Donald Norman: "Here's how psychiatry can (and must) return to human centered thanks to technology"

Mental health and technology: a look to the future between virtual and augmented reality for psychiatry, with the perspective of artificial intelligence intervening in situations of urgency

(photo: Wikimedia Commons) Augmented and virtual reality are entering more and more in the world of psychiatry, and the pandemic only accelerates trends such as those of telemedicine and remote assistance. In addition, unfortunately, to increasing the incidence of mental problems, so much so that today one European out of six is ​​affected, for a total of 84 million people. But on what basis - technological and human - can specialist assistance continue to be based on people in difficulty? How can you get the best out of digital tools, without generating distortions and aberrations?

The cognitive psychologist Donald Norman, former director of the Design Lab at the University of California, talks to Wired. We met him (naturally with a tele-interview) on the sidelines of the hackaton of the past 13 and 14 October, a major event dedicated to digital mental health conducted by Wired and organized by Angelini Pharma. An event born in conjunction with World Mental Health Day and which involved 20 young and motivated psychiatrists from all over Europe, interested in innovations in the field of mental health, as well as guests of the caliber of Norman. All to develop a digital solution for patients suffering from depression, schizophrenia or other pathologies in mental health, and to respond to the growing need for support especially during and after the Covid-19 pandemic. An issue which was also discussed at the Wired Next Fest.

Donald Norman, speaking at the hackaton on digital mental health, spoke of the need for psychiatry to maintain a human-centric approach rather than technology-driven : what do you mean?

“Medicine is a discipline that deals with people, not technology. And psychiatry, in particular, should focus on the individual as a whole rather than on drugs. Many medical specialists look only at their branch, as if they were wearing blinders, and do not go beyond their own clinical specialty. This often leads to erroneously speaking of patients rather than people, and not infrequently it leads to misdiagnoses.

“I believe there are four pillars of human-centrism that should also underpin psychiatry, and more in general of medicine. First of all, a design principle, with the focus on people from the very beginning. Then don't simply look at the symptoms, but look at the heart of the problem that causes them. Third, to become aware that the human being is complex and interacts with the environment, so we need to broaden our gaze and extend it, for example, to his family and relationships. Last but not least, we should accept that whatever is created or prescribed is not perfect: that's okay, knowing that we need to continue to improve, to experiment and to correct the aim ".

How can these be translated principles in practice?

"In a healthcare context where the efficiency of doctors is measured on the basis of time, much of the freedom of action has been lost. In the United States, just 15 minutes are dedicated to each patient, which is clearly insufficient time to create empathy and properly care for the person in front of you. We should go back to the old way of treating people, seeing them as human beings rather than as a collection of symptoms ".

What are the potential of virtual and augmented reality for psychiatry today, and how do you think they will change the way doctors operate?

“The relationship between carer and carer will not change. Technology is important to the extent that it allows you to do things that were previously impossible. For example, for those suffering from vertigo, virtual reality is a good way to desensitize fear, taking people in an instant to the top of skyscrapers or to the edge of overhangs. Both virtual reality, which takes you to other worlds, and augmented reality, which allows you to add things into the real world, are suitable for remote therapies. In general, I think it is always better if the doctor and patient are physically in the same place, but if there are great distances, logistical difficulties or - I know - a pandemic, then tools like these help to overcome distances and improve interaction. For some specific activities, then, remote interaction is equivalent or even better than face to face. For an interview like this one, for example, with digital technology, nothing is lost.

“We must also add that today there are sensors that allow us to remotely obtain a lot of information: we can determine mood, emotions, heart rate , oxygenation of the blood and much more also by small temperature variations on the forehead and expression. Already today the facial recognition systems of emotions work quite well ".

Are you alluding to the idea that soon we could have artificial intelligences doing the doctor's job?

“In a certain sense, yes, for example in radiology computers already perform certain tasks better and faster than doctors in flesh and blood. But beware: in this case, radiologists are happy with the arrival of technology, because they are tired of carrying out routine tasks, and thanks to innovation they can save time to spend more time with their patients. But not all medical specialties are comparable.

“I believe that in general we can have diagnostic systems that will give recommendations. Think of a parent with a child who wakes up in the middle of the night and is sick: now you don't know how to behave, but in the future an artificial intelligence will quickly understand if it's something serious that requires a rush to the emergency room. or not.

“The same applies to psychiatry: an artificial intelligence will be able to understand if a person's condition requires immediate interventions, and moreover it will be able to give immediate psychological assistance by talking to us. Even if it will hardly have skills comparable to those of specialists, and certainly it will not be a perfect system nor will it replace the human professional, it will be able to give help in situations of particular urgency ".

Speaking of psychiatry, he believes that hi-tech applications will have a major impact on the daily life of professionals?

“The life of psychiatrists will be easier, first of all because they will have more information available. Let's think about patient data, or the history of all treatments, including perhaps the emergency ones made by a colleague in the middle of the night, of which we now risk losing track. What psychiatrists most hate about their work is the paperwork and documentation. In the future, automatic systems will compile documents and records by themselves, perhaps thanks to speech recognition systems that will quickly synthesize key information. Removing the heavy burden of bureaucracy would leave them time to deal with what they want to do, that is, take care of patients and talk to them ".

Within this trend, what are the peculiarities of mental health compared to other areas of health?

"Psychiatry is a field of medicine that has to do with the most complex part of the human being: the mind. While in other medical specialties we know the details of physiology and understand exactly what happens, on the brain we can only see trauma and physical damage, but conditions such as paranoia and stress are identifiable only by the professional without the use of instruments. Thoughts are invisible, and even though we can see which parts of the brain are active we cannot observe reasoning and anomalies, thus making a diagnosis. At the moment, technology allows us to identify concrete causes such as injuries and strokes, and for this reason the psychiatrist talks more and more often with the neurologist, but the majority of patients have mental health problems that no instrument can highlight.

“Sure, the tools to analyze the brain electrically are improving, but what creates problems most of the time is the chemistry of the brain. This is why we have drugs. I think an interesting perspective is that of personalized medicine, with specific treatments for the individual determined on the basis of his DNA. But it is a long-term perspective, and we cannot know if this will one day be automated. "

We are at the beginning of a new cold season that promises to be complex from the point of view of managing the pandemic. How is Covid-19 changing the telemedicine landscape for mental health?

“Some of the innovations introduced in time of the pandemic will remain, while others will be only temporary. The pandemic has forced us to change more rapidly, inducing discontinuities. We have found that some activities are even better when done on video call, and others are obviously worse, just like they do at school. Students are sometimes able to see and follow the teacher online better than being in a noisy classroom, creating a more direct interaction: an analogue can also be true in medicine. However, I believe that in the long term we will get back to the old normality, doing many things offline but keeping all those positive parts that online has taught us ".