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The Internet Is Not a Doctor

"The internet is the biggest source of misinformation about mental health that has ever been created," says Dr. Robert Epstein, mental health expert and former <i>Psychology Today</i> editor-in-chief.

Image by Andy Baker

If you Google the phrase "depression test," you aren't likely to stumble upon the Beck Depression Inventory, which is administered by health care professionals around the world and has been the gold standard for measuring the severity of depression since it was first developed in 1961. Instead, your search will likely lead you to a plethora of sites offering any number of unverified quizzes promising to tell you, finally and truly, what's really wrong with you.

Mental health expert and former Psychology Today editor-in-chief, Dr. Robert Epstein, thinks this is a major problem. "The internet is the biggest source of misinformation about mental health that has ever been created," he told VICE. "There are literally thousands of unvalidated mental screening tests." Epstein has ventured to rectify this by developing his own internet-friendly test, the Epstein Mental Health Inventory, a 63-question test available freely at the SEO-optimized DoYouNeedTherapy.com.

Epstein's test is one of the few clinically-tested inventories on the internet—over 3,400 subjects took the first version of the test before it was published. Epstein updated the test in 2013, decreasing the reading comprehension level from 10th grade to 6th grade and revising the content to take into account the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Epstein's test follows standards often not upheld by the ones offered on DepressedTest.com or any of the other strange quizzes that are available via pages that end in .net and pop up at the top of Google searches. However, since those dubious tests top the results of search engines, they're the ones most often being clicked on and, thusly, utilized.

A 2011 study shows that nearly 60 percent of clicks are from the top three results of Google searches, while nearly 90 percent of clicks are from the first page. Now, try to remember the last time you went to page two of a search. Not hitting subsequent pages of search results isn't necessarily about laziness on the part of users, but instead something about our trust in the algorithm's divinity.

"People believe whatever is ranked more highly," says Epstein. "They think there is some omniscient god-like entity that has evaluated every single website in the world and these are the best." It's reasons like this why simply showing up on Google seems to have the power to influence close elections.

The internet is the biggest source of misinformation about mental health that has ever been created.—Dr. Robert Epstein

There's also Google's echo-chamber problem. Think about the fractured political landscape we live in, where meat-munching Red Staters can punch in "Obama's a Muslim," while patchouli-scented libertarians can type up "Bush did 9/11," and both can be validated with pages giving them "evidence" for whatever they'd like to see. "Google is extremely good at giving you what you want," says Epstein. "They're doing more customized rankings, they're getting better at knowing who you are. It's a feel-good experience."

Consider the person genuinely searching for a "mental health test" on Google. They're not in a great place to consider their prejudices. "Some of them are on the verge of suicide," says Epstein. "They don't have the skills, and certainly not the stamina. They are the people least capable at that particular point in time, and they need help the most." And even if they're going through an up phase, that doesn't mean they should be administering self-tests. "People looking at a bunch of numbers are likely to misinterpret the results."

Another problematic aspect of these tests is that their web pages feature advertisements for dubious medications, helping give these products an undue air of legitimacy. These pills promise they will make users feel better, but many of them haven't been approved by the FDA or even tested. Although some of these medications may be presented with familiar names, they are often counterfeit and made with dangerous materials.

"A lot of the alternatives are nothing but snake oil," says Epstein. "Like the penis enlargement industry."

There's no real policing, and the "snake oil" ads and posts are written in the same visual design as the rest, so they all look to be tried-and-tested techniques. At least during Web 1.0, we had the stupid flash animation of Geocities to raise red flags. Now, randomly shat-out nonsense and peer-reviewed scientific journals look the same, and thusly have the same credibility to the non-skeptical consumer.

Besides the issues facing people taking unregulated online quizzes to assess their mental health, there's another issue that impacts the entire practice of diagnoses in general. According to Melodee Jarvis, the Warm Line manager for the Mental Health Association of San Francisco, "In general, diagnoses are subjective and arbitrary."

The mental health field, after all, isn't the same kind of science as general health. The cause of your depression is tougher to pin down than going to the doctor to find out why your left shoulder feels wonky. Mental symptoms are hard enough to describe, let alone diagnosis on a grand scale. Sure, problems often fall into large categories determined by the medical field, but not always, and even when they do, the categories consistently need tweaking. If they didn't, there'd be no reason for constant DSM revisions—for instance, more than 40 years ago, the DSM considered homosexuality a mental health disorder.

"Once you have the diagnosis, [you think] it will somehow lead to a feeling of empowerment, but a lot of times it can't," says Jarvis. "Identifying with a label is not going to really help someone in the long term."

Internet searches are also ripe for over-diagnosis: If you've ever felt a weird pain in your side and found yourself in a late-night click-binge and subsequent last will and testament composition, you know how quickly something innocuous can turn into "probably cancer."

As an example in the mental health realm, Jarvis mentions someone hearing voices in their head. During an internet search, of course, they'll stumble upon a diagnosis for schizophrenia, the worst case scenario, which immediately becomes what they definitely have.

"Schizophrenia is a lifelong illness, so that means they'll never get over [it], and that really upsets and discourages [people] with the feeling that their life is over," says Jarvis. "But hearing voices can be all kinds of things."

More and more people in desperate need are turning to the internet in the hopes that the search results will unveil some great truth about what's wrong with them.

However, the relationship between the internet and mental health isn't all bad. Jarvis, for example, thinks patients are smart to study a quick overview of symptoms before going into a therapy session. "Anybody arming themselves with mental health knowledge is being a smart consumer," says Jarvis. "Information is not sacrosanct."

In other words, starting a session by announcing where your research has led you isn't a bad idea. At the very least, it can shorten an expensive introductory session and get to the heart of the matter. At the best, it can protect against dangerous misdiagnoses from an inept physician.

More widely-distributed information about the side effects of medication is another plus. "There's more information from different perspectives," says Jarvis, "from consumers who advocate medication, to consumers who don't, and people who are a mix. This is different from psychiatrists or general practitioners who are not giving a full picture of what the medication does." This phenomenon described by Jarvis could be helping contribute to the growing fear that psychiatrists are actually overprescribing for mental disorders in America today.

In addition to helping patients understand their treatment better, the online mental health world also helps people locate peer groups. "Being able to talk about [treatment] with other people, being able to find community and other people who've been through what you've been through, who give an insider's perspective and help you along with your own journey and recovery," says Jarvis. "That's really the power."

But those positives are ancillary to the main issue at stake with the avalanche of people using the web to self-diagnose. Google continues to tweak its algorithm in the never-ending effort to deliver the exact information the consumer's looking for. And more and more people in desperate need are turning to the internet in the hope that the search results will unveil some great truth about what's wrong with them. While every week, every day, every second, more and more content is created and shoved into the great worldwide trash heap.

"As big as the problem is now," says Epstein, "it'll be bigger tomorrow."

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If you are concerned about your mental health or that of someone you know, visit the Mental Health America website.