Mental Health in the Digital Age

Sheri Bauman, Ian Rivers

• Publisher: Palgrave Macmillan
• Year: 2015
• Print ISBN: 9781349566549, 9781137333162
• eBook ISBN: 9781137333179
• Topic: Psychology
• Subtopic: Computer Science General
• Index: Psychology

This book examines the intersection of mental health and digital technology to make informed decisions about the new options provided by digital technology. It highlights the rise in online therapy and social media and examines the ethical dilemmas involved in online research to suggest that the benefits created far outweigh the possible risks.

1

Overview of Mental Health in the Digital Age

Mental health is defined by the World Health Organization (WHO) as, “a state of well-being in which an individual can realise his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community” (http://www.euro.who.int/__data/assets/pdf_file/0004/215275/RC63-Fact-sheet-MNH-Eng.pdf?ua=1, p. 1). This definition is also used by the Centers for Disease Control in the United States (US). Indicators of mental health include perceived life satisfaction, generally positive emotions, optimism, purpose in life, healthy relationships with others, and self-acceptance. Mental health is the optimal psychological state, and attaining that state is a putative goal for people everywhere. It is part of overall health, and is influenced by genetic, biological, and environmental factors.

On the other hand, mental illness is a serious public health problem around the world, with about 450 million people having a mental health disorder (http://www.mentalhealth.org.uk/help-information/mental-health-statistics/UK-worldwide/). Anxiety and depression are the most common disorders. About 25% of adults in the US and United Kingdom (UK) will experience a mental illness in a given year, while 13% of US youth aged 8–15 and 20% of adolescents aged 13–18 will have a severe mental disorder in a given year, along with 13% of those aged 8–15 (NAMI, 2013, http://www.nami.org/factsheets/mentalillness_factsheet.pdf). In the US, the economic impact of mental illness is enormous. It is estimated that $193.2 billion in earnings are lost to mental illness each year; in the UK, the Organisation for Economic Co-operation and Development (OECD) estimates that the cost of mental health problems is about £70 billion per year. In addition to the economic impact, there are other negative consequences. For example, more than 50% of US students aged 14 and older with mental disorders drop out of school (NAMI). Unfortunately, about 60% of adults with mental illness, and half of young people aged 8–15, do not receive services for their condition (NAMI). In the WHO European region, about 25–35% of the population has a mental disorder in a given year, but as in the US, only half of people with these disorders receive treatment, and not all of that treatment is of good quality. Although rates of mental illness vary depending on the disorders included and the source of data, there is no doubt that these disorders affect significant numbers of people, negatively impact their quality of life, and involve losses to society at large.

We now live in a world that is saturated by digital technology. The changes that have come about as a result of this technology have been described as “the Industrial Revolution of our time” (Kaufman, 2012). The World Wide Web was introduced in the 1990s and by the end of that decade had become part of life for a significant portion of the population. In the 2000s, computers became faster and smaller, mobile phones were commonplace, and many people in the developed world began to rely on this technology to navigate their daily lives. In the current decade, the 2010s, we have smart phones and tablets and cloud computing, all of which put the Internet at our fingertips.

There are those who would draw a connection between the risks inherent in the new technologies and increases in mental health problems, but to our knowledge such a connection is not supported by data. As with earlier innovations (telephones, television), the novelty evokes fears, and the media sometimes inflames these fears with coverage of extreme cases of harmful consequences of technology use. In reality, there are both risks and benefits to digital technology, and we believe that the benefits far outweigh the risks. Nevertheless, it is important to understand the intersection of mental health and digital technology in order to make informed decisions about the many options available in cyberspace.

The questions we address in this book are:

1.  Is mental health enhanced or diminished by the digitization of our world?

2.  Are mental health disorders exacerbated or ameliorated in the digital environment that is now pervasive?

3.  What mental health benefits does the digital world provide?

4.  What mental health difficulties are associated with the advancements in digital technology?

Throughout the book, we include actual case studies when they are available to illustrate the topics under discussion. Permission has been obtained from all persons whose stories are included; their identities are disguised to protect their privacy. We also include findings from current research to support our information with empirical studies.

In Chapter 2, we examine the quality of mental health information available online. Many users of the Internet seek and locate physical and mental health information on the web. We discuss the pros and cons of this practice, including that of self-diagnosis using tools available online. We also describe how individuals with existing mental health conditions use the Internet. We go into some depth on the use of Internet support groups, which have proliferated in several forms (moderated, unmoderated, professionally led, and so on) and we both describe the advantages of, and provide cautions about, these groups. We then turn to groups that promote certain harmful behaviors (eating disorders, self-harm) and consider what function they serve in society.

In Chapter 3, we describe a variety of treatments that are made available through digital technology. We weigh the benefits and disadvantages of these therapies, and discuss the various platforms and therapies in some detail. We look at both computer-based and mobile phone-delivered treatments. We then turn to the problems of substance abuse and eating disorders, and consider how digital technology can be used to reduce the relapse rates for these conditions, and how it can be appropriated for prevention programs. Finally, we explore the use of virtual reality and online games for treatment of mental health disorders. Before concluding this topic, we look at guidelines for digital forms of therapy that have been established by professional organizations.

Digital technology provides opportunities for research – and research is clearly needed to expand our understanding of the many aspects of cyberspace. In Chapter 4, we turn to the issues of conducting research in and on this environment, and discuss the ethical considerations involved. Some forms of research can be accomplished by using meta-data collected by websites (e.g., Facebook or Twitter), but other studies require that the researcher be a participant in the activity. In the offline world, this type of ethnographic study is a respected form of qualitative research, but is the same true of the online environment? What are the ethical implications of the researcher’s active participation? We also consider the ways in which traditional research approaches do or do not translate to cyberspace. What does informed consent look like in the online world? The potential ethical dilemmas are identified and explored. As with many topics covered in the book, research in cyberspace provides numerous exciting opportunities – but also carries risks that must be considered by the ethical researcher.

We have already alluded to the risks that digital technology presents, and in Chapter 5 we focus on these in some detail. We also discuss how resilience, or the ability to rebound from negative experience, can be developed in the context of cyberspace. We stress that although the media, and to some extent scholarship, have concentrated on risks to children and adolescents, there are risks to all ages, and resilience is important for both children and adults to be able to withstand the inevitable negative experiences online. We review developmental considerations that present different risks and opportunities at different stages of life, and examine more closely content-related risks, contact-related risks, and conduct-related risks, with a focus on cyberbullying and sexting.

In Chapter 6, we examine the phenomenon of social networking. Although new social networking sites appear (and disappear) regularly, two enduring and widely used sites, Twitter and Facebook, are discussed in depth. Not only are they the most popular sites in terms of numbers of users, they represent two different models for social networking. These sites have generated some research, and we include both empirical findings and illustrative experiences provided by users of the sites. We also discuss the presence of trolls, whose behavior is deliberately shocking and distressing to others.

Many people find that digital technology provides ways to connect to others. Human beings are a social species, and relationships with others are central to mental health. Thus, in Chapter 7, we explore the ways in which friendships are enacted in cyberspace, and the ways in which online and offline aspects of friendship blur and merge. We describe qualities of friendship and discuss how those qualities are supported (or not) using digital technology. We focus closely on the ways in which digital technology influences friendship among special populations, such as lesbian, gay, bisexual, and transgender (LGBT); homeless youth; disabled youth; and the elderly.

Similar to social networking, virtual worlds that exist in cyberspace are online opportunities that attract large numbers of people. In Chapter 8, we consider the use of such environments at different life stages, and then look closely at two virtual worlds that are exemplars of this genre: World of Warcraft and Second Life. The former is a massively multiplayer online role-playing game (MMORPG), which includes competition and goal achievement for players. The latter is a parallel universe with no competition or goals. Residents enact many activities of the offline world here – they work, play, bank, open businesses, create objects, meet others, have sex, marry, and so on. Each of these two sites has wide appeal and attracts large numbers of players or residents. In this chapter, we describe the role of these worlds in the lives of special populations, such as LGBT and persons with disabilities. We review the positive impacts these worlds have on the lives of users, and consider the possible harm that can arise from their use.

There has been much speculation about online portrayal of the self, and in Chapter 9 we consider how the self is represented in the digital world. We begin with a discussion of the distributed self, a concept proposed by Sherry Turkle, and consider its application to both the self that is revealed in different platforms, and to the use of avatars. We focus on the fluidity of gender in many online environments, the ways in which offline and online selves merge or diverge, and how the selves we create or express in cyberspace interact with our mental and physical health in the offline world. We look at the impact of blogs and social media on well-being, and how the self is exhibited in contexts such as chat rooms.

Finally, in Chapter 10 we present our conclusions about mental health and digital technology. We acknowledge that we are not the final authority on the subject, but we believe our professional training and expertise, and our adventure in writing this book, give some substance to our views. We are hopeful that the book will generate further discussion and research, since mental health is essential for overall well-being, and in the digital age, technology is a feature of modern life that must be understood as a significant and salient environmental influence on mental health.

2

Mental Health on the Internet: Opportunity or Danger?

Introduction

The explosion of Internet content relevant to mental health means there are many and varied avenues to obtaining information online about mental health topics. The Internet is always available and has copious amounts of information which can be located easily, anonymously, and generally without cost. Accessibility to the Internet has increased so much that most people in developed countries have either a personal device with Internet connectivity (87% in the US, 90% in the UK) or free access via computers in public spaces, such as a local library. In addition to information, there are online groups that purport to provide help and support to those with particular mental disorders. In this chapter, we explore two major themes: the quality of online information and diagnostic tools, and the value of online group support platforms.

Quality of mental health information online

Websites devoted to general mental health first appeared on the Internet in the mid-1990s in North America, and were followed by sites focused on specific disorders, often providing both information and discussion platforms. Europe and Australia began creating similar sites just a few years later. Of users of the Internet, 28% report using it to search for information on various mental disorders (Colón & Stern, 2011). Currently, it is common to find sites for individuals with mental disorders and also sites for their relatives and friends. Many sites with information also offer self-help support groups. The design and accessibility of websites vary, with some being more text-based, and others integrating audio and video. Some are more easily navigated than others. This is to say, for a person seeking information, there is likely to be a site that will appear in their preferred format. This also means the person may have to check numerous sites before finding one that is suitable for their needs and preferences.

Grohol, Slimowicz, and Granda (2014) did a rigorous study of mental health information on the Internet, examining 440 websites found by search engines Google and Bing for the 11 most commonly searched-for mental disorders. They found the highest scores (most complete and accurate information) on sites about dysthymia, bipolar disorder, and schizophrenia, with the lowest scores on sites for phobia, anxiety, and panic disorder. Overall, sites did the best job clarifying that there is more than one treatment option and providing additional sources of support. They did worst at explaining the risks of treatment and descriptions of the likely effects of not getting treatment. One issue revealed by these researchers is that the complexity of the material on many sites would make it difficult for some consumers to comprehend the information. Finally, they found that non-commercial sites had higher scores on their measures than commercial sites.

It is important to remember that the Internet is not a refereed medium. There are no editors or external reviewers who evaluate the content to determine whether it should be published (or posted). Thus, anyone with the basic skills necessary to create and maintain a website can post information; the accuracy and quality of that information is not guaranteed. How is the searcher to sift through the large number of sites (623,000,000 hits on a Google search for “mental health”) to find the one that is most likely to provide information that is factual and complete?

• Firstly, seekers of information must use the correct search terms. If they have specific questions, it is usually more fruitful to include the entire question rather than just a word or short phrase.

• Secondly, the searcher should peruse the links beyond the first page of “hits”, as some of the sites with high traffic (which will therefore appear on the first page of search results) may be commercial ones rather than the most accurate.

• Finally, one study (Tang, Crawell, Hawking, Griffiths, & Christensen, 2006) located more useful sites for information on depression using general search engines (e.g., Google) rather than domain-specific ones (e.g., nimh.gov). However, these researchers also discovered that when seeking information about treatment options, several sites located by Google contained information that was contrary to current scientific evidence. On the other hand, Bell (2007) argued that this concern is exaggerated; he believes that inaccurate websites are not likely to be highly ranked in search engines due to the process by which pages are elevated to high rankings.

Some rules of thumb can be useful when evaluating a website (Grohol, 2007). Identifying the author of the site or page is a good first step. What are the author’s credentials? Do those credentials qualify the person to be offering information on the current topic? When the author is someone whose work has been subjected to critical review by peers (searching on Google Scholar can ascertain whether that is the case), there is evidence of expertise. How extensive is the expertise? A scan of the titles of publications can provide that information. Does this mean that practitioners’ and/or individuals’ sites should be considered invalid? Not at all. It means that the author of the material should be vetted for relevant experience and unbiased presentation.

Some persons find reading personal accounts from those who experience a disorder to be valuable, as these may present a perspective that is lacking in more factual sites. Sometimes these personal accounts offer suggestions for managing the disorder based on the individual’s experience. Authors of such accounts believe they are using their experience in the service of others. These motives for posting personal accounts are understandable; readers must keep in mind that each person with a disorder is unique, and while someone else’s experience may be enlightening, it may also be dissimilar in ways that are important.

To determine whether a site is biased, the author information is helpful for evaluating how the author’s experiences or affiliations may result in material that is not completely objective. For example, when research on the efficacy of a new drug is conducted and sponsored by the drug company that manufactures the drug, we are likely to be cautious and skeptical. In contrast, when the research has been done by independent researchers and funded by a source that does not stand to profit from the findings, our confidence is justifiably higher.

One way to evaluate potential bias on a mental health website is to see if products or services are being promoted or sold. If they are, the information may be selective; it may in...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Figures
• About the Authors
• 1. Overview of Mental Health in the Digital Age
• 2. Mental Health on the Internet: Opportunity or Danger?
• 3. Mental Health Treatment
• 4. Research and Ethics in the Digital Age
• 5. Risks and Resilience in Cyberspace
• 6. Social Networking
• 7. Being Connected: Friendships and Social Interactions
• 8. Virtual Worlds
• 9. Representing “The Self” Online
• 10. Conclusion
• References
• Index