Mind: Recalibrating Therapy for a Wired World - The Digital Doctor

But the virtues of the digital age are not always aligned with those of psychotherapy. It takes time to change behavior and alleviate emotional pain, and for many patients constant access is more harmful than helpful. These days, as never before, therapists are struggling to recalibrate their approach to patients living in a wired world.

For some, the new technology is clearly a boon. Let’s say you have the common anxiety disorder social phobia. You avoid speaking up in class or at work, fearful you’ll embarrass yourself, and the prospect of going to a party inspires dread. You will do anything to avoid social interactions.

You see a therapist who sensibly recommends cognitive-behavioral therapy, which will challenge your dysfunctional thoughts about how people see you and as a result lower your social anxiety. You find that this treatment involves a fair amount of homework: You typically have to keep a written log of your thoughts and feelings to examine them. And since you see your therapist weekly, most of the work is done solo.

As it turns out, there is a smartphone app that will prompt you at various times during the day to record these social interactions and your emotional response to them. You can take the record to your therapist, and you are off and running.

Struggling with major depression? Digital technology may soon have something for you, too. Depressed patients are characteristically lacking in motivation and pleasure; an app easily could lead patients through the day with chores and activities, like having a therapist in one’s pocket. Not just that, but the app might ask you to rate depressive symptoms like sleep, energy, appetite, sex drive and concentration in real time, so that when you next visit your psychiatrist, you can present a more accurate picture of your clinical status without having to worry about your recall.

When it comes to collecting and organizing data, software is hard to beat. But information has a tendency to spread, especially digital information. To wit, electronic medical data containing sensitive personal information can be released, either accidentally or deliberately, and disseminated. Anyone who has followed the hacking of supposedly secure and encrypted financial databases knows this is not a remote possibility.

More worrisome to therapists, perhaps, is that technology also enables access: These days patients reach out via text, e-mail, Facebook, Twitter. For some of them, the easy connectivity that technology makes possible is a decidedly bad idea.

Take a patient who has a fundamental problem in maintaining intimate relationships and who can’t tolerate being alone without feeling bored or anxious — in other words, a patient with typical features of borderline personality disorder. Not surprisingly, such a patient would love instant access to a therapist whenever an uncomfortable feeling arises.

In this case, connectivity would interfere with the central goal of any reasonable treatment, namely acquiring the skills to manage painful feelings by oneself and the ability to tolerate some degree of disappointment. Access-on-demand would mitigate efforts to develop patience and frustration tolerance, and might encourage a sense of entitlement and an illusory notion of power and control.

But perhaps the more difficult challenge is this: By removing barriers to access, digital technology can make therapists more real and knowable to their patients. This cuts both ways.

Recently, a patient I had treated for depression was struggling with the approaching death of his beloved dog. Just divorced, he was dreading another loss. One night while surfing the Internet, he came across a piece I wrote years ago about the death of my own dog.

“So you understand what it’s like,” he said during one of our sessions. This discovery made him feel understood and comforted.

Sometimes, though, digital technology can undermine the clinical rationale for a therapist to maintain distance.

For example, in insight-oriented psychotherapy, which focuses on unconscious processes at the root of personal conflicts, the patient essentially uses his relationship with the therapist to understand how he structures relationships with people in general. The therapist must be free to “become” many different important people in the patient’s life; the more the patient knows of the therapist’s real life, the likelier it is that the treatment will be confounded.

Imagine how you might feel if you had a philandering parent and were having trouble in your own relationships, and you discovered that your own therapist was married and having an affair. It would be hard to believe this would not affect your relationship with your therapist.

Many patients don’t want to know how their therapists feel or the details of their personal lives, and for a good reason: It can undermine the perceived authority of the therapist, making patients feel less secure. And it can inhibit patients from being open for fear of hurting or upsetting their therapists.

I wonder if it’s even possible for therapists to remain anonymous in the age of the Internet, where we can all be found in the electronic cloud. A Google search might not reveal a therapist’s deep, dark secrets, but even basic information begins to alter the relationship.

Last summer, a patient learned that I was swimming in a benefit race in Cape Cod because I’d written something about it that was available online.

“Be careful, Dr. Friedman,” he said with a smile on the way out of my office. “I heard there were sharks out there.” Beneath the humor was anxiety — or perhaps something darker.

Digital technology has the potential to either enhance or confound therapy, but much depends on the patient and the condition being treated. Some patients will find that the glowing screen only feeds their psychopathology. Others will find digital technology a boon to self-esteem and assertiveness. We are only beginning to figure out which patients are which.

Dr. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College in Manhattan.

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Art.sy Is Mapping the World of Art on the Web

But until now, there was no automated guidance for art lovers seeking discoveries online — no “If you like Jackson Pollock’s ‘No. 1,’ you may also enjoy Mark Rothko’s ‘No. 18.’ ”

Enter Art.sy, a start-up whose public version went live on Monday. An extensive free repository of fine-art images and an online art appreciation guide, it is predicated on the idea that audiences comfortable with image-driven Web sites like Tumblr and Pinterest are now primed to spend hours browsing through canvases and sculpture on their monitors and tablets, especially with one-click help.

After two years of private testing and with millions of dollars from investors, including some celebrities in the art and technology worlds, the site aims to do for visual art what Pandora did for music and Netflix for film: become a source of discovery, pleasure and education.

With 275 galleries and 50 museums and institutions as partners, Art.sy has already digitized 20,000 images into its reference system, which it calls the Art Genome Project. But as it extends the platform’s reach, Art.sy also raises questions about how (or if) digital analytics should be applied to visual art. Can algorithms help explain art?

Robert Storr, dean of the Yale University School of Art, has his doubts. “It depends so much on the information, who’s doing the selection, what the criteria are, and what the cultural assumptions behind those criteria are,” Mr. Storr, a former curator of painting and sculpture at the Museum of Modern Art, said. In terms of art comprehension, he added, “I’m sure it will be reductive.”

The technology, at least, is expansive. To make suggestions successfully, computers must be taught expert human judgment, a process that starts with labeling: give a machine codes to tell the difference between a Renaissance portrait and a Modernist drip painting, say, and then it can sort through endless works, making comparisons and drawing connections.

For the Art Genome Project, Matthew Israel, 34, who holds a Ph.D. in art and archaeology from the Institute of Fine Arts at New York University, leads a team of a dozen art historians who decide what those codes are and how they should be applied. Some labels (Art.sy calls them “genes” and recognizes about 800 of them, with more added daily) denote fairly objective qualities, like the historical period and region the work comes from and whether it is figurative or abstract, or belongs in an established category like Cubism, Flemish portraiture or photography.

Other labels are highly subjective, even quirky; for contemporary art, for example, Art.sy’s curators might attach terms like “globalization” and “culture critique” to give ideological context. “Contemporary traces of memory” is an elastic theme assigned to pieces by the Chinese Conceptual artist Cai Guo-Qiang and the photographer and filmmaker Matt Saunders.

A Picasso might be tagged with “Cubism,” “abstract painting,” “Spain,” “France” and “love,” all terms that are visible and searchable on the site. Jackson Pollock’s works typically get “abstract art,” “New York School,” “splattered/dripped,” “repetition” and “process-oriented.” Predictably, some of those criteria show up on paintings by Pollock’s contemporaries Robert Motherwell and Willem de Kooning, but also on artists from different eras and styles, like Tara Donovan, whose contemporary abstract sculptures using stacked and layered plastic foam and paper plates have also been marked with “repetition.”

As the categories are applied, each is assigned a value between 1 and 100: an Andy Warhol might rate high on the Pop Art scale, while a post-Warholian could rank differently, depending on influences. Software can help filter images for basic visual qualities like color, but the soul of the judgment is human.

“Literally, a person goes in by hand, and they enter a number for all the relevant fields,” Mr. Israel said.

The technical complexity is outweighed by the curatorial challenges. “We learned that the data matters much more than the math,” said Daniel Doubrovkine, 35, who is in charge of engineering at Art.sy. “How are you going to pick something that shows ‘warmth’ with a machine? We’re not.”

Similarly, Pandora has a roomful of musicologists deconstructing each tune; their analysis is then fed into an algorithm, called the Music Genome Project, that recommends songs in its player based on users’ taste and the ratings they give each track. (Joe Kennedy, the chief executive of Pandora, served as a consultant to Art.sy.)

But Art.sy aims to make connections among artworks that are seemingly from different worlds, with a catalog that encompasses pieces from the British Museum, the National Gallery in Washington, the Los Angeles Museum of Contemporary Art and others. A recent partner, the Cooper-Hewitt, National Design Museum in Manhattan, a branch of the Smithsonian, has added objects to the mix, which will be a test of the site’s technology and the parallels it draws, said Seb Chan, the Cooper-Hewitt’s director of digital and emerging media.

Culturally, “what does it mean to recommend a painting from seeing a seventh-century spoon, for example?” he said. Anticipating such questions, the Art.sy staff has a blog explaining how its process works.

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Switching cause and effect in quantum world? A causes B causes A

One of the most deeply rooted concepts in science and in our everyday life is causality; the idea that events in the present are caused by events in the past and, in turn, act as causes for what happens in the future. If an event A is a cause of an effect B, then B cannot be a cause of A. Now theoretical physicists from the University of Vienna and the Université Libre de Bruxelles have shown that in quantum mechanics it is possible to conceive situations in which a single event can be both, a cause and an effect of another one.The findings will be published this week in Nature Communications.Although it is still not known if such situations can be actually found in nature, the sheer possibility that they could exist may have far-reaching implications for the foundations of quantum mechanics, quantum gravity and quantum computing.Causal relations: who influences whomIn everyday life and in classical physics, events are ordered in time: a cause can only influence an effect in its future not in its past. As a simple example, imagine a person, Alice, walking into a room and finding there a piece of paper. After reading what is written on the paper Alice erases the message and leaves her own message on the piece of paper. Another person, Bob, walks into the same room at some other time and does the same: he reads, erases and re-writes some message on the paper. If Bob enters the room after Alice, he will be able to read what she wrote; however Alice will not have a chance to know Bob's message. In this case, Alice's writing is the "cause" and what Bob reads the "effect." Each time the two repeat the procedure, only one will be able to read what the other wrote. Even if they don't have watches and don't know who enters the room first, they can deduce it by what they write and read on the paper. For example, Alice might write "Alice was here today," such that if Bob reads the message, he will know that he came to the room after her.Quantum violation of causal orderAs long as only the laws of classical physics are allowed, the order of events is fixed: either Bob or Alice is first to enter the room and leave a message for the other person. When quantum mechanics enters into play, however, the picture may change drastically. According to quantum mechanics, objects can lose their well-defined classical properties, such as e.g. a particle that can be at two different locations at the same time. In quantum physics this is called a "superposition."Now an international team of physicists led by Caslav Brukner from the University of Vienna have shown that even the causal order of events could be in such a superposition. If -- in our example -- Alice and Bob have a quantum system instead of an ordinary piece of paper to write their messages on, they can end up in a situation where each of them can read a part of the message written by the other. Effectively, one has a superposition of two situations: "Alice enters the room first and leaves a message before Bob" and "Bob enters the room first and leaves a message before Alice.""Such a superposition, however, has not been considered in the standard formulation of quantum mechanics since the theory always assumes a definite causal order between events," says Ognyan Oreshkov from the Université Libre de Bruxelles (formerly University of Vienna). "But if we believe that quantum mechanics governs all phenomena, it is natural to expect that the order of events could also be indefinite, similarly to the location of a particle or its velocity," adds Fabio Costa from the University of Vienna.The work provides an important step towards understanding that definite causal order might not be a mandatory property of nature. "The real challenge is finding out where in nature we should look for superpositions of causal orders," explains Caslav Brukner from the Quantum Optics, Quantum Nanophysics, Quantum Information group of the University of Vienna.View the original article here

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