Does Early Intervention Promote Recovery?

Director of NIMH Leaves for Google to Develop New Technologies

There is a growing trend among large companies in the private sector to join in health promotion efforts, both at home and on the global stage. Google is no exception. Within the next year, Google will begin crafting new technologies aimed at prevention and early intervention of mental illness. Dr. Thomas Insel, director of the National Institute of Mental Health (NIMH), announced his intention to leave the agency to join Google as their new Director of Life Sciences. This division of Google, which is currently reorganizing into a technology company called Alphabet, is best known for a glucose-sensing contact lens that helps people manage diabetes. Insel was hired by Google to develop new tracking technologies aimed at detecting early psychosis through language analytics because disorganized speech has been identified in research as a prominent feature. Insel and his new colleagues wonder whether computer algorithms may be useful in detecting and screening people in early phases of psychiatric illness.

During his 13-year tenure at NIMH, Insel enacted a controversial policy change at the agency to no longer support research that uses psychiatric diagnostic categories from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental health. Instead, Insel argued that “patients deserve better,” ostensibly through research that is focused on the brain. Studies of biomarkers, including those revealing compelling findings in the area of epigenetics, contribute promising new perspectives that may help to reduce the growing burden of psychiatric illness. But many criticize Insel’s explicit focus on the brain, arguing that psychosocial research has been stalled. This makes Insel’s move to Google all the more intriguing.

While it may seem intuitive that early intervention and better screening would yield positive outcomes for those living with serious and persistent mental illness, some anthropologists are wary of this approach. Many social scientists argue that labeling people with a psychiatric illness too early will foreclose opportunities for recovery.

Anthropologists Kim Hopper and Lauren Cubellis have studied a new intervention in New York City that aims not just for better screening and early detection, but for peer-run support that is more social than biomedical. Parachute New York is an alternative to hospitalization that builds on innovative work in Finland where researchers found that community and family-based interventions promoted long-term recovery far more effectively than those that were primarily psychiatric. In these models, the focus is not on fixing a brain disorder, but on bolstering empowerment and repairing moral and social injury.

During his time at NIMH, Insel pulled funding from studies using DSM-V categories because he argued these models could not fully explain mental distress as biological disorders. And yet, illnesses like schizophrenia and bipolar disorder are heavily over diagnosed among people of color (Metzl, 2010), raising serious questions about perspectives that do not consider the sociocultural aspects of assessment. A study which examined the influence of patient race and ethnicity on clinical assessment (Gara et al., 2011) found that African American patients were more likely to be diagnosed with schizophrenia, whereas their White non-Latino peers presenting with identical symptoms were diagnosed with less severe mood disorders. Gara and colleagues hypothesize that clinician bias may be due to the ways mental health providers interpret cultural idioms, worldviews and language. How then, will Insel’s new technologies at Google account for such dangerous bias?

The technologies being developed with Alphabet are still in their preliminary phases, but we know they are meant to detect early signs of mental illness through the interpretation of language that appears disorganized. As Insel has said, Google’s sweet spot is in the area of data analytics. In recent interviews with tech companies, Insel cited interest in shifting psychosocial interventions to smart phones, which people may prefer over visiting a clinician. One cannot help but question the motivation for collecting such data with smart phones. As Nora Kenworthy has argued in her compelling study of how the Product(RED) campaign shapes and changes treatment of chronic illness across the globe, it is important to consider why private sector industries engage in what might be considered humanitarian fetishism.

Given what anthropologists know about the ways that concepts of health are deeply cultural, how might we make sense of this new surveillance terrain? A fascinating multi-site study by Tanya Luhrmann and colleagues investigates auditory hallucinations across cultures. While those in the US tend to hear violent and demeaning commands, people in India and Ghana had a richer, and more relational understanding of what it means to hear voices. Some participants understood hearing voices as a positive experience. Therefore, it may be fruitful to consider what may happen if Google’s new technologies detect potential signs of mental illness within populations with cultural concepts of mind that differ from the biomedical paradigm, which understands disorganized language as only psychopathology.

As these new technologies develop, it will be important for medical anthropologists to join the conversation. We need to better understand what segments of the population will be screened, how this will occur, and with what aim. And as new behavioral interventions and methods for screening are rolled out, we should not lose sight of the ways that addressing structural inequality may arguably be the most efficacious form of mental health prevention.

 

To submit contributions to this column please contact SMA Contributing Editor Megan Carney (megcarney@gmail.com).

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