Art, Technology and The Human Side of Mental Health in the Age of AI
Interview with Dr. Josephine Loftus by Houda Bakkali
In this interview, Dr. Josephine Loftus, one of the most respected and renowned authorities in psychiatric medicine, reflects on the impact of new technologies on human behavior, the importance of communication, the value of happiness, and the role of art in mental health.
In her work as a psychiatrist, Dr. Josephine Loftus has specialized in mood disorders, personality disorders, and attention deficit hyperactivity disorder. She has focused on integrating biological and psychotherapeutic approaches, including mindfulness-based approaches, into her practice. During her time as Assistant Clinical Director in the Department of Psychiatry at the Princess Grace Hospital, Monaco, she established an Alzheimer’s unit, a mood disorders unit, and integrated the French network of Bipolar Disorder assessment centers by establishing a diagnostic center within her department. She also initiated psychotherapeutic groups for the treatment of chronic pain and introduced and encouraged training in mindfulness, cognitive behavioural therapy, and compassion-focused therapy.
She was made a Fellow of the Royal College of Psychiatrists, UK, in recognition of her contribution to clinical work and research in psychiatry. She has recently retired from her hospital position but plans to continue her journey in the field of psychiatry.
Dr. Josephine Loftus stands as a true reference in the field of medicine. It is a privilege to share her insights — those of a distinguished professional and an extraordinary individual: a great humanist, a devoted admirer of art and science in all their forms, and an exceptional communicator.
What are the main mental health problems currently being diagnosed?
About 1 in every 8 people in the world live with a mental health disorder according to statistics from the World Health Organisation (WHO). Mental health issues contribute to approximately 16% of the global disease burden.
Depression and anxiety are the most common mental disorders diagnosed. Depression is one of the leading causes of disability worldwide. The number of people living with depression and anxiety has significantly increased since the COVID-19 pandemic. Post-traumatic stress disorder (PTSD) is also on the increase given the growing number of conflicts worldwide where civilians are severely impacted by the violence of warfare and displacement from their homes.
What are the main challenges facing psychiatric medicine?
There are several challenges facing psychiatric medicine. The most important one is lack of resources. Services are underfunded, making it difficult to meet the needs of increasingly complex and needy patients. Mental health disorders such as schizophrenia and bipolar disorder begin in the late teens or young adult stage of life and require lifelong psychiatric care in the majority of cases. In the absence of professional treatment, young people can resort to substance abuse as a form of self-medication.
Prevention, early diagnosis and treatment can have a positive impact on outcome and quality of life. Large caseloads and the increasing administrative burden mean that psychiatrists are unable to provide the regularity of follow-up recommended in clinical guidelines. Mental health professionals also have to deal with more violent situations in the course of their work due to the increase in substance abuse.
Psychiatry is facing a major recruitment problem in many countries, leading to a shortage of psychiatrists at a time when they are sorely needed. Psychiatry has long been an underfunded area of medicine and could be said to suffer from the same form of stigmatization as the patients it treats.
More than ever, psychiatrists need to play an active role in education and in raising the profile of mental health problems by lobbying government members. Fondation FondaMental has shown the way in France. It is a trust devoted to early diagnosis, prevention, psychoeducation and personalized treatment plans, which has succeeded in obtaining government and private finance to promote research and raise the public profile of mental illness.
Another major challenge facing psychiatric medicine and medicine in general is ensuring that doctors are not reduced to diagnostic and prescribing technicians who lose the ability to connect with patients and their suffering. In an era where the business model is taking over medicine, where goals and efficiency are of paramount importance and technology is advancing at a rapid pace, it is more important than ever for doctors to remember that they are dealing with a feeling, thinking human being. It is important to maintain the “art” of medical practice.
Mental health and Psychiatry are not the same thing. How are they related? How do they benefit each other?
Mental health, as defined by the WHO, is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It includes our emotional, psychological and social well-being.
Once the balance between these domains of well-being is affected, the risk of developing a mental health problem with a significant disturbance in cognition, emotional regulation and behaviour is increased, and so is the need for psychiatric follow-up.
Psychiatry is the area of medicine which focuses on the diagnosis, treatment and prevention of mental, emotional and behavioural disorders. The ultimate goal of Psychiatry is not just to alleviate symptoms and prescribe medication but to provide a multidisciplinary treatment plan which will enable the patient to recover their mental well-being in all domains.
A lot of the work in Psychiatry by mental health professionals is oriented towards helping patients find that balance in order to promote well-being and to lead meaningful lives in their communities.
Many mental illnesses remain a stigma and a taboo for patients. How can we break down these barriers?
Education, raising the public profile of mental illness, challenging stereotypical views of mental illness and, most of all, getting rid of the divide between “us and them.”
The experiences described by people with mental illness are not alien to the population in general. What is different in a person who suffers from mental illness is not the nature of the experience but the intensity, frequency and sufferinggenerated by these experiences.
The media plays an important role and has done so in publishing the stories of celebrities who talk openly about their bipolar disorder, substance abuse or depression. The media needs to be more responsible when reporting violence perpetrated by a psychiatric patient.
So, stigma needs to be tackled at both a societal level and an individual level, beginning with the patient who suffers the most from stigma but who also stigmatizes him/herself because of the illness.
Ensuring people with mental health problems have access to a supportive work environment is also important.
There are increasingly more technological applications being implemented in therapies and diagnoses in the field of psychiatry. How do you evaluate this?
These technological applications will improve access to care, especially for geographical areas where there is a shortage of psychiatrists and other mental health professionals. Telepsychiatry consultations provide access to mental health professionals and crisis support.
Technology allows massive amounts of clinical data to be processed in order to predict changes in mental health and also to identify disease subtypes and disease progression. The data collected can potentially lead to a more individualized approach based on a patient’s pattern and profile as opposed to a one-size-fits-all approach.
In theory, these approaches have great potential for increasing access to care, monitoring symptoms, improving treatment compliance, facilitating diagnosis and implementing more personalized treatment plans based on big data analysis.
How does AI impact our mental health?
At one level, AI has been described as having a potentially transformative and revolutionary effect on mental health through its capacity to analyze extensive data sets and complex human behaviors. Its integration into overburdened mental health services could enhance early detection, provide personalized treatment plans, and make care more accessible through innovative platforms.
However, there are important ethical considerations, such as the lack of a comprehensive regulatory framework for the use of AI in mental health, the protection of privacy, and the need to preserve the human element. AI should be used as a supplementary tool and not replace the human element in therapy.
Although potentially useful in the field of human health, its limitations and dangers need to be recognized.
Technology unites us across distance, breaking down physical and temporal barriers. Is this really beneficial for our minds, or does it merely fuel a fantasy?
Certainly, technology has broken down barriers, facilitated communication and training across time zones and geographical barriers. However, there are concerns about the effects on our brain structure and function.
Research indicates that technology may have both positive and harmful effects on our brains. Harmful effects may include attention deficit symptoms, impaired emotional and social intelligence, social isolation, impaired brain development and a decrease in working memory capacity. Intensive use has also been linked to depression, anxiety and sleep disturbance.
On the positive side, certain online tools, programs and videogames can provide mental exercises which activate the brain, improve connectivity between different neural circuits, improve sleep, diminish anxiety and improve memory.
So, in conclusion, there are arguments both for and against technology. Technology can be beneficial or harmful depending on how it is used and the particular vulnerability of the person using it.
What environmental factors have the greatest impact on our mental health?
The social and natural environment both have an impact on our mental health.
Different forms of abuse — sexual, physical and emotional — have all been shown to have a negative impact on mental health in adult life and are associated with psychosis, mood disorders and substance abuse.
Social isolation, loneliness and lack of a support network have been shown to contribute to depression and poorer physical health in general. Major conflicts affecting civilian populations contribute to the development of post-traumatic stress disorder (PTSD).
Studies have also shown an association between dense urbanization and the prevalence of mental illness. The number of green spaces and walkable areas appears to be a protective factor against the development of mental illness.
How does a lack of communication influence our behaviour?
Lack of communication can have an adverse impact on the quality of our relationships with others. Maintaining healthy relationships is important for both our physical and mental health.
Lack of communication can impact our behaviour through increased frustration, stress, anger and resentment. This can manifest itself as irritability, impatience, violent behaviour and social withdrawal.
This reinforces feelings of incomprehension, anger and frustration and results in further social isolation and loss of network, increasing the risk of both physical and mental illness.
How does psychiatric medicine evaluate optimism?
Optimism is the antithesis of hopelessness. Maintaining an optimistic view has been shown to reduce the risk of mood disorders, anxiety disorders and alcohol abuse.
Cognitive behavioural therapy focuses on negative thoughts and helps individuals challenge the validity of these thoughts through reasoning and behavioural experiments in order to develop a more balanced mental attitude to life.
The idea is to tilt the brain from a negative mindset toward a more balanced mindset where positive experiences have equal salience to negative events.
Social media is a means of communication, but what challenges do they pose for mental health?
Addiction, paradoxically social isolation, and worsening conditions such as social anxiety.
There are also highly mediatized problems such as online bullying, which has tragically led to suicide in schoolchildren.
For healthy use, restricted use in children and adolescents and moderate use in adults is recommended.
Success and failure: how do they affect mental health?
Failure can generate emotional distress and cause depression and anxiety. Protective factors include higher self-esteem, a more positive attribution style, and less perfectionism.
Success can have a positive impact on mental health by creating a sense of well-being, unless the need for success is driven by poor self-esteem and fear of failure.
You are an expert in mindfulness. What does this therapy consist of, and how can it benefit mental health?
Mindfulness is “a way of paying attention in a particular way, on purpose, in the present moment and non-judgementally.” — Jon Kabat-Zinn.
Mindfulness is the practice of being fully present and aware of experiences as they arise, without overreacting or being swept away by thoughts and emotions.
It has been shown to reduce relapse rates in addiction and depression and to improve overall quality of life. It improves attention, mood, decreases anxiety and encourages a more compassionate attitude toward oneself and others.
In a world where constant doing is highly valued, mindfulness reminds us of the value and benefits of non-doing.
Can we talk about a mentally healthy person? What conditions must be met?
A mentally healthy person has good coping strategies to manage stress and is capable of maintaining healthy relationships with others.
A good social network and support system is very important. Loneliness has a deleterious effect on both mental and physical health, so the importance of social connection cannot be sufficiently emphasized.
Having fun through leisure activities or meaningful moments with family and friends also plays an important role in maintaining our mental health.
What value does art have in the well-being and recovery of patients?
For thousands of years, people have used art as a means of self-expression, healing and communication.
Art therapy has been shown to decrease anxiety, promote better emotional regulation, improve self-esteem, interpersonal relationships and help people cope with stress and despair.
Art therapy answers the social, spiritual, emotional and clinical needs of the patient. Let us not forget that the word psychiatry literally means “medical treatment of the soul.”
The Catalan cardiologist Josep Brugada once said that happiness is one of the best medicines for cardiovascular health. Does the same hold true for mental health?
Happiness is a state of well-being that contributes to better mental health. The happiness that leads to good mental health is related to a more stable core feeling of wellbeing that comes from living a life that has meaning and is in harmony with one’s own values.
A core feeling of well-being comes from reflecting on what is fundamentally important in one’s life and understanding one’s relationship with thoughts and emotions.
The more we integrate the different facets of our psyche, the healthier and more honest our relationship with ourselves and others becomes. Cultivating a sense of well-being is important because it sustains people through difficult situations and promotes both physical and mental health.