious conditions such as schizophrenia or bipolar disorder but there was scope for that in the future.

“Within five to 20 years we will have a proven e-therapy for most of the psychological conditions. Once you do that, you have 24-hours-a-day, seven-days-a-week low-cost access for everyone,” said Professor Austin.

Everyone. Oh good. At least they’re planning ahead. This is where the drugs are likely to come into play as most things perceived as serious mental illness are treated with drugs as a chemical problem in the brain not simply a coping, life handling or perception problem.

Patients log on anonymously to complete modules on cognitive behavioural therapy and breathing and relaxation techniques through videos, podcasts, online forums and interactive questionnaires.

Next month, courses will begin for people with eating disorders and gambling addiction.

I’m convinced computers can be of some benefit in a therapeutic setting whether it’s to impart information, the support found in many forums or supplemental counseling. The biggest problem, though isn’t in the counseling aspect of it but in the assessing. While the move to computer based diagnosis promises to extend mental health care to more people, we need to question the level of care and its potential to do more harm than good. We’re talking about diagnosing people online that we’ve never met. The internet has proven to be an unreliable way to get to know people. Something gets lost in translation between the keyboard at one end and the screen at the other. That’s why some people hide behind them, filtering and crafting their online persona and others with the best and most honest intentions just don’t come across as themselves. Many would argue that the computer isn’t even a good way to determine whether someone is dateable but somehow we think we can ascertain someone’s mental and emotional state and diagnose them which will have a huge and far reaching impact on the course of their lives.

We are all complex individuals to varying degrees. One can no more experience another’s state of mind through a computer’s screen than the fullness of a symphony through its crackling plastic speakers. I can’t imagine letting the care of someone’s mental well being hinge on that poor a translation.

June 13, 2010 at 1:07 pm

iTherapy

Our relationship with technology never ceases to amaze me — mostly in its ability become a substitute for actual relationships. For better or worse, the cell phone has had a clear impact on the way we interact with each other. We think we’ve had a nice chat with a friend when we’ve  sent them text messages from the back of a cab or a line for the bathroom. We know what our friends and family are up to because we’ve read the status updates and seen the pictures on their facebook profile. We can now interact with people without having to make any time and without getting to make any memories. It’s all very distant. Our work relationships are similarly affected. Many of us are corresponding with coworkers and clients almost exclusively via email, exchanging information in small blips. We’re all starting to look very drone-like in the unflattering light of our phone’s glow. In the interest of convenience, we’ve made a mobile version of everything and an app to address every portion of our fragmented lives and many serve the distinct purpose of reducing human contact — directions, reservations, information, therapy — therapy?

That’s right, we can finally all manage our mental health via applications on our smart phones. From NPR:

As the computing power of cell phones increases, more and more sophisticated mobile apps are being developed for the mental health field. They’re seen as a way to bridge periodic therapy sessions — a sort of 24-7 mobile therapist that can help with everything from quitting smoking to treating anxiety to detecting relapses in psychotic disorders.

Now, I’m not saying it’s all bad but where are we in terms of real care if we are trusting our doctors with the weighty task of “detecting relapses in psychotic disorders” on the basis of what is essentially a text message? When can we admit we’re giving entirely too much credibility to smart phone apps?

These mobile technologies let users track their moods and experiences, providing a supplemental tool for psychiatrists and psychologists.

“It gives me an additional source of rich information of what the patient’s life is like between sessions,” says University of Pennsylvania researcher Dimitri Perivoliotis, who treats patients with schizophrenia. “It’s almost like an electronic therapist, in a way, or a therapist in your pocket.”

Now, like I said, it’s not all bad. I can see such a thing being useful. Tying our moods to where we are in time and space and recognizing patterns in our own lives is critical. It’s no different than jotting things down in a journal and we can all appreciate having one less thing to carry around. A journal sitting in a drawer at home doesn’t do any good when you’re trying to track your moods in real time. I’m all for it as a way to record information, just not to handle our deeper human problems.

My first thought, however is that this could have the effect of taking huge steps further down the path of distant and unfeeling emotional care. It’s gotten to the point that 15 minute med adjustment visits have replaced real therapy in offices everywhere and the course of a life can be changed by answers on a questionnaire. Now we may be approaching, whether intended or not, an age where your well being can be surmised from a few lines of text and a doctor’s window to your world is a two inch screen glanced at between stock market values and football scores.Now, I don’t mean to be alarmist and I’m not saying this is the death of human care, not by a long shot but it has to be said that we’ve  traded off a lot in real interaction in the name of convenience. It’s not so much a problem of cell phones but cell phone culture. Cell phones, rather than augmenting our human encounters, are replacing them and in something as complex, sensitive and human based as the care of our mental health, I don’t think we can afford the distance and I think we’ve already traded off enough effectiveness and depth of care in the interest of convenience. It seems unlikely that an iphone app, no matter how sophisticated and involved can even scratch the surface of the human experience. Of course, now that we’ve reduced the human experience to brain chemistry, it’s not that far a leap to further reduce it to mere shards of information.

June 1, 2010 at 8:10 am 58 comments

A Domestic Take on “Internet Addiction”

For all you poor souls addicted to the internet or retreating to the safe cocoon of World of Warcraft, take heart. Psychiatry has a place for you too. It’s a six bed inpatient facility called ReSTART in Redmond, WA, strangely close to Microsoft headquarters that also tackles gaming and texting dependencies. Conveniently, they have a full and informative website. At just $14,500 per 45 day stint in the program, it is the first known treatment facility of its kind. From the Associated Press:

“We’ve been doing this for years on an outpatient basis,” said Hilarie Cash, a therapist and executive director of the center. “Up until now, we had no place to send them.”

Internet addiction is not recognized as a separate disorder by the American Psychiatric Association, and treatment is not generally covered by insurance. But there are many such treatment centers in China, South Korea and Taiwan — where Internet addiction is taken very seriously — and many psychiatric experts say it is clear that Internet addiction is real and harmful.

Thank goodness, we finally have another place to drop off our troubled youth. No, internet addiction is not recognized as a separate disorder… yet. Give them time. The DSM-V isn’t due out until 2012. For now, most see it as falling under the umbrella of impulse control disorders. Also, I’m not sure China’s approach to internet addiction is one you’d want to use as your supporting example of internet addiction “taken seriously.”

While I think the price tag is beyond ludicrous and the idea of internet addiction as  a disorder is ridiculous, the idea of helping to shift people’s focus to real-life, fleshed out interactions is certainly valid. It has to be understood, however, that “internet addiction” is, if anything, not a disorder but a manifestation of other problems. You could just as easily turn to doing anything to an unhealthy degree. In fairness, ReSTART’s mission statement clearly expresses an interest in addressing “underlying problems.”

At reSTART, we understand that Internet and gaming addiction often co-occurs with other mental health conditions. Our program is individually designed to address a wide variety of underlying issues which may contribute to excessive Internet use (e.g., family problems, divorce, childhood trauma, depression, anxiety, ADHD, etc.).

I don’t believe they are “underlying” at all but that those social or life-handling issues are the true problems with withdrawal into a technological closet being just another outlet.

Not content to limit their reach to the “real” world, a British psychiatrist has even begun to assemble a team of psychiatrists to enter the World of Warcraft. It is not yet known whether they will side with the Alliance or Horde factions but if history proves useful, they’ll probably play both ends. That should make for a comfortable and relaxed gaming environment for all involved. Maybe they can start offering psychiatric care in skate shops and live music venues too — really reach kids where they live.

September 9, 2009 at 2:01 pm 7 comments


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