Short talk given by Mark Brown at Mind, Body, Spirit: Psychiatry in context in London as part of a panel debate Digital Psychiatry: will advancing technology support or destroy the patient-professional relationship?
I love the title of this panel discussion: will advancing technology support or destroy the patient-professional relationship?
Right there, first and foremost you have a title that presents psychiatry as an embattled state, surrounded on all sides by the mechanised forces of technology. Think John Connor in the Terminator films, the last chance of humanity triumphing over the never-sleeping, never-resting, relentless loss of ground to the grinning, robotic, unfeeling machines that threaten to make such fleshy, inconsistent, emotional creatures obsolete. Support. Destroy. Advance. Exterminate!
Is this really the case, though? Is there are anything that is really under threat right now that wasn’t under threat ten years ago? Twenty years ago?
The language that we’ve chosen to frame this debate with speaks very much to the idea that digital technology is increasingly moving into areas that previously had been the domain of non-digital effort. Andrew McAfee Co-author of The Second Machine Age refers to this as digital encroachment, the direct replacement of human labour with machine labour. In mental health, as in other areas of public service delivery, there are some who feel this digital encroachment as literally that: an army of computer screens and ill-understood gadgets skulking in the shadows a bit like in The Terminator again, ready to leap out and take away everything they hold dear, including their jobs.
Digital encroachment is not always a comfortable experience, especially when it’s your labour that’s being encroached upon. There’s a tendency for all of us to see the way that we do things as being vital to the final outcome of what we’re doing. We take pride in our craft, in our method, in doing the things we’ve been trained or learned to do. When new possibilities for methods of achieving that outcome become available we begin to feel worried. What if our craft become obsolete? What if something is lost in the process of something being gained?
This must have been how the monks felt when Johannes Gutenberg turned up with his new fangled printing press, and look how that turned out. If your purpose was to make books more widely available it was awesome. If your purpose was to continue to engage in the practice of copying by hand, well, history shows that your role was to become slightly less central than you might have hoped.
One question we must really be asking is ‘which technologies are we talking about?’ Are we talking about a particularly threatening copy of OpenOffice here? Or are we really talking about the potential of digital technologies, including the advances in internet enabled devices and methods of communication to redefine what it means to ‘do’ psychiatry with people? Similarly, we must also be asking: ‘which patient-professional relationship are we talking about?’ Are we talking THE patient-professional relationship as an abstract principle or are we talking about a multitude of different forms of relationship between professionals and patients?
It’s worth remembering that we are currently in the middle of the single largest experiment ever in modifying the behaviour of human beings by the widespread adoption of technology. In the western world it has completely redefined the way in which we live our lives and has rewired the majority of our daily routines. It’s massive, and no one has even noticed it happening. It’s not the web, not telephones, not the combustion engine. It’s the widespread availability of artificial light. No longer is humanity limited and regulated by natural light. That’s huge, but because we all grew up with that we don’t even notice it. Digital technologies look and feel new to people who are coming to them as if they are new.
It’ll terrify you to know that Facebook first became available to UK users in October 2005 and that twitter launched in early 2006. Livejournal, the blog sharing platform launched in April 1999. The first i-phone? June 2007. Skype? August 2003. The point is: digital technologies have already been changing people’s lives for decades. As William Gibson, the oft-quoted parent of cyberpunk is often quoted as saying: “The future is already here, it’s just not evenly distributed yet”. The point is not ‘will digital technology change things; but how has it changed things already?
It’s a myth that all human endeavours are equally likely to be completely disrupted by digital encroachment. Some things will always need direct human labour. Psychiatry is probably one of them. This does not, however, mean that psychiatry shouldn’t explore digital technology as a way of better meeting the needs of those that the profession seeks to serve. Just as we wouldn’t think of sitting in the dark today at half four when the sun goes down, so digital technologies are tools at our disposal to change the environment or to enable things to happen that otherwise would be beyond our reach. Psychiatry needs to look for its place in the post digital world rather than debating whether it needs to maintain its separation from it.
Digital technology isn’t that ‘that weird thing on computers’, it’s a part of people’s lives. Increasingly it’s a layer of connectedness between people and between people and tools and information. We need to stop asking ‘is digital technology bad for people’s wellbeing?’ with a view to suggesting they just unplug and go off and do something less bothersome instead and ask ‘how can we make sure people are getting what they want and need from digital technology?’
As to whether digital technology changes the relationship between patient and professional? For some people it will, for some people it won’t. It all depends on how digital technology is approached and which choices are made, both in terms of redefining the ways in which psychiatry works and the ways in which people interact with it.
Relationships change. One of the immense changes brought about by digital technology is the exponential increase in the amount of information available to any individual who can get an internet connection. That has all manner of effects, all of which change the ways in which people view their position in a patient-professional relationship. There’s no genies to return to bottles. There’s just people and relationships and social and economic conditions.
We would view as suspect anyone who defined the only valid family relationship as being the ‘Mummy, Daddy and baby’ that they grew up with themselves.
I’d suggest we should also be suspicious of anyone who claims that the only valid patient-professional relationship is the one that looks exactly like the ones we knew back when everyone was in black and white and psychiatrists all smoked pipes.
It presents opportunities for the practice of psychiatry and the development of new forms of relationship or provision but also asks psychiatry to consider digital technology not just as a thing people use but also as an integral part of who they are.
Digital technology is not a possible future, it’s an unfolding present and I’d suggest that psychiatry might benefit from getting out of the embattled bunker and joining the rest of us.
Mark Brown is development director of Social Spider CIC. He is @markoneinfour on twitter