Mental health and identity in the digital age – part three: the Big White Wall

In the first piece I wrote for Unthinkable, I have got a thing, we looked at how information and taxonomy (provided, in part, courtesy of the web) leads to the labelling of, and sometimes over-identification with, an element of ourselves. In the second part, I have a thing, but should I be me?, we explored – courtesy of three personas – how social media and mental health identity interact specifically in the context of Twitter. In this final piece I want to explore a more formal attempt to harness these energies, namely a NHS-backed, Care Quality Commission-assessed, mental health website and phone app called the Big White Wall (from now on let’s call it the BWW).

The Big White Wall

In its own words (taken from its website):

‘A safe online community of people who are anxious, down or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.

Available 24/7, Big White Wall is completely anonymous so you can express yourself freely and openly. Professionally trained Wall Guides ensure the safety and anonymity of all members.’

BWW’s effectiveness is backed by clinical research, and I have no reason to doubt that it is successful in supporting people (it states on the site ‘Almost half of people share something on BWW for the first time and 70% of members feel better after using BWW’). See here for more details on the ‘science’ behind the BWW.

Although a private business it has buy-in from the NHS. It has the potential to, as Mark Zuckerberg puts it, ‘move fast and break things’, though hopefully in as benevolent a manner as possible. It is also based on being completely anonymous, so is the opposite of Facebook (leaving Twitter in an ambiguous middle ground).

Payment

As I said above, this is a private limited company with share capital. It raises its money not through advertising – like Twitter, Google and Facebook – but through people buying its service. This does make it very different from the more ‘informal’ structures discussed in part 2. In parts of the country you can be referred to by the NHS. Or you can buy into the service yourself, which costs £24 a month.

Let’s take a look at the main elements of the service:

Peer support and monitoring

This is at the centre of the process. And takes place on several levels. There are bricks (that you put into a visual wall) stating your state of mind, and more general ‘messageboard’ style discussions called ‘talkabouts’.

Underpinning these features is the fact that people are not talking about their ‘mental health’ in their daily life, and the view that they will benefit from a safe outlet to do so.

I have engaged a little with these, and it is interesting. The peer support element succeeds in making me want to help people – to discuss paranoia with the paranoid.

If you look into the archaeology of peer support you find the structures of Alcoholics Anonymous, which believe that the best way an addict can help her/himself is to help other addicts. There has been a move in mental health services (in the UK) in the past 10-15 years to try to harness this approach (though I doubt that all those appplying it see themselves as directly relating to AA), including employing ‘service users’ directly.

I can see how there could be a compulsive element to this. That one could start to worry about your community on the BWW more than the community around you in meatspace.

It is very different to the Wild West of Twitter. The community is monitored by Wall Guides, who will step in if needed to sort out disputes and upsets. They also watch the site (with the help of search algorithms) to see if anyone is about to commit suicide. Someone watches over you.

Self-assessment (and running apps)

Are you depressed? Answer a questionnaire and find out and see if you get better over time.

I’m a runner (well, a ‘chunky jogger’ might be more accurate) and have experimented with various running apps on my phone. All of these apps have a homepage you can look at, full of details of past runs, average paces, ‘well done, you’ve got a PB’ shout outs when you achieve personal bests. And buy-ins (they generally work on the freemium model) to improve the assessment of your road pounding skills.

I don’t think it would be trite to describe the BWW as a ‘running app for mental wellness’.

Courses

Referred to on BWW as ‘Guided Support’, courses are available in a variety of topics such as Managing Stress and Depression, PTSD and Cutting Down on Drinking.

A question of time, for both user and service provider

Clearly one of the biggest advantages of a one-stop mental wellbeing shop like BWW is the flexibility of its delivery. It also means you can internationalise and outsource mental health services to other countries and timezones (the BWW uses staff in New Zealand to help run its UK service, meaning you don’t have a sleep-deprived staff team doing sensitive work).

Live therapy

There is a ‘Live Therapy’ element to the service, involving therapy over Skype or the like, which you can’t buy into privately but but can be arranged through the NHS. This is assessed by the Care Quality Commission. It’s an interesting idea, and a challenging one for traditional face to face therapy. I wonder, what are the qualitative differences between therapy on Skype and ones done in an actual face to face context?

Hedonic Adaptation

I wonder about hedonic adaptation in relation to the the BWW. We feel seduced and excited by the new – especially in relationship to digital community building. Facebook feels good for a while, then Twitter, then Instagram and now WhatsApp. Ths isn’t necessarily a bad thing: the introduction of supportive novelty can lift the brain out of the churm of anxiety and depression, and it’s a more wholesome novelty than ECT or ketamine (though there is some research into ketamine as a tool in fighting major depression). But the reward of all these platforms lessens after a while, and I wonder if this also applies to the BWW.

Not for the paranoid?

I struggle more with paranoia than anything else at the moment, so the sense of a ‘safe place’ is always underscored by a sense that this is ‘a place of potential betrayal’. I didn’t feel safe on it, but I expect that is to do with me, my state of mind (that book I got on Edward Snowden on the two for a fiver deal from Fopp was a mistake).

Which is, I suppose paranoid. But not entirely worth dismissing out of hand. A site like the BWW relies heavily on the Online Disinhibition Effect (people will say shit online that they won’t say in ‘real’ life). People are weird, but how we should express our weirdness, and how that relates to the broader consequences of ‘public disclosure’ are interesting.

Things are being recorded all the time. Donald Trump (pussy grabbing) and Hillary Clinton (private servers) remind us of this. I’m not going to go on about this in any detail. But I’m just going to mention it, for the paranoid of us.

The quiet desperation of life (a story)

You live with your mother with dementia, you love her but she is hard work, and the smell of urine that permeates your home gets you down. Life is hard and you often feel exhausted and depressed – you’ve tried anti-depressants, but they make you feel more exhausted and depressed. You go and see your GP, there isn’t time during the day to go to a support group, what with all the incontinence and your mum’s constant demands for tea, which make her more incontinent, it’s a water wheel you feed and clean up. A really badly designed water wheel. So the GP tells you about the Big White Wall, which is paid for you through the NHS. You find it supportive and helpful and you feel less isolated. It doesn’t provide you with a good care home for your mum.

Wellness and the depoliticised space

I do like a good skeptical about postive thinking book (thank you Oliver Burkeman, thank you Barbara Ehrenreichand one of the more interesting of recent times is The Wellness Syndrome (for a well-written and rather damning review read here , for a postive review here), which suggests the obsession with ‘wellness’ is some sort of con perpetuated by the neoliberalism (though to be honest the phrase neoliberalism has ceased to have any meaning, it was originally an ideological project to stop wars!). That the ‘self-tracking culture’ (which the questionnaires on the BWW could be seen to represent) is oppressive. That employers will increasingly enforce ‘wellness contracts’ on employees (as happens to some students in the US). In life we are ill, it’s part of the programme, don’t let people make money out of this, don’t struggle against this.

As I said in my first piece, mental health is always ‘disputed territory’. The reason I included The Quiet Desperation of Life story is to underline the actuality of life’s problems. We can talk about the death of community (the left), we can talk about a dependency on the state to solve your problems (the right) – but what do we do? If mental health is seen a medical expense in Europe and North America (whether public or privately funded), how do we provide effective support to people? It may be that ‘formal’ digital support is one way of dealing with this, though no amount of digital support will help care for elderly relatives. Until robot carers become cheap and ubiquitous, that is.

Conclusion

It does make my head spin the massive change that something like BWW means. I do consider it something which is good for the ‘functioning but struggling’ element of the population. I included the ‘Quiet Desperation of Life’ as an attempt to underline this. Most people who experience despair and anxiety don’t completely fall apart (though some of us do), because they can’t (or they can, but the results would be catastrophic for those around them – food needs to be put on the table, children need to be taken to school, toilets need to be cleaned). In our culture, this ‘struggle’, for better or worse, has come to be seen as a ‘mental health’ issue. And digital solutions will increasingly be seen as part of the solution.

Though, I will state this again, when it comes to mental health solutions and diagnosis, I think ‘buyer beware’ should always be your first port of call. People meaning well doesn’t mean that the will do you good. But hey, I am a bit paranoid. There’s an app for that.

To cope or not to cope, that is the question (Just About Managing has become a social class after all). What does not coping mean? Er….that’s another thing.

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