As editor-in-chief of the JNMD, I see literally hundreds of books or book promotions arrive in either my snail mailbox or e-mail—and therein lies the nut of the issue here. We live in two worlds that sometimes intersect—the real one and the virtual one. In any case, for reasons I will explain, I asked our hardworking book editor, Pedro Ruiz, and competent assistant managing editor, Lisa Cleary, if I could review this book, largely because I have been concerned about the downside of the Internet on behavior (Talbott, 2012, self-published) and wanted to see if the editors' assurance that they would equally discuss the upside, would be illuminating. To cut to the conclusion—it was.
But let me return to my interest in Internet/cyber/digital behavior. I intended to spend a sabbatical year, quite some time back, exploring the future of artificial intelligence and mental health and illness, but as many worthy ideas prove to be, it was much too ambitious for one man in one year to even get a handle on. I had also been involved in the introduction of digital technology in my Department of Psychiatry, in the journal Hospital and Community Psychiatry (now Psychiatric Services) and, after serving as webmaster for a primitive ListServe for the Chairs of Departments of Psychiatry, I served a several year stint as co-host on a nonscientific website where 99% of the posters were anonymous international nonscientific citizens. The behavior I encountered was an astonishing flip-side of what I had seen from self-identified largely American scientists.
The editors of the book under discussion asked chapter author pairs to discuss the research on the downside and upside of Internet usage on mental health and illness, and the issues I had identified experientially—anonymous posting, rage, “losing it” to the point of psychotic utterances, bullying, trolling, and addiction/overuse are certainly well covered here. As are video games, the neurobiology of pathology, “cyberchondria” (a new version of hypochondria), and suicide.
But their chapter authors also cover the brighter side of things—specifically, psychoeducation, online psychotherapy (especially cognitive behavioral therapy and virtual exposure therapy), and mobile applications (apps) that track mood, sleep, energy levels, and symptoms.
There is one last chapter, which although placed in the Opportunities (not in Challenges, aka negative) section on the electronic medical record subtitled “Promise and Pitfalls,” really serves as a summary as much as the editors' concluding section “Grave Dangers, Great Promise.” This book tries to balance the positive and negative aspects of the impact of the Internet on mental health and illness and does a pretty good job at it.
Their conclusion is much like I was taught about the jungle before going to Vietnam, it's neither good nor bad, it's what you make it. Thus, they see both grave dangers (suicide and cyberbullying being the worst) and great promises (therapy and wellness being the best). Although this may be more of a book for specialists in the field, it's a very good snapshot of where we are on the subject. I look forward to their update in a few cyberseconds.
John A. Talbott, MD
Department of Psychiatry
University of Maryland
School of Medicine
The author declares no conflict of interest.