Online Risks for People Within the Psychosis Spectrum: Envisioning a Digitally Safer World

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, pp. 87-88), psychotic disorders are clusters of key symptoms such as delusions and hallucinations, among other things. Moreover, the DSM-5 defines delusions as “fixed beliefs that are not amenable to change in light of conflicting evidence”, and hallucinations as “perception-like experiences that occur without an external stimulus”. Furthermore, Davey (2018) explains that the symptoms of psychosis can often leave individuals “feeling frightened and confused” (p. 237), and that “sufferers frequently believe that their thoughts are being interfered with or controlled in some way” (p. 239).

There are different types of delusions: persecutory (paranoia), grandiose (narcissistic), control (feeling controlled or manipulated by external forces), referential (thinking that the media, advertisements, news and events are all in some way giving cues about oneself, as if everyone else “knew”), nihilistic (beliefs that go beyond the scope of existence as we know it. This could include thinking that one does not exist any more), and erotomanic (the delusional belief that someone is in love with oneself, regardless of whether they actually have met the person or not). Even though all these types of manifestations often overlap, it is delusions of persecution and delusions of reference that I will be highlighting in this post. 

Preliminary facts:

• Suicide rates have dramatically increased within the last few years in the UK (Kaur and Manders, 2019). 
• People with symptoms of psychosis have a difficulty in making sense of what is real and what isn’t (Davey, 2018). 
• People on the psychotic spectrum struggle with suicidal thoughts, suicidal attempts, and some do succeed in such attempts (American Psychiatric Association, 2013). 
• 11% of homicides happen as a result of mental health problems (Pilgrim, 2015). 
• Hassan et al. (2011) as cited in Fisher et al. (2018) studied 3000 newly convicted offenders, and found that 10% were suffering from psychosis. 
• According to the United Nations News (2019), a person dies by suicide every 40 seconds.

A Case Scenario

Please note this is not a critique of the Youtuber, his personality, integrity, or his work. I have not watched the videos. This analysis is specifically in relation to the name and the cover art of the channel, as well as about Youtube’s liability for managing and preventing these deadly risks. 

As I was scrolling and scrolling on Youtube trying to find something to watch, I came across a recommendation from a channel titled They Will Kill You. I instantly thought: Wow, if I still was suffering from psychosis, just being exposed to such recommendation would have caused me great internal distress, confusion, and maybe even a crisis. So I decided to explore the channel, and noticed that the cover art states It wants to kill you, whilst showcasing a picture of a person hung off a tree by their neck. In other words, a picture of suicide by hanging. Such a combination of design is the perfect recipe for having to create stricter regulatory protocols in the digital world. The content elicits feelings of paranoia, persecution, and suicidal ideation. Moreover, I predict that in the future, such technical neglects might be classed as manslaughter, or as assisted suicide should anyone die; both of which are classed as criminal acts in the UK. So let’s get serious about this.

Critical Evaluation:

If a person has delusions of persecution, they might think that the reason why nobody is trying to help them is because people want him or her to kill themselves, and if such delusions of persecution are mixed with delusions of reference, the person might feel that this Youtube channel is part of the “conspiracy”. For example, they might already be thinking that their upstairs neighbours are trying to kill them (Eysenck, 2000) through enforced psychological torture designed to trigger their suicidal desires. And being exposed to the name of this channel and to the cover art might lead them to assume that their paranoid delusions are undeniable, and might actually reinforce their schema to go forward with suicide whilst thinking that they have no other choice, and that such are everyone’s wishes. In another possible fatal case scenario, a person might be experiencing complex and bizarre events (Eysenck, 2000) and this type of digital content might serve as an anchor for what can be homicidal acts. Furthermore, Fisher et al. (2018) explained that relapse and recidivism can be triggered by psychosocial stressors. I would like to reinforce this whilst also including digital stressors.

Pilgrim (2015, p. 222) states: “Those with a diagnosis of mental illness are predominantly described in the mass media as a risk to others. However, collectively psychiatric patients are at far greater risk from others and to themselves, as victims of crime and exploitation and from self-harm […] the risk of violence increases with the presence of positive not negative symptoms”. With this statement I rest my case about the necessity for safer algorithms.

Call to Action: 

This channel’s name  and cover picture are an example of the high risk potential to trigger distress in people within the psychosis spectrum due to the unpredictability of YouTube’s algorithms. Moreover, considering the mental health crises we are facing here in the UK, I strongly recommend that there is more regulation of potentially deadly risks. I also recommend for this user to be encouraged to change the name of the channel to one that is less threatening. Youtube should hire the necessary professionals to manage these complexities.

To summarise, as human beings living in an age of mental health and environmental crises, preventing suicide or homicide should be a common goal in society. Any death that can be prevented should be prevented.

If you or anyone you know know is having suicidal thoughts, please call 999. Alternatively, call Samaritans on 116 123, or email them to jo@samaritans.org