Psychiatry 2.0 is a term that I am using to describe the application of web technology to Psychiatry. While this might seem a rather abstract exercise, the hope is that this definition can contribute to improving patient care. This first stage in establishing a definition however is a long way from achieving this aim in any systematic way. Additionally the process of arriving at such a definition runs in parallel with experiences in the real world where applications of the principles that will form part of such a future definition are already happening. This move towards a definition therefore is partly a formalisation of events that are already happening (e.g open access journals). However another part of the definition consists of structuring principles in such a way that they can form a basis for organising the available technologies in novel ways.
So what is Psychiatry 2.0 all about? To begin with, Psychiatry 2.0 is about the application of the web culture to Psychiatry. I have used the term web culture here which encompasses the interaction of people and web technology. Thus the web culture is the culture resulting from the ability of people to connect with each other, with technologies and with datasets using part of the internet referred to as the World Wide Web. The internet is a global connected network of computers which communicate using the internet protocol. The World Wide Web is part of the internet which is organised according to the principles of hypertext linking. In essence this means that you can click on a hypertext word or link with the mouse and navigate to a related page. In one sense this means the difference between typing in an IP address on the keyboard and using the mouse to get to where you want to go. Although hypertext links were a useful innovation (the formal proposal was written by Tim Berners Lee and Robert Cailliau), the initial proposal involved some technical software and hardware specifications that ensured that the concept worked. The World Wide Web is much more than a network of computers connected through hyperlinks and is accessed through web browsers and web servers.
So what is the Web Culture? This is more tricky to answer and evolves with time. As a starting point I have borrowed from the definition of Web 2.0 to begin to answer this question. Web 2.0 was a term coined at the O’Reilly Conference and described some of the ways in which people have adapted to the possibilities generated by the World Wide Web. The original Web 2.0 definition used many examples to illustrate the principles including commercial companies that had successfully utilised World Wide Web technologies. I have taken a closer look at the Web 2.0 definition in previous posts in relation to science (see Appendix 1).
Having thus far established that Web 2.0 principles can be used to generate a definition of Psychiatry 2.0, the next step is to deconstruct Psychiatry itself. In order to apply Web 2.0 principles to Psychiatry there has to be a clear understanding of what Psychiatry is. Broadly speaking Psychiatry is that branch of Medicine which is concerned with the assessment and management of people with mental illnesses. Although this seems fairly straightforward, for the purposes of the definition of Psychiatry 2.0 this has to be further deconstructed.
I would suggest therefore that Psychiatry can be divided into the theoretical and the clinical. ‘Theoretical Psychiatry’ is the broad term that I will use here to describe the theoretical underpinning of Psychiatric practice. This can be further subdivided into the body of knowledge that can directly or indirectly be applied through Clinical Psychiatry and the means to arrive at that knowledge. This knowledge itself is less than straightforward to understand. The most well known clinical Psychiatric applications – Psychotherapy and Psychopharmacology have been influenced by a diverse range of disciplines. Psychotherapy has been influenced heavily by the Humanities as well as the Sciences whilst Psychopharmacology has been significantly influenced by those Sciences including Psychology, Biochemistry, Pharmacology, Neuroanatomy, Chemistry and Physics to name just a few. Psychopathology – the study of the pathology of the inner experiences of the mind has been influenced by Philosophy, Literature and several branches of the Sciences again just to name a few. Psychiatry encompasses a broader range of considerations than discussed here but already it will be evident that the disciplines contributing to the theoretical underpinnings of Psychiatry are diverse. Practically speaking there are intuitive limits to the areas of these disciplines which are more usually considered to be immediately relevant to Psychiatry. These limits are a function of culture.
Having considered the body of knowledge that is relevant directly or indirectly to Clinical Psychiatry we can now turn to how that body of knowledge is arrived at. For each area of knowledge there are corresponding disciplines each with their own communities. I have examined one aspect of scientific communities in my review of Thomas Kuhn’s ‘The Structure of Scientific Revolutions’ as well as an ongoing interpretation of scientific revolutions (See Appendix 2). Here the application of Web 2.0 is more appropriately considered by the communities themselves although at the interface there is significant room for exploration*.
Turning to Clinical Psychiatry this is an area where there would appear to be more immediate clinical benefits for the application of Web 2.0 principles. I will deconstruct Clinical Psychiatry into the following broad categories
1. Psychiatric Technology. The application of the body of Psychiatric knowledge. Bear in mind that this knowledge base is both direct and indirect and potentially vast. Also the definition of technology here is broader than some definitions of technology which are restricted to the application of scientific knowledge .
2. Management of clinical resources. Here the term refers broadly to the management of clinical resources ranging from economic considerations through to workflow processes within the clinical setting.
3. Relationship with the patient and the public. Since it is the patient and public that are served by Psychiatry, the relationship of Psychiatrists and Psychiatry to the patient and public is a significant consideration.
4. Relation to colleagues and synergistic organisations. Psychiatrists work with a range of allied healthcare professionals, other professionals and synergistic organisations in order to deliver clinical care. This again is an area for consideration.
5. Knowledge transfer into the domain of Clinical Psychiatry. This covers a range of processes which ensure that knowledge transfer occurs at both the level of the individual and the community. This includes the conversion from knowledge to technology.
6. Evaluation and improvement of the application of Psychiatric Technology. In order to maximise the benefits from the application of Psychiatric Technology, the application needs to be governed by mechanisms which ensure an improvement in clinical outcomes and clinical processes.
The coverage of all of these areas provides a clear overview of this initial definition of Psychiatry 2.0. I would add just one further point which is the issue of licensing. Whilst debate can be stifled by issues around trademarking, I would consider Psychiatry 2.0 to be a public domain concept rather than a trademarked concept. The aim here is to facilitate discussion and collaboration, to ensure debate is not stifled. The potential for the Psychiatry 2.0 debate is too significant for it to be diverted by future trademark assertions and so at this early stage I make a claim through this detailed definition for Psychiatry 2.0 for the term to remain in the public domain. Although this may appear to be a curious point to make, Trademark cases have been made for other such terms including Web 2.0.
*In this area, it is entirely possible that languages can be developed to facilitate the traversing of these boundaries.
Appendix 1 – Science 4.0 Articles on the TAWOP Site
Appendix 2 – Discussion of Thomas Kuhn on the TAWOP Site
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