Technology in Psychiatry

Technology in Psychiatry:

Copyright 2019, Lee Coleman, All rights reserved

Some Background

Because history is always ignored at our collective peril, let’s start with a brief look at Psychiatry’s current “revolution” before focusing on the subject of this article, another revolution planned jointly by psychiatry and computational social science (CSS). CSS is a field of endeavor still trying to decide what it is and what it isn’t, but nonetheless very sure that through “machine intelligence” it can change the world for the better. (Kellogg, 2017)

While both partners may be rather inexperienced at planning revolutions, with psychiatry having nothing to show from its present efforts but overblown promises, they are surely to be reckoned with, given the fact that the richest companies in the world are backing them to the hilt. (Rauch, 2017, 2018; SourceFed, 2013)

Psychiatry’s disease model has been questioned by some within the inner circle as early as 2009. (Frances, 2012) A growing but easily ignored community of outsiders has demonstrated the lack of science (Whitaker, 2016; Gotzsche, 2015) and even further back a few lonely voices understood that psychiatry’s adoption of medical language did nothing to change the fundamentals—the power given to psychiatry by the state to force itself on unwilling subjects was unique in medicine and must no longer be ignored. (Szasz, 1963) (Coleman, 1984)

An ever-more-powerful cartel joining Psychiatry, Government, and Pharma with Major Media has grown into a public relations machine of enormous proportions, one that proclaims that the proof of the promised brain diseases is “just around the corner”. By now the public needs no more convincing, acting more like cheerleaders than critical thinkers.

Let’s Have Another Revolution

The thesis to be developed here is that while the public relations juggernaut that has disguised the truth about Psychiatry is still in place, Psychiatry and its wealthy backers are once again going on the offense, developing a brand new partnership between digital technology and psychiatry’s “best and brightest” to create a bloated brand of Psychiatry that seeks to “reach out and touch” the ever-increasing percentage of the world’s population (now claimed to be no less than one-third of humanity) with algorithms developed by the very young and very hip new discipline of “Computational Social Science” (CSS).

I am talking about giants like Google, Facebook, and Microsoft entering into a world traditionally run jointly by Psychiatry and Law Enforcement. This is a partnership blending the old with the new, and if there was ever a time for clarity in our understanding of what is about to happen, it is now. The only medical doctors empowered by the State to use force are also the only medical doctors with no diseases to treat because the serious problems are not medical. There surely must be a connection between these two facts, and something unpleasant. Why else should our society have looked the other way for so long?

Parens Patriae Primer

Responding to disturbing but non-criminal behavior has traditionally been assigned to Psychiatry by a legal doctrine called parens patriae, or “the State as Parent”. (Robitscher, 1980; Szasz, Coleman) The key to finally addressing the social and personal harms that have always surrounded psychiatry is to be found in the fundamental dishonesty of parens patriae. Until society confronts the fact that the very aims and purposes are dishonest, not merely its administration, the poisoned atmosphere surrounding psychiatry as a specialty of medicine will continue to plague us all.

First, state interference said to be justified by the need for parental protection of those unable to protect themselves exists in truth for the convenience of society.

Second, psychiatrists and police have never been willing to limit their interference to the laws as written, and neither have the judges who are supposed to watch over the behavior of psychiatrists and police. Purported “safeguards” protecting patients’ rights presume the legitimacy of a class of citizens with fewer rights because of their status as “mental patient”. (Gottstein, 2008)

Psychiatry’s sham examinations provide the fig-leaf that makes it easier to pretend that science and benevolence are the genuine reasons behind parens patriae, while fear and convenience are really running the show.

So, with Psychiatry’s power and influence already healthy, and with no real questioning of the poisoned roots of its legal authority, why should we now be facing a gigantic threat that makes the already formidable financial muscle of the Psychiatry, Government, and Pharma cartel seem rather puny by comparison?

Facebook’s Chutzpa Blows the Cover

Facebook’s behavior preceding the 2016 election, in which its data was made available to enemies of a free and fair result, led not only to public outrage but also to questioning of the broader issue of just how Google, Facebook, Microsoft and Big Data in general was spreading its tentacles over more and more social platforms. (Singer, 2018)

While Mark Zuckerberg rushed to apologize (yet again, and again) for pre-election behavior that was obviously indefensible, he was quick to point out that Facebook was also collaborating with outsiders to do something beyond reproach– partnering with psychiatry and the police to promote mental health and public safety. Doesn’t that seem like a neat way to make friends and be liked?

His consistent claim that all Facebook wants to do is “make the world a better place by bringing everyone closer together” is reminiscent of what Utopians have always claimed. (“Utopia”)

I picture Santa Claus reaching into his bag and pulling out two special presents: “Here you are Psychiatry, this will help you treat the mentally ill sooner, better, maybe even catch the illness before it strikes…and here you are Mr. Policeman, this will make your job easier too.”

By now, everyone understands that Facebook’s rhetoric is hardly trustworthy and that the truth will require either whistleblowers or undercover investigations. Recently Aljazeera gave us just such an opportunity when it aired an undercover investigation of the training of “content moderators,” those who after a three-and-a-half-week course paying minimum wage decide whether content is permitted or pulled. (Inside Facebook: Secrets of the Social Network, 2018)

Here are some highlights of the rules that Facebook, in collaboration with CPL Resources in Dublin, teaches in secret to its content moderators-in-training. As a result of this investigative report, CPL severed its ties to Facebook. (Facebook’s Dublin moderators criticised for not removing abusive videos, 2018)

— child abuse—slapping, kicking, punching, screams of terror: permitted if no reason to assume it is happening now. Reasoning: “If you censor too much, people will lose interest.” Example shown had been viewed 44,000 times, for six years, based on assumption (later proved false) that “abuse was not current.”

— children under 13 not allowed to have a Facebook account, but no mechanism for enforcement. One dishonest click about viewer’s age goes uninvestigated.

— physical assault, child to child: permissible. Reasoning: “should not interfere with Facebook’s ability to highlight a problem like children settling differences.”

— self-harm: remains up unless evidence that injuries are “fresh.”

— hate speech—Encouraged: by granting of “special consideration” for groups with large followings. Britain’s Tommy Robinson with 900,000 followers, assigned the same latitude as the British Government and Major Media outlets.

In other words, do or say something vile enough to attract enough followers watching ads and be rewarded with “special consideration. (Inside Facebook: Secrets of the Social Network, 2018)

Understanding the Partnership

Predicting an individual’s behavior from a distance is something that even psychiatrists will shrink from, but that is what CSS seems to believe they have achieved.

Psychiatrists have, of course, always justified their legal authority to use force, under parens patriae, by claiming their “clinical examinations” were capable of foreseeing imminent danger to self or others. But CSS brings to the partnership the claim of being able to make accurate predictions en masse and instantaneously. This means evaluating millions at a time. What Psychiatry wants to do is treat all those patients, given that “estimates are that one-third of the world’s people will become mentally ill.” (Rauch, 2018)

Psychiatry is not interested in actually seeing all those people, but with local agencies armed with the power of parens patriae, drugs are always available. And if the “diagnosis” or “prediction” from the machine is in truth worthless at best and more likely both stigmatizing and destructive, that’s no worse than what psychiatry is already doing.

Time for a Celebration- McLean Hospital TIPS, 2018

It is time to hear from a representative of each side of this new partnership, first Dr. Scott Rauch of Harvard Medical School’s affiliate, McLean Hospital, and director of McClean’s Technology in Psychiatry (TIPS) program, and then Dr. Munmun De Choudhury of Georgia Tech’s College of Computing. (De Choudhury, 2016)

As I watched and listened, one question consumed me: Is this a meeting about computer science and medical science, or is this an example of artificial intelligence from both sides? Is this Science or is it Sales? Let us begin with highlights from Dr. Rauch’s welcoming address:

“we now know that over one third of people will have a psychiatric condition in their lifetime…disorders of brain and behavior represent the number one cause of disability worldwide…psychiatric illness is really the principal driver of total medical expense… although there are many effective evidence-based treatments, there are really major gaps in what we know in the treatments that we have available … “There’s absolutely an ocean of need…and the answers will really lie in new discoveries and innovations when technology in this digital age is beginning to offer the promise of potential solutions to these paramount challenges… new targets, better treatments, even cures, the ability to track, predict and intervene in a timely way, and ideally to prevent…

“…I’m very much reminded of the emergence of the field of psychiatric neuro-imaging now almost exactly a quarter century ago and what it was like to be a pioneer on that landscape. It’s clear that the field of digital psychiatry is absolutely on that same kind of hyperbolic upward trajectory today. It has all the hallmarks of a revolutionary scientific movement and I’m just going to say a word about what the hallmarks are, when you’re in the midst of early stages, the tipping point in the way of a revolutionary scientific movement.

“First and foremost there’s the realization that new tools and approaches have truly opened entirely new vistas to address large-scale high-impact problems and indeed these are some of the most important and vexing challenges of our day… this has really captured the imagination of the best and brightest, from senior leaders to trainees, we see people coming in droves to this field, across multiple disciplines to pioneer what heretofore is uncharted territory…. I think all of us know how crucial funding is in fact in this domain… there’s already been a surge in NIH funding reflecting an explicit strategic commitment of resources…

“It may not surprise people here …. that the ultimate harbinger of such a revolution is industry and …. industry is going all in, from startups to major established players to even traditional big Pharma, they all see this domain as the future and they’re putting their money where their mouths are … They’re all there, they’re all investing in this domain, believing that it’s a critical part of the future….

“Our TIPS is virtually unique in bringing together clinicians and scientists with expertise across a broad range of domains essential to digital psychiatry and also bridging cultures, academia, policy and industry. So again, I really mostly just want to welcome you on behalf of McLean Hospital and our Institute for Technology in Psychiatry. We are deeply invested in collaborating to revolutionize our field in order to advance the mission of improving the lives of people and families affected by psychiatric illness…”

Difficult as it is not to comment immediately on such plans and promises, let us go on to Dr. De Choudhury. She had caught my attention in the days after Facebook announced that it was working with Suicide Prevention and Police to combat suicide and violence. Her presentation, “Employing Social Media to Improve Psychiatric Treatment Outcomes” was a brief summation of a decade of work, first with Microsoft and then Georgia Tech’s School of Computing. (History of GT Computing, n.d.) Some highlights:

“Since about ten years ago…there’s been a lot of interest in trying to take… data that people are leaving behind on these platforms and putting it together to make sense of behaviors at a scale and a granularity… that was not possible before…. all the data can be useful for mental health…. implications of this data… for improving psychiatric treatment outcomes. In 2013 we decided to look at new moms … sharing information about having had a newborn… showing signs of social isolation… less interaction … more self-intentional focus… So the question is… how does it link to mental health?”

Next, De Choudhury and colleagues decided to see if they could diagnose people from a distance, using machine intelligence. They concluded that they could.

“You can actually build pretty good predictive models that would distinguish individuals who are likely to get diagnosed going forward…So we developed machine-learning models and we drew inferences from the literature to identify some kind of language cues …. the beautiful thing about social media, especially things like Reddit is that you actually can see how the social community is supporting or sometimes exacerbating these experiences….”

About halfway through her presentation, de Choudhury made reference to a New York Times article (Singer, 2014). That article was highly critical of a partnership between Technology and Psychiatry, so the fact that de Choudhury made reference to it led to a moment of hope. Was she about to introduce some genuine scientific caution into the celebration?

Sadly, no. Instead, she was only pausing before describing more work in which she compared her machine diagnosis with a real live psychiatrist’s diagnosis on the same patient. Need I add that neither CSS nor Psychiatry understands that diagnosis requires a disease, not a list of symptoms?

More highlights:

“Can we predict relapse with Social Media…psycholinguistic differences in a period of five months preceding a relapse hospitalization and comparing it with a healthy period before their first ever hospitalization… hallucinations, feeling like people other people are watching them, I’m feeling like there are cameras installed in their homes are voices talking to them talking…. we can do a pretty good job ….77% … predicting… So envision a snapshot on Facebook …”

Finishing up, de Choudhury stressed that CSS wasn’t talking about a take-over, but a true collaboration with psychiatry.

“I haven’t actually talked about how this will actually be helpful …clinicians are very willing to use some of this kind of information… Are these models good enough… I don’t have a good answer… our technology machines and humans working collaboratively …this is a question of trust. I want to share that information with… their friends, families.”

One thing was clear. De Choudhury wasn’t yet sure her data was good enough to trust, i.e, be good enough to justify violating someone’s privacy, but she had no doubt whatever that she could trust Psychiatry. It all seems so obvious. If you can’t trust your doctor, who can you trust? But let’s save that for the discussion at the end.

The Age of Surveillance Capitalism

Once Psychiatry’s false medical claims and “treatments” are understood, it follows that any type of partnership Psychiatry chooses to join will of necessity be corrupted. If the chosen partner is likewise illegitimate, so much the worse. The proceedings of the 2018 Tips Conference made it clear that psychiatry was not alone in its failure to understand the harm that will result from any effort “to track, predict and intervene.” CSS is just as sure of itself, and with Psychiatry as its trusted partner, and Google, Facebook, Microsoft, and a host of others anxious to pay the bills, great things were coming.

If all this were not disturbing enough, so much so that I felt duty-bound to alert others to these developments, I learned of a new book, “The Age of Surveillance Capitalism”. (Zuboff, 2019)

My article would have to wait until I learned more about the Tech side of the partnership, and as I made my way through Zuboff’s account, the threat to a decent society became ever clearer as its history, personalities, and finances began to fill the gaps in my understanding.

Right away, an enhanced understanding of Dr. De Choudhury’s background emerged and was frightening. Before Georgia Tech she was part of a Microsoft team that filed a patent in 2013, “User Behavior Monitoring on a Computerized Device” Granted in 2016, the concept involved “monitoring user behavior via a computerized device and alerting trusted individuals of user behavioral changes that are likely to affect the user’s mental health…a monitoring mechanism may invoke steps for automatically identifying and predicting behavior changes…and may generate alerts for the pending behavior changes. (US 9427185B2)

“Monitoring,” “alerting trusted individuals,” “mental health,” “predicting behavior changes,” and “generate alerts”: Would I be wrong in being reminded more of cyberwar than helping someone in emotional distress? Who is really behind all this?

As I looked over the drawing of its machine, showing just how mental illness would be not only detected, but predicted, so that medical professionals, caregivers, family members, etc. could be alerted, I didn’t know whether to laugh or cry, or alternate between them. Perhaps readers may wish to look for themselves.

This one example demonstrating that the considerable charm of de Choudhury was not a reliable guide to the true meaning of her work, will have to do for now as an indication of just how important is Zzuboff’s expose. But alas, my romance with “The Age of Surveillance Capitalism” ultimately left a bittersweet aftertaste.

Zuboff apparently still trusts psychiatry, for she never comments on the overwhelming evidence that more psychiatry does not mean more help but more harm. The implications are enormous, so it must be assumed that she has had no opportunity to ponder whether the better CSS becomes at its predictions, as it tries to “improve psychiatric treatment outcomes” the worse it will be for those swept up in the surveillance.

“Treatment” is just a word. What psychiatrists actually do does not qualify as genuine help, certainly when force is involved and all too often the rest of the time as well. Because psychiatry’s “treatments” come down to drugs and electric shock, both of which are brain damaging, life shortening, frightening and stigmatizing, it is profoundly discouraging that Zuboff seems to be in the dark on this.

There seems to me a profound irony in the fact that each time Zuboff illuminates the profound harm that unbridled Technology is creating, she fails to notice that what Psychiatry has always done –have the final word on what is wrong in someone’s life and what to do about it–will simply be magnified by its partnership with CSS. As frightening a picture as she paints sans the truth about psychiatry, the threat from CSS is that much greater once a recognition of psychiatry’s true nature is recognized.

In conclusion, I want to do it for her—add the fundamental dishonesties that are today’s psychiatry to the witch’s cauldron, daring to hope that if readers of this discussion join me in this educational effort, maybe Zuboff herself, and others like her, will join our community in a new partnership of our own.

The Right To The Future Tense

This is Zuboff’s expression for “the individual’s ability to imagine, intend, promise, and construct a future. It is an essential condition…of the inner resources from which we draw the will to will.” (p.20) She adds, “Any person, idea, or practice that breaks these bones and tears this flesh robs us of a self-authored and we-authored future…the right to the future tense is endangered…all for the sake of its guaranteed outcomes…”

It was passages like this that drove me to read every page, underlining example after example, all the while hoping Zuboff would finally demonstrate a recognition that it is not just Big Data that wants to eliminate the “right to the future tense”. That is precisely what psychiatry already does and wants now to do “at a scale” previously unimaginable.

It all begins with a “diagnosis,” and no one has expressed it better than Laura Delano in her YouTube post, “Recovering From Psychiatry: The Power of Psychiatric Diagnosis.” (Delano, 2013). As she explains, it is the medical language, something available to no venture capitalist and no computational social scientist, that triggers the chain of events that Zuboff refers to as the stealing of “a self-authored future.” Once psychiatry’s disease model is accepted, “doctor knows best” naturally follows.

Common Rule and Informed Consent

Common rule is “designed to protect against the abuse of the experimenter’s power… It does so by procedures that guarantee informed consent….” Zuboff, once again with total command of her subject but no understanding of how psychiatry has been exempted from the rules, rightly condemns Technology for arranging for “academic researchers [to] escape ethical restrictions by teaming up with private companies to test increasingly dangerous or harmful interventions….”

Since the 1940s and even earlier, psychiatrists in public institutions called “hospitals” but in reality being prisons for the disturbed, have been free to use whatever invasion they could dream up and rationalize, whatever poisons, butcheries, confinements, terrors that struck their fancy and then been free to call each of them a “treatment.” To imagine that the idea of “informed consent” was even entertained by those in charge could in itself be considered a new form of “mental illness,” it least in my diagnostic manual.

Zuboff makes no mention of this history, apparently lumping psychiatrists with all other physicians under the assumption that, of course, doctors obtain consent before initiating treatment or conducting experiments. The fact that genuine informed consent requires both honest information and freedom from coercion, and that these are lacking whenever psychiatrists administer drugs or electricity in an isolated state hospital or a Beverly Hills suite, is similarly unconsidered.

And so we come to what to me seems the most challenging conclusion to be drawn from these truly frightening developments: Those who see to the bottom of why Psychiatry’s threat to human dignity is apparently bottomless must recognize that our task is one that aims at the masses of ordinary citizens, uses a simple language, embraces rather than shuns strong emotion, and constantly emphasizes that the coming catastrophe can only be avoided by focusing on the legal and moral issues that should never take a back seat to questions of “evidence.” That way merely empowers those with all those degrees, those who seem too frightened to rise up.

Lee Coleman, MD

Berkeley, Ca. 2019