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The Never-Ending Battle for Online Mental Health

The Never-Ending Battle for Online Mental Health

I’m an old-timer online.

I got my start in the 1980s with BBSs and internet access through my university as an undergraduate. When I hit grad school in 1990, I spent a lot more time in the discussion forums at the time (Usenet, like today’s Reddit).

That’s when I found an online outlet for my rebellious nature.

Yes, I was in graduate school to get my doctorate in order to help people in psychotherapy. But it would be another 5 years before I’d get that degree — too long for my impatient needs.

So I turned to this online world of forums and started helping out where I could. I regurgitated information I was learning in grad school about mental illness and its treatment. I helped people navigate the symptoms of depression, ADHD, and anxiety. And I created user-friendly indexes to help others find online support groups more easily.

All of this was strictly not allowed and frowned upon by mental health professionals at the time. “You can’t tell patients what the symptoms of depression are — they’ll just fake them in order to get treatment!” is something that was actually said to me.

It gets worse.

In 1996 when I began offering automated screening quizzes online for things like depression, I got a lot more blowback. “You can’t tell people they might have depression through an online quiz! That’s unethical!!”

That was the usual retort for anything I advocated for back in those early days of the web. It was unethical to provide people more information about their own mental health. It was a very strange time to have to navigate these kinds of obstructionists in my own profession, in order to help a greater number of people.

You Can’t Share Mental Health Diagnostic Symptoms

The more that people know about mental health, the more informed they become. They start to give up the stigma and misinformation they may have learned through their parents, movies, TV shows, and elsewhere. They begin to understand that mental health is a thing you work on your entire life, just like your physical health.

They also start to understand that when things go wrong and a person is diagnosed with mental illness, it’s not the end of the world. There is an unspoken message of hope in knowing, because it is in the knowing that one’s fears lessen.

Imagine how scary and ridiculous a motor vehicle would be to someone from 400 BCE. Even though most people don’t understand much about how their automobile works today, they certainly don’t fear it. It’s become second nature because it’s understood and accepted in society through its ready availability in first-world countries.

I was repeatedly chastised for sharing the diagnostic criteria spelled out in the DSM-III-R and later DSM-IV with the lay public. I was told, time and time again, “This is unethical. You shouldn’t be doing this.” Wait a minute… I shouldn’t be sharing information with people that professionals use to diagnose mental illness? Why the hell not??

You Can’t Do Therapy Online

In the 1996 timeframe, licensed psychologists and other therapists started offering therapy online. The overwhelming response from the establishment at the time was, “NO! You can’t do psychotherapy online!” They were aghast people were trying this, and again trotted out how “unethical” it was to see patients via an online platform (or email — this was long before HIPAA). Yet, gladly, forward-thinking therapists charged ahead and did it anyways.

I documented, observed, and always advocated for the patient during these times. E-therapy or online therapy was a forgone conclusion in my mind, as early as 1996. I saw no reason it couldn’t work, or wouldn’t work. And indeed, by the time I joined an online therapy startup in 1999 in Boston, we had hundreds of patients and thousands of therapists signed up for our service.

Anything you can envision being impossible to do online, innovative, entrepreneurial people have found a way.

You Can’t Give People the Tools to Help Themselves

While well-accepted today, apps were not a thing in the early 2000s, since smartphones had yet to be invented. Instead we had online mental health self-guided tutorials (also called programs or courses). These online services could teach anyone the basic foundation of and enhanced strategies of cognitive behavioral therapy (CBT). CBT is the cornerstone of most modern therapist’s arsenal of techniques they draw from.

What makes CBT great is that not only is it a research-backed psychotherapy, it’s also full of super-easy techniques that can be readily taught to people. With or without a therapist present.

Most therapists still are a little uncomfortable when I say things like this. But you don’t have to take my word for it. There’s a large research base demonstrating the efficacy of these online programs. Moodgym is the granddaddy of these online CBT programs, first developed in 2001.

So yes, online CBT programs have been around for over two decades now and have the research evidence to support their effectiveness. And there’s absolutely nothing unethical about providing these kinds of self-guided tools to individuals to help them better themselves.

What’s Next?

I get it. Therapists often fear technology will someday replace them. They scoff at the idea that an app can replace what they do in-person with individuals they see every week in the security and comfort of their office.

But as the pandemic showed, that safety and security is somewhat of an illusion. Yes, it’s nice but not at all necessary to making therapeutic progress with individuals.

What I’ve learned in these past three decades is that all of these online tools and information help to expose more people to the basic principles of good mental health and introduce them to the idea of getting help for their psychological problems when they arise. They don’t take patients away from therapists. Instead, they expand the population that has access to therapeutic tools and services.

I will always support anything that a professional (or company or organization) can do to help expand access to mental health services.

Because at the end of the day, I’m not here to defend my profession or protect my guild. I’m here to help as many people as possible live as fulfilling a life as possible, free from mental illness.