Jeffrey Geller, MD, MPH

Not so long ago, when one said in the psychiatrist’s office, “There’s a third presence in the room,” one was referring to the patient’s mother, father, or another person in the patient’s history who was figuratively or psychologically there. In the second decade of the 21st century, that third presence is a computer.

Not so long ago, if a patient’s records were to be released to any third party, the patient signed a release of information to a specific person or facility. The patient did so by signing a piece of paper with a pen.

Not so long ago, it was not so easy to invade the privacy of a psychiatric patient and, if one did, not so easy to disseminate the information. There were few motivations to do so-maybe a litigious divorce. Now information can be spread through social media; a picture of a celebrity on a psychiatric unit can be sold for enough money to buy a substantial house.

The 3 articles in this series [scroll down for the list] discuss different aspects of the quandaries posed by modern communication technologies in the practice of psychiatry. More important, they provide guidance on how to navigate these largely uncharted waters.

Psychiatry and medicine are not alone in being vulnerable to the speed and ubiquity of modern communication. And new communication technologies seem to have made the invasion of privacy somehow more legitimate.

General Eisenhower had an affair with his driver throughout WWII, but no one suggested we pull him from his command. General Petraeus has an affair in 2012, and he is quickly shown the exit door from his CIA leadership post. How can we stop the same from happening in psychiatry? Are we already too late? Who doesn’t know the psychiatric struggles of some contemporary celebrities? Kendrick and Sarvet, Dunne and colleagues, and DeJong offer us wise counsel in these matters.

Modern communication capacities have the potential to decrease or to increase stigma and the isolation of persons with serious mental illness. We can do great damage. An article in the 

 of November 12, 2012, starts out: “A psycho attacked a Manhattan psychiatrist in his office with a sledgehammer . . .” A few paragraphs later, the article states, “[The psychiatrist] managed to wrestle the knife away from the nutjob . . .”

As you read these articles, remember that as new as the technologies are, the dilemmas we face with them in psychiatry are not new. In 1925, in his American Psychiatric Association presidential address, William Alanson White, MD, observed:

The whole elaborate machinery that is considered essential to the modern hospital is awe-inspiring in its variety and complexities, but it has another aspect. It seems to me that the introduction of these highly technical methods has been accompanied by a corresponding lack in development, at least, if not an actual loss, of any adequate dealing with the patient as an individual or a human personality.

 Burke K, Parascandola R, Paddock B. Disturbed man attacks psychiatrist in Manhattan office with sledgehammer, knife. November 12, 2012. http://www.nydailynews.com/news/crime/crazed-man-attacks-

psychiatrist-office-cops-article-1.1200916#ixzz2CJz2odeX. Accessed November 15, 2012.

Articles

Modern communication capacities have the potential to decrease or to increase stigma and the isolation of persons with serious mental illness. Psychiatrists especially need to know how to navigate these largely uncharted waters.

Jeffrey Geller, MD, MPH

Articles

Introduction: Navigating the Waters of Digital Technology