5 ms·

New cognitive science tool to shed light on mental health

69 points by rglover 4y ago

alexfromapex 4y ago
As "cool" as this is, providing actual healthcare for the veterans would be a much better step than creating a tool to flag people with mental health issues.
- rafaelero 4y ago
  Why do you believe they don't already have access to healthcare?
bjtitus 4y ago
Wonder how long it will take until people are being put on mental health holds based on this data.
bannedbybros 4y ago
elil17 4y ago
Contrary to many people's expectations, the most typical profile of someone who kills themselves is a 33 to 44 year old man who presents no warning signs and leaves no note. This is a tool that could be extremely helpful for addressing a large portion of suicides. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777349/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777349/ https://www.health.harvard.edu/blog/suicide-often-not-preceded-by-warnings-201209245331 https://www.health.harvard.edu/blog/suicide-often-not-preced... https://www.medpagetoday.com/meetingcoverage/cap/82375 https://www.medpagetoday.com/meetingcoverage/cap/82375
- deleted 4y ago
  [deleted]
- 90d 4y ago
  The road to hell [...] good intentions.
  - elil17 4y ago
    I see other people in the comments saying that this might be used to limit people's rights. I don't view that as a good reason to not pursue this research. We have existing legal frameworks for ensuring people's rights are protected. Doctors can't just kidnap someone, courts are involved. In many cases those rights and protections should be strengthened. The fact that those protections and frameworks aren't perfect shouldn't stop doctors and medical researchers from doing their job, which is to treat patients.
    - akira2501 4y ago
      I'd be fine with this being developed in a civilian clinical setting. I am not fine with the military developing this and then considering it's use on service members. Particularly troubling are the lines "since patients will often tell their clinicians what they think the clinician wants to hear rather than how they are truly feeling" and "on aggregating preconscious brain signals to determine what someone believes to be true." They see an issue with a voluntary clinical process and they want to remove the voluntary aspect of it. To me, it seems they are interfering with a process failure they haven't categorized correctly and are attempting to remove the patient from their own process of care. If the intention is to use this on service members without their explicit request, this presents one of the slipperiest slopes I've ever seen.
      - giantg2 4y ago
        "I am not fine with the military developing this and then considering it's use on service members." This. The rights and protections you have in the military, as well as the military judicial system, are vastly different from the civilian world. I have very little confidence in even the civilian side (so many abuses and so much incompetence).
      - elil17 4y ago
- derbOac 4y ago
  My impression (I do research in this area broadly speaking) is that this sort of tool is not really very strongly related to the reasons why they present no warning signs, etc. Implicit measures tend, on replication and rigorous scrutiny, to kind of be very broad brush and not very specific. There is a literature on implicit measurement and suicide, and it seems they hold up, but they don't dramatically add to anything, and there's also tricky issues about the meaning of "preconscious" assessment. So, lots of false positives etc, and also maybe even bigger questions about the meaning of implicit processing relative to conscious opportunities for "revision". I think the problem is, what good does it do if someone has some predilection toward suicide but isn't aware of it? If they were going to be resistant to addressing it without this tool, why would they be less resistant to it with it? The problem with suicide prediction has never really been in predicting suicidal attitudes or cognitions, it's been predicting the actual follow-through with an attempt or success. That depends on a lot of stuff that exists outside of attitudinal space, for lack of a better way of putting it. Someone can basically feel disturbed by the idea until they don't, and then change rapidly in their feelings about it, or vice-versa. I can't say I think this research line is a bad idea; I think the more information the better. But I'm really skeptical about how well it will work up when really skeptically evaluated, with lots of data, especially when you put it to practice. There's a lot more hurdles than people think.
  - djexjms 4y ago
    Even if it turns out not to be the perfect solution, it might turn out that this kind of measurement might be useful for things like estimating the effectiveness of medication and other medical interventions, or even lifestyle changes. Imagine if this kind of thing could be turned into a medical device. Many people who end up committing suicide have had previous suicidal episodes. Being able to have a technology that people with known suicidal tendencies can use to help keep tabs on their own mental health could potentially be as useful to them as blood sugar monitoring is to diabetics.
  - godelski 4y ago
    > I think the problem is, what good does it do if someone has some predilection toward suicide but isn't aware of it? If they were going to be resistant to addressing it without this tool, why would they be less resistant to it with it? (Not a researcher in this area, but someone who's dealt with depression) this is a big concern of mine, and it doesn't seem different from the issues with a standard lie detector. A depressed person can feel fine one day and not the next. If we think of things like anhedonia, grief, guilt, etc they aren't constant day to day. A lot of suicides are preventable simply by getting a person through a day or two. This is the number one reason I'd argue for waiting periods on pistols (most gun deaths are suicides btw). Would such an event even show up on this device? Timing becomes an extremely important factor here. My understanding too is that we still don't even know how these diseases function from a chemical level in the brain (norepinephrine, dopamine, and serotonin). Categorically there can be: too much, not enough, broken uptake mechanism; and our main treatments are with reuptake inhibitors (SSRIs or SSNRIs) and these tools are really limited in those categories (which are very high level fwiw and need to be broken down substantially more to target good drug delivery). I am also very concerned about how this technology can be abused. While I agree that there can be a lot of uses to it, that doesn't mean we shouldn't be concerned with how it can be abused.
- smeeth 4y ago
  You and I seem to have different definitions of "warning signs." From the medpagetoday story you linked: - 239/657 suicides were people under psychiatric care (please note they used present tense, more of them might have had a history of care) - 187/657 had a previous attempt (!!!) - "About 22% of the deaths were accompanied by no known inciting event or identified life stressor" Phrased differently, 78% of suicides accompanied a life event or stressor. Contrary to popular belief, risk prediction isn't usually rocket science. Suicide correlates are extremely well studied, and any experienced mental health professional can point high risk individuals out to you if they ever cross paths with one. The most challenging problem often is: what do you do about it? Can you get them the help they need? Can you navigate them through a big bureaucracy like the VA? Do you have grounds to forcibly keep them in in-patient psychiatry? Etc, etc. Source: Relative is a psychologist @ the VA.
  - s1artibartfast 4y ago
    I think you are overstating the predictive power. You can find strong correlations looking backwards, but that doesn't mean that they are good or strong predictors looking forward. To take just one of your data points as an example, 78% of suicides were preceded by a stressor. If you flip it to make a prediction, what percentage of Life stressors lead to suicide? The number of people who experience major life stressors must be enormous. If tens or hundreds of millions people have major stressors a year, that doesn't help you very much in targeting limited services . The same holds true for psychiatric care. Prior suicide attempt is probably the exception there, but even that int ~30% predictive power looking foward.
    - smeeth 4y ago
      You're missing that the models (including mental models) that professionals use to predict suicidality are not univariate. When a manic depressive with substance abuse issues and prior suicide attempts walks into a clinic nobody needs a "new cognitive science tool" to tell them if they're high suicide risk, and these cases are a larger proportion of suicides than most people think. Also that sort of missed the point of my comment, which is perhaps my fault for not being clear enough. Preventing suicide is a two step process: 1) find high risk people 2) prevent their suicide attempts My comment was simply relaying the POV of someone who does this professionally: as a society we are better than most people think at #1 and worse than most people think at #2.
cphoover 4y ago
How about we fix the existing support systems. Popular media constantly exalts things like the suicide hotline/chat, or mental health services. But those services often don't even work when people need them, they are either unavailable (where people are put on hold indefinitely) or the applications and websites have bugs that make them totally unusable. Also the way healthcare is tied to employment in the US is a huge health risk for anyone changing jobs or at risk of termination.
- barbazoo 4y ago
  > How about we fix the existing support systems. From the article > Using the preconscious will hopefully enable us to detect signs of depression, anxiety, or suicidal ideation earlier and more reliably than ever before. If successful, NEAT will not only significantly augment behavioral health screening, but it could also serve as a new way to assess ultimate treatment efficacy, since patients will often tell their clinicians what they think the clinician wants to hear rather than how they are truly feeling. Wouldn't this count as an attempt to fix the existing support system by helping identify those in need which is always the first step?
  - deleted 4y ago
    [deleted]
- deleted 4y ago
  [deleted]
jessegavin 4y ago
> NEAT is not focused on lie detection, truth detection, or assessing someone’s credibility but, rather, on aggregating preconscious brain signals to determine what someone believes to be true. How is this NOT a lie detector? This would definitely be useful when interrogating someone right?
- rglover 4y ago
  Yes. It's a "mind reader" and it would be granted blind trust/authority by whoever relies on it like all other technology ("but NEAT says you want to kill yourself, Jerry."). I view this as a weapon, not a benevolent tool for helping veterans.
boredumb 4y ago
This will most certainly be used to limit US citizens access to their second amendment. The unseen use cases for this will be equally horrifying. DARPA creating a precrime detection tool is about as dystopic as is gets.
- djexjms 4y ago
  That one take on it. The other is that it could potentially save literally tens of thousands of lives. Immediately classifying a potentially life-saving medical technology is a threat to the second amendment might not be the best look for 2A advocates.
  - giantg2 4y ago
    People make assumptions about new policy based on their experience or knowledge on previous policy. This tool could be lifesaving. This tool could also be for oppression. It's valid to question the potentially harmful uses of any medical tool and the policy that surrounds them (see opioids as an example).
- deleted 4y ago
  [deleted]
- nbaugh1 4y ago
  We could use a little more restriction on access to weapons in this country tbh
- thinkmcfly 4y ago
  What is the precrime tool you're talking about?
snapcaster 4y ago
This is really worrying, hopeful it doesn't work and this research fails
- adventured 4y ago
  If the research actually works, they'll pretend it failed and it'll vanish.
armatav 4y ago
What about one that uses the preconscious to detect criminal intent before it happens? Could file it into a sort of very small report
kayodelycaon 4y ago
So, they created what they think is a better lie detector. Even if they claim otherwise, it will get used for this purpose. And it will get used against people as much as possible. The temptation is just too high. We're see this happen with polygraph tests. To the point where it was being used in job interviews. The only hope I see here is US courts treating it as a polygraph device and effectively banning it from common use.
rafaelero 4y ago
This is so obviously how things should be done in psychiatry. These types of disease most certainly have some signals that can be collected and interpreted by an AI to offer a diagnosis. No idea why it is taking so long.
NumberlessMan 4y ago
If you think this is a good idea, [I think] you need to understand the discipline of psychiatry better. My impression is that anything about you that is non-functional to you as a rational, self-interested agent in the world is a disorder, example [1]. Read about how they characterize delusions [2]. Essentially, if you don't preface everything you say with the words "I think", you are deluded. It's an interesting field, but [I think] it's dangerous to put too much power in the hands of this field. [I think] it blunts a lot of normal humanity. [I think] having suicidal thoughts is a normal part of an open-minded human life. [I think] going through a very bad near suicidal crises should be able to happen without the state labeling you in a fashion that can absolutely ruin your life should you decide to return to it. [I think] allowing people the privacy of their own minds is an essential human freedom, that we abandon at our peril. In addition [I think] forcing people to state "I think" at the beginning of every sentence they say is a way to limit their persuasive power. Which is an interesting norm, but [I think] it needs to be universally applied as otherwise [I think] it can be used as a way to detooth opposition to authority. That said, I wish all people tormented by their own minds the best possible future. I think therapy can help, as can reaching out to people who love you, if you have any in your life. But I think if you don't want to tell your therapist about your suicidal tendancies because you're worried about how a nervous bureaucracy will respond, I think that's your right. Involuntary psychiatric care is no picnic. Having your freedoms taken away from you because of things you said, and finding you can't find the right sequence of magic words to leave is about as frustrating a position as a person can be in. What you might view as a serious bump in the road is viewed from the outside as a whole new social trajectory for you. The people I met in there told me everything would get better once I just accepted I would never leave. That this was my life now. To stay calm, I did have to imagine a life where I never left, and figure out a way to be okay with that. It's a very hard mental exercise if you've ever wanted good things for your own life, and it doesn't surprise me not everyone can manage it without acting out. [1] https://en.wikipedia.org/wiki/Scrupulosity https://en.wikipedia.org/wiki/Scrupulosity [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/

69 points by rglover 4y ago

As "cool" as this is, providing actual healthcare for the veterans would be a much better step than creating a tool to flag people with mental health issues.

rafaelero 4y ago
Why do you believe they don't already have access to healthcare?

bjtitus 4y ago

Wonder how long it will take until people are being put on mental health holds based on this data.

bannedbybros 4y ago

elil17 4y ago

Contrary to many people's expectations, the most typical profile of someone who kills themselves is a 33 to 44 year old man who presents no warning signs and leaves no note. This is a tool that could be extremely helpful for addressing a large portion of suicides. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777349/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777349/ https://www.health.harvard.edu/blog/suicide-often-not-preceded-by-warnings-201209245331 https://www.health.harvard.edu/blog/suicide-often-not-preced... https://www.medpagetoday.com/meetingcoverage/cap/82375 https://www.medpagetoday.com/meetingcoverage/cap/82375

deleted 4y ago
[deleted]
90d 4y ago
The road to hell [...] good intentions.
- elil17 4y ago
  I see other people in the comments saying that this might be used to limit people's rights. I don't view that as a good reason to not pursue this research. We have existing legal frameworks for ensuring people's rights are protected. Doctors can't just kidnap someone, courts are involved. In many cases those rights and protections should be strengthened. The fact that those protections and frameworks aren't perfect shouldn't stop doctors and medical researchers from doing their job, which is to treat patients.
  - akira2501 4y ago
    I'd be fine with this being developed in a civilian clinical setting. I am not fine with the military developing this and then considering it's use on service members. Particularly troubling are the lines "since patients will often tell their clinicians what they think the clinician wants to hear rather than how they are truly feeling" and "on aggregating preconscious brain signals to determine what someone believes to be true." They see an issue with a voluntary clinical process and they want to remove the voluntary aspect of it. To me, it seems they are interfering with a process failure they haven't categorized correctly and are attempting to remove the patient from their own process of care. If the intention is to use this on service members without their explicit request, this presents one of the slipperiest slopes I've ever seen.
    - giantg2 4y ago
      "I am not fine with the military developing this and then considering it's use on service members." This. The rights and protections you have in the military, as well as the military judicial system, are vastly different from the civilian world. I have very little confidence in even the civilian side (so many abuses and so much incompetence).
    - elil17 4y ago
derbOac 4y ago
My impression (I do research in this area broadly speaking) is that this sort of tool is not really very strongly related to the reasons why they present no warning signs, etc. Implicit measures tend, on replication and rigorous scrutiny, to kind of be very broad brush and not very specific. There is a literature on implicit measurement and suicide, and it seems they hold up, but they don't dramatically add to anything, and there's also tricky issues about the meaning of "preconscious" assessment. So, lots of false positives etc, and also maybe even bigger questions about the meaning of implicit processing relative to conscious opportunities for "revision". I think the problem is, what good does it do if someone has some predilection toward suicide but isn't aware of it? If they were going to be resistant to addressing it without this tool, why would they be less resistant to it with it? The problem with suicide prediction has never really been in predicting suicidal attitudes or cognitions, it's been predicting the actual follow-through with an attempt or success. That depends on a lot of stuff that exists outside of attitudinal space, for lack of a better way of putting it. Someone can basically feel disturbed by the idea until they don't, and then change rapidly in their feelings about it, or vice-versa. I can't say I think this research line is a bad idea; I think the more information the better. But I'm really skeptical about how well it will work up when really skeptically evaluated, with lots of data, especially when you put it to practice. There's a lot more hurdles than people think.
- djexjms 4y ago
  Even if it turns out not to be the perfect solution, it might turn out that this kind of measurement might be useful for things like estimating the effectiveness of medication and other medical interventions, or even lifestyle changes. Imagine if this kind of thing could be turned into a medical device. Many people who end up committing suicide have had previous suicidal episodes. Being able to have a technology that people with known suicidal tendencies can use to help keep tabs on their own mental health could potentially be as useful to them as blood sugar monitoring is to diabetics.
- godelski 4y ago
  > I think the problem is, what good does it do if someone has some predilection toward suicide but isn't aware of it? If they were going to be resistant to addressing it without this tool, why would they be less resistant to it with it? (Not a researcher in this area, but someone who's dealt with depression) this is a big concern of mine, and it doesn't seem different from the issues with a standard lie detector. A depressed person can feel fine one day and not the next. If we think of things like anhedonia, grief, guilt, etc they aren't constant day to day. A lot of suicides are preventable simply by getting a person through a day or two. This is the number one reason I'd argue for waiting periods on pistols (most gun deaths are suicides btw). Would such an event even show up on this device? Timing becomes an extremely important factor here. My understanding too is that we still don't even know how these diseases function from a chemical level in the brain (norepinephrine, dopamine, and serotonin). Categorically there can be: too much, not enough, broken uptake mechanism; and our main treatments are with reuptake inhibitors (SSRIs or SSNRIs) and these tools are really limited in those categories (which are very high level fwiw and need to be broken down substantially more to target good drug delivery). I am also very concerned about how this technology can be abused. While I agree that there can be a lot of uses to it, that doesn't mean we shouldn't be concerned with how it can be abused.
smeeth 4y ago
You and I seem to have different definitions of "warning signs." From the medpagetoday story you linked: - 239/657 suicides were people under psychiatric care (please note they used present tense, more of them might have had a history of care) - 187/657 had a previous attempt (!!!) - "About 22% of the deaths were accompanied by no known inciting event or identified life stressor" Phrased differently, 78% of suicides accompanied a life event or stressor. Contrary to popular belief, risk prediction isn't usually rocket science. Suicide correlates are extremely well studied, and any experienced mental health professional can point high risk individuals out to you if they ever cross paths with one. The most challenging problem often is: what do you do about it? Can you get them the help they need? Can you navigate them through a big bureaucracy like the VA? Do you have grounds to forcibly keep them in in-patient psychiatry? Etc, etc. Source: Relative is a psychologist @ the VA.
- s1artibartfast 4y ago
  I think you are overstating the predictive power. You can find strong correlations looking backwards, but that doesn't mean that they are good or strong predictors looking forward. To take just one of your data points as an example, 78% of suicides were preceded by a stressor. If you flip it to make a prediction, what percentage of Life stressors lead to suicide? The number of people who experience major life stressors must be enormous. If tens or hundreds of millions people have major stressors a year, that doesn't help you very much in targeting limited services . The same holds true for psychiatric care. Prior suicide attempt is probably the exception there, but even that int ~30% predictive power looking foward.
  - smeeth 4y ago
    You're missing that the models (including mental models) that professionals use to predict suicidality are not univariate. When a manic depressive with substance abuse issues and prior suicide attempts walks into a clinic nobody needs a "new cognitive science tool" to tell them if they're high suicide risk, and these cases are a larger proportion of suicides than most people think. Also that sort of missed the point of my comment, which is perhaps my fault for not being clear enough. Preventing suicide is a two step process: 1) find high risk people 2) prevent their suicide attempts My comment was simply relaying the POV of someone who does this professionally: as a society we are better than most people think at #1 and worse than most people think at #2.

cphoover 4y ago

How about we fix the existing support systems. Popular media constantly exalts things like the suicide hotline/chat, or mental health services. But those services often don't even work when people need them, they are either unavailable (where people are put on hold indefinitely) or the applications and websites have bugs that make them totally unusable. Also the way healthcare is tied to employment in the US is a huge health risk for anyone changing jobs or at risk of termination.

barbazoo 4y ago
> How about we fix the existing support systems. From the article > Using the preconscious will hopefully enable us to detect signs of depression, anxiety, or suicidal ideation earlier and more reliably than ever before. If successful, NEAT will not only significantly augment behavioral health screening, but it could also serve as a new way to assess ultimate treatment efficacy, since patients will often tell their clinicians what they think the clinician wants to hear rather than how they are truly feeling. Wouldn't this count as an attempt to fix the existing support system by helping identify those in need which is always the first step?
- deleted 4y ago
  [deleted]
deleted 4y ago
[deleted]

jessegavin 4y ago

> NEAT is not focused on lie detection, truth detection, or assessing someone’s credibility but, rather, on aggregating preconscious brain signals to determine what someone believes to be true. How is this NOT a lie detector? This would definitely be useful when interrogating someone right?

rglover 4y ago
Yes. It's a "mind reader" and it would be granted blind trust/authority by whoever relies on it like all other technology ("but NEAT says you want to kill yourself, Jerry."). I view this as a weapon, not a benevolent tool for helping veterans.

boredumb 4y ago

This will most certainly be used to limit US citizens access to their second amendment. The unseen use cases for this will be equally horrifying. DARPA creating a precrime detection tool is about as dystopic as is gets.

djexjms 4y ago
That one take on it. The other is that it could potentially save literally tens of thousands of lives. Immediately classifying a potentially life-saving medical technology is a threat to the second amendment might not be the best look for 2A advocates.
- giantg2 4y ago
  People make assumptions about new policy based on their experience or knowledge on previous policy. This tool could be lifesaving. This tool could also be for oppression. It's valid to question the potentially harmful uses of any medical tool and the policy that surrounds them (see opioids as an example).
deleted 4y ago
[deleted]
nbaugh1 4y ago
We could use a little more restriction on access to weapons in this country tbh
thinkmcfly 4y ago
What is the precrime tool you're talking about?

snapcaster 4y ago

This is really worrying, hopeful it doesn't work and this research fails

adventured 4y ago
If the research actually works, they'll pretend it failed and it'll vanish.

armatav 4y ago

What about one that uses the preconscious to detect criminal intent before it happens? Could file it into a sort of very small report

kayodelycaon 4y ago

So, they created what they think is a better lie detector. Even if they claim otherwise, it will get used for this purpose. And it will get used against people as much as possible. The temptation is just too high. We're see this happen with polygraph tests. To the point where it was being used in job interviews. The only hope I see here is US courts treating it as a polygraph device and effectively banning it from common use.

rafaelero 4y ago

This is so obviously how things should be done in psychiatry. These types of disease most certainly have some signals that can be collected and interpreted by an AI to offer a diagnosis. No idea why it is taking so long.

NumberlessMan 4y ago

If you think this is a good idea, [I think] you need to understand the discipline of psychiatry better. My impression is that anything about you that is non-functional to you as a rational, self-interested agent in the world is a disorder, example [1]. Read about how they characterize delusions [2]. Essentially, if you don't preface everything you say with the words "I think", you are deluded. It's an interesting field, but [I think] it's dangerous to put too much power in the hands of this field. [I think] it blunts a lot of normal humanity. [I think] having suicidal thoughts is a normal part of an open-minded human life. [I think] going through a very bad near suicidal crises should be able to happen without the state labeling you in a fashion that can absolutely ruin your life should you decide to return to it. [I think] allowing people the privacy of their own minds is an essential human freedom, that we abandon at our peril. In addition [I think] forcing people to state "I think" at the beginning of every sentence they say is a way to limit their persuasive power. Which is an interesting norm, but [I think] it needs to be universally applied as otherwise [I think] it can be used as a way to detooth opposition to authority. That said, I wish all people tormented by their own minds the best possible future. I think therapy can help, as can reaching out to people who love you, if you have any in your life. But I think if you don't want to tell your therapist about your suicidal tendancies because you're worried about how a nervous bureaucracy will respond, I think that's your right. Involuntary psychiatric care is no picnic. Having your freedoms taken away from you because of things you said, and finding you can't find the right sequence of magic words to leave is about as frustrating a position as a person can be in. What you might view as a serious bump in the road is viewed from the outside as a whole new social trajectory for you. The people I met in there told me everything would get better once I just accepted I would never leave. That this was my life now. To stay calm, I did have to imagine a life where I never left, and figure out a way to be okay with that. It's a very hard mental exercise if you've ever wanted good things for your own life, and it doesn't surprise me not everyone can manage it without acting out. [1] https://en.wikipedia.org/wiki/Scrupulosity https://en.wikipedia.org/wiki/Scrupulosity [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/