Whether ’tis Nobler in the Mind

I may have inadvertently stumbled upon something important. I may have found a boundary marker that potentially distinguishes New Age from Old Age. Of course, definitionally I could be way out of my league –New Age being construed as anything that happened after I left university- but considered as a panoply, I think it works, if only conceptually.

I happened upon an article in the CBC news app while scrolling through my phone, that struck me as interesting: http://www.cbc.ca/1.4302866 -perhaps because I had never thought about technology in those terms, and perhaps because I felt embarrassed that I had been caught doing just that.

The premise was that we seem to turn to various apps on our devices for problem solving of many sorts. Everything from comparing shopping prices to trends in fashion to the latest news. And, as we are increasingly discovering, these digital peregrinations revisit us in the form of directed advertisements hoping to cash in on our whimsical journeys. Nothing is thrown away in the digital world –even our whims are stored, categorized, and pragmatically redistributed. And if notions, then it seems a small step to include moods. Emotions –positive, or otherwise- should be equally trackable.

In fact, I learned that ‘Google announced it now offers mental-health screenings when users in the U.S. search for “depression” or “clinical depression” on their smartphones. Depending on what you type, the search engine will actually offer you a test. […] And Facebook is working on an artificial intelligence that could help detect people who are posting or talking about suicide or self-harm.’

Perhaps this is where I feel the shadow of a boundary issue. There seems little question that mood disorders transcend age and gender; what is more problematic, however, is whether there may be a generational divide in confiding those emotions digitally, or even believing that solace could lie therein. The problem is not so much in putting these issues in writing –diaries, and correspondence, after all, have long been a rich retrospective source for biographers. The difference, it seems to me though, is the intent of the disclosure –diaries have traditionally been personal, and usually, not meant as a way of communication, but rather a way of sorting out thoughts. Private thoughts. Letters, as well, were directed to particular individuals –often trusted confidants- and not meant for publication outside that circle. Have the older generation –Generation R, for example (Retirement, to attach a label)- been sufficiently swept up in the digital river, to feel comfortable in clinging to its flotsam like their children?

I’m certainly not gainsaying the efforts of the internet giants to expand into the mental health realm –it seems a natural progression, so perhaps this is a start… and yet it’s one thing to key in on various words like ‘depression’ and have the algorithm kick in with a screening test, but another to sift through the context to determine the appropriateness of offering the test. I suppose random screening like that may be helpful for some, but as Dr. John Torous, the co-director of the digital psychiatry program at Harvard Medical School and chair of the American Psychiatric Association’s workgroup on smartphone apps, observes, ‘”One of the trickiest things is that language is complex … and there’s a lot of different ways that people can phrase that they’re in distress or need help.”’ Amen to that.

Quite apart from translational difficulties and the more abstract and culturally-fraught issues with their changing metaphors and societal expectations, there are other language problems –even in the dominant language of whatever country: changing vocabularies, local argot, and misspellings, to name only a few.

To state that human culture is complex, is a trope, and to believe that artificial intelligence will be able to keep up with its multifaceted, ever-changing face, anytime soon is probably naïve. And, as the article points out, privacy –no matter the promises of the internet provider, or the app-producer- is another weak link in the chain. Quite apart from malicious hacking, or innocent and trusting confidence in the potential for help, ‘Our phones already collect a tremendous amount of personal data. They know where we are and who we’re speaking and texting with, as well as our voice, passwords, and internet browsing activities. “If on top of that, we’re using mental-health services through the phone, we may actually be giving up a lot more data than people realize,” Torous says. He also cautions that many of the mental-health services currently available in app stores aren’t protected under federal privacy laws [at least in the United States], so you’re not afforded the same privacy protections as when you talk to a doctor.’

In a very real –if mainly age-related- sense, I am relieved I did not grow up in the digital age. I am fortunate that Orwell’s prescient ‘1984’ was available, not as a quaint attempt at predicting the future, but as a warning about a creeping surveillance that seemed so malevolently unrealistic when it was written –it was first published in 1949, remember. And when I read it, the date was still sufficiently far in the future that it seemed more science fiction than predictive. Yet, as the years wore on, and society changed in unexpected ways, the horrors of the theme, for me at least, became more and more uncomfortable. More and more possible, despite the reassuring smoke blown in our eyes by those eager for progress, and mesmerized by the possibilities.

I mention this, not to suggest that I was unique in this discomfort –I was obviously not- nor to imply that what we are now experiencing is evil, or even threatening, but merely to explain the hesitation of many of those my age in accepting, unreservedly, the digitally-wrapped gifts so readily proffered. It is not a venue to which I would likely turn for health issues, or emotional sustenance.

For me, there is something more reassuring about an eye-to-eye encounter with another member of the same species, able to understand the vagaries of language, and compare the nuanced phrasing of my words with the expression on my face. Perhaps, I’ll change -perhaps I’ll have to- and yet… and yet I’d still feel better dealing with an entity –a person– able to experience the heart-ache and the thousand natural shocks that flesh is heir to. And yes, someone who has read and understood what Shakespeare meant.

Performance Anxiety

I have recently developed performance anxiety -no, not the wide-eyed, heart-thumping, late night Viagra-requiring variety… although that does sound interesting. And not the more artistic type you would expect to get while standing behind the curtain backstage before walking into the spotlight to the expectant applause of a full theater. I don’t have that kind of talent. And anyway my more immediate concern there would be tripping. No, it’s far more… digital than that. Perhaps I should explain.

Ever since my days as a high school nerd, pocket protectors have epitomized my calling. True to the role, I tried to stay at the cutting edge of social ineptitude, but as I aged and morphed into an adult, I became aware that the plastic protector pouch looked silly and that, like a tail,  carrying too many pens was vestigial. The age of the nerd was ending and there seemed no one but me around who was at all nostalgic for it. It had become anomalous -a quaint but naive time in a world that had evolved beyond it.

I was able to keep up with the social awkwardness, however, thanks to my annoying habit of not watching sufficient TV to be able to talk sports at the parties to which I’m no longer invited, or by not using the latest slang expression properly -if at all- at work. I still can’t bring myself to say “No worries,” if someone bumps into me, and am more likely to excuse myself for being in their way. I have trouble knowing how to respond to a ‘high five’ gesture, and when introduced to someone new, have an amazing penchant for immediately garbling her name and then promptly forgetting it.

So it was with high hopes that I felt I would be riding a new and different wave with the Electronic Medical Records system I was reluctantly forced to install in my office. In spite of my hesitation, I felt I was about to reincarnate into Geek, the twenty-first century equivalent of my high school name.  I loved the word and immediately tried to parse it.

I have been writing for years on a computer, so I didn’t anticipate any problems with the transition. I do have to admit to a certain nostalgia for paper, though; crumpling it when you make a mistake is one of Life’s irreplaceable pleasures. Even the subsequent necessity of throwing it into some sort of receptacle -and hitting the target- is a form of release. A silent Cognitive Behaviour Therapy.

But I very much suspected that not having something to shuffle in front of me, to rumple up or underline with emphasis, not being able to free-hand a diagram with curved lines and arrows and otherwise describe difficult and obscure anatomical features in full view of a curious patient would prove disappointing. Nerds -extinct or not- have always been complex integrators -visual as well as cerebral. We didn’t just carry all those different coloured pens around for show. We used them -all of them- on different occasions, each with a purpose, like actors in a play.

And indeed, writing, drawing, and underlining while the written-about watched was part of the show. Part of the interactive play. By changing pens, or circling something scribbled on the paper, the person across the desk knew she had said something important. Something helpful. It encouraged her to continue, often with details she would not otherwise have supplied. And it’s a full eye contact game: the nodding head, the subtle but respectful smile, the slow reach for a lab requisition -all signs to the patient that she has succeeded in conveying her concerns. All boding well for an auspicious climax for the interview.

I had difficulty imagining that the clack -or lack of clack- of my fingers on the keys would elicit the same response. Somehow, restricting my interactions to a screen that only I can view seemed anathema to the relationship I was trying to foster. Since everything is printed and filled out in the secret bowels of the computer, there would be no moment of hesitation and then deliberate reaching for different coloured forms -each one invested with authority; no more wide-eyed admiration for the amount of  information I had been able to extract that she could see in her shared view of the chart from across the desk; and no more wonder at the ability of doctors to read their own handwriting -all part of the magic and method that is Medicine.

But when the moment came to transform the interaction from the smooth hiss of a pencil drawing a diagram, from the silent mating of pen on paper, from the sweeping elegance of an encircled thought, or an underlined, obviously critical datum -from, in other words, personal to digital- an unexpected problem arose. Something I could not have anticipated. Something not all the preparation, all the latest technology, nor all my previous experience with computers would have suggested: I simply could not type with another set of eyes staring at my fingers. I could feel the criticism with every pause to check the keys, the judgement whenever I slowed down, the silent mirth in her eyes whenever I chanced a look in her direction and made a mistake… And the more I thought about it, the clumsier I became. I typed like someone wearing gloves. I kept flashing back to the piano lessons I had as a child when I first discovered, to my shame, that I was distressingly ametronomic.

My older patients seemed to understand -I don’t think they even noticed my almost stochastic approach to the keyboard. They were too busy searching for my eyes. Feeling my pain. Like they had come to help me. No, it is the young who notice. But they are usually too polite to criticize openly, too amused at the unexpected levelling effect of shattered hubris to do other than smile. It is I who feel discomfited, I who feel I must apologize… And I who inadvertently delete the page trying to recoup my composure. Re-establish my rhythm.

Performance anxiety now has new meaning for me. It is the wave I am riding as I attempt to surf into the new époque. But I am philosophical about it, and I had a thought: could it be keyboard performance and not the other stuff that is really what separates the young from the grey? Something you don’t need a pill for because it improves with time? And hope sprung eternal… The golden age is before us, not behind us –as Shakespeare wrote, probably typing the whole thing without a mistake -assuming no one was watching from across his desk, of course…