Thursday, July 31, 2014

Twitter Psychosis as a Cultural Artifact

UPDATE (Aug 6 2014): This story has spun entirely out of control, with breathless coverage at The Daily Dot and Jezebel. Today the hapless first author told NBC News: "No, at this point Twitter psychosis is not 'real.'" 

And no, a woman was not committed to psychiatric hospital with ‛Twitter psychosis’! However, the general confusion created by the ensuing media circus might be what the authors were trying to get at...

The original post resumes below.

The creation of the category “Twitter Psychosis" tells us more about the culture of contemporary psychiatry than it does about the purported dangers of social media overuse. Can Twitter really “cause” psychotic symptoms in predisposed individuals? Or is Twitter merely the latest technical innovation that influences “the form, origin and content of delusional beliefs” (Bell et al., 2005)? Twitter as the new telephone tower, radio waves, microchip implant or personal TV show, if you will.

Via Twitter (@DrShock, @vaughanbell), of course, comes news of a one page paper entitled, Twitter Psychosis: A Rare Variation or a Distinct Syndrome? (Kalbitzer et al., 2014):
The authors report the development of psychosis in a young woman coinciding with excessive use of the online communication system Twitter and the results of an experimental account to argue that Twitter may have a high potential to induce psychosis in predisposed users.

The authors presented the case of a 31 year old woman who was hospitalized for intensive suicidal thoughts and compulsions. She had no previous history of psychiatric illness and denied current hallucinations.1 Her friends and family said the symptoms began about 8 months earlier. Approximately 4 months prior to that she started using Twitter “excessively” (defined as “several hours a day reading and writing messages, neglecting her social relationships and, sometimes, even meals and regular sleeping hours”).2 At some point she came to believe that a famous actor was communicating to her personally (a common delusion), and to see hidden symbolic messages in Tweets:
During the next couple of weeks, Mrs. C increasingly felt that the messages of other users were “meant in a symbolic way” and that she had to react to these “tasks” in a certain manner. After approximately 2 months, she started to discover the same symbols in her real-world environment. She then started to feel that there “must be some organization behind these tasks” and started to suspect a sect, pointing to the development of systematized paranoid delusion.

None of this really seems like a Distinct Syndrome, and I doubt it's even a Rare Variation any more. The authors wanted to discuss (with the larger medical community) “whether they already have to speak of a distinct syndrome of social media-induced psychosis.”

And in fact, Dr. Vaughan Bell is one of the top experts to discuss this issue, and I imagine he will address the authors over at Mind Hacks.

But then the Brief Report completely derails with an “experiment” reported in the remaining paragraphs...

The Ben Goldacre Experiment

Someone (it's not clear who) created a fake account to address whether “Twitter communication responds to changes in communication style.” [NOTE: I'm not sure what this means.]

To test this, a test person created an account and responded to the messages of Ben Goldacre, the maker of the blog Our test person responded to a message of Mr. Goldacre about the pope, but Mr. Goldacre did not reply. However, the authors received an answer from an unknown participant, writing "<our username> Cold blooded RT. XXX: I am in the church: <link>." The link led to different Web pages with commercials.

...when the authors followed the link, they were confused about a flood of useless information (commercials). The authors understood that this was a spam message, but this might not be the case for a person who is predisposed to psychosis and, in addition, in a stressful psychosocial situation.

So from this ill-defined, bizarre and staged interaction with a test person, the authors concluded that “Twitter might combine several aspects that could induce or further aggravate psychosis.” In a presumably peer-reviewed publication.3

This is preposterous. Hopefully we will not see “Twitter causes psychosis” headlines any time soon.

 Vaughan should have the last Tweet here:

Further Reading

Returning to the title of the post, here's more on Twitter and cultural artifacts:

Twitter as a Cultural Artifact

Tools for Tech Thinking: McLuhan on Twitter

ADDENDUM Aug 6 2014: The authors have commented on this post to clarify that they were being deliberately provocative with their title and approach to the topic, but serious about the possibility that the interactive social media aspects of Twitter might have unique qualities in how it could affect those with (or predisposed to) psychosis. Furthermore, the authors are not inclined to generate a new host of DSM-5 diagnoses; in fact, Heinz and Friedel (2014) stated: "The inclusion of non-substance, behavioral addictions poses the danger of pathologizing a wide range of human behavior in future revisions of the classification."


1 However, Bell et al. (2008) showed that individuals with delusions do not always have anomalous perceptual experiences.

2 I imagine “several hours a day” could apply to many individuals without a formal diagnosis of mental illness. I will not deny that Twitter and other forms of social media can have an addictive quality for some people, but the “Twitter addiction” construct is not very useful.

3 Can I put this blog post on my CV?? Here we learn about academic publishing in psychiatry and the propensity to categorize.


Kalbitzer J, Mell T, Bermpohl F, Rapp MA, & Heinz A (2014). Twitter Psychosis: A Rare Variation or a Distinct Syndrome? The Journal of nervous and mental disease, 202 (8) PMID: 25075647

Subscribe to Post Comments [Atom]


At August 01, 2014 9:20 AM, Anonymous Jan Kalbitzer and Andreas Heinz said...

Dear Neurocritic,

You are wondering:
"Can Twitter really “cause” psychotic symptoms in predisposed individuals? Or is Twitter merely the latest technical innovation that influences “the form, origin and content of delusional beliefs” (Bell et al., 2005)?“

We feel that there is a difference explaining unusual experiences in a delusional way by ascribing them to radiation machines, on the one hand, and being involved in a way of communication with many participants, a high amount of symbolic content and automated spam responses, on the other hand. We thus pose the question whether modern complex and anonymous ways of machine-based communication facilitate the exacerbation of psychosis.

As regular readers of your blog we are somewhat surprised by your lack of humor. We did indeed use a provocative title in order to open a discussion on delusion phenomenology. Having criticized the explosion of diagnoses in DSM-5 ourselves, we certainly do not claim that syndromes constitute disease entities. On the other hand: if there exists a variety of psychotic symptoms, should there not be a discussion of whether some forms are promoted by communication patterns while others are not?

In our world, case reports to do not improve a CV but we hope they stimulate debate and we thank you for your passionate opener.

Jan Kalbitzer and Andreas Heinz

At August 01, 2014 9:51 AM, Blogger The Neurocritic said...

Dear Jan Kalbitzer and Andreas Heinz,

Thanks your comment. I usually have a good sense of humor, but I did miss out on the 'joke' here (or the deliberately provocative nature of the title, case report, 'experimental' findings, and interpretation). Being unfamiliar with your previous work, I wasn't aware of your stance on the explosion of DSM-5 diagnoses.

Perhaps your brief report (whether real or fictitious) will provoke a discussion about whether interactive social media have a different effect on shaping the manifestation and content of delusions, compared to other forms of technology.

Thanks again for stopping by, and for reading the blog.

At August 01, 2014 10:36 AM, Anonymous S. Kay said...

The bot says I'm missed at the fandom forum. I'm sure it's really the star sending a coded message that she loves me too.

At August 01, 2014 11:56 AM, Anonymous bengoldacre said...

Dr Kalbitzer,

please can you give me the name of the ethics committee or IRB that gave you permission to experiment on me?



At August 02, 2014 3:02 AM, Blogger Neuroskeptic said...

Dear Jan Kalbitzer and Andreas Heinz,

"As regular readers of your blog we are somewhat surprised by your lack of humor."

I was confused by this statement.

Are you implying that your paper ought to be read by someone with a sense of humor? In other words, that it is a joke paper?

At August 02, 2014 3:34 AM, Anonymous Anonymous said...

Dear Dr Kalbitzer, you are not funny. That is why people don't laugh at your "jokes". :)

At August 08, 2014 1:07 PM, Anonymous Anonymous said...

Jan Kalbitzer says more here...

At August 09, 2014 8:47 PM, Anonymous neurosci said...

Although I have questions about the true intention here, I think there needs to be a discussion about provocative titles in peer-reviewed research in general. It seems like it's becoming more common, even with somewhat legitimate findings, to overstate the importance and generalizability of the findings in the title. Journal editors and reviewers shouldn't be allowing "provocative" titles to be attached to papers, regardless of the merit of the findings. The title should tell you what you can expect to find in the paper, not be written like Gawker clickbait.

At August 11, 2014 8:09 AM, Blogger L K Tucker said...

The problem is real but it's not Twitter. It's Subliminal Distraction caused by texting on a phone long hours while suppressing the vision startle reflex.

Engineers discovered it fifty years ago when it caused mental breaks for office workers.

Visit VisionAndPsychosis.Net a 12 year investigation of Subliminal Distraction.

Learning what it is,then taking simple free precautions to avoid it will not interfere with any treatment you have for Bipolar Disorder or mental illness.


Post a Comment

Links to this post:

Create a Link

<< Home

eXTReMe Tracker