Social networks aspire to connect people, which is a noble but naive goal. When we uncritically accept connection as a good thing, we overlook difficult, important questions: Are some forms of virtual communication more nourishing than others? Might some in fact be harmful? Is it possible that Facebook, for instance, leaves some people feeling more lonely? No one knows for sure. We tend to build things first and worry about the effects they have on us later.

Robert Morris is taking the opposite approach. Starting with the desired effect of helping people deal with depression, he developed Panoply, a crowdsourced website for improving mental health.

So begins this week’s Reading.

This is not your typical selection. Though the disease discussed is depression, the treatment involves social networks, not sertraline. The article is well written, but it doesn’t appear in the pages of World Psychiatry but Wired. The article details therapy, but with a focus on apps, not Adler. CBT is important, but crowdsourcing is talked about more than cognitive distortions.

Welcome to psychiatry in the 21st century.

You can find the link for the article here:

(Because of browser issues, try cutting and pasting the web address if the link doesn’t open properly.)

Morris, working with MIT, has created a website that he hopes will help people with the negative thoughts so associated with depression and anxiety. People using the site, though, don’t simply get support. The goal is to offer support but also to help people work on cognitive reappraisals.

So, for example, a person may feel overwhelmed by a roommate who comes home and doesn’t even look at him. He thinks: “I’m not popular. I’m not cool…” and posts this on Panoply.

Posts like these triggered a three-tiered wave of crowdsourced action. The first person or two simply came by to lend support and sympathy… A second wave read the entry and labeled specific places where the poster was distorting reality or thinking illogically. Then, a third group came and completely rewrote the initial story, casting the events in a less dire light. The system produced crowd-generated reappraisal unique to every dark thought.

In this way, the mass action of the Internet – the crowdsourcing that can, say, build an encyclopedia from scratch – can help people cope better.

The article makes mention of published results in the Journal of Medical Internet Research.

MIT. Wired. A journal paper. It’s all very cool.

Having read the paper, I’m not actually sure it’s all very persuasive, however. The study didn’t involve people suffering from depression – but people who had depressive symptoms. The n was small. It’s not clear if there are any lasting benefits to Panoply.

And so, I like the idea of this article more than the article itself. Of course, we are talking about a project under development, and early data is just that – early data. (The one-sided reporting of the Wired article makes me wonder if a Madison Avenue executive earned his Christmas bonus eight months early.) And, hey, perhaps I’ll regret this commentary in the future. But if Panoply is a work in progress, this much is clear: technology is very much changing psychiatry.

And that’s a good thing.

Panoply strikes me as fanciful. The need it attempts to address, though, is too real: according to Statistics Canada, only one in three people with mental health issues gets the care he or she needs.

We are collectively failing.

Thus, experiments like Panoply are needed. Panoply is one of many efforts to reach patients virtually, both in the private and public sectors. Speaking to the latter: In Australia, the federal government has invested heavily in e-therapies, particularly important in a country with a rural population spread over vast distances (geographically different from our country, but with practical similarities in terms of under-serviced rural need). Just last month, the United Kingdom’s National Health Service introduced the Mental Health App Library, endorsing several apps and websites, recognizing that many people use Internet resources and that the NHS can help guide their choices.

Closer to home, Dr. Allison Crawford is the program director for CAMH’s Northern Psychiatric Outreach Program, working with her team to make psychiatric services more accessible; with telepsychiatry, they are bringing care to the furthest corners of our country. Dr. Crawford was just awarded the 2015 ORION Leadership Award (Innovation). The senior team at Ontario Shores has led an effort to open up their electronic health records to patients, engaging them in a way that would have been impossible just a few years ago. Ontario Shores won an HIMSS Analytics Stage 7 Award for this. (On a personal note, I heard Physician-in-Chief Ian Dawe present Grand Rounds on this topic and was dazzled by both the project and Dr. Dawe’s enthusiasm.) And at The Scarborough Hospital, we use Internet-assisted CBT, part of a research study with Queen’s University, offering services to outpatients who may not be able to make it to our clinic because of physical issues (pain) or psychological issues (severe anxiety). No award for us yet, alas, but I’ll be presenting some research findings with Faiza Khalid-Khan, Shawnna Balasingham and Ettsa Papalazarou – all of The Scarborough Hospital’s Adult Outpatient Program – at the Ontario Psychiatric Association Annual Conference this Friday at 10:45 a.m.

Dr. Allison Crawford

Many of these experiments will fail. Some will succeed. And in the coming years, they will help change the face of psychiatry.

For more on the NHS App Library, see:

Morris et al.’s paper can be found here:

And for the program of this year’s OPA Annual Conference, see:

Note that there is a discounted rate for allied health professionals, and registration is free for medical students and residents.


Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.