Spirited Thought

I am a believer that we are both the creator and observer of our own reality. What does it mean then if you have an overpowering psychological condition like severe depression, schizophrenia, bipolar or obsessive compulsive disorder? The belief can still stand, but it is fair to say that the chemistry and construction of the brain and body got a little too creative, or maybe not creative enough.

I have experienced through reading, administering developmental and behavioral experiments in college and, best of all, life, a variety of people with their demons. In every case, even when they were labeled with the same words, the demons were different and more importantly, the people were different. I start listening as if I know nothing, because for any given person it might be different and who am I to put my baggage on them.

For all the desire to master the brain through therapy and psychopharmacology, everyone is a unique case that we flounder to understand, the most talented among us saving our fellow man. Add to that my general feeling that we all have demons, even the most blessed and hopefully you get a sense that I am not against medication. I am, however, against what is a growing trend of medicating without answering why we are suddenly in the position of having to do so at such an alarming rate. A recent New York Times article, Proof Is Scant on Psychiatric Drug Mix for Young, by Gardiner Harris, pulled together some great research on medicating children.

Antidepressants are commonly paired with stimulants, but antidepressant use has declined over the last year after the F.D.A. warning about suicide risk. In their place, physicians are prescribing combinations that include antipsychotic and anticonvulsant drugs, according to Medco. From 2001 to 2005, the use of antipsychotic drugs in children and teenagers grew 73 percent, Medco found. Among girls, antipsychotic use more than doubled.

As with almost anything worth thinking about, there is plenty of complexity below the surface. This article is about how we medicate our children, apparently 1.6 million of them with 280K under 10 years old. To be counted, they needed to be prescribed two psychiatric drugs.

More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

Harris tells us that some studies show adults benefiting from two drug cocktails specifically around depression, OCD, and the mania associated with bipolar. As with any study, others show no conclusions of import.

The use of two-medicine combinations in children is on much shakier ground. Even for single drugs, the effectiveness of some psychiatric medications in younger patients is questionable: most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect. But hardly any studies have examined the safety or the effectiveness of medicine combinations in children. A 2003 review in The American Journal of Psychiatry found only six controlled trials of two-drug combinations. Four of the six failed to show any benefit; in a fifth, the improvement was offset by greater side effects.

If the evidence for two-drug combinations is minimal, for three-drug combinations it is nonexistent, several top experts said.

As members of one of the most developed societies, it is safe to say even the adults are struggling to make sense of their world, even the non-medicated. We have data showing that since 2001 we have begun heavily medicating our children in ways our best psychiatrists are unable to rationalize. If the reality we create in our minds, arguably the only reality that exists, is unnecessarily affected by doping, what is the affect on our ability to construct a different one?

For some, medication brings them closer to center, often with side affects, but more desirable than being consumed with self-destruction. I have heard that relative to their un-medicated state, some drugs slow things down too much or keep people in a fuzz. I think it is probably worth it if you suddenly have the opportunity to ponder the world of your design - for all you know you might be living in someone else’s.

For those of us who are challenged with loved ones who need medication, may we have the wisdom to withhold our own discomfort and psychological effects, so that medicating is done, not for us, but for you. As for the overly medicated children among us, may we not screw you up to the point where you can no longer consider what is real.

For my birthday, I received a new book that I had been eyeing, Happiness by Richard Layard. I am about a quarter through it and while I am not so hip to his writing style, I am enchanted by the information presented. You see, Layard is actually an economist that worked with a variety of others – psychologists, philosophers, sociologists etc. Just as you get through the initial premise you begin to think, “yeah, but how about this other aspect, you cannot discount that?!” and then he answers you before the chapter is over. You feel smart until you realize that Layard has done his home work and you, well I, get giddy being the student.

On the way into New York City, on an early train, I started scribbling some thoughts on the back of an old business card. They apply to more than just happiness and obviously resonate with my current outlook.

It is not how good it is, it is how good people think it is.

This came out of a section where Layard presents how over time people have become wealthier while happiness has stayed constant. He presents a series of examples where people show that wealth relative to others is more important than absolute increase in wealth – it is all about where people perceive they are in relation to others. Given the opportunity to have more relative to others, people elect that over an increase in wealth and no upward mobility.

It is not how good it is, it is how good people think it is.

This seems to be all that matters and all that is important in so many circumstances – politics, relationships and commercials to name a few. Everything is impression management and very often, the altruistic among us (that includes me) feel like there should be some kernel of purity worth worshiping beyond the manufactured experience. Relating this to the field of user experience design, all that matters is what users think.

What people experience is not our reality it is theirs. We do not get to decide, which really refocuses the importance of other related elements. Very often technology gets a lot of focus when, for the most part, a user rarely interacts with it – even more so when on the web. What server, middleware or backend is employed, the user has no idea or cares. As technologists, we use technology as a way of expressing ourselves, but fail when all we see is a technical problem. In the end, all that matters is what people think, in which case, as technologists we need to be far more sensitive to how we create delightful experiences. Extend that to any relationship.

Every day, we have the opportunity to create life-long memories, even more so if we pay attention to how people experience us. Who doesn’t want to be that impactful?