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- Convenors:
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Jennifer Cearns
(University College London)
Mikkel Kenni Bruun (King's College London)
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- Discussant:
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Daniel Miller
(University College London (UCL))
Short Abstract:
This panel examines the development and ramifications of digital technologies in mental healthcare in the wake of the pandemic, with a focus on the politics and economics that influence normative delineations of 'wellness', and the effects these can have upon users.
Long Abstract:
Alongside a sharp increase in remote and virtual healthcare provision during the COVID-19 pandemic, there has also been a proliferation of apps and online services offering digital diagnostics, mood-tracking, and even AI-mediated therapy and 'friendship'. Digital technologies are being heralded as a cost-effective solution to open up access to better care provision in a context of growing need and increasing austerity measures. There is also growing excitement that digital technologies may provide healthcare solutions that are better than human: more empathic, less expensive, more personalised, better informed. This panel will bring together scholars from across medical and digital anthropology to examine the development and ramifications of these technologies.
Themes may include:
* Neoliberal politics and austerity measures affecting the roll out of these technologies
* Algorithmic bias and the politics of representation (or lack thereof) behind these systems
* Digital diagnostics and the delineation of 'wellness' from 'unwellness'
* Public/ private partnerships within healthcare and the socioeconomics of this
* Power dynamics and the normative models of personhood promoted through these technologies
* Notions of 'personalisation' in digital care technologies
* Difficulties and merits of digitalised forms of mental healthcare from the perspective of clinicians
* Effects of 'mind'-monitoring technologies (e.g. smartphone mindfulness apps) in the daily lives of users
* Digital visions of mental healthcare - therapeutic/scientific ambitions and solutions
Accepted papers:
Session 1 Tuesday 11 April, 2023, -Claudia Lang (University of Leipzig)
Paper short abstract:
Using the case of the Indian-developed app Wysa, I explore how designers imagine automated therapy to help people in distress, encode situated assumptions into this app targeting a global usership, and build networks with governments, insurances, hospitals and companies.
Paper long abstract:
A growing market of mental health apps is characterized by techno-utopian imaginaries to transform global mental health. Interventionists and entrepreneurs celebrate automated therapy as innovative and cost-effective technologies that bridge a treatment gap, ‘leapfrog’ infrastructural constraints, circumvent stigma, and intervene in cases in which face-to-face interaction fails. Critics argue that mental health apps are nothing but technological fixes and band-aids, and that digital solutionism and neophilia obscures decaying mental health infrastructures and broader structural and environmental precarity. Going beyond these polarized debates, I use the case of the Indian-developed app Wysa to offer a more nuanced picture. Wysa is a chatbot, designed to be a “digital couch” or “AI friend” built into your smartphone. Using natural language processing, it aims to help users in reducing distress, get in touch with emotions and thought patterns, deal with distressing situations, and develop resilience. Anonymous, available around the clock, and fits in your pocket, the app relocates the therapeutic relationship into a digital encounter with a machine and bridges temporal and spatial obstacles. Which forms of care emerged in automated therapy? Which assumptions about self and wellbeing are encoded? Based on conversations with Wysa’s designers since 2019, I explore how they imagine automated therapy, encode situated assumptions of wellbeing and everyday working on the self, and build networks with governments, insurers and hospitals. While Wysa responds to neoliberal austerity politics, its designers envision it not only as transformative to users’ relatedness to themselves, but also imagine the chatbot therapist as potentially better-than-human.
Jennifer Cearns (University College London)
Paper short abstract:
This paper considers how 'empathy’ is defined and designed into the code underpinning digital mental health interventions, often in a culturally normative and gendered manner, to offer reflections on how such technological developments may challenge our own conceptions of selfhood and subjectivity.
Paper long abstract:
Alongside a sharp increase in remote and virtual healthcare provision during the COVID-19 pandemic, there has also been a proliferation of apps and online services offering digital diagnostics, mood-tracking, and even AI-mediated therapy and ‘friendship’. Many digital healthcare companies have shifted their focus towards developing AI-assisted software which purports to assume the role of a talking therapist. Rather than speaking face-to-face with a therapist, some patients are encouraged to chat with a chatbot therapist (visualised through an animated avatar), the likes of which they can also co-design by selecting their preferred gender, hairstyle, or even ethnicity. This chatbot in turn draws on algorithms and AI to train itself as it ‘gets to know’ the patient. Such developments are increasing in the wake of a global pandemic and increasing pressures on NHS budgets for mental healthcare provision in the U.K.
This paper will consider how non-medical staff define and attempt to design ‘empathy’ into the code of these softwares and algorithms, often in a culturally normative and gendered manner. It will offer some reflections on what the development of technologies such as this may mean for our own conceptions of selfhood and subjectivity, especially in the light of algorithmic tools which ‘learn’ from the patient how best to respond to them, in a striking difference to the assumed position of neutrality that talking therapists are typically trained to take.
Mikkel Kenni Bruun (King's College London)
Paper short abstract:
Digital health technologies have offered new ways of imagining and enacting 'wellness' in and beyond clinical contexts. Drawing on fieldwork in Britain, this paper argues that mental health apps encourage modes of being well that decentre and reconfigure 'the therapeutic relationship'.
Paper long abstract:
Digital psychotherapeutics features increasingly as a central rather than peripheral aspect of British mental healthcare. The proliferation of smartphone apps promoting mental health and wellbeing has been shaped in particular by the novel coronavirus outbreak and subsequent calls for digital solutions to a reported mental health crisis. In a (post-)pandemic world, mental health apps have offered new ways of imagining and enacting 'wellness' in and beyond clinical contexts. Drawing on ethnographic fieldwork carried out in Britain on the uses of digital health technologies, this paper argues that mental health apps encourage users to practise modes of being well that radically decentre 'the therapeutic relationship' found in (non-digital) psychotherapy. We will see that 'mental health' emerges as simultaneously an object and tool of observation and inspection that constitute new therapeutic relations for everyone involved.