Click below to listen to this week’s episode of Culture Critically
Show contents:
- General show update
- Story of the week: Flo and ‘Anonymous Mode’
- Online mental health platforms and the cul de sac of care
Full show script
Intro
Hello and welcome back to Culture Critically. It’s been a while! We took time off at the end of the academic year, I’ve been teaching summer classes, and I’ve got some updates to share with you on today’s show.
If you’re joining us for the first time, we’re a podcast that talks about big ideas in communication, media, technology, and popular culture. We care about how these areas impact how we think, know, and live.
I’m your host, James Gilmore, and I’m a professor of media and technology studies in Clemson University’s department of communication.
In today’s episode, I’m going to be outlining some of the changes in the podcast moving forward, before talking with you about a recent journal publication analyzing online mental health platforms.
We’re moving to a planned podcast every other week for the time being, likely with more happening during the academic year.
In our previous podcasts, we’d focused on roundtable discussions with students. While students will remain an integral part of the podcast during the academic year, I also want to find opportunities to devote episodes to discussing recent events, interview colleagues and friends, and provide perspective and commentary.
Because undergraduate students rotate in and out of working with me, they’ll be invited on to share research occasionally, often near the midpoint and end of semesters.
I’ve been thinking, in the month and a half off, about what this podcast is meant to do. I’ve arrived at trying to play around with podcasting as a form of “gray literature”
I can’t promise everything—heck, anything—we discuss will be fully formed, but it seems that right now, with so much going on in the realms of media, technology, and culture, this blog can serve as a space for reflection, commentary, and discussion.
There are lots of opportunities for CS researchers and analysts to develop gray literature online: Blogs, microblogging like Twitter, video-based media like YouTube and TikTok, and audio media like podcasting all offer unique opportunities.
I’m excited to play around with what I can offer you in this show
Story of the week
We have to highlight the Supreme Court’s decision to overturn Roe v Wade, a decision that is already causing chaos across the United States and leaving the future of bodily autonomy and reproductive rights in horrifying uncertainty.
But for the story of the week, we wanted to highlight how technology is part of this chaos and uncertainty. You may have heard about the calls to delete period tracking apps as well as to request all data from your profile.
For the next episode of Culture Critically, I’m hoping to do a deeper dive into the policies around data collection on these apps and talk about them in relation to issues in datafication and surveillance.
For now, I want to point out that Flo, the most popular period tracking app, just on Friday announced that it intends to create an Anonymous Mode for data collection. In a June 24 tweet, Flo Period Tracker said: “You deserve the right to protect your data. We will soon be launching an ‘Anonymous Mode’ that removes your personal identity from your Flo account, so that no one can identify you”
A year and a half ago, Flo settled a complaint with the Federal Trade Commission over how the company had “deceived its users” based on language stating it would not share “information regarding…marked cycles, pregnancy, symptoms [and] notes” to any third parties or other health data to certain types of parties. https://www.mobihealthnews.com/news/fertility-app-flo-health-settles-ftc-over-sensitive-data-sharing-complaint
The FTC alleged the following: Flo, as early as 2016, “handed users’ health information out to numerous third parties, including Google, LLC; Google’s separate marketing service, Fabric…Facebook, Inc. through its Facebook Analytics tool…marketing firm AppsFlyer, Inc…and analytics firm Flurry, Inc….And Respondent took no action to limit what these companies could do with the users’ information. Rather, they merely agreed to each company’s standard terms of service. By doing so, Respondent gave these third parties the ability to use Flo App users’ personal health information expansively, including for advertising” https://www.ftc.gov/system/files/documents/cases/192_3133_flo_health_complaint.pdf
I want to devote our next episode of Culture Critically to talking about Flo and other trackers more in-depth, but for now let me just say this: Flo fundamentally failed to protect its users for a three year period, until—according to the FTC complaint—the Wall Street Journal revealed this practice in 2019. Flo may say that you have the right to protect your data, but that’s not a right the company was interested in protecting until it became expedient for it to do so, first in 2019 after its deceptive practices were made public, and again in 2022 after women are rushing to stop using these apps.
Flo is not here to protect you, and you shouldn’t expect a third party tracking application with this kind of record to adequately care for your health data.
Main story: TAO
But onto our main story, which is a discussion of my recently published article “Stuck in a cul de sac of care: Therapy Assistance Online and the platformization of mental health services for college students.” It was published several months ago in Television & New Media, and I share authorship with seven former students, most of whom were undergraduates when we performed this research together!
This article emerged from our undergraduate students trying to grapple with the lack of available mental health resources on our campus. And it’s not just a Clemson problem. In a 2018 study of 571 US college counseling centers, 34% report a wait list to mental health services and an average wait time of 17 days.
So instead of directing more funding these centers so they can hire more counselors and serve the needs of students dealing with a variety of mental health concerns—most specifically anxiety, depression, stress, and sleeping disorders—many universities are trying to instead license technological platforms that can supplement care. At Clemson, we have TAO, or Therapy Assistance Online, which is a cognitive behavioral therapy platform designed to help provide care to students who can’t get an appointment in the counseling center.
When COVID-19 first hit and Clemson pivoted to online education in March 2020, the university sent an email to all employees and all students about how to navigate a landscape becoming rapidly upended. There was a dedicated section on Mental Health, and TAO was touted in the first paragraph of this section: “There are nine online treatments with multiple modules from which you can select to best address your concerns.”
Calling TAO “online treatment” is generous, at best. We were already in the midst of researching the platform when this email was sent, and we were shocked that the university was placing it front and center in its mental health response to the COVID crisis. TAO’s promotional materials sound great: a user an “work on behavioral change online anytime…work when you want, where you want.” While it positions itself as accessible, it also positions itslf as work, and it’s up to the user to navigate, understand, and apply its information. There’s no therapist, no counselor, just pre-made videos loaded with stock footage. All the while, users are providing data to the platform without receiving feedback.
In one of its promotional videos—which was embedded on Clemson’s counseling and psychological services website—TAO explicitly argues it is more effective than face-to-face therapy at improving “life functioning,” “global mental health,” “well-being” and “symptoms” in a bar graph that is never explained. Moreover, its promotions do not align with the realities of the program: Its founder has claimed the platform uses “artificial intelligence to create practice tools so people can practice with feedback throughout the week.” For instance, there are claims the platform “introduces [users] to different approaches to depression, and then based on how they are responding to depression perhaps moves them into a cul-de-sac of modules that take that particular approach. If they’re not responding the way you would expect or not really liking it…you can move them to a different model.”
There’s a logic of personalization here and, in fairness to TAO, maybe that does exist in some version of its service, and maybe our university just didn’t license that version of the service, but here’s some of what we found:
- Its consent form explicitly claims it is “not a treatment for mental health disorders. If you require treatment for an emotional or mental health problem please contat your local counseling service.” However, our local counseling service was deferring to TAO as an online treatment, misrepresenting it. The company calls TAO a “prevention program,” but its legal documents qualify that pretty considerably: it is “a platform to assist you to bounce back from life’s disappointments and frustrations.” Using “disappointments” and “frustrations” in place of words like “stress’ and “depression” make clear that TAO is legally positioning itself not as a care provider, but as something else.
- We were constantly asked to complete the Warwick-Edinburgh Mental Well-Being Scale, which asked questions like “I’ve been feeling optimistic about the future” on a scale of “None of the time” to “All of the time.” Over our two-month research period, we all responded truthfully in our personal accounts to the Scale. Every time we completed the survey, we received a prompt thanking the user, and that was about it. None of us saw any changes in the programs we were offered or the assignments we were asked to complete. This Scale was just sucking up our data, but never giving us anything in return.
- This replayed itself when completing other activities. In the session “Core Beliefs,” we were asked “What is the first picture that comes to mind from your childhood?” After filling out a form and hitting next, we were then asked “Why? What was the conclusion you reached from this experience?” We answered these questions honestly, with some of us sharing traumatic memories and others sharing non-traumatic memories. Regardless, hitting “Submit” simply ended the session and we never received any sort of feedback from the system.
- As we used TAO, we came to see it more as a data extraction platform than a care platform. While teletherapy has many benefits for many people when done ethically and compassionately, the experience of using TAO was mostly just constantly giving the platform survey responses, qualitative answers, and answering other forms of prompts while never getting the kind of personalization, feedback, or care structures promised in the advertising
Calling TAO a cul-de-sac is quite fitting, as in French it simply means “dead end.” TAO is a constant series of dead ends.
We know that mental health is reaching epidemic status among college campuses, if it’s not already there. If we can’t provide better funding to support these students, we deserve to give them better than a bunch of forms to fill out and hope that works.
Conclusion
Alright, that’s our show. Thank you for joining us on today’s episode of Culture Critically.
You can find us on social media, with rebranded accounts:
On Twitter, we’re @culturecriticly and on Instagram we’re @culturecritically
You can find me @JamesNGilmore
Thanks for listening and I look forward to being back with you soon.
