Move Over Doctors, Robots Will Be Diagnosing the Mental Disorders Now

also: just say no to genetic determinism, and some chronic pain thoughts

Are You Guys Excited About Surveillance Medicine??

There’s a piece in NYT this week about a new kind of AI that could diagnose mental disorders:

…some artificial intelligence researchers now believe that the sound of your voice might be the key to understanding your mental state — and A.I. is perfectly suited to detect such changes, which are difficult, if not impossible, to perceive otherwise. The result is a set of apps and online tools designed to track your mental status, as well as programs that deliver real-time mental health assessments to telehealth and call-center providers.

I absolutely love that surveillance is being presented as healthcare! The future is gonna be great!

One of the doctors quoted in the piece said that this will work because depressed people talk slow and monotone, and anxious people talk fast, which I find hilarious, as someone with ridiculously high anxiety who is always being told how “chill” and “soothing” I am. They failed to consider masking! I could trick that AI, no problem.

This tech is as-yet-unproven, and all the usual AI downsides apply here — bias, privacy issues, and the fact that algorithms are “black boxes” even their makers don’t understand. But despite those pesky problems, development of AI NurseCops (officially the field is called “digital phenotyping”) does not appear to be slowing down.

A team at the University of Alberta published results of a study in February where they used machine learning to identify people who had PTSD from their tweets. (Using Twitter for surveillance medicine seems to be a popular thing for researchers. Foucault is rolling in his grave.)

Bezos-funded therapy app Mindstrong focuses on people with diagnoses like bipolar and schizophrenia, tracking the “timing of their keyboard strokes” to monitor their mental states. Students in Minneapolis have their Google docs and chats monitored by an app called Gaggle, which flags and reports on their mental health to school administrators.

Apple wants the iPhone to track your behavior and tell you when you’re depressed. iPads could be used to diagnose toddlers with autism when they don’t look at the screen enough, according to whoever set the rules about how much you’re supposed to do that.

And last but definitely not ever least, Google is working on making its search function better at identifying people who are in crisis, then offering them the standard “We thought you might need some help so here’s a suicide hotline number” pop-up you get on Facebook.

That suicide hotline might geolocate you and call the police without your consent, or sell your data to another company to help them develop better customer service bots, but it’s for your own good!!!

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A Very Good Argument Against Genetic Determinism:

I’ve been very interested in this extremely niche topic lately, and I stumbled upon this review of Freddie DeBoer’s book The Cult of Smart, which basically argues meritocracy in education/society bad (agree) and since IQ is genetically determined (disagree), that’s an argument for socialism (????). Nathan J. Robinson calls this “the communist equivalent of The Bell Curve argument” (a reference to the infamous 1994 racist IQ book).

The piece is very long, but there are some really great explanations of the gene/environment problem in it, particularly the hypothetical example of “Sam Speedy” and “Sarah Slow” at Socialist Utopia Middle School, where everyone has enough resources and support.

Sam Speedy is great at chemistry, he learns it fast and aces all his tests; Sara Slow doesn’t understand it at all and won’t stop asking what an atom is:

For the purposes of the hypothetical, let us assume that the difference between Sam and Sarah is actually occurring because of genetics. Sam has a natural zeal for chemistry. Sarah fucking hates it. And that could be the result of something they were born with. But what DeBoer asks us to conclude is that if we see this pattern repeat across classrooms—genes determining differences in academic outcomes—we must conclude that Sarah simply genetically lacks the capacity to understand chemistry, while Sam possesses it. Trying to continue to force Sarah to learn chemistry is wasting her time and ours. DeBoer explicitly advocates letting 12-year-olds drop out of school, and Sarah might well take that opportunity if she is allowed to do it (and if our society has adopted deBoer’s thesis that hereditary variations are immutable). 

But what happens at Socialist Utopia Middle School, a place where teachers are more concerned about meeting their students’ needs, is that Sarah isn’t flunked out or told she can’t do it, she’s sent to the philosophy department. Sarah isn’t genetically inferior at learning, she’s just far more concerned about understanding every concept fully and completely before she can move on.

In this hypothetical, Sarah “took nine years before she was satisfied that she understood what an atom was” but eventually went on to become a Professor in the Philosophy of Science:

Put Sarah in the capitalist competitive system and she will fail utterly, because she’s economically non-viable. She takes too long to figure things out. She’s inefficient. She can’t even hold a damn job because she immediately asks her boss obnoxious questions they can’t answer. But at Socialist Utopia Middle School, the changed shared environment has unlocked some radical new consequences of the same genetically-influenced traits. 

If Sarah had been raised in the current United States, another intellect would have been snuffed before we even gave it a chance to blossom, as occurs in schools all over the country every single day. If you do not think this happens, you do not know the pain that teachers in bad, underfunded public schools have as they watch bright and curious young kids struggle in an environment where only those with “natural talent,” aka, those who are good at taking tests and completing assignments and who do not require a public school to be high-quality in order to achieve good grades, are going to thrive. 

(Okay Sarah is autistic in this hypothetical, right??) Robinson concludes by explaining that “heritability” is not just about genes — environments pass things down through family, too. Religion is heritable, and so is a love of dogs.

Your experiences in life determine what genes express, and how that expression is treated:

A trait can be entirely heritable and yet whether it manifests itself or not can be 100 percent environmental. If we discover, for instance, that “criminal behavior” is highly heritable, meaning that there is a strong correlation between whether a biological parent went to prison and whether you go to prison regardless of whether you are raised with them, this means criminal behavior under a given set of environmental conditions. “Criminal” is a social construct, first off, just like basketball. But it’s also the case that a child could have whatever genetic component (imagine it’s, say, a slightly greater propensity for impulsiveness) manifests as “criminal conduct” in one set of circumstances and have it earn them social approbation in another…

Change the society, you radically change—or even flip-flop entirely—the way even things that are “genetic” in origin show up in people. 

Although Robinson doesn’t say it, this is a clear neurodiversity paradigm argument to me, even down to the way this example about criminal behavior and impulsivity applies to the thing we hear all the time about ADHD causing incarceration.

How many kids like Sarah Slow are labelled with a learning disability when they don’t conform well to the rigid standards of our education industrial complex? We don’t afford anyone extra time or support, and then we chalk it all up to inevitable genetic differences and wash our hands of it.

The problem with the gene/environment argument is that 1. it’s a false binary and 2. genes are not static codes, they’re environmentally reactive. I think a lot of people perceive arguments against genetic determinism as science denial, but I’m not ever saying genes are irrelevant.

They’re just not inevitable or deterministic, and operating on the assumption that they are leads to an abdication of our social and moral responsibility to create environments where everyone can thrive, regardless of their genes.

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Something Something cHRONIC PAIN:

Ever since I got that totally normal panel of bloodwork back that explained absolutely nothing at all about the periodic flares of pain I get in my hands that make them basically unusable for days (and also, you know, my entire back and neck and sometimes hips), I have been lurking on the fibromyalgia subreddit when I can’t sleep.

So I decided to re-read Tender Points by Amy Berkowitz (very triggering sexual assault content, be forewarned) and this second reading has me like, oooohhh, that tracks:

I don’t have any diagnosis for my pain, and I understand that fibro is often treated like a “wastebasket diagnosis” where they throw people whose tests come up inconclusive (also called a diagnosis of exclusion). Berkowitz thinks of her pain as a mystery, not a puzzle she can solve.

I’m also pleasantly surprised by her embrace of the term psychosomatic, which has become a bit of a dirty word. She discusses how a lot of people in the chronic pain community want to vehemently disavow the idea that chronic pain has anything to do with the psyche, because it’s used to dismiss patients (despite the fact that psychosomatic illnesses have been recorded across cultures throughout history!) and oftentimes, people’s conditions that legitimately have nothing to do with their emotions do get neglected and misdiagnosed because of this.

The problem here, I think, is medical neglect and bias, not the concept of psychosomatic illness (it’s a bodymind, after all). Personally, I’ve always thought of my pain as an expression of the emotions I’ve gotten really good at repressing. Berkowitz calls the “true name” of her disease “My Body Is Haunted by a Certain Trauma”. (There are things that live in between my bones that I can’t know, is how I wrote about it recently.)

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While I agree that it’s fucked up to be dismissed by doctors (and I avoid seeing them because of this very fact), I’m skeptical of leaning too hard into biology for validation. I think what causes someone’s illness should be irrelevant to whether they receive care or not, and I wish we could stop being so dualist about it, just like, as a society.

This is why I go to acupuncture, because my acupuncturist is not like, oh, your anxiety is causing you physical pain? Go to therapy! He’s like, yeah, obviously your mind and body are all one thing, it’s not just anxiety, now let’s stabby-stabby those Bad Feelings out of your muscles.

Anyway, I will leave you with these words, awash in the perpetual purple light of my sensory cave:

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As always, feel free to send me things of interest or note at sluggish@substack.com! I hope you get to touch sooo much grass this weekend <3