Posted by name on January 26, 2001, at 1:35:56
In reply to The article, posted by Dr. Bob on January 25, 2001, at 18:45:22
While the article is primarily an administrator’s self-assessment and explanation of his on-line project, since the administrator intended to “publish the results of a project” the project would most likely be “always regarded as ‘research.’” Preparation of the article was research, which is “systematic investigation ... designed to develop or contribute to generalizable knowledge.” The author began the research when he intitiated a project for his own participatory observation, intending to use the results for publication. The article then, can be seen as a published research finding in support of a hypothesis.
(U of Chi. IRB Guidelines).The research method was “participant observation (in which) the researcher assumes a role in the setting or group being studied” (USDHHS Office of Human Protections IRB Guidebook.)
The topic of the research, a “hybrid type of group” in which a mental health professional serves as an administrator while participants offer mutual self-help, was “first discussed long before there was an Internet.” The hypothesis studied in the research is that the specific type of group administered by the author offers the best of self-help groups and of groups lead by a mental health professional. (Quotations denote content from Cyberpscyhology article)
While the group might offer benefits of both types of groups, there is no evidence offered to support a finding that the group offers the “best of both worlds” because neither “world” outside the author's project is thoroughly surveyed in search of its best qualities.
The research findings, in support of the conclusion that the site offers “the best of both worlds” include:
* that “usage statistics and the anecdotal evidence of the posts themselves support the effectiveness of the group,”
* that “the group is accessible and safe,”
* that while “on-line self-help groups also have the potential for destructive interactions” “mental health professionals … minimize … such disruptions”But negative findings are that:
* “to our (whose?) knowledge, no outcome study has been done. Systematic research on this site and others is, however, certainly needed.”The assessment of negative results does not include:
* consideration of the site administrator's role as a researcher,
* the lack of systematic oversight as is standard in research involving human subjects or
* the potential stigmatization of participants who are prompted by an experimental intimate environment to reveal personally identifiable details related to their psychological well-being or mental health.Some random observations about findings offered in the article include:
The administrative structure of the site suggests that only one mental health professional is involved, and that no peer review is conducted to refine procedures or to minimize harmful aspects of the site.
> "Contrary to early predictions that 'computers will remain on the fringe of patient education' the Psycho-Babble useage statistics, in fact, demonstrate their popularity."
The statistics do not, however, compare the popularity of the Psycho-Babble format with other educational methods, or with other computer-based educational methods.
> “Usage statistics … support the effectiveness of the group.”
Rates of usage and the technical difficulty cited are products of the open format. If usage statistics and anecdotal audience support were the only measures, The Jerry Springer Show could be represented as an effective group therapy setting. The author does acknowledge that 48 percent of posters posted only once, and suggests that the site might not have been helpful to them, yet the author does not seem to weigh the possibility evenly with anecdotal indicators of effectiveness, or assess anxiety that might have developed as a result of visiting for any of that 48 percent of one-time participants.
> “Drawbacks are the potential for multiple identities and the technical difficulty of preventing determined individuals from gaining entry into the group.”
Yet, the site author has since twice supported the use of multiple screen names (at http://www.dr-bob.org/babble/admin/20001124/msgs/312.html : and at http://www.dr-bob.org/babble/admin/20001124/msgs/134.html )
Other sites easily overcome the technical difficulty of excluding unwanted members, without embarrassment or stigmatization. Structurally, E-groups sites provide a flexible, combined message board/mailing list format that allows moderators to strictly control entry with a registration process somewhat similar but more selective than that of Psycho-Babble. While in the Cyberpsychology article, the author compares message boards with chat rooms and with mailing lists, administrative styles of other on-line mental-health self-help message boards are not comprehensively compared with that of Psycho-Babble.
As a limited comparison with other on-line self-help group administrative styles, in one instance the author writes: “When messages are considered by the author not to have been civil, messages to that effect are posted. Others would do this privately, by e-mail and that would have the effect of being less embarrassing.”
The author proceeds to explain his opinion of the advantage of his method, but does not completely survey other methods. Other sites include lists of rules. While the author’s occasional postings “offer the advantage of clarifying the limits for others” he declines to succinctly define in the site limits not explained in the “one rule” which he acknowledges must be clarified for many who do not recognize the author’s definition of civility. In this manner, the site tends to reflect the author’s personal values. “Very important posters” who have followed hundreds of posts might be familiar with arbitrary and subjective limits. The group of VIPs then tends to reinforce the credibility of the author’s values, while outsiders who might be more familiar with limits of other on-line groups are sacrificed as examples of poor citizenship. By not offering readily available, concise explanations of site-specific limits to all who choose to visit the group, the administrator’s role becomes that of model citizen whose values are to be studied and emulated.
From a mental health professional, an assessment of incivility can easily be construed as a diagnosis of an anti-social personality, though none of the interviews or examinations required to reach such a diagnosis have been offered. Because the author serves not only administrative and therapeutic functions, but also functions in a research capacity, the insinuation of a diagnosis in the course of research activity might cause harm or stigmatization of the person so identified. Human subjects are ostensibly to be protected from such harm during research activities.
The author did not discuss a Psycho-Babble site dedicated specifically to pscyhological problems of children. Children enjoy special attention by USDHHS standards for oversite of human research.
> “The only cash expenditures to date have been $40 for the Fluid Dynamics Search Engine and $349 for a secure web server certificate.”
The only expenditures listed are those of the administrator. Someone must be paying for the Internet access and for the server equipment. The value of those services likely far exceeds the listed expenditures.
> “The site is not advertised.”
Though it is promoted now in at least two on-line journals.
> “Sustaining others is in any case a worthwhile enterprise.”
While sustaining others is worthwhile, sustaining perceptions is not always worthwhile. Unlike interaction that sustains people contemplating suicide, interaction at Psycho-Babble can sustain specific perceptions, some of which might interfere with transformative realizations.
The author acknowledged discussion elsewhere of Virtual Munchausen Syndrome, but overlooked other related syndromes that could relate to the site, such as Munchausen Syndrome by Proxy, and Virtual Hyperchondria, (dubbed Cyberchondria in a recent popular press item on MSN). As a result of increasingly available information about diagnoses, Internet users learn symptoms of diseases that they may then perceive in themselves. Coupled with television and print advertising by psychopharmaceutical manufacturers, the public is better equipped than ever to report to physicians the symptoms likely to result in prescriptions of commonly abused drugs.
One group member whose postings were used in the article as an example of help-rejecting had requested that those at the site, “Please stop talking about me.”
A group member’s screen name was included in the article by way of a screen shot.
Comments:
The theme of these remarks is that the site could provide a more supportive and educational environment if other sites were reviewed and the benefits of their administrative styles incorporated.
These remarks also suggest that promotion of advantages of the site, absent a wider comparison with other options, expand the opportunity for potentially harmful results of research on human subjects. To conduct a novel project, and to publish statements about the effectiveness of the project is clearly a form of research. While the author’s intentions might be the best, the research has not undergone the systematic review that offers the best protection expected by human research subjects, as suggested by the U.S. Dept of Health and Human Services. Harmful results include the possibility that people are encouraged to participate in a new and intimate environment, and to disclose potentially damaging personal details, with insufficient advice about the ramifications of releasing details that can lead to job loss, stigmatization or criminal prosecution.
Of course, under the leadership of Tommy Thompson, the U.S. Dept. of Health and Human Services might redifine what is politically correct for reasearch projects that study human behavior.
To offer critical responses to a journal article is not to suggest that Dr. Hsuing is a bad person or that the site is not in some way effective in its stated purposes of support and education. That a person offers such criticism here is not evidence that the person feels himself or herself a messiah or is being antagonistic to see whose buttons they can push (as suggeted elsewhere on this site). A person might reply because the author of an article asked, “You'll let me know what you think?”
These insights are offered here as much for the general readership of the site as for the few designated as "very important posters." A person might reply to this discussion on this board because it is a topic of general concern, and because the person is somewhat able to endure withering criticism by a few that might prevent others from discussing those concerns. Some might recognize such an effort as selfless service. On the other hand, maybe it is just a more productive and interesting way to spend time than watching television.
poster:name
thread:326
URL: http://www.dr-bob.org/babble/admin/20001124/msgs/330.html