Politics and the Culture of Fear: Is There a Place for Digital Disruption?

It feels as if we can’t escape the culture of fear and extremism that is pervading politics. Political discourse is more vitriolic than ever after San Bernardino and Paris, and during the months of partisan name-calling and ugly mud-slinging among candidates for the U.S. Presidential Race. And clearly, there are no easy solutions to unraveling this vicious cycle.

During the Christmas holiday, I had an experience that perfectly illustrated this to me. My family and I were at a friend’s house for a holiday event, and I overheard her guests talking as I walked through the kitchen. I heard, “The more he says, the more I like him.” Then, “He says the things we all think but are afraid to say.” I started to get that sick feeling in the pit of my stomach, hoping they weren’t talking about Donald Trump. Then I heard, “The only problem with building a wall between Mexico and the U.S. is that it will have to be so big that it’s impractical and expensive.”  I tried to talk myself off the ledge, saying to myself, “Don’t open your mouth, just keep walking, don’t say anything, it won’t help or change anyone’s mind…..” But then as I was about to turn the corner, safely avoiding a conversation that would surely have turned ugly, I heard, “Of course we should ban Muslims from entering the country. Look what they did in Paris.” So, I turned sharply on my heel and unwisely marched over to the little group sitting around the kitchen table.

“Excuse me,” I said, “but I couldn’t help but overhear your conversation, and I wish that you would consider the fact that excluding or persecuting people solely on the basis of their religion or ethnicity is how (voice rising) the Holocaust started.” And then, when the response to that grenade lob was dropped jaws and the explanation, “It would only be temporary,” I looked at them incredulously, probably with disgust on my face, and said, “That’s what Hitler said and” just in case they didn’t get it the first time, “that’s how the Holocaust started.” Then I abruptly left, muttering, “This was a mistake, I can’t talk about this…..”

I found this conversation terrifying – not only because the thought of Trump as Presidentimages is terrifying, nor because I was disappointed in myself because I lost my cool, and created an extreme, unbridgeable divide between our viewpoints by invoking the Holocaust. No, this conversation was most terrifying because these people were not bad people. They were the type of people I appreciate: good, kind, hard-working people who love their kids and their family.

So where does that leave us?

I don’t have a solution, and indeed, my own extreme reaction during the kitchen table conversation shows that I lack objectivity and am certainly part of the problem. I do, however, as a scientist believe that we can harness what we know about our minds and brains to neutralize this vicious cycle of social and political extremism. Could digital disruption help move us along a path to such change? There might not be an app for that, but below I list three steps I believe could put us on the road towards digital disruption of the political culture of fear.

1. Frame political extremism as an emotion regulation problem. Before any digital disruption can happen, we have to make sense of the problem and have a concept of what’s going wrong. We have all had one of those kitchen table conversations I described above. In these conversations, our emotions get the better of us – fear, disgust, anger. This is a problem in how we control our emotions and how our emotions control our thoughts, decisions, and actions – something psychologists call emotion regulation. The problem is that our strong emotions rarely convince our debating partners. Instead, they solidify the views everyone already holds, causing us to cling to them even more strongly and rigidly. Common ground is lost, and the divide between perspectives seems increasingly unbridgeable.

Imagine how a version of that kitchen table conversation happens on the political world stage, sabotaging attempts at diplomacy and mutual understanding. The result is not just upset and angry people. Now the result is that our emotions directly shape political discourse, legal decisions, and policies that can affect generations to come.

Thus, a first crucial step towards disruption of the political culture of fear is to frame political discourse in terms of emotion regulation – applying what we know about what goes wrong and how to fix it on the individual and group level.

2. Use technology to promote empathy. Recent research in political psychology suggests that empathy can help heal rancorous political divides. A recently-published study showed that when political advocates fail to understand the values of those they wish to persuade, this “moral empathy gap” causes their arguments to fail. However, when political arguments are reframed in the moral terms of the other side, they are more effective. For example, when asked about their views on universal healthcare, conservatives who heard “purity arguments” (e.g., sick people are disgusting and therefore we need to reduce sickness) were friendlier towards universal healthcare, compared to when they heard “fairness arguments,” which are more consistent with liberal values.

If we can use technology to bridge the moral empathy gap, we might be able to reduce political polarization and promote better emotion regulation, more compromise, and deepened understanding. Virtual Reality (VR) might be one such technology. I previously wrote about Chris Milk’s thought-provoking TED talk on VR as the “ultimate empathy machine.” By creating a sense of presence and of real interactions with people and worlds, VR forges empathic bridges leading to greater understanding and compassion. In his work with the UN, Chris Milk uses VR to vividly portray the plight of refugees to politicians and policy makers. How does seeing and experiencing the suffering of 5-year-old children in the refugee camps influence policy making?: Almost certainly for the better.

3. Use technology to calm the fearful brain. As political ideologies become increasingly polarized, neuroscience research suggests that the differences between liberal and conservative viewpoints may extend beyond policy preferences to fundamental differences in the “fearful brain.”

In a paper I wrote in 2014 with Dave Amodio, a professor at NYU, we found that children of liberal compared to conservative parents showed a stronger “N2” brain response to mildly threatening and conflicting information. A greater N2, derived from EEG, suggests more openness to uncertainty, ambiguity, and threat. A culture of fear, in politics or otherwise, is marked by the opposite of this: inflexibility and discomfort in the face of uncertainty and ambiguity, along with resistance to change. These aspects of fear are part of the foundation upon which intolerance is built.

What if we could create computerized interventions that promote our ability to cope with uncertainty and change – perhaps by strengthening the N2 response? My research on the stress reduction app Personal Zen, as well as other research, shows that this may be possible. More research is needed, but if science-driven digital mental health continues to evolve, reducing the political culture of fear could soon be in the palm of our hand.

Digital Mental Health: A Revolution without a Manifesto

Mental illness is THE public health crisis of our time, greater in terms of personal and economic costs than any other disease, dwarfing cancer, diabetes, and cardiovascular illness. Half of us Americans are at risk and likely to suffer from one of these problems in our lifetime. The global economic burden of mental illness over the next decade has been estimated at $16 trillion. Yet, this is only the tip of the iceberg because half of us never seek treatment – 45% say price is a barrier and 40% say the stigma of mental illness is a barrier.

Digital health technology is the perfect disruptive innovation for this sorry state of affairs – it directly addresses these barriers by being instantly accessible, affordable, and private. Perhaps as importantly, with mental wellness in the palm of your hand, the dialogue around mental health could be reinvented. Instead of focusing only on illness and pathology, we could focus on the pursuit of mental fitness, making it as socially acceptable as improving physical fitness.

I don’t think this is just a nice dream. We are standing on the edge of a revolution and digital technology will be at the epicenter of that revolution. But we are uncertain how to move forward. Elsewhere, I have described this state as the Wild West, a lawless frontier, full of potential.

In order to realize this potential, we need goals, guidelines, and values. We also need to create a truly cross-disciplinary dialogue to fully understand the personal and societal implications of digital mental health, and how to work with the vast amounts of data this movement will create. Until we do so, digital mental health will be a revolution without a manifesto.

A manifesto should dissolve the past, reinvent the future, define and antagonize, inspire and provoke to action, spark community and presence. Here I outline what I believe should be six core principles of the manifesto, to guide the digital mental health revolution. Vive la revolution!

translationFocus on Translation. For digital mental health to succeed there must be translation between the analog and the digital, between technical innovation and scientific evaluation. For example, there are thousands of mental health apps on the market, but only a tiny percentage – fewer than 1% – have ANY evidence base. Science is the best way we have to figure out which digital health tools work. It’s how we find the signal in the noise. Yet, this translation requires that people on both sides of this equation think outside their boxes. Technologists need to think randomized controlled trials and researchers need to think nimble science. Creating more academic-corporate partnerships with vision and gusto will increase innovation, reach, resources, and reality base on both sides.

personalizePersonalization. We know that one size does not fit all – in mental health as in most things. We have long talked of personalizing mental health treatments in Psychology. Without a perfect understanding of how and for whom mental health treatments work, we are far from this goal. Yet, while we shouldn’t create an unrealistic standard of everything being personalized, the massive amounts of data created by our digital signatures could move us closer towards data-driven personalization of mental health interventions. Utilizing these data in effective but responsible ways must be a core goal of the digital mental health revolution. Personalization could also provide a new platform for overcoming racial, gender, and cultural insensitivity in our treatment approaches –personalization must be based on who we are as people.

control

Control in the hands of individuals. We expect to self-curate our lives – our self-image, our social network, our information, our entertainment, the tools we use to navigate the world. Why should mental health be any different? We must create a play-list or Netflix model for self-curating mental wellness tools. At the same time, we need guidelines and standards, a balance between the prescriptive from professionals and personal choice. This major challenge is the gorilla in the room. How do we insure privacy while maintaining treatment integrity? How do we avoid using the carrots and sticks of “behavioral design” and gamification in controlling ways that treat individuals like rats in a maze?

digital 1Disruptive innovation. The digital mental health tools that populate the field must be truly disruptive, drastically increasing the accessibility and adoption of mental health diagnosis tools and interventions. To do this, we must first work out machine learning technologies combined with electronic medical records to improve diagnosis, treatment recommendations, and treatment delivery. Second, mental wellness tools must be in the palm of every hand. To do this, we should leverage targeted treatments that are brief and low-cost, and identify portable “active ingredients” that can be translated into many digital and cultural contexts. Therapy is not always appealing, so we must build products that are “sticky,” sophisticated, and aesthetically inspiring.

stigmaAttack stigma. Mental illness is among the most pervasive and potent of social stigmas. Mental illness is not contagious, but we fear it as if it were. The mentally ill are NOT more likely to be violent, and yet this is assumed. As long as mental illness remains a sign of disgrace and shame, people will avoid seeking help because it makes them feel broken – perhaps beyond repair. Digital mental health can’t fix all this, but it will shift the dialogue towards mental wellness rather than pathology, on building mental fitness rather than being broken. It will harness our desire for self-disclosure and “being seen” on social media to better overcome the silence that drives shame.

brain on techUnderstand the costs and benefits of technology. Lest this blog post come across as an ode to technology, let me stop you right there. Technology is by definition the application of scientific knowledge for practical purposes. If the technology that could transform mental healthcare was hydraulics, or kundalini yoga (and I’m not counting these out) I’d be all for it. At this moment in time, however, digital technology seems most likely to drive real innovation. But we don’t yet grasp the costs and benefits of these technologies. What does our “brain on technology” look like? What is the opportunity cost of being obsessed with and absorbed in our mobile devices? What is the impact of digital burden, of never making time for mind-wandering? We don’t know, and so we must walk a careful line between technophobia and technophilia, avoiding both.

The Ethics of Digital Disruption

Alister Cameron from Squareweave give us an important thought piece on technology companies that are transforming our lives and why we should care about the ethics of their company cultures.

Depression: A Coming Out Story

A wonderful and courageously honest blog post from Shira Renee Thomas on the experience and stigma of clinical Depression. The personal (and economic) burden of psychological disorders is profound, and greater than that of any other type of disease – including diabetes, cancer, and cardiovascular illnesses! Over 350 million people worldwide suffer from Depression. Yet, we’re only now waking up to the importance of thinking of Depression and other psychological diseases as a public health crisis that requires much, much more awareness and many more resources to reduce stigma and help alleviate individual suffering.

sally brampton quote

Why Digital Mental Health is Like the Wild West

Why Digital Mental Health is Like the Wild West

When I talk to people about the digital health space – specifically digital mental health – I often say, “It’s the Wild West!” and everyone nods. But then I stopped to think about what I really mean by the Wild West. I realize that the metaphor holds up very well.

wild west

There is a gold rush. The California Gold Rush began on January 24, 1848. News of the gold brought some 300,000 people to California from around the world. They were called forty-niners in reference to the year the fever really hit, 1949. Tens of billions of today’s dollars in gold was recovered. The gold rush transformed the economy of California and economies all over the world.

The financial opportunity – and temptation – represented by the digital mental health revolution is similarly profound. Americans alone spend over $148 billion annually on mental and emotional health. Moreover, more than half of people suffering from emotional and mental distress will never seek treatment – meaning there is a huge, unmet need. Of these who don’t seek treatment, over 45% cite price as a barrier, and over 40% cite stigma as a barrier. Digital health tools, like mental health apps, address these barriers by being highly accessible and highly affordable. They also have the potential to neutralize stigma because, as I’ve argued before, mobile devices are the hub of our lives and thus what we do on them automatically gains an aura of “good.”  Digital health therefore represents a perfect marriage between social good and economic potential, and there are plenty of forty-niners who see this opportunity and want to cash in.

There are snake oil salesmen. Indeed, many companies are jumping on the wagon and digging for digital health gold (to keep the Wild West metaphor going). Some of these companies offer great, beneficial products, but others are “snake oil salesman.” Snake oil is an old-fashioned term that tends to refer to fraudulent health products or unproven medicine, but in general refers to any product of questionable quality. A snake oil salesman is someone who knowingly sells these fraudulent products. You see these guys as comic relief in Western movies all the time, usually a traveling “doctor” selling fake medicines, who leaves town before customers realize they have been cheated.

One way for us to get around the risk of snake oil is to elevate the dialog around digital health and develop ways of evaluating the scientific quality of what’s out there, since none of this is regulated (yet). This will help us look past the shiny bottles of alluring medicines that are actually snake oil, and find the real healing agents. Psyberguide is one organization I came across that appears to be trying to do just that.  If we don’t push ourselves as an industry to meet standards, we risk becoming comic relief rather than a true paradigm shift. We also risk repeating the failures of the analog healthcare system, just making them digital.

There are pioneers.  I believe that a science-backed digital health revolution will be the single most important paradigm shift in the failing mental health industry. This revolution will allow people to promote their personal wellness like they do their physical wellness and fitness. It will allow people to access treatments that are effective without being too expensive, burdensome, or stigmatizing. We need to think outside of the box for a true paradigm shift to occur in how people access support for their emotional and mental health – whether that’s the transformation of how patients access their health information through electronic medical records, how health information is collated to lead to better diagnosis and treatment, how health information is gathered through tests done on mobile devices, or how interventions are accessed, through mobile health apps and digital brain training. Pioneers in digital health are rethinking how to empower the individual to promote their own mental and emotional wellness, to use personal health information to actually improve our lives, not just be monetized by big companies mining our big data.

I firmly believe that destigmatizing mental illness and emotional distress will be the linchpin in this paradigm shift. Mental health – when we say those words, we think illness, not health. We think of people being crazy, despondent.  Why is that? It is because Psychology and Psychiatry have failed to make mental health a positive goal like physical health and fitness. When we struggle emotionally, we feel broken. Treatments are burdensome, hard to access, and stigmatizing. We need to be on the vanguard of a paradigm shift away from stigmatizing, expensive treatments emerging from the “if we build it they will come” mentality, and towards a new vision in which people are empowered to personalize their mental wellness through tools that work for them, when and where they want them.

If pioneers brave the Wild West that is the digital health field of 2015, we have a chance of creating something that transcends our humble beginnings to actually make a difference.

What It’s Like to be Blind in the Age of the Internet

A fascinating thought piece on being blind in the digital age.  Technology can be both beautiful and terrible.

The Ultimate Empathy Machine

Chris Milk TED TalkI just watched Chris Milk’s recent TED talk about virtual reality. He calls virtual reality the ultimate empathy machine. I see the vast potential of virtual reality – its use in therapy for psychological conditions like PTSD, gaming, education, and as a tool to help people create beautiful experiences. But I have to admit, my gut also has told me that virtual reality has more costs than benefits, more risks than payoffs. Perhaps I’ve read one too many future dystopia sci fi novels, but I have often thought that the temptation to reside in an artificial, constructed world of our own choice and design is too tempting for most of us; that eventually, when virtual reality is sophisticated enough, it will keep us from engaging in the “real” world in the ways we need to in order to have have substantial and lasting happiness. Think the creepy, organic virtual reality game consoles called “game pods” from the 1999 David Cronenberg film eXistenZ, and that’s where my mind goes.

treachery of sanctuaryBut Chris Milk might have just convinced me to question my gut, to think more of the artistic and humanitarian potential of virtual reality. Watch the talk to hear more about the amazing work he’s doing with the UN to vividly portray the plight of refugees to policy makers and the public through virtual reality. He also showed a film of the interactive art installation he created called The Treachery of Sanctuary. A boy stands in front of the piece, becoming a bird on the screen that he is viewing ….until all of sudden he takes flight to join the flock. I have to ask myself, why did that bring me to tears? Chris Milk believes that virtual reality is a machine that makes us more human. Perhaps the benefits could outweigh the risks.

Just Do It: A Conversation with a Shaolin Monk

What is going on in this picture? I’m the one on the right.

Embedded image permalink

Well, I was having a special moment with Shifu Shi Yan-Ming, a master of the Shaolin Kung Fu tradition. Our conversation was part of the Rubin Brainwave festival. I was fascinated to hear about his life, from the age of 5, as a Shaolin monk, training in the most rigorous Kung Fu discipline. The title of our conversation was “Discipline as Art” and as was obvious from his demonstration on stage, his physical prowess is impressive and beautiful. You can sense the focused energy he devotes to his art, the discipline of Kung Fu.

In many ways, my conversation with Shifu (an honorific indicating a master in martial arts) was an action meditation, an illustration of how he thinks about his place and relationship with the world.

Me, asking about his feats of Kung Fu training: “Why did you learn to break a brick with your head?”

Shifu, with a laugh: “Someone asked me to!”

Me: “How do you talk to your students about overcoming obstacles in their life, about dealing with emotional challenges?”

Shifu: “I tell them to just do it!”

Like Kung Fu, his philosophy is action-oriented and full of focused energy. When facing obstacles in your life – just do it. Nobody changes you, you change yourself.

Improv for Scientists

Science has serious PR problems, and at their root are scientists themselves! We scientists often don’t know how to communicate with non-scientists without a whole lot of jargon and obscure words. Brevity is also difficult for many of us, so the art of effective sound bites and elevator pitches remains a mystery. Yet, those of us who go into academia are, despite first impressions, passionate people. We are in love with ideas, with teasing apart mysteries. So, we have the potential to be incredibly powerful advocates for science, translating the knowledge we generate in our labs into real world applications. If only we could stop putting our audiences to sleep…

Then, along comes Alan Alda, who for decades has been a curious, charming, and enthusiastic advocate for the popularization of science. He excels at translating how fascinating science can be to a wide audience. I just discovered that he founded The Alan Alda Center for Communicating Science back in 2009. The Center teaches scientists media communication skills and how to boil down your research findings into understandable take-home messages and engaging stories. And he teaches them improv! Perhaps this is some of the most important work the Center does, because improv allows scientists to practice being present and telling a human story. Here is a clip of what improv for scientists looks like.

Picture taken from http://www.centerforcommunicatingscience.org/improvisation-for-scientists/

Thank you, Mr. Alda. If you can cultivate and empower even a few scientists to communicate more effectively and compellingly, the positive impact of our research could reach a whole new level.

The Future of Medicine is in Your Smartphone

Picture by Helen Weinstein

A great essay from the Wall Street Journal on the promise and challenges of the smartphone revolution in healthcare – from mobile physical exams, to merging day-to-day health data from wearables with medical records. A key – and underdeveloped – innovation here will be to integrate health tracking with mobile therapies. This transformation of healthcare – both physical and mental – is going to happen, and it is up to us, as patients and professionals, to make sure that it is done right, with the privacy and well-being of the individual as top priorities.

I’ve been interested in some emerging companies, like Mana Health, that are on the cutting edge of this revolution because they are solving the problem of how to effectively merge clinical data with health data collected in the daily lives of patients, and directly empowering patients to have a clear voice in their healthcare and greater collaboration with doctors.

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