In my post of October 7th, 2017, I reported on Tom Insel’s optimistic view that “digital phenotyping” with smartphone technology would improve psychiatric diagnosis and possibly even treatment (“How digital is man?“). Another important aspect of digitalization of psychiatry is the development of machine therapists in mental health care working with artificial intelligence. Adam Miner and colleagues from Stanford University, California, give a brief overview of the current status in their article “Talking to machines about mental health problems”, which was published in the same issue as Insel’s (JAMA 2017; 318; 1217-1218).
Picture: Pixabay: Geralt
Machine therapists that communicate with patients are already in use in the USA and in China. These “conversational agents” are called “Gabby” or “Ellie”. They perform psychiatric interviews and might some day be able to even perform formal psychotherapy. Miner and colleagues are optimistic about the potential usefulness of conversational agents. “Optimism is growing that conversational agents can now be deployed in mental health to automate some aspects of clinical assessment and treatment.” According to Miner et al., “some data suggest that people respond to them as though they are human.” This could be helpful “especially to improve access for underserved populations”. Interestingly, one study suggests that people who know that they are talking to a computer are more willing to disclose.
Miner et al. further state: “The bridge from human responses and machine responses has already been crossed in ways that are not always made clear to users. Chinese citizens engage in intimate conversations with a text-based conversational agent named Xiaoice.” The authors, however, admit that conversational agents have not been evaluated in clinical trials and that they might not only be ineffective but cause harm. Additional future problems of the technology might be issues of confidentiality. Does a machine therapist has to be as secretive as a human?
Furthermore, most of the current technology seems to be based on the communication of text, that means it is based on semantics. Communication in psychiatric contexts, however, is much based on context. Empathy cannot be coded in words.
While we once believed that psychiatry is the most human medical specialty, scientists now seem to believe that this is the first specialty that will be replaced by computers. Would you talk to a machine therapist about your emotions, your conflicts, your desires?