Cultures of the Internet: identity, community and mental health

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2013 50: 165Transcultural PsychiatryLaurence J. Kirmayer, Eugene Raikhel and Sadeq Rahimi

Cultures of the Internet: Identity, community and mental health

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Cultures of the Internet: Identity,community and mental health

Laurence J. KirmayerMcGill University

Eugene RaikhelUniversity of Chicago

Sadeq RahimiUniversity of Saskatchewan

Introduction

The Internet and World Wide Web have woven together humanity in new ways,creating global communities, new forms of identity and pathology, and new modesof intervention. This issue of Transcultural Psychiatry presents selected papers fromthe annual McGill Advanced Study Institute (ASI) in Cultural Psychiatry on‘‘Cultures of the Internet’’ which took place in Montreal, April 26–29, 2011. TheASI addressed four broad areas: (a) how the Internet is transforming human func-tioning, personhood, and identity through the engagement with electronic media; (b)how electronic networking gives rise to new groups and forms of community, withshifting notions of public and private, local and distant; (c) the emergence of newpathologies of the Internet, e.g., Internet addiction, group suicide, cyberbullying, anddisruptions of neurodevelopment; and finally, (d) the use of the Internet in mentalhealth care, for example, by consumer advocacy and support groups, aswell as for thedelivery of health information, web-based consultation, treatment intervention, andmental health promotion. In addition to some of the ASI papers, this issue includesother recent contributions to the journal on related themes. In this introductoryessay, we set out some of the broad implications of the Internet and related newmedia and information communication technologies (ICT) for cultural psychiatry.

The Internet as medium and message

The Internet and associated technologies have been heralded both as a source ofgreat boons and new human potentialities and as the cause of serious social

Corresponding author:

Laurence J. Kirmayer, McGill University.

Email: [email protected]



problems and pathologies. Many have viewed the Internet as intrinsically demo-cratizing, allowing the free-exchange of information and providing people with amore comprehensive view of their local situation and a kind of public voice orrepresentation that would otherwise be available only to the wealthy and powerful(Hand & Sandywell, 2002). At the same time, reliance on these same channelsrenders people vulnerable to new forms of surveillance and social control bystates and other powerful organizations (Morozov, 2011).

Viewing the Internet as having intrinsic properties that shape the nature of itseffects has its roots in technology and media studies (Lievrouw, 2002). MarshallMcLuhan (1964) famously claimed ‘‘the medium is the message,’’ capturing theessential truth that the ways that information is packaged, exchanged, and deliv-ered may carry as much information as the message itself, exerting complex effectson whole domains of thought and practice (Coupland & Saul, 2009; Hayles, 2012).At issue, however, is the extent to which the use of the Internet itself—independ-ently of any particular content—has specific psychological or social consequences.Like other media, the Internet may exert biases on cognition and social practice,making some concepts or types of information easier to formulate and share,thereby putting its imprint on experience, but it also constitutes a flexiblemedium that can be used in myriad ways—which are constantly being discoveredor invented. Although networks have their own dynamics, much of what is viewedas intrinsic to the Internet may have more to do with how it is currently configuredand used than with any of its fundamental properties (Morozov, 2013). Moreover,this configuration is not something that has emerged spontaneously, but is theresult of a complex history driven by particular interests. A sketch of the develop-ment of the Internet is instructive both because of the rapidity and recency of itsemergence, and because of the complex interplay of military, university, govern-ment, and commercial interests that have underwritten its development (Green,2010; J. Ryan, 2010).

The Internet is a global distributed data communications network built on anelectronic backbone that began as a vehicle for military research. The precursor oftoday’s Internet began in the 1950s amid the tensions of the Cold War and emergedas Arpanet in 1969, the first network using ‘‘packet switching’’ which initiallyconnected Stanford University and UCLA, and then extended to Harvard, MIT,and other institutions (J. Ryan, 2010). This backbone allowed for early forms of filetransfer and message exchange, as well as the creation of electronic bulletin boards.Basic e-mail was developed in 1971 and the same year saw the start of ProjectGutenberg, which aimed to make books and documents in the public domain freelyavailable in electronic format.

The advent of the personal computer led to exponential growth of the Internet(J. Ryan, 2010). Social media and games began to emerge with the advent of thepersonal modem in 1977, starting with the Bulletin Board System in 1978, and thefirst online social games (‘‘Multi-User Dungeons’’ [MUD], inspired by the fantasyrole playing game Dungeons and Dragons, and later generalized to ‘‘Multi-UserDomains’’). The development of protocols for network addressing (HTTP, URLs)

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and exchange of hypermedia (HTML) led, in 1990, to the creation of the WorldWide Web. The first web page was created in 1991. Mosaic, the first widely usedgraphical browser, appeared in 1993, followed by Netscape Navigator in 1994.These tools accelerated the shift from primarily text-based information to increas-ingly elaborate visual and multimedia sites. The commercialization of the Internetbegan in 1995 with the shift from infrastructure owned by government institutions(e.g., the National Science Foundation and collaborating academic institutions) toincreasing corporate support and control. Along the way there has been a constantelaboration of new media, giving us hypertext, and ever more complex animation,video, and audio content. Wikipedia was established in 2001 and, as with many ofthe later innovations, this allowed for new forms of social collaboration with muchdebate about how to insure quality and consensus while minimizing hierarchy(Fallis, 2008). A further shift occurred around 2004 with the arrival of Web 2.0,characterized by highly interactive and user-driven software applications deliveredover the Internet (Han, 2011). At the same time, social networking media began toemerge with Facebook and other sites, each with their own character and commu-nities. Mobile web technology became popular starting in 2007 with the release ofthe iPhone. Mobile communications technology has exerted a profound effect bymoving access to the Internet away from the desktop and into the spaces and placesof everyday life (De Vries, 2013). The technologies of web-linked watches and eyeglasses will accelerate this merging of virtual and everyday worlds in ‘‘augmentedreality.’’

Identity and virtuality: Ontologies of the Internet

The Internet is transforming human functioning, personhood, and identity. It pro-vides new modes of social presentation and positioning, new media for expression,and new ways of narrating the self. Some have considered the transformations sobasic and far reaching as to mark fundamental evolutionary shifts toward the‘‘posthuman’’ (Haney, 2006; Rahimi, 2000). The new technologies include bloggingand other social media, as well as the virtual places and communities that consti-tute cyberspace (Crampton, 2003; Papacharissi, 2011). These provide novel ways ofaccessing information, organizing memory, and relating to others. To the extentthese technologies change our modes of self-experience, understanding, and par-ticipation we can speak of new forms of self and personhood.

Many have claimed that the Internet not only changes how we communicate orinteract with online information but that it also exerts more profound effects onbasic cognitive functions including memory, attention, and thought, as well as ourexperiences of embodiment and community (Brockman, 2011). For some, thesechanges promise an extraordinary augmentation of human capacities (e.g.,Chorost, 2011; Shirky, 2010), while for others, the invasion of the Internet portendsthe loss of some of our most basic human qualities, values, and capacities(Aboujaoude, 2011; Carr, 2010). Both optimistic and pessimistic accounts, how-ever, recognize the changes are extensive, with implications for human knowledge,

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selfhood and consciousness. The philosopher Hubert Dreyfus (2001) raised fourbasic concerns about the impact of the Internet on identity and meaning-makingprocesses: (a) the limitations of hyperlinks as a way of organizing meaningfulinformation and knowledge; (b) the limitations of distance learning, which areespecially salient with the recent emergence of massive open online courses(MOOC); (c) more broadly, the lack of presence in telepresence; and (d) the prob-lem of anonymity and nihilism when there is no physical encounter.

Much of what we attribute to the Internet reflects its role as a platform for newmedia, which have their own effects on flows of information, organization ofmemory, and expressions of identity. Hypertext changes the structure of reading,adding another dimension that allows trains of thought or associations to move outof the semantic frame of the phrase, sentence, paragraph, or larger narrative (M.-L.Ryan, 1999). Hyperlinks can provide essential background knowledge, (the defin-itions and etymology of words, the provenance and history of ideas and events,etc.), encourage divergent thinking or a kind of Talmudic reading in which alter-native viewpoints, commentary, and arguments are always ready-to-hand (Rosen,2000). At the same time, the digressions from the line of argument or distractionsfrom a vivid narrative may undermine the cogency and coherence of a complexargument or story. Hypertext and the breadth of search engines may result in ahorizontal leveling out of all information as potentially equivalent. Ease of accessdoes not obviate the need for human expertise and integration to make ‘‘raw’’information useful as knowledge.

The Internet as repository of knowledge is transforming from an aid or supple-ment to memory, to its functional core. In 2002, worldwide digital storage capacityovertook total analog capacity and by 2007, estimates are that almost 94% of allhuman information storage was in digital form (Hilbert & Lopez, 2011). Web-based databases allow us to access information in new ways, often with remarkableease. Gone is the arduous labour of constructing manual concordances to the Bibleor the works of Shakespeare; even indexes are quick becoming an archaicapproach, since search engines can instantly find any word or phrase in a textand, if augmented by artificial intelligence, could perform much the same functionsas a skilfully constructed topic index. The enormous volume of information servedup by the Internet makes it a sort of auxiliary brain. Mobile devices extend thesecapacities of the web into our daily lives. This changes how we use our memories,moving beyond the book with a new level of accessibility to even arcane informa-tion. The challenge becomes how to filter and find what is needed and how towarrant its accuracy given the free circulation of idiosyncratic ideas, rumours,and misinformation. Ideas and images ‘‘go viral’’ not because they are true, beau-tiful, or edifying but simply because they are novel, amusing, or arresting to largenumbers of people.

The Internet reduces the richly embodied nature of interpersonal encounters andindividuals’ sensual engagement with the world to a few electronically mediatedsenses. The most common interface of the Internet is the computer screen or mobilephone, both of which privilege visual information. Although speech and sound are




also readily available, other sensory modalities still have little presence. Hence,Internet use further strengthens an epistemic reliance on sight (‘‘seeing is know-ing’’) that may have evolutionary roots but that was strongly reinforced with theadvent of print culture and the book. However, while the book has a linear struc-ture imposed by its physical nature—turning the page to follow the narrative(unless we skip ahead to find the finale on the last page)—the Internet and hyper-text encourage something approaching simultaneity. This mode of informationdelivery certainly leads to changes in attention—at issue is whether these are tem-porary adaptations to the use of the medium or will have more lasting effects onpsychological processes and give rise to qualitatively new modes of subjectivity andself-consciousness, with corresponding changes in neural functioning (Greenfield &Yan, 2006) and, perhaps, even become selective pressures on human evolution,leading to new kinds of brains.

More immediately, we face the dilemma of drowning in information, inundatedwith ideas, texts, and images that saturate attention, cognition, and imagination(Kegan, 1994; Klingberg, 2009). Novelty seeking is among the more powerfulhuman motivations and the Internet has capitalized on this in every domain,from storytelling and entertainment, to mass marketing, to exacerbating our appe-tites for sexual imagery (Paasonen, 2011). In the process, we risk being fragmented,morselized, scattered, and disorganized. Of course, as Suparna Choudhury andKelly McKinney (2013) point out in their contribution to this issue, argumentsabout the deleterious effects of digital media on brains—and particularly develop-ing adolescent brains—are supported by a relatively thin and ambiguous set offindings from cognitive neuroscience research.

Although memory is central to learning and identity, the fallibility of memoryalso affords us the opportunity to forget what is shameful, harmful, or derailing,allowing for the possibility of new beginnings. Indeed, for most of human history,the default mode of memory was forgetting (Mayer-Schonberger, 2009). Recall—atleast of mundane events—took special effort, which was reflected in the ceremonies,ritual observances, and storytelling of oral traditions. Print culture created archivesand paper trails, but these were scattered and often difficult to access. The Internethas allowed access to digital archives that take the persistence and accessibility ofmemory to new levels. The indelible memory of the Internet does not allow us toescape any of the vagaries of our personal histories. Past indiscretions, childishmistakes, and other errancies can come back to haunt us endlessly. This situationmay ultimately demand a new level of caution and consistency (which few will beable to maintain)—or a new level of tolerance for human foibles—but it also lendsitself to oppressive use and abuse, subverting our life narratives and efforts at self-presentation (Mayer-Schonberger, 2009).

The Internet has led to the creation of novel kinds of virtual space and sociallife—with new worlds to explore and new people (or their simulacra) to meet(Baudrillard, 2000; Shields, 2003). This, in turn, has changed the nature of embodi-ment and enactment, offering us the prospect of a virtual heaven (or hell) withoutbodies (Wertheim, 1999). In fact, the experience of virtual reality itself involves

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forms of embodiment (Murray & Sixsmith, 1999). Moreover, as Richard Powersmakes clear in his novel, Plowing the Dark (2000), virtuality is a basic capacity ofthe human imagination intrinsic to our ability to become immersed in stories orvivid images. Nevertheless, the virtual worlds of the Internet, whether abstract andtext based or richly decked out in colour and texture like the avatars of Second Life(Boellstorff, 2010), afford more elaborate forms of role playing. In the face of thisimaginative freedom and power to reconfigure virtual identities, the forms of sociallife derived from our physically shared world may come to seem threadbare, con-fining, or redundant.

Sherry Turkle (2011) sounds a related note of caution in her recent study of howsocial networking technologies and the devices which make them portable andever-present may be shifting our expectations of human relationships. Turkle isparticularly concerned that the condition of always being connected or ‘‘tethered’’to one’s device—and thus having the potential to communicate with parents orfriends—undermines young people in developing relatively autonomous selves,able to experience emotions and make decisions without continual feedback andsupport. More broadly, many of the young people and adults Turkle speaks to aresimultaneously compelled by the possibilities for identity-play, sociality, and escapeenabled by these technologies. While they are hopeful about their potential formanaging their social anxieties and vulnerabilities, they are also troubled by theways they may simplify and flatten relationships and intimacy. She writes, ‘‘wehave to be concerned that the simplification and reduction of relationship is nolonger something we complain about. It may become what we expect, even desire’’(2011, p. 295). The writer Gary Shteyngart depicts the nadir of this flattening ofsocial life in his comic novel Super Sad True Love Story (2010) in which the eventsof everyday life, including romantic encounters, are blogged and rated online inreal-time and achieving high ratings counts for more than the quality of the humanencounter.

Increasingly, the Internet is connected to the material world not only at theinterface of screen and keyboard (or glasses and gloves of virtuality), andthe technologies of robotic extensions and multisensory modalities that are onthe horizon (Goldberg, 2000), but also through economic, social, and politicalconsequences. The real world is always present behind the virtual—both in theinfrastructure that runs the web and in the very human interests and agencies thatrun the show (Goldsmith & Wu, 2006; Morozov, 2011).

At the McGill ASI, the Mohawk artist Skawenatti Fragnito told a striking storyof the interplay of virtual and material worlds.1 She used Second Life as a softwareenvironment in which to develop machinima, digital animations, for a project onIroquois history and futures (J. Lewis & Fragnito, 2012). At one point in theproject, some of the laboriously constructed graphic objects on their virtualisland began to disappear. Attempts to find a software glitch were not successful.Finally, Skawenatti—or, rather, her Second Life avatar—flew up over their islandand found a pirate ship floating there that was sucking up their virtual property.She went inside and confronted a group of ‘‘hackers’’ sitting around a table. They




asked who she was and, in an inspired moment, she stated, ‘‘I am the land.’’ In thisdramatic statement she was invoking not only conventional property rights, (shehad paid real dollars to build and maintain the virtual space and resources for hermovie sets), but also older indigenous notions of land-based identity. However, thedigital pirates’ willingness to respond to this claim, or any other appeal to socialorder, law, or moral convention, depended on their knowledge and memory of thesocial order beyond the virtual world.

The intrusion of the real is not only a disturbing reminder of the conditionalnature of virtuality and its dependence on the usual economic and political struc-tures (Morozov, 2011, 2013), it is also a return to the comfort of warm bodies onsolid ground. We surely have a need for real presences, with us in flesh as well as inspirit. William Gibson, who coined the term ‘‘cyberspace,’’ and whose novelNeuromancer (1984) fully imagined the ethos of the hackers who prowl its backalleys, explored this hunger for the real in a later novel, Idoru (1996), in which theprotagonist longs for physical union with a virtual pop idol.2

The new Leviathan: Culture, community and politicsin cyberspace

On one reading, the Internet is a great tool for democratization, allowing a newpopulism and leveling out of access to information and expression. Virtual com-munities can form rapidly around any sort of shared interest or concern. This caninclude specialized groups for individuals with disabilities or unique modes ofexperience (Antze, 2010), support groups for those with stigmatizing or rare illness(Gowen, Deschaine, Gruttadara, & Markey, 2012), as well as online groups fordiasporic communities (Bacigalupe & Camara, 2012), or groups with often fleetingyet affectively powerful shared political interests, as we have seen in places likeIran, Tunisia or Egypt in recent years. ICTs provides new opportunities for theemergence of ad hoc forms of organization that allow groups to work togethertoward common goals (Dolan, 2010; Gasemiyeh & Zariffard, 2012). In addition tohuman community, the Internet can provide resources, connections, and meaning-ful activities and employment for people with sensory and motor disabilities, thehousebound, and those with other specific needs.

Research on diasporic Muslim communities has highlighted the need for a dis-tinction between two separate ‘‘communities’’ when speaking of the ‘‘Muslim com-munity’’: a virtual digital community located in cyberspace, and a lived ‘‘real’’community located within political and geographical borders. Ever sinceBenedict Anderson’s (1983) work on ‘‘imagined communities,’’ the notion hasbeen widely used and expanded by scholars of Islamic societies to theorize thecentral Islamic notion of ummah, which denotes an abstracted, transnational ‘‘com-munity’’ consisting of all Muslims around the globe (Lewis, 2002; Roy, 2004;Shavit, 2010). With the advent of new technologies of information and commu-nication, an increasingly active ‘‘digital ummah’’ is born of the serendipitous

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convergence of traditional ideology and postmodern technology, offering aradically new definition for the notion of imagined communities(Campbell, 2010; Roy, 2004, 2010). As Spalek and Imtoual (2007) report, theinternet has given Muslim youth now more than ever the option of joiningthe digital ummah as ‘‘an imagined community that works through minds,attitudes and discourses rather than geographical locales or through social andfamilial ties’’ (p. 194).

Linked with mobile phone cameras, the Internet has become a vehicle for docu-menting and disseminating information on events with political implications. Manyhave attributed some of the dynamics of the Arab Spring to the ready circulation ofinformation, which both motivated and coordinated protests and challenges toexisting structures (Stepanova, 2011). However, it is crucial to remember that gov-ernments and corporations retain control over the infrastructure of the Internet aswell as mobile communication technologies and can not only throttle or block useof these channels, but actually employ them for surveillance of individuals theydeem a threat (Morozov, 2011). The Human Rights Council of the United Nationsissued a report in 2011 that linked access to the Internet to the right to freedom ofopinion and expression (United Nations, 2011). Hence, disconnecting people fromthe Internet is a human rights violation and against international law. This isclearly directed in part against states that seek to block content that would bedamaging or destabilizing to their regimes.

While some have argued that the Internet is rapidly ushering in a new globalculture, there is evidence that it also contributes to the differentiation of groups,allowing them to forge new hybrid identities or maintain various forms of ethnicity(Parker & Song, 2006; Tynes, Giang, & Thompson, 2008). As Bhui and Ibrahim(2013) discuss in their contribution to this issue, the Internet can be used to pro-mote identification with a radical political cause with potentially disastrous effects.Zygmunt Bauman suggests,

rather than homogenizing the human condition, the technological annulment of

temporal/spatial distances tends to polarize it. It emancipates certain humans from

territorial constraints and renders certain community-generating meanings extraterri-

torial—while denuding the territory, to which other people go on being confined, of its

meaning and its identity-endowing capacity. (Bauman, 1998, p. 18)

The implication is that the collective identities forged through the Internet mayhave qualities they derive from the medium itself of being more or less divorcedfrom their immediate circumstances and hence less responsive to localcommunities.

The networking afforded by the Internet is forging new social processes(Castells, 2010) and new types of community founded on common interests andemerging identities, leading some to speak of a new tribalism (Adams & Smith,2008). These range from simple exchanges of information like business, to sharingcreative projects of music or film, celebrating important life events, or sharing




intimate confessions and cris du cœur. There are specific forms of social mediasuitable for each of these but individuals put a site conceived for a specific purposeto new and unexpected uses. Facebook has been used by many to narrate mundanelife events. There are Aboriginal communities in Canada that chat online in theirIndigenous language, keeping it alive in a new generation. For Indigenous peoplesthe Internet not only provides a platform for communication between remotecommunities and a way to preserve and share traditional knowledge both locallyand with the wider world, it also is a natural medium for meetings between the gen-erations (Adamson, Daborn, Houston, & Tootoo, 2009; Adelson & Olding, 2013).

Although there is still a ‘‘digital divide’’ that excludes many in low-incomecountries from ready access, mobile phones have become ubiquitous and theInternet is increasingly available to people with limited means. Migrant and dia-sporic communities are making intensive use of the Internet and associated mediato strengthen and maintain new forms of transnational identity and connectivity(Alonso & Oiarzabal, 2010; Hiller & Franz, 2004). The Internet makes prolongedcontact possible for people who, in the past, would have had limited opportunitiesfor communication. For example, Filipino mothers who must leave children behindwhen they emigrate for work, can now maintain daily contact even leaving videoconnections open for long stretches of time to bridge the distance (Madianou &Miller, 2012).

A key point here is that while the Internet has certainly allowed the developmentof new types of relationships and communities, the interactions which take place inthese seemingly anonymized spaces may also have (often unintended) consequencesfor offline, face-to-face relationships. This is especially significant in the case ofrelatively small diasporic communities where the density of offline interpersonalnetworks can make online anonymity tenuous at best (e.g., Humphrey, 2009).

Particular kinds of online spaces set certain conditions for social interactionwhich may have unforeseen potentialities as well as consequences. Facebook andother global social networking sites are especially apt examples. Facebook hasabout a billion active members in 127 countries and there are other social net-works that also have massive size (Popkin, 2013): QZone in China has over 500 mil-lion users; in Russia V Kontakte (‘‘VK’’) and Odnoklassniki have 190 million and45 million users, respectively; while Iran’s Cloob has one million users. As amedium for relationships, Facebook opens a new channel of communicationwith its own ambiguities due both to the medium and its imposed constraintsand, especially, its quasipublic nature. It creates new zones of privacy and intimacyand new scope for projecting a public persona. Illana Gershon (2010) argues thatFacebook favors a neoliberal view of the self, framed in terms of personal prefer-ences, interests and patterns of consumption. Indeed, Facebook and other socialnetworking sites encourage participants to treat the self as a market commodity, ondisplay for others to judge its attractiveness and seeking always to gain moreattention and market share. This is, of course, explicit in business-oriented siteslike LinkedIn, but readily extends to academic and other specialized socialnetworks.

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These new forms of social networking allow the creation of new selves (or per-sonas) with qualities that can transcend some of the usual physical and sociallimitations of identity and community. For example, Boellstorff (2010) arguesthat virtual worlds like Second Life afford individuals extraordinary new oppor-tunities for self-fashioning, creative play, and community.3 However, examiningthe links between the virtual world of Second Life and its real world corporatecreator, Malaby (2009) argues that certain limits, constraints, and even certainideologies may be embedded in the structure of such online worlds and thuswe must pay attention to their producers (in this case Linden Lab) as much astheir users.

While the Internet and digital technologies have clearly transformed the chan-nels, potentialities, and temporality of community and political action, they havealso produced their own novel political movements and debates (Vinge & Frenkel,2001). This is a point taken up by several social scientists in examining the cultureand political arguments associated with self-described ‘‘hackers’’ or ‘‘geeks,’’ whohave focused on the attempts to reframe matters understood by the lay public to be‘‘merely technical’’ in political, social, or aesthetic terms (Coleman, 2009; Coleman& Golub, 2008; Kelty, 2005). For example, Gabriella Coleman shows how partici-pants in the ‘‘Free and Open Source Software’’ movement have sought to framecode as speech, as a means of maintaining their highly valorized autonomy asproducers of code—a process which has often involved as much tinkering withthe law as with technology (Coleman, 2009). More broadly, Chris Kelty has arguedthat the form of social imaginary specific to the Internet is that of the ‘‘recursivepublic,’’ highlighting the idea that ‘‘specific contemporary ideas of social or moralorder that just as often take the form of argument-by-technology as they take theform of deliberative spoken or written discussion’’ (Kelty, 2005, p. 186). By this,Kelty means that self-described ‘‘geeks’’ not only argue about ‘‘the technical struc-ture and legal rules’’ that make up the Internet’s infrastructure, ‘‘but they considersacred the right to change these rules by rewriting and reimplementing the coreprotocols (the ‘‘rules’’) and core software that give the Internet its structure’’(Kelty, 2005, p. 186).

Beyond the geeks and hackers for whom the Internet is something close toa raison d’etre, the new generations of ‘‘digital natives’’ who feel at home onthe Internet will exert increasing influence on popular culture and the shapeof our social worlds (Palfrey & Gasser, 2008). A recent example is the growingmovement of Kopimism, hailed as ‘‘the world’s newest religion’’ (George, 2012).The Church of Kopimism, which was registered by the government of Swedenas an officially recognized religious organization (BBC, 2012), is a congregationof file sharers who consider copying and sharing of information to be not onlya right, but a sacred act. The slogan of the Missionary Church of Kopimismis, ‘‘Information is Holy. Code is Law. Copying is Sacrament.’’ Whateverits merits as the basis for a religion, it remains unclear to what extent thiscreed is the rallying cry of a young generation accustomed to sharing digital




media, a clever strategy to circumvent copyright law, or the genuine expression of anew ethos centered on the free flow of information.

Pathologies of the Internet

As Internet access has grown worldwide, so have various behaviors, practices, andsocial phenomena understood by many clinicians and social critics as pathological,harmful, or in some way problematic—ranging from ‘‘Internet addiction’’ to cyber-bullying, social isolation, and the amplification of psychopathology. While fewwould question the claim that many people have experienced the Internet andrelated technologies in ways which are distressing or associated with a constrictionrather than an opening of possibilities, such potentially Internet-related pathologieshave provoked numerous debates and raised important issues for psychiatrists andsocial scientists. Many of these questions relate to the particular role played by theInternet and other information and communications technologies in shaping andenabling these behaviors and practices. Are technologies producing fundamentallynew or distinct kinds of pathological behavior for which novel nosological classi-fications and clinical interventions may be necessary, or are they simply providingnew channels for the enactment of familiar forms of distress? For example, while‘‘cyberbullying’’ has attracted significant attention over recent years, researchersand policy makers differ over the degree to which it represents a set of dynamicsrelatively distinct from face-to-face bullying (e.g., M. A. Campbell, 2005; Mitchell,Finkelhor, Wolak, Ybarra, & Turner, 2011). These questions have an importantethical dimension as well; for in answering them clinicians and researchers mustdistinguish moral panic and unwarranted medicalization from conditions in whichmental health interventions may be helpful.

In conjunction with the global spread of identity-based politics and broad socialshifts which have encouraged greater patient autonomy over recent decades, theInternet has become a vital space for the creation of biosocial communities—withethical, political, social, and clinical consequences which are yet being worked outand debated (Bell, 2007; Charland, 2005). As in the case of apotemnophilia (bodyintegrity identity disorder)—a condition in which individuals express (and often actupon) an urgent desire to undergo limb amputation (Elliott, 2000)—the Internethas fostered the creation of communities around forms of pathology that wouldotherwise be exceedingly rare, acting as a new vector in what Ian Hacking hascalled ‘‘making up’’ people (Hacking, 1986, 2002). The networks of websitesformed around delusion-like beliefs (in particular, mind-control experiences) areanother example—with significant consequences for clinical conceptualizations ofdelusion vis-a-vis the consensual reality of communities (Bell, Maiden, Munoz-Solomando, & Reddy, 2006). The significance of such cases is not only that other-wise isolated individuals may understand themselves differently when they commu-nicate with people experiencing similar conditions, but that certain experiences,affective states, and beliefs may be reinforced or amplified, both through the

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social ‘‘looping effects’’ associated with identification and sociality, and throughthe triggering of embodied responses to certain images and ideas.

These developments require sustained attention from social scientists and cul-tural psychiatrists if we are to move beyond responses driven by alarmism andmoral panic, particularly in those cases where the Internet is used to developcommunities around what many understand as potentially harmful or pathologicalforms of behavior. For example, the emergence of online communities of self-identified ‘‘pro-anorexics’’ (‘‘pro-anas’’), ‘‘pro-bulimics’’ (‘‘pro-mias’’) and personsengaged in self-injury has been greeted with alarm by many mental health profes-sionals, as well as the lay public—because they are often understood as potentiallypromoting, amplifying, or triggering harmful behaviors in vulnerable individualswith a history of self-injury or eating disorders (Adler & Adler, 2008; S. P. Lewis,Heath, St Denis, & Noble, 2011; Miah & Rich, 2008; Norris, Boydell, Pinhas, &Katzman, 2006). Scholarly and clinical debates surrounding these communitieshinge on the question of whether they actively promote harmful behavior—inpart by framing eating disorders or self-injury as identities and legitimate waysof being rather than pathology—or whether they provide a safe, nonjudgmental(and potentially therapeutic) space for the discussion of one’s problems (Bell, 2007;Brotsky & Giles, 2007; Dias, 2003). Some linguistic and ethnographic studies havefound that pro-ana websites may have positive effects for participants in terms ofhelping to manage anxiety and gaining insight into one’s condition (Fox, Ward, &O’Rourke, 2005; Lyons, Mehl, & Pennebaker, 2006).4 While such findings arelimited in that these studies have no access to the offline lives of forum participants,several experimental studies suggest that viewing pro-ana websites may have morenegative effects in terms of affect, self-esteem, and likelihood to engage in dis-ordered eating (Bardone-Cone & Cass, 2007; Jett, LaPorte, & Wanchisn, 2010).A similar set of issues surrounds the various suicide-related Internet communitiesand websites, like those described in the paper by Ikunaga and colleagues (2013) inthis special issue. Many observers have raised concerns about Internet-based sui-cide pacts and the availability of instructions for effective methods online, whileothers argue that online suicide-related venues may have preventative effect bypromoting communication and feelings of belonging (Becker, Mayer,Nagenborg, El-Faddagh, & Schmidt, 2004; Bell, 2007; Ozawa-De Silva, 2010). Inhis article on suicide communities in this special issue, Ronald Niezen (2013)explores the possibility that both influences may occur, with consequences differingaccording to the contexts and vulnerabilities of individuals and even wholesocieties.

Debates about Internet addiction are similarly illustrative of the contentiousnessand ambivalence surrounding questions of mental illness and new communicationstechnologies. While the idea of ‘‘Internet addiction’’ or ‘‘computer addiction’’ hadbeen suggested by others, the first formalized diagnostic tool to be widely taken upwas developed during the mid-1990s by psychologist Kimberly Young (1998a). Inboth specialist and popular publications, Young argued that her diagnostic ques-tionnaire for Internet addiction, which was based on a pre-existing battery of




questions on pathological gambling, successfully measured a syndrome of uncon-trolled and harmful Internet use (Young, 1998a, 1998b, 2004). The subsequent15 years have seen an explosion in research and debate about the validity ofInternet addiction as a diagnostic category, with much discussion following pro-posals for its inclusion in the DSM-V (Aboujaoude, 2010; Block, 2008; Byun et al.,2009; O’Brien, 2010; Pies, 2009; Tao et al., 2010). Proponents of the category havedescribed it as a ‘‘compulsive-impulsive spectrum disorder,’’ and have argued thatit involves key symptoms and behavioral patterns which mirror those of substanceaddictions: namely, excessive use, withdrawal, tolerance, and negative repercus-sions (Block, 2008). For many researchers in the neurosciences, this argument issupported by the broader reframing of substance use disorders and various behav-ioral compulsions (pathological gambling, as well as, potentially, overeating) asvariations of a single disorder: ‘‘addiction,’’ understood (in part) as a disruption ofcommon neural pathways linked to reward and desire (Dackis & O’Brien, 2005;Kalivas & Volkow, 2005; O’Brien, 2010). According to this model of addiction as a‘‘chronic, relapsing, brain disease,’’ activities such as online gaming may activateneural reward pathways intensely enough to make them analogous to alcohol,opiates, and other psychoactive substances (O’Brien, 2010).

Critics of the concept of ‘‘Internet addiction’’ as a discrete disorder (or even as auseful clinical heuristic) have pointed to the inconclusiveness of epidemiologicalstudies (which are themselves beset by a lack of agreement on measures), as well asto more fundamental conceptual problems (Widyanto & Griffiths, 2006; Yellowlees& Marks, 2007). Some researchers have argued that in the absence of clear evidenceof physiological effects, the use of terms such as ‘‘withdrawal’’ and ‘‘tolerance’’ isessentially ‘‘metaphorical’’ (Pies, 2009).5 Other critics have argued that a languageof ‘‘addiction’’ is too suffused with non-specialist meanings to be useful as a setof analytical terms. Thus ‘‘addiction’’ is often used in North America as a short-hand for expressing an offhand ambivalence about the role of technology in every-day life (e.g., references to ‘‘CrackBook’’ or ‘‘Crackberry’’) or as a positivedescriptor of a technology’s ‘‘holding power’’ (e.g., ‘‘This game is so addictive!’’;Johnson, 2009). Vaughan Bell and others have argued that the very notion of‘‘Internet addiction’’ represents a category error, in that ‘‘the Internet’’ is amedium of communication or a particular kind of environment, rather than abehavior (Bell, 2007). While one means of addressing this concern would be tocreate even more specific categories (such as ‘‘online video game addiction,’’[Hellman, Schoenmakers, Nordstrom, & van Holst, 2013]) which would addressparticular computer-related activities, the broader point Bell and others make isthat distressful patterns involving communications and information technologiesmay be adequately described using existing diagnostic categories (Bell, 2007; Pies,2009). In other words, a question which remains deeply contested in the literatureon harmful Internet use is whether activities such as video gaming create the con-ditions for distinct kinds of disorder or whether they simply furnish a context forthe enactment, precipitation, or amplification of behaviors associated with pre-existing conditions such as OCD or depression.

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The issues at stake here are not only the global ones which confront any attemptat constructing psychiatric nosologies, but also include one that is somewhat spe-cific to our entanglements with technology: namely, how to understand the etiologyand causal mechanisms of disorders in which interaction with a technology (ormaterial substance) is involved. In the history of thinking about substance-relatedaddictions there has been a tension between emphasizing the addictiveness of thepsychoactive substance and focusing on the vulnerabilities (whether understood ingenetic, psychosocial, or cultural terms) of particular individuals or populations.Recent technology-related discussions have clearly tended toward the first of thesetendencies, focusing on their purportedly inherently ‘‘addictive’’ characteristics(N. D. Campbell, 2007; Valverde, 1998). In her recent ethnography of videomachine gambling in Las Vegas, anthropologist Natasha Dow Schull takes a con-ceptual approach which avoids ‘‘the tendency of strict materialism to treat tech-nology as an autonomous, determining force, while also avoiding the tendency ofhuman-centered approaches to regard technology as a passive, neutral tool’’(Schull, 2012, p. 19). Drawing instead on the work of Bruno Latour and otherscholars of human–technology interaction, Schull examines gambling addiction asa phenomenon which is coproduced by, or emerges in, a dynamic interactionbetween video gambling machines and the people who play them (e.g., Latour,1992). Schull pays close attention to the accounts of players—particularly theirdescriptions of being ‘‘in the zone,’’ the ‘‘world-dissolving state of subjective sus-pension and affective calm’’ which some machine gamblers seek to attain again andagain, despite experiencing extremely painful consequences in many domains oftheir lives as a result (2012, p. 19). Yet her investigation focuses as much on thedesigners of gambling machines and casino architecture—that is, those who‘‘inscribe’’ machines and spaces so as to encourage such experiences—as it doeson the people who find themselves caught in circuits of escape and enclosure(Schull, 2012). Not only are the dynamics at play here similar in many ways tothose of particular kinds of Internet use, but the conceptual focus on experiencesand behavioral patterns as neither immanent to a particular technology, norentirely ascribable to individual vulnerabilities, offers a productive vantage fornew research on these issues (e.g., Ash, 2012). In fact, online gambling is an enor-mous industry which, ironically enough, has been a major source of revenue forsome Indigenous communities already engaged in running casinos (Williams,Wood, & Parke, 2012).

An additional problem with the ‘‘addiction’’ category is that it tends to frameresearch questions entirely around the question of pathological or harmful Internetuse or video gaming. Much like other health-oriented research on substance abu-se—which often forgets the socially productive factors which draw many peopleinto drinking or drug-use to begin with—research premised on the notion of‘‘Internet addiction’’ sets out to look only for harmful or distressful effects orresults. In research reported in this issue, as well as elsewhere, Jeffrey Snodgrassand his colleagues (Snodgrass et al., 2012; Snodgrass, Lacy, Dengah, & Fagan,2011; Snodgrass, Lacy, Dengah, Fagan, & Most, 2011) have developed a project




which instead seeks to understand the factors shaping both harmful and positivetrajectories of online gaming. Using a combination of ethnographic and surveymethods, Snodgrass and colleagues have shown that players in the massively multi-player online game,World of Warcraft, were more likely to experience distressful orproblematic patterns if their game-play was motivated largely by a desire foror enjoyment of competition or in-game achievement, rather than social interactionor immersion in the game environment (Snodgrass et al., 2012; 2013). Moreover,gamers who played with offline friends and acquaintances—and thus were able to‘‘transfer in-game accomplishments and experiences to offline social networks’’(Snodgrass, Lacy, Dengah, & Fagan, 2011, p. 1211)—reported less problematicand disruptive relationships to their gaming than those who did not. This workcontributes to literature focusing on ‘‘problematic Internet use’’—rather than‘‘addiction’’—a term meant to index underlying psychosocial issues rather than adiscrete disease entity (e.g., Aboujaoude, 2010; Shapira et al., 2003; Yellowlees &Marks, 2007).

As these discussions suggest, the category of ‘‘Internet addiction’’ remainshighly contested—especially in North America, Europe, and Australia. Despitethe efforts of its proponents, it will appear only in an appendix of the DSM-5,along with other diagnostic constructs for which additional research has beendeemed necessary. The situation is strikingly different in China, (as well as otherEast Asian countries, particularly, Taiwan, South Korea, and Singapore), where‘‘Internet addiction’’ has been much more readily accepted by clinical professionalsand governing institutions and translated into (often controversial) interventionand social policy (Bax, 2011; Manjikian, 2012). Since the early 2000s, as Internetcafes became increasingly common sites for online gaming in China, a series ofsensational suicides, murders, and other deaths (heavily covered by the media)understood as linked to online gaming, fuelled popular and expert anxieties overpathological Internet use, leading to the recognition of ‘‘Internet addiction’’ as adisease by Golub and Lingley (2008, p. 62). Interventions have included stateefforts to regulate Internet cafes and online game operators, as well as the estab-lishment of numerous boot-camp style Internet addiction treatment facilities(Manjikian, 2012). (In response to a series of investigative reports on the deathsof several young people, legislation was passed in 2009 outlawing electroshocktherapy in such facilities in China [Stone, 2009]). Some social scientists have inter-preted the obsession with online games as a response to the intense familial pres-sures to achieve high grades experienced by many young people in China today(Bax, 2011), while others have argued that the moralizing and pathologizing mediaand expert discourses around Internet addiction in China represent a means ofstate-fostered social control (Manjikian, 2012), a site for the negotiation of shifting‘‘moral relations in contemporary Chinese society’’ (Golub & Lingley, 2008, p. 72;Szablewicz, 2010), and a focus for anxieties about the neo-colonial cultural effectsof the Internet—crystallized in talk about online games as ‘‘electronic opium’’(Golub & Lingley, 2008, p. 64). Such studies have generally focused on mediareports, and there is much work to be done in expanding their insights with

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survey studies like that of Yang and colleagues (2013) in this special issue, as well asfiner grained ethnographic and interview-based research, drawing upon the richliteratures of cultural psychiatry and psychological anthropology.

e-Health

The Internet has made vast resources of knowledge and opinion available to thoseable to navigate its shoals. This access to technical information and opinion hasaltered the dynamics of clinical negotiation. Many patients now arrive at the clin-ician’s office with Internet printouts in hand, requesting a specific treatment thatthe doctor may not yet have heard about (Heaton, 2010). This represents a signifi-cant change in the availability of the information that constitutes the professionalexpertise of the clinician. Indeed, it has led to real challenges for health careprofessions that are based on a model of the caregiver as expert. The accessibilityof knowledge and the ‘‘flattening’’ of the knowledge-power hierarchy broughtabout by the new technologies of information confront psychiatry with a crisisof identity (Rahimi, Hannah, & DelVecchio Good, 2012).

The use of Internet-based health resources has great potential to enhance mentalhealth literacy, promote self-care, and improve health outcomes and well-being(Anderson, 2004; Dey, 2004; Norman & Skinner, 2006). Much of the informationavailable on the Internet is of high quality (Reavley et al., 2012). However, lay-people may be ill-equipped to judge reliable guidance from idiosyncratic opinion.

The global reach of the Internet makes it a powerful tool for providing resourcesfor rural and remote communities (Griffiths & Christensen, 2007). In many regions,small remote communities are the homes of culturally distinctive Indigenous peo-ples. Internet-based mental health promotion can address some of the basic needsof these communities for information, self-management techniques, and interven-tion (Ybarra & Eaton, 2005). In these settings, Telehealth can provide an import-ant adjunct to local resources and, when coupled with innovative media, can reacha wide audience (Hunter, 2007). A wide variety of interventions can be deliveredthrough the Internet and other ICTs (Strecher, 2007). In this special issue, JohanaMonthuy-Blanc and colleagues (2013) discuss the potential for delivering psycho-therapy using videoconferencing to remote Aboriginal communities in Canada.

The potential to access information privately and anonymously makes theInternet a particularly important resource for those coping with the social stigmaoften associated with mental health problems. There is evidence that Internet userswith mental illnesses are more likely than those with nonstigmatized conditions touse the Internet to search for health information or to communicate with careproviders (Berger, Wagner, & Baker, 2005; Leach, Christensen, Griffiths, Jorm,& Mackinnon, 2007). However, because Internet use requires technical skills, thereliance on web-based resources may aggravate existing disparities in access tohealth information (Neter & Brainin, 2012).

A growing body of research documents the impact of Internet-based technolo-gies on clinicians (Pluye, Grad, Dunikowski, & Stephenson, 2005; West & Miller,




2009). Internet-based communication strategies offer many advantages for clinicalinformation exchange. First, they allow for networking, creating links betweencommunity groups, clinicians, and government organizations (Murero & Rice,2006). Secondly, they allow for much wider accessibility, making these materialsand tools available in rural or remote locations (Hunter, 2007). At the same time,the flexibility of an electronically based resource can facilitate local cultural adap-tation. For example, the same basic information structure can be recreated inmultiple languages or with multimedia adjuncts that improve access to thosewith low levels of literacy (Boiko, Katon, Guerra, & Mazzoni, 2005).

Conclusion: Visions of the future

‘‘In the past, even the future was better’’

Karl Valentin, as quoted in Carriere and Eco (2011)

The Internet provides us with new media, new connectivity, and new terrain toexplore and colonize. This is coupled with new modes of self expression and par-ticipation afforded by specific types of social media, ranging from the instant cor-respondence of e-mail and the narrative of Facebook, to the monologues ofpersonal blogs, the pseudo-aphorisms of Twitter, and the visual exuberance ofYouTube. The Internet allows for new kinds of social amplification, in whichvideos produced by an adolescent in their bedroom can ‘‘go viral’’ with millionsof viewers and sometimes translate into fame and fortune. At the virtual Hyde Parkcorner, anyone who has the energy and garrulousness can grab the electronicmegaphone of the Internet and be heard far beyond what would previously havebeen possible. The linking of mobile telecommunications and recording devices tothe Internet allows new forms of instant documentation and reporting that canchallenge forces of repression and become tools to promote accountability andsocial change. However, these tools are also often regulated and controlled bypowers beyond the individual or local community, and so can be used to silenceand repress or to spread disinformation with potentially devastating effects.

The Internet is growing in scale and complexity, prompting some to herald theemergence not only of a global village (Malamud, 1997; McLuhan & Powers,1989), but a global consciousness (Chorost, 2011; Levy, 1997). By 2007, all thegeneral-purpose computers in the world computed 6.4� 1018 instructions per sec-ond—the same order of magnitude as the rate of nerve impulses within a singlehuman brain (Hilbert & Lopez, 2011). Indeed, the emergence of consciousnesswithin the Internet itself is a recurrent theme in science fiction. In David Brin’snovel Earth (1990), for example, the planet itself becomes a sentient being able toprotect its own welfare. More recently, Robert Sawyer (2009) has written a trilogyin which the Internet becomes self-aware and linked to human consciousnessthrough a computerized visual prosthesis for a blind girl. The resultant web-mind intervenes to save humanity from itself. Whereas the Cold War visions of

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sentient machines generally ushered in the apocalypse, many of these newer visionsherald a utopian world in which a benevolent consciousness that shares our ethicaland aesthetic values solves many of our pressing problems. This utopian viewechoes the vision of the Christian mystic Teilhard De Chardin who saw the emer-gence of a noosphere, a collective intelligence that represented humanity’s capacityfor self-transcendence.6

The power and ubiquity of the Internet and ICTs transforms the meanings ofculture in the contemporary world with implications for mental health and illness(Barak, 2008; Silver & Massanari, 2006). To explore this new terrain, culturalpsychiatry requires new theoretical models and research methodologies thatinclude digital ethnography (Boellstorff, Nardi, Pearce, Taylor, & Marcus, 2012;Burnett, Consalvo, & Ess, 2010; Coleman, 2010; Miller & Horst, 2012). The issue athand is not that the Internet will become self-aware but that our own awarenessand self-understanding may be inadequate to comprehend and anticipate the con-sequences of this medium, which gives rise to new aesthetics, ethics, and politics.There are the effects of technology we intend and others that come along unbidden,creating new problems and predicaments as well as possibilities. Psychiatry mustwork with the social sciences to understand and engage these new forms of net-working, knowledge production, identity and community which are changing themeanings of culture itself.

Notes

1. For a summary of this work see http://indigenousartsnetwork.ca/artists/skawennati_tricia_fragnito/

2. Although Gibson coined the term, one of the earliest accounts of cyberspace and some of

its political implications was imagined by Vernor Vinge in his story True Names, whichhad a direct influence on the development of the technologies through the MIT media lab(Vinge & Frenkel, 2001).

3. Second Life allows users to construct their own avatars, modifying not only clothing butbasic physical characteristics. Working the software controls that change the avatar’sfeatures, including the height and weight but also colour of skin, eyes, and hair, widthof the nose, and other markers of racialized identity can have an immediate effect on the

participant’s sense of physical embodiment. Many participants strive for an accuratemirroring of their bodily appearance off screen but some explore radical alterations ofself (Bloustien & Wood, 2013). These choices and the degree to which an individual feels

actually present in the virtual environment may be related to mental health and well-being (Behm-Morawitz, 2013).

4. A key problem posed by these communities for researchers is the difficulty of following

participants in their nonvirtual worlds (rather than simply exposing nonparticipants to thecontent of certain websites). For a variety of practical and ethical reasons, the vast majorityof research on such communities has consisted of ‘‘lurking’’—reading publicly posted

dialogues in online forums. We have, however, much less knowledge about how theonline lives of these community participants intersect or depart from their offline lives.

5. A different example of such metaphorical use of addiction language are recent mediareports about ‘‘digital drugs,’’ ambient sounds—known as binaural beats—that




are advertised as inducing consciousness altering effects which mimic those of specificpsychotropic drugs (e.g., Komando, 2008).

6. De Chardin’s vision was an influence on Marshall McLuhan’s idea of the emergence of

the global village (De Vries, 2013).

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Laurence J. Kirmayer, M.D., is James McGill Professor and Director of the Divisionof Social and Transcultural Psychiatry in the Department of Psychiatry, McGillUniversity. He is Editor-in-Chief of Transcultural Psychiatry and directs theCulture & Mental Health Research Unit at the Institute of Community andFamily Psychiatry, Jewish General Hospital in Montreal, where he conductsresearch on culturally responsive mental health services, the mental health of indi-genous peoples, and the philosophy of psychiatry.




Eugene Raikhel is Assistant Professor in the Department of Comparative HumanDevelopment at the University of Chicago. A cultural and medical anthropologistby training, his research interests encompass the anthropology of science, biome-dicine and psychiatry; addiction and its treatment; suggestion and healing; andpost-socialist transformations in Eurasia. Along with William Garriott he iseditor of Addiction Trajectories (Duke UP, 2013).

Sadeq Rahimi is Assistant Professor of Medical Anthropology and AssociateFaculty in Psychiatry at the University of Saskatchewan. He received his Ph.D.in Transcultural Psychiatry at McGill University and training in ChildPsychoanalysis in Montreal, followed by a Postdoctoral Fellow appointment inGlobal Health and Social Medicine at Harvard Medical School, a Research Fellowappointment at the Harvard Center for Middle Eastern Studies, and PostdoctoralClinical Fellowship in Adult Psychoanalytic Psychotherapy at the Boston Institutefor Psychotherapy. His current research interests include: cultural and politicaldimensions of mental health; political subjectivity and the role of digital ummahin Muslim communities; and the problematics of future subjectivities.

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Cultures of the Internet: identity, community and mental health

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