Mental health goes digital

In April 2022, The Guardian published an article on the “rise of mental health chatbots” in the United States.

Placing the increased usage of chatbot apps such as Woebot in the context of enduring problems in the mental health system that were worsened by the COVID-19 pandemic, the article explains that young people are seeking artificial intelligence chatbots to support their mental health challenges.

Part of the reason for this is the perceived absence of judgment and the objectivity afforded by the robot. The article cites a user who comments, “It’s a robot … It’s objective. It can’t judge me.”

An empathic computer that receives and recognises feelings without judgement and a computer that feels – such is the broad ambition of digital mental health products.

Apps, wearables and ingestibles

In my new book, The Artefacts of Digital Mental Health, I look at three types of products that purport to support positive mental health: pocket-size infrastructures powered by artificial intelligence and other advanced algorithms (apps); body-focused devices that ‘read’ one’s vital signs (wearables); and sensors that are swallowed (ingestibles) as well as the convergence of the app, wearable, and sensor.

Apps like Wysa and Woebot apply artificial intelligence in their design to power and automate robots that can chat with users. Known as chatbots, these apps form part of a shift in app design where the therapeutic relation is enfolded and encoded into artificial intelligence-powered algorithms.

Smart wearables that are networked to smartphones, embedded sensors and advanced data processing functions, like automated decision-making and artificial intelligence, became a genre-defining technology at the intersection of the health and fitness industry with the unveiling of the first Fitbit in 2009.

Wearables have also operationalised the language of ‘wellbeing’, and companies have been able to position their devices as having a range of benefits, including improving mental health.

The number of connected wearables worldwide has soared from 325 million in 2016 to 722 million in 2019 and reached 1.1 billion in 2022.

Ingestible sensors are much less common but are growing in popularity. Abilify MyCite is a psychotropic medication (aripiprazole) embedded with a sensor and in 2017 became the first drug with a digital ingestion tracking system approved by the US Food and Drug Administration.

The Abilify MyCite system includes a sensor that is ingested with the drug, a patch worn on the ribcage to which data is transmitted, a smartphone app that records data such as digestion, moods, and activity levels, and an online portal shared with the prescribing physician.

Digital mental health and the ‘shadow pandemic’

The deployment of such technologies in mental health predates the COVID-19 pandemic, but the events of 2020 and 2021 have been a springboard for fast-paced, technology-driven changes in mental health.

At times labelled the ‘shadow pandemic’, the mental health impacts of the pandemic were a frequent topic of discussion in the media and in scholarly research, which, more broadly, also highlighted the need for reform in the mental health system.

It became stark to me that during the pandemic, elements of techno-solutionist imaginaries – that is, ideas that technology will offer relatively straightforward solutions to complex social, economic, and political issues – emerged to address loneliness, isolation and mental ill health.

Digital mental health is not limited to clinical practice. It is increasingly mundane, circulating in everyday life beyond the confines of the clinic, through technologies that are tethered to the self.

It’s all in the data

A key dimension holding together these digital artefacts is a focus on reading, tracking and interpreting the body’s vital signs as a way to translate mental health.

Where past discussions of mental health may have focused exclusively on the mind or the brain, or the body but not the digital, these technologies wholly rely on the body, its vital signs, its inflections and its movements, while claiming to access (and act upon) the brain and the mind through the materiality of the body.

Mental health data are typically viewed as uniquely sensitive in medicine and law. Consequently, corporations that design and manufacture apps, wearables and ingestible sensors are particularly enthusiastic to stress the (positive) clinical research into their products on their websites and sometimes on social media.

This sensitivity is partly connected to the kinds of data typically collected, for example, those related to mood, communication, social practices, and in some cases, location.

For some researchers, data sensitivity in digital mental health is connected to broader social stigma, while for others, digital mental health is a possible avenue for addressing the stigma associated with mental ill health.

Data doesn’t judge?

In many digital mental health products, body data hold apparent impartiality that words, narratives and stories of emotional distress cannot or do not offer with sufficient precision.

Intensely embodied sensations and responses such as shivering, sweating, increased heart rate, deep or shallow breathing and sleep (and embodied actions during sleep including snoring or tossing and turning), once rendered into data, are – often in combination – supposedly closer-to-accurate indications of mental health and ill health.

Central to how the benefits of wearables for mental health are framed is the purported ability of physiological data to resolve the ‘problem’ of subjectivity in self-reports of mental ill health.

In other words, where spoken narratives of struggle and distress are viewed as time-consuming and coloured by subjectivity, physiological data is near-incontrovertible, if not neutral.

Blurring the boundary between physical and mental Health

Despite the sensitivity associated with mental health data, digital mental health continues to expand, often beyond the purview of regulatory systems. The datafication of mental health is not only far-reaching but also, its expansion is amplifying the blurring of boundaries between ‘physical’ and ‘mental’ health.

While, on the one hand, the blurring of physical and mental health can signal a more holistic and complex understanding of mental health beyond ‘symptoms’, it also signals data capaciousness; that is, the collecting, processing, and analysing of multiple body data are presented as essential and unavoidable.

This edited extract of The Artefacts of Digital Mental Health by Dr Jacinthe Flore was published by Pursuit.