A Study in Contrasts: Technology Versus “Humanology”

March, 2021. In this issue of the Journal, Fowler and colleagues provide an elegant description of their increasing use of “integrated digital technologies” as part of routine psychiatric care. What they describe goes well beyond the now almost universal use of the electronic medical record, itself a “sea change” in standard medical practice. A crescendo of advances in the use of technology in general medical/surgical settings is happening at warp speed, such as the use of robotics, wearable bio-monitoring devices, imaging, big data, and many other innovative digital/technological strategies. This developing frontier has been less visible in the world of psychiatry and mental health care, but that is changing. Fowler and co-authors describe “a digital care navigation and data collection system, to integrate traditional … outcomes monitoring with novel biological monitoring between visits to provide patients and caregivers with real-time feedback on changes in symptoms such as stress, anxiety, and depression.” They present a 4-stage program that can be implemented in many types of mental health care, as well as in primary care. But the authors caution that as “alluring as technological innovations are, the focus must continually be brought back to the value of human contact and interaction in delivering quality care.” Also in this issue of the Journal, Villela and Lazar provide a Psychotherapy Guest Column entitled “Moving forward while standing still: A case of mental health advocacy evolving in the time of COVID-19.” Here, they describe an interesting recent challenge in Canada, where the Ontario Ministry of Health proposed to “radically limit psychotherapy provided by psychiatrists and family physicians,” modeled on managed care strategies in the United States. The argument rested on the view that time-limited cognitive-behavioral therapy is the only “evidence-based” type of psychotherapy that has been demonstrated to be effective, a position vociferously challenged by the authors. (See also an earlier Psychotherapy column by Plakun and Villela published in this Journal in 2019.1) Villela and Lazar refer to an opinion piece by Norman Doidge, MD, titled “In Ontario, a battle for the soul of psychiatry” and published in the Toronto Globe and Mail in April, 2019.2 In it, Doidge made a persuasive case that longer-term psychotherapy, funded by the Government in Ontario, is essential for patients who need it, and that it is both effective and cost-effective. Villela and Lazar contend that these conclusions have been demonstrated by peer-reviewed published evidence-based research, an argument also strongly endorsed by Eric Plakun in his introduction to this guest column. Although it may not be immediately apparent, here’s what, to me, links these 2 seemingly disparate contributions to this issue of the Journal. One aspect of the technological frontier is the development of computer-administered brief cognitive therapy, either alone, or assisted by a “mental health technician.” Let me quickly add my belief that this is an exciting exploration of the broadening potential to make effective therapy more widely available, a development particularly relevant in this era of COVID-19 with the burgeoning use of telemedicine and telepsychiatry. But each progressive step in the world of technomedicine must be taken with caution and these new techniques must be utilized appropriately. And in my opinion, nothing should ever replace the essential ingredient of compassionate mental health care—the capacity to connect, listen, and be there with and for our patients (someday face-to-face, instead of mask-to-mask). Hence my title, “Technology versus ‘Humanology’.” But perhaps I should have said “and” instead of “versus,” since we need both. John M. Oldham, MDEditor

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