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| ADVOCACY/DEBATE |
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| Year : 2019 | Volume
: 1
| Issue : 1 | Page : 62-66 |
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Social psychiatry in the era of cyber age and globalization: Threatened, empowered, or both?
Rachid Bennegadi
President Elect, World Association of Social Psychiatry; Medical Referent of the Françoise Minkowska Institute, Paris, France
| Date of Submission | 17-Jun-2019 |
| Date of Decision | 18-Jul-2019 |
| Date of Acceptance | 18-Jul-2019 |
| Date of Web Publication | 27-Sep-2019 |
Correspondence Address:
Dr. Rachid Bennegadi
Medical Referent of the Francoise Minkowska Institute, 12 Rue Jacquemont, Paris
France
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_18_19
The cyber age and the era of rapid globalization have fundamentally challenged and changed the way human beings communicate, relate, and respond to one another. While these processes of change have undeniably speeded up human transactions and obliterated distances, they have also created unique challenges. Some of these challenges are directly relevant for social psychiatry, which is alternatively seen as either empowered or threatened by these challenges. This article is the result of an ethical reflection on the place of digital era in the different aspects of life (psychosocioanthropological dimension), considering the impact of the digital world on our mind. I propose that even in this era of digital revolution, globalization, and artificial intelligence including big data and machine learning, the fundamentally social nature of all communications and feedback systems will remain valid. I suggest four examples how social psychiatry can be empowered (rather than threatened) by wisely utilizing the technological advances of the cyber era and globalization: webminars (webinars), supervisions via the Internet, mental health apps, and developing “mindwares” for promoting mental and social well-being. I conclude by posing several conceptual, ethical, and practical questions for our reflection and debate.
Keywords: Cybernetics, globalization, social psychiatry
How to cite this article:
Bennegadi R. Social psychiatry in the era of cyber age and globalization: Threatened, empowered, or both?. World Soc Psychiatry 2019;1:62-6 |
| The Context | |  |
The strategy of social psychiatry in the context of globalization is based on a tripod:[1],[2],[3]
- To identify the links between social psychiatry and other disciplines of psychiatry, i.e., clinical psychiatry, transcultural psychiatry, social psychology, and all approaches to disability rehabilitation
- The theoretical and pragmatic links that can exist between social psychiatry and mental health and well-being (WHO definition)
- Examine what would be the role of social psychiatry in the issues raised by digital health, telepsychiatry, and new applications on mental health; in short, on the coming into force of artificial intelligence (AI), along with its powerful algorithms.
This contribution is the result of an ethical reflection on the place of digital era in the different aspects of life (psychosocioanthropological dimension), considering the impact of the digital world on our mind.[4]
| Cybernetics, Information, And Communication | | |
Wiener was the first to mention the place of cybernetics in communication. In his definition of cybernetics, he classified the notions of communication and regulation together:
“When I communicate with another person, I send them a message, and when that person communicates with me, they send me a message of the same nature that contains information accessible to them first and not to me. When I control the actions of another person, I communicate a message to them, and although this message is imperative, the communication technique does not differ from that of the transmission of a fact. Moreover, if I want my control to be effective, I must inform myself of all the messages emanating from the person, able to warn me that the order is understood and that it has been executed.”[5]
Shannon and Weaver's work on communication is essential to understand the complexities of the relationship.[6] In his paradigm of communication, a message sent by an information source is transmitted in a noisy channel and then received by the recipient: such a schema which clearly distinguishes the roles of the sender and the receiver feels completely natural today. The very idea of digital communication is now so commonplace that one might wonder why Shannon felt the need to state such an obvious thing. The core of the theory presented in this book is the notion of entropy, and that of conditional entropy, applied to information sources and transmission channels. Shannon shows how these notions are natural and uses them, thanks to the principle of maximum entropy, to prove his coding theorems.
Alexandre raises the fundamental question: which scenarios will humanity have to choose when it comes to the war of intelligences between human intelligence and AI? Should we accept the transhumanistic vertigo that biologically “upgrades” us but keeps us as human beings? Shall we merge with AI by becoming cyborgs? Shall we prohibit or severely limit AI? It is this fundamental and fascinating issue that Alexandre raises.[7]
The philosopher Ferry, in The Transhumanist Revolution, argues that the two genetic and economic revolutions rely on the same technical infrastructure: the Internet, Big Data, AI, three-dimensional printers.… the robotics.[8]
Cohen in his book “Il faut dire que les temps ont changé” analyzes the confinement of new generations in a kind of perpetual present, consequences of the collapse of a civilization: the industrial society. One after the other, leftwing and rightwing utopias shattered a reality that is now possible to designate by its name: the digital society. For Cohen, an immense fear runs through society. Will yesterday's chain work give way to the dictatorship of algorithms? Are social networks the means for a new formatting of minds?[9]
All these elements seem essential to me to better apprehend the impact of cybernetics on mental health of any person in search of well-being in a globalized society and extremely determined to construct our happiness, but at what price?
We already arein a cybernetic era. Nothing can be decided without measuring the impact of social networks, which have changed the sociological game, and this has a certain influence on the feeling of the self. The relation between the structuring of the ego and the organization of the superego is questioned. I suggest to validate the ethical dimension with a phenomenological approach, that is to say, what could philosophy teach us on the reinvention of the modes of communication? What is happening simultaneously with passing time, can it be intelligible? How to engage psychotherapeutic work via telepsychiatry? What to do with countertransference and transference? And finally, how to manage the legal part: what to do with medical confidentiality, how can the therapist be sure that there is no breach of medical confidentiality by the presence of a third party he would not see, via the camera or in relation to a diffusion by the patient. This raises not only practical problems but also legal and ethical problems. On the other hand, the advantages of telemedicine are concrete compared to situations of handicap or a problem of distance for the access to the care or possibly an inability to move for physical or psychiatric reasons. All these elements should be part of a clear scientific debate to define some indicators and present them to the health authorities. Can telepsychiatry or the control of social networks be useful, to serve as a social link, an important element in resilience processes?
| Coding, The New Language Of Power | | |
Possibly, this societal dimension of progress in the computer science appears underlying this power crisis: it is not merely a societal problem but also an impact on the subject from a psychological point of view, not to say a traumatic issue for some who might feel totally deserted from their freedom. As Harari rightly says, this issue will be a real arm wrestling.[10] Google and Microsoft, among others, are already efficient in this regard and provide supposedly prevention tools for health and good advisors for decisions of the citizen-connected consumer. It is too easy to say that it is a purely financial report that Google, Apple, Facebook, Amazon, and Microsoft is taking power, yet it is important to understand what it is all about and what impact it may have on the personality structure and about mental health.
Social psychiatry in its dimension of social psychology and understanding the mental health of a subject, can intervene by offering an accelerated and competent training for all the citizens who are connected on the net to allow them to tackle these issues without panic, without persecution, and without depressive element. Does this mean that we must all have a Ph.D. in computer science and that we must all learn to code! It's not just that! It should therefore be possible to integrate this new progress in the management of the self and the management of its relationship with the world. In the same way, it would be desirable for the World Association of Social Psychiatry (WASP) to engage in the creation of digital tools and training on the Net.
| Tactics Or Strategies? | | |
The acceleration of ethical and philosophical issues is impressive, at the risk of messing the paradigms together. This will come sooner or later to the personality structure and organization of everyone's knowledge. Indeed, social psychiatry is not only an intermediary between psychiatry and sociology. It must become a science, taking charge of the societal dimension in the face of the brutal evolution of today's society, at least on the register of AI and the Big Data universe. Social psychiatry has to explain, possibly train, and propose plans and strategies to counteract this element. Progress has always gone against logics based on routines and intellectual comfort; hence, it will not be the first time this problem arises since the emergence of the power of mathematics and physics as the basis of scientific discoveries. It is not about the therapies of tomorrow being managed by robots. It is about the empathy of the human never being replaced by pseudosympathy of a creature structured around AI. On the other hand, it would be great if the therapeutic frameworks were facilitated by means of telepsychiatry, it could allow access to care for everyone, prevention, access to structures. There are already a number of powerful institutes that exist: it is important that mental health professionals, psychologists, psychiatrists, educators, social workers, all this universe that supports, accompanies, and organizes a management of suffering psychic and social, all these professionals would benefit from acknowledging this universe of AI. The fight will be tough, but the human conscience will prevail because it is difficult to imagine that by a strategy of code and by what is called the “data-ism” (that is to say the powerful collection and the exploitation of Big Data), we can replace the tremendous psychic functioning that allows not only the awareness but the consciousness of being aware and supports the process of empathy, a real cognitive-emotional tool. We cannot see the robots (whatever words we use to name them), which can, thanks to algorithms, ask questions and solve them instantly, find time to wonder about their role in society and have moments of dreams, of freedom, of being able to disconnect from time to time, in a spiritual moment! Consciousness is structured on an internal and external universe whose complexity will certainly pose real problems to the universe of algorithms of AI.
| How Did We Get Here? | | |
Yet research on AI began during the Second World War with Alan Turing, a mathematician, who deciphered the secret of Enigma encryption machine and thus allowed the English to successfully resist the enemy aviation. Turing, who started from the basics of computing, posed the question of AI from the beginning. Sixty years ago, he suggested a test, the “Test of Turing,” which would be successful when a machine manages to pass for being human by communicating with keyboard interposed with experts. In June 2013, a computer passed the test for the first time posing as a 13 year old. One can only dream about the extraordinary vision of Turing. However, the so-called “intelligent machine” still does not exist, though several teams are working on artificial neurons that may eventually replace computer chips at the Institut National de la Santé et de la Recherche Médicale, for example, but also at NeuroSpin, which is a research infrastructure in Saclay, on the brain and which exploits large instruments' imaging.
All researchers agree that a human brain cannot be born, develop, and exist without interaction with other human brains. Our brain activity is not just the synthesis of the activity and coordination of our neural networks. We exist with and through others; we exist as a social individual at the intersection of cerebral determinism and social probabilism. The algorithm is a calculation scheme, in the form of a series of elementary operations obeying a determined sequence. It plays a role more and more pregnant and visible in our lives and our brains. The question becomes paramount now with a generalized jamming of borders, a hybridization between man and machine, the living and the artificial, the intelligence and the algorithm.
| Four Cybernetic Propositions | | |
Social psychiatry must find its place in globalization because there is no other position today than to lay the foundations for the organization of social and medical support. It seems important not to neglect the social, anthropological, economic, and political determinants' mental health. As far as research is concerned, it is essential to focus on clinical field and at the same time to give way to fundamental research. It will be necessary in the global reflections that will underlie political decisions. Because there is a point on which everyone agrees: there is no social psychiatry without a public health approach and without a precise understanding of the societal context. It seems quite relevant to insist on the reflection, the abstraction, and the distance necessary to set up programs whose objective is to train professionals of the social and mental health for the management of the precariousness of their handicap of the psychological suffering of the psychological disorder and the neuropsychiatric disorder. In the name of communication, the privacy of people is no longer a business. But what would be relevant, what would help to use these new technologies and train generations who will be the future professionals of social psychiatry?
A webminar (webinar)
We should set up a “webminar” (or “webinar”) on social psychiatry giving voice to the great figures of this discipline, mainly clinicians but also researchers with the need to always start from a social and societal reality before speculating on beautiful ideas. Of course, the way of expressing things is important since it will be necessary to present the projects to be financed by policies. Without the means, there will be no results or impact on the social handicap reality of exclusion and marginalization. Without improved access to care, there will be no salvation.
Supervisions via the internet
It should be possible to supervise young professionals who are looking for solutions based on the humanist dimension but also on the pragmatism of long and difficult care. Put in place on the website of the WASP a space where a debate can be set up with the followers who will give their opinion, speculate, and criticize. This place of debate would have to be rich in possibilities and at the same time protected by the confidentiality since it is about taking care of patients. Let us change the dynamic involving the professionals of care and mental health, involving caregivers, social workers, educators, teachers, community leaders, etc. Why is it so important that this modern approach is put in place as soon as possible? It is because today, speed is an important concept. Knowledge is changing, practices are taking place in difficult contexts, information is often inadequate, and professionals are rarely trained in this new speed in the profession of health professionals.
Mental health apps
We need to create applications that allow us to identify the social and mental difficulties that we can go through with mobile devices such as iPad and iPhone. An application would allow everyone to assess their own social and mental distress and quickly appeal to places where people can provide answers whether directly through social networks or whether by an appointment for support. This kind of application would benefit from being validated by the WHO because it is not a gadget but a multimedia tool that affects public health, global public health, and no longer national public health. Manmade systems are based on rules predefined by man himself: for example, a computer program using a traditional approach will provide a suitable treatment to a patient who presents arterial hypertension based on predefined recommendations. On the other hand, models using machine learning learn rather than follow rules.[11] Algorithms cross millions of characteristics (medical notes, patient follow-up data, medical images, so on and so forth) to then determine a diagnosis with good accuracy. AI can compile billions of data from millions of medical records based on patient history. The human being can, unlike AI, establish relationships between different characteristics from few data and is also endowed with a common sense.
Mindware and well-being
Market is currently deciding on the employability of the software without worrying about the impact on our “mindware” (let us dare this neologism that tries to reconcile neuroscience and algorithms.). “Will the human and the machine robot(s) appreciate each other, or will one of them eventually demonize or subdue the other?” Today, the debate on the impact of the cyber world on mental health revolves around the partisans of transhumanism (the human being improved and increased in his skills and his emotions) and posthumanists (for whom the human will disappear in favor of humanoid structures). In the field of mental health, it is important to anticipate the disorders, disturbances that this will provoke in the daily life of the people, in the provision of psychological care, and in the course of care of patients: people who ask for psychotherapeutic help. Consciousness is built inside each human being by love and protection of those who educate him (parents, school, and society). Today, none of us are programmed, we have our rituals, but we have room for maneuver to invent our psychic life and our social life. This right to error qualifies the human being. The permanent search for the truth qualifies the human being. While it is the transhumanist or the posthumanist, where is your tone with this wave of creatures coming from the cybernetics, be said to improve the human intelligence? The question may seem too premature but the digital world is not going at the same speed as the world of emotions. Today is a single person an unconnected person? We have millions of friends and no friends. We have forums without any skills and we witness hate like never before. All of this is part of the everyday intellectual environment without regulation. Something has run loose from us, and this reminds us of Golem, the mythic creature created by man and overflowing man. It is a collective fear as old as humanity, and today, it has become a reality.
| Concluding With Some Questions | | |
The discourse of neurosciences is more and more emphasized in the knowledge of psychic functioning and consequently of mental health. However, the psychoanalytic discourse is not rejected, but we see more and more that the discourse on communication is framed by cybernetic, systemic notions, and of course with the dimension created by the hegemony of the digital in the life of everyday. How to implement these discoveries in the organization of a system of care that is supposed to offer the maximum of possibilities to the citizens in the art and the way of preserving their well-being? As far as ethics are concerned, the relationship between a mental health professional and a person asking for psychological help involves new concepts that therapists are not trained for. For example, taking charge via telemedicine means that a person implies a prior agreement on the request for help and the offer of care. Does the presence of a digital tool complicate the notion of empathy? Is confidentiality guaranteed? Is nonverbal language considered? And finally, how do we define the role of digital as a transitional element in the relationship? We are facing a shift of paradigm that must not be underestimated because it is a question society balance. One only has to hear the speeches in the forums on the role of digital tablets on infant mental health. Everything is said about psychological risks for children surrounded by digital objects. These are observations and consultations regarding a large number of psychological disorders. Should we expect a very serious impact on children and adolescents to address this problem, which is not considered a public health problem?
It would be best to answer three questions:
- Does the brain suffer damage through perception using video games or reading on e-readers intensively? Does this impact the brain via sleep disorders associated with impaired concentration and language disorders?
- Are these disorders concerning neurology or psychiatry?
- Is this dysfunction about psychotherapeutic support or about a new discipline: cyberpsychology?
Parents want to know whether the use of powerful social networks, extraordinary digital tablets, and the Internet as information tools are elements of progress or a psychological threat. Ultimately, we must break out of fiction and use the latest discoveries of neuroscience research as part of a phenomenological reflection to be able to answer, in part to all these questions. What do social networks do to the subject's personality? Are phobias turning into “cyber phobias?” There is indeed a psychopathological impact on the personality. This digital dimension of sickness is no longer a way of being in the world, it is a key factor in a certain number of phobic, persecutory, misinformative pathologies, particularly in the collateral effects on the subject's consciousness, which will lead to severe psychopathological disorders. It seems important to classify these new pathologies in the future editions of the WHO International Classification of Diseases.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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