Share: A System for Use in Mental Healthcare
August 8, 2003
Share is a prototype of an application designed for sharing emotional input and output between patient and doctor for use in the mental healthcare community.
Overview of Share
Share is a hypothetical application for use in the mental healthcare industry. It is a tool intended for psychiatrists, psychologists, therapists, and counselors in order to measure and recall patient emotion over time. Patient emotion is entered via a daily or semi-weekly post (similar to a journal or online blog). Share contains an optional community component to allow patients to interact with others in similar situations, as well as the ability for doctors to collaborate with other professionals in their area of interest. Share is intended for use primarily between patient and doctor, so security and privacy are top priority. The community component allows members to share information with a select group of people only.
Introduction
Understanding human emotion appears to be the Holy Grail for many contemporary psychologists, product designers, and marketers. By understanding the emotions of another person, we can learn to better communicate with them, and discover what makes them “tick”. Unfortunately, the human mind is complex enough to result in very few instances of total understanding; therefore we rely on everyday communication to express ourselves using the tools we’ve gathered throughout our lives. Anyone who has ever asked another person about their feelings knows that methods of communication vary widely between different people. Children, it seems, have a clear way communicating feelings, though asking them how they feel can often lead to a look of puzzlement. The same can be true for adults at times, but as experiences build our emotional histories, we slowly begin to uncover our own emotional toolkit – that is, the methods each of us has to understand, and communicate our feelings to one another.
What about those of us who have trouble deciding how we feel? There is no “truth serum” to make us undoubtedly aware of our emotions, or magic beans to make us open up (though some might argue that alcohol works to some degree). This essay attempts to offer an emotional aid in the form of a tool for communicating and understanding the emotions of one another. It is an application designed to promote emotional intelligence between patients and doctors. While the idea may provide a potentially new platform to study and treat patients with mental illnesses, it can perhaps reach beyond this demographic… but not without consequence. As with many computer applications, there is Good, and there is Evil....
Avenues of research on emotion & interfaces.
Emotion is a hot topic in the field of Human Computer Interaction today. At first, it might seem that emotion is a privilege of those organisms that think and breathe. Not true says current research. Product Designers have long been obsessed with creating breakthrough products that not only solicit specific emotions from people, but that elicit emotions themselves. That’s right. Inanimate objects that smile, laugh, breathe, and dance. But before heading too far down that path, it should be stated that the emotions written about for the purpose of this essay, come strictly from humans, not products. It is important to make that distinction as we continue to look further into these methods of researching emotion, for some of the methods of measuring emotion in products and people are similar, but the contexts of their use is different. Emotion and Design can be seen from three different perspectives:
A. Human response to products.
Don Norman is a usability guru whose recent essay on Emotion and Design has made designers in the HCI community a happy lot. His approach argues, “Attractive things work better.” Norman suggests that by using products that are a balance of prettiness and usefulness, users have the ability to be affected in a positive manner. In addition he says, “True beauty in a product has to be more than skin deep, more than a façade. To be truly beautiful, wondrous, and pleasurable, the product has to fulfill a useful function, work well, and be usable and understandable”. Looking at how emotion factors into this he begins his essay by saying that, “Advances in our understanding of emotion and affect have implications for the science of design. Affect changes the operating parameters of cognition: positive affect enhances creative, breadth-first thinking whereas negative affect focuses cognition, enhancing depth-first processing and minimizing distractions.” Pieter Desmet of Delft University in The Netherlands has written extensively about his research on emotion and product design in his book, “Designing Emotions”. Desmet has investigated consumer reaction to dozens of products and developed the “Product & Emotion Navigator” as a result. To summarize, the Norman and Desmet perspectives consider the human emotional response to products.
B. Products with emotion & personas.
While Norman alludes to the idea that the products themselves are eliciting emotions through their design, it seems appropriate to consider this as a separate initiative here. That is, the products are capable of emitting emotion-like states, with or without a human present. Consider the idea of a car that appears to be smiling, or a toaster that says, “Good Morning”. These products seem to have personalities of their own and continue to inspire designers to reach a balance of use and pleasure in their work. On a similar level to products with personas, are electronic books with segments that can be broken down by emotion. Consider the book, “Little Red Riding Hood”. A group at the MIT Media Lab has studied how to visualize the affective structure of a document such that readers can navigate to the “scary part” or to the “sad part” etc. We know that books themselves do not emote, but the words on the page describe certain moods or emotions that many readers recognize. This can be communicated, visually, by use of color for example. These two examples, while not completely parallel, can be considered aspects of emotion and design that does not deal with human emotion by itself.
C. Measuring human emotion.
The third avenue of research involves the idea of measuring human emotion by itself. This is a complex task in that it requires users to identify emotions they feel, and registering them using some method of measurement. While it may be difficult to pinpoint exact emotions in people, there are a few tools that allow us to communicate moods and expressions. In the physical world, for example, we can simply look at another person’s face, or listen to his or her voice, or just ask them directly. The Gaming industry has recently found that biomedical feedback can be used to measure emotion. However, more often than not in the digital world, the senses are a luxury, but technology has given us a palette of sorts to choose from that can often communicate our feelings somewhat accurately. We use spur-of-the-moment tools such as emoticons in instant messaging applications, or by choosing an avatar based on how we feel. These tools are optimal for a conversation that occurs in the present, but what happens if we ask people to register their emotions over time? What methods would they use and what would it look like in terms of output?
Emotion measurement and online communities.
There are literally thousands of thriving virtual communities. Members of these communities are provided with the opportunity to share information or comment on their mutual interest of specific topics. The most sustainable communities provide members with a reason to come back. When members provide one another with an emotional infrastructure in which to provide virtual support for one another, the end result can be positive and often impossible to substitute. Most virtual communities today contain tools for expression to allow members to communicate freely about their feelings. This can have potentially damaging results alongside the obvious positive ones. The following scenarios look at what one system might produce in terms of results when emotion measurement is investigated.
A. User scenarios.
Intended Use: Elena is a psychiatrist who uses a private online forum to communicate with her patients. Her patients log journal entries, similar to a blog that only designated users may read. Her patients are encouraged to enter their emotional state by using features to record what they are feeling, in addition to standard text. After a month or so of logging entries, Elena searches by patient to view emotional state over time, and is shown a graph of that user’s emotional history. Elena prints the graph and discusses it with her patient in order to decide the best course of action to take.
Use for “Good”: Elena has been desperately trying to help her patient, Sarah, regulate her medication due to her default chemical imbalance. Elena has been studying Sarah’s moods and emotions over a five-month period until she eventually notices a pattern in Sarah that alternates every other month. Elena changes the recommended dosage based on these patterns and Sarah begins to improve tremendously within 60 days.
Unintended Use: Elena is a Psychiatrist who uses a private online forum to communicate with her patients. Ralph is a patient who suffers from depression. Ralph has recently been feeling a sense of hopelessness regarding his improvement and begins posting entries reflecting 90% positive emotional input as a way to avoid dealing with the truth. Elena logs in to collect Ralph’s emotional history for the month, and finds, to her surprise, that his posts are positive or (happy). Elena feels Ralph might be improving, until his next appointment, where he reveals the truth.
Use for “Evil”. Elena develops a mad crush on a patient that suffers from depression. One evening, Elena finds herself searching the forum for date ranges that might reveal a pattern of emotion showing when her patient is most lonely, and down. Within a few weeks, she has rescheduled her appointments with this patient to coincide with these dates, and begins making sexual advances during the appointment in hopes of winning the patient’s affection.
Methods of visualization.
Visualizing emotion, similar to other types of data, is best presented based on the intention of the viewer, and his or her goals. Depending on the priorities of the viewer, different information can potentially be visible, but which graphical method is the most appropriate? The answer is that, it depends. While some users have the time and the ability to read complex diagrams containing three dimensional graphics and 3 or more axis’ of information, the average viewer wants a quick view of the information in order to “get it” as quickly as possible. Perhaps it is ideal to allow users to decide for themselves which view is most suited for them by selecting the default view or the “advanced view”? In deciding the appropriate visual method of communicating emotional history of an individual, there are a few simple methods that get the job done, quickly and easily such as bar charts or pie charts.
A. Overview of application features for Share.
Share contains tools for doctors and patients to communicate. The doctor’s area of the application contains access to a database of his/her patients, messages to and from his/her patients, research, community and other doctors. The patient’s area contains messages, an online journal, ability to view their own history, send messages and see their doctors notes on their prescriptions. The following diagram below is a more detailed look at the application sitemap.
1.Patient Search: Search is the quickest way for a doctor to view her patient’s emotional histories and information. The doctor chooses the first and last name of the patient, and has other search criteria to choose from, such as a group name, date range, key words, and a sort option. The results are shown in a list format and allow the doctor to view specific journal entries and navigate directly to them, or simply to view their emotional histories.
2.View History. Once the doctor searches on a patient’s name, and selects the name from the results list, the doctor can view the patient’s emotional history by looking at several views, depending on the time frame and level of detail. By default, the date range specified in the search is represented by a monthly emotion that was the “most frequently recorded emotion” for that month. Detailed views of each monthly view of all recorded emotions can be selected, all the way down to the individual daily posts.
3.Toggled View: Allowing the doctor to adjust his or her view of the information provides options for those with less or more time to read the fine detail. The default view contains a simple bar chart while the pie chart shows more information in less space. Doctors may also navigate to all three views.
4.Patient Input. Patients are the key to populating the application with information. Posting is similar to an online discussion forum with the exception that the information is kept between patient and the doctor, unless otherwise specified. The tools available to record the patient’s emotional state include, text, color, and the selection of an animoticon, or a small, animated figure that represents the emotion, gesture, and sound, that most closely matches what they are feeling. For the purpose of this prototype, I have chosen to represent the idea of the animoticon using the research of Mr. Pieter Desmet for his work on PrEmo, a tool developed in The Netherlands for measuring emotional reaction to products.
Problems with Share.
Share has the potential to solve some immediate issues involving the need for patients and doctors to better understand emotion and emotional disorders. This prototype is perhaps an oversimplification of its usage, but the intent is to provide a platform for thinking ahead in terms of what is possible with current web application technology. Probably the single most important issue is the fact that measuring emotion can be considered a moving target in that our emotions and moods change frequently, and we might change moods more than once or twice, in any given day. Another potential problem is that humans are not exact creatures. We might fib unintentionally when it comes to telling someone how we feel because we may not recognize our feelings until it is well “after the fact”. Additionally, accuracy of information is hard to measure because there is no wrong answer in these systems. If there is a user error because of an interface issue, then it would be hard to detect without a professional usability study. These are just a few of the issues Share might present, but its intent is to aid in the communication between doctor and patient, not replace it. If doctors have information on a patient between sessions, they could perhaps be better prepared to help, and offer solutions based on information that might not be easy for the patient to reveal in person.
Future Research.
It would be valuable to consider the option of using agents to “learn” the behavior of users before registering a permanent emotion to certain posts using this prototype. In some cases, one person might tend to use the color red to associate with the feeling of being happy, where as the default color key in Share specifies red as angry. Predicting user behavior is difficult and it would be worth noting what users do, over a specified period of time, before deciding on which system of colors and emotions belong to one another. This would present an issue for the doctor if they use a different color system, but it is not impossible to provide software that translates the information before it reaches their desktop or laptop.
A. Cultural differences.
It is difficult to visually represent a universal emotion among people of different cultures, as psychologists who study facial expressions have noted. Consider the fact that individual facial expressions differ from person to person, for the same expression. Additionally, as noted above, color can vary from person to person. We have come to accept a certain level of universal colors, for example, anger insinuates, “seeing red” etc. This however, changes from culture to culture for certain feelings. Language is an obvious difference, and slang, or certain expressive phrases have a different meaning when translated. A system such as Share would need to accommodate this by allowing administrators of the system to change certain key phrases. One Seattle message board company, Infopop, has allowed for this using .XML chunks or “wordlets” that allow administrators to customize in the system. This form of localization is the key to crossing cultural boundaries. This is not a cure-all, however in that some communities will undoubtedly contain members from around the world. At that point, perhaps the answer lies in client-based translation technology, where each individual computer, not the server, satisfies the localization requirements.
Trust & Privacy
As in any personal relationship, trust is a key component to its defining success. The same can be said for an application that facilitates the sharing of emotion from patient to doctor. While we can assume that the information being shared is protected under the same law that protects the patient and doctor exchange, the application that accommodates this exchange is subject to mistrust. “In the online world, a web site that looks very professional may also appear to be trustworthy, even if we do not know anything else about it. Clearly there are ways of changing perceptions about trust when our later experiences conflict with our first impressions.“ It is critical that patient and doctor develop an in-person relationship before the system becomes trustworthy enough to sustain and encourage future growth. A key component of trust and privacy lies in what is ultimately done with the personal information the patient enters in Share, or similar applications. The same can be said of any online community. If the discussions on a message board or in a virtual world are exploited in some way, or bring any kind of physical or emotional harm the original user, then any form of trust in the system (and its other users) is broken. The online world, and its physical counterpart are full of “bozos” and “grievers”. It is up to the system designers, policy makers, and end users to work in parallel to constantly develop improvements to the user experience that provide protection that results and trust and privacy. Without this collaboration and cooperation, a system that relies on the exchange of personal information is likely to fail long-term.
Concluding thoughts.
Emotional intelligence is a touchy, scary issue when building it into software, but no more scary than building it in humans. The risk exists in both worlds, equally. It could be argued that people are more threatening. As Science and Technology continue to strive to build a stronger relationship with its end-users, designers, developers and policy-makers have a continuous challenge. The cycle of use of these systems can be fascinating, as users sway to-and-fro among the treetops of acceptable use and the (one time) pure joy of email becomes the agony of SPAM. The most frightening aspect of emotion is vulnerability when it is being shared. Sharing it with another person by way of a software application is not second nature; and while risk management and technology is maturing, so must we. After all, growing pains are part of reaching full potential.
References
D. Norman. Emotion and Design. Attractive things work better. Interactions Magazine, ix (4) 36-42.
P. Desmet. Designing Emotions. ISBN90-9015877-4Pg 187-190
H. Liu, T. Selker, H. Lieberman. Visualizing the Affective Structure of a Text Document CHI 2003
Infopop Corporation. Open Topic. http://www.infopop.com/products/opentopic/features.html
M. Waldman, L. Cranor, A. Rubin. Peer-to-Peer. Harnessing the Power of Disruptive Technologies. Ch 15. Pg 243
Posted by Amanda McCoy Bast at August 8, 2003 10:40 PM