How would we spot a nervous breakdown on Twitter?
With so much of people’s conversations and personalities now available for everyone to see, is there a responsibility on us as users of social media to keep an eye out for others?
If the answer is ‘yes’ – as I should hope it is – does that mean that we should also learn to see cries for help and signs of ill mental health? If it does, what mechanisms are already in place for supporting this, and what needs developing?
Or perhaps it should be left to those qualified to deal with such issues: in which case should they be monitoring online activity for warning signs? And, again, what mechanisms are there to alert them when we suspect someone is in need of help?
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Of course we should – we’re friends and people, first and foremost, after all – but haven’t these issues already been thrashed out on mailing lists, bulletin boards and Usenet? What’s different now?
Andy Mabbett
Hiya
I have been in the position (online, preTwitter) where I have realised someone is in need of help and mobilised other members of the group nearer the person to check up and find help for them (me, in Brum; they, in USA).
I did have second, and third, thoughts at the time, mainly to do with privacy and, not knowing the person terribly well, uncertainty as to any natural inclination to over-dramatise, or not. Ultimately, I felt that it was worth any comeback or flaming, if I was wrong. I could not have lived with myself if I had failed to do everything in my power to make sure this person was ok.
I was tipped off by a series of worsening comments and checked out their blog, which made me certain the person needed some help.
Twitter’s nature – shorter comments – could make it difficult to spot something so early on.
I don’t know if there are any existing mechanisms, I didn’t find anything with my experience, although admittedly I didn’t look far beyond the group.
I’m not sure how monitoring would work. Who would do it? What privacy aspects need to be taken into account?
That’s not to say I’m against it. Just not sure how it could work. I think the internet is an easy place for people to fall apart in, cry for help in, make grand statements in and become enthralled by. Unfortunately, a person in a state of distress may not get that the connection they feel to the people they meet ‘out there’ on the web may not be as strong as they’d like. Cries for help may go unnoticed.
Having had my own fair share of ‘mental distress’ over the years, I’d welcome anything that allowed people in need to connect with people who can help. Just not at the expense of autonomy and privacy, the loss of which could be a major factor in worsening the person’s fears and doubts, regardles of the sentiment in which it is done.
A fine, fine line. I’ll keep my eye on this, I’m very interested in what others feel on the subject.
Cheers
Z
Lyndsey Michaels
Interesting question, but then of course it relies on how to define and identify a nervous breakdown. Wikipedia struggles to identify http://en.wikipedia.org/wiki/Nervous_breakdown
From my limited experience (zen and the art of motorcycle maintainance, family members and friends) a breakdown is a result of obsessing over a particular topic, or extreme clash of personality vs situation.
Since insanity is a sane reaction to an insane world (R.D. Laing), and our treatment of “insanity” is itself questionable, real world diagnosis is questionable enough. Ultimately we are responsible for the psycological wellbeing of friends, but placing them in the hands of “experts” or psycologists or medical professionals is not neccessarily beneficial. Many of the greatest people in history were insane, autistic, schitzophrenic, obsessive compulsive, or social deviants.
All this aside, I don’t think it is possible to spot such things on twitter, it’s not what is said, but how. There are many tells a person has but words alone cannot give many subtle clues unless they declare suicidal desire for example. But at the end of it all, who are we to judge – if someone represents neither danger to themselves or society, let them be. Misery or happiness are merely states of being that people choose.
More questions here than answers possibly, or am I myself exhibiting signs of mental illness?
Jay Cousins
Andy, I think the difference is that pretty much everyone is now online in some way or other. As everyday lives are increasingly lived on the internet these issues will become (are becoming, I believe) much more serious.
Michael
Thanks for the great comments. I don’t have any answers, and I’m not even sure if I believe it’s possible or desirable. My concern stems from a fear that we may be naively jumping into the internet with gleeful abandon, without the tools to deal with what life online will throw at us.
If we are going to be living as much (or more) online than off, then I think we need at least to have considered how to support people in this way.
The comments here are really interesting, and I think it’s worth continuing to struggle with this issue.
Michael
Paul Henderson says “would it be poss to have your electronic medical records ‘following’ your/certain tweets, then the doc see them when you go in”.
Possibly, but it would have to be opt-in only. There would be enormous privacy concerns: it could be comparable to a doctor requiring us to record our every movement and conversation. And if a doctor can do it, then why not the police, or anyone else?
So it would have to be strictly opt-in. The trouble is that in that case it would, by the nature of the exercise, most likely miss the very people it’s trying to help.
But let’s keep thrashing at this. Is there mileage in trying to scope out a viable, non-invasive model for helping spot warning signs of people in need?
Michael
Maybe we can’t spot them (having been a ‘them’ from time to time, myself). Maybe we have to allow them to spot us: folk who are open to helping and pointing in the right direction. Do organisations such as Samaritans Tweet?
I know, that doesn’t help with the identification of a person potentially ‘going under’ or identify warning signs. But what if there was a well respected organisation, with a significant online presence, we could gently direct them to – with Twitter, we would not have to aim it directly at them, just be putting the info out there for them to pick up on (if they can at that point. It’s not always obvious to the person themselves that they need help).
Very few people in that situation react well to being told (however gently) they need help. Maybe we just put help in their way?
Hm. Still pondering.
Z
Lyndsey Michaels
Hi Lyndsey. Maybe there’s another element to this: where the expert help (eg Samaritans) is accessible, but also a mechanism for concerned folk to point those experts discreetly in the direction of people they’re worried about?
Obviously there are numerous issues to iron out here, but it would mean that the experts have control of how to take things forward: contact would only ever be between ‘pateint’ (for want of a much better word) and ‘expert’ (likewise).
Michael
Being ‘followed’ by a mental health expert might send me over the edge of the paranoic abyss! No, jesting aside, really I do see what you’re getting at.
It’s no wonder we (human race) have not got terribly far with knocking down the taboo of mental health, there are so many tightropes to walk with privacy Vs greater good and so on. Right here and now, I’m almost tempted to say “but when a person is in need of help, they may not be able to help themselves, therefore we should step in on their behalf.”
Almost, but not quite. The thought of anyone ‘stepping in’ on my behalf – unless they are one of the named people in my close family & friends who have my express permission to intervene on my behalf – sends my panic levels racing even now. At the peak of distress, I can imagine how all the ‘forces’ working in my addled brain might translate that help into something more sinister.
Having said that, I do believe that after the fact, once help had been received and I was back on track, I would be extremely grateful and relieved.
Also, there are differing levels and types of distress. The person going through a tough divorce may have a one off episode of depression, and may be more likely to be able to recognise and gladly accept an intervention, whereas the long-term ‘sufferer*’ may be distrustful of health services in general as well as some other complications.
Still, that’s only my personal view developed via my own experiences and those of others I know personally. When I’m sane, I can look at things really quite objectively, when I’m not… oooh boy, do I get tunnel vision.
Z
*The word doesn’t sit well with me. If it wasn’t so PC as to make one vom, I’d go for ‘differently minded’ or some such.
Lyndsey Michaels
Thanks for synthesising my thoughts on light touch ‘monitoring’ – I wasn’t originally thinking about mental health, where there are the issues that are being discussed here but more pinpointing times and dates when such and such pain started or tying together several seemingly unconnected symptoms that someone might tweet about (I’m sure this will be on an episode of House if hasn’t already been..) Presumably by tweeting though, you are giving ‘permission’ of a sort for people to access your innermost thoughts – or at least those that you wish to publish and have recorded forever on the internet.
Automatic monitoring would, of course, be massively subjective (unlike tracking something like blood pressure etc which is pretty objective) and therefore require some pretty sophisticated language interpretation if it was possible at all. But I’m sure the guys at GCHQ would be able to help out..and if they were ‘following’ you, you might well be justified in thinking you were losing it.
Paul Henderson
I think when asking ‘Could this person be in trouble?’ we’d need to know someone fairly well already as there are some folks who (perfectly legitimately!) use Twitter to vent and rant. So yes, you’d need to know the pattern, style or whatever of someone tweets before spotting any warning signs.
That aside, if someone were behaving unusually, as was Lyndsey’s experience …
Just as happens offline, people become part of communities online – groups of friends – so I’d like to think that, if I was in trouble, yes, someone would care enough to want to help. I’d certainly want to help and be supportive if I thought somebody might want or need it.
If I did ever suspect someone had a problem they might need some help dealing with though, I’d first want to get in touch with that person, privately. That’s just what I’d do if it were any of my friends offline. It’s also what I’d prefer someone to do if I were having problems, rather than either raising it with me in public or discussing it with other people first. That might just be me though.
If that didn’t help, however, I’d (again, privately) get in touch with other people from our mutual community to ask their opinion. Twitter’s great for that sort of thing!
I’m not sure any of that makes much sense but it’s such an interesting question – one I’ve not come close to answering! – that I wanted to respond to it in some way, if just with some rambling thoughts.
Essentially, this sort of situation has perfect parallels with offline stuff: Online communities can be just as strong as offline ones, but it’s always going to be difficult to raise sensitive, personal issues with people – especially when they may not quite be themselves.
Katie