8. Discussion and Recommendations
This article is part of a research study publication on Experience Design for PTSD. This section reflects on the role of design within the domains of mental health care and PTSD. Recommendations for further research and design work are suggested.
The first chapter of the study presented the case for the inefficient and ineffective service of the current mental health care system. A major identified issue is the overemphasis on illness and diagnosis. The expertise of the medical field is using scientific method to investigate mental conditions and the output of this effort is a standardised treatment. However, there are various barriers preventing the people in need of this treatment to access it resulting in inefficient distribution of supply of and demand for the treatment.
Design has a role to play in addressing this inefficiency because of its inherent focus on people. The expertise of human-centred design is using ethnographic method to investigate people’s needs and challenges regarding mental conditions and the output of this effort is the key to delivering the treatment as a health care service.
Therefore, the optimal allocative efficiency of supply and demand for mental health treatment would be a function of clinical and human-centred design expertise.
The clinical process is typically linear using a scientific method to determine disease characteristics and define diagnosis according to which a standardised treatment is prescribed. The main material of the clinical field is the disease. Because the characteristics of disease are determined by scientific method, it is considered indisputable and therefore stable material to work with. Hence, the resulting treatment can be standardised.
The material of the design process are human needs which depend on multiple variables due to the diversity of people and contexts. Therefore, the output key cannot be standardised. It depends on the specificity of individuals being designed for. This implies, that if design is to play a role in the future service delivery, there will be many different keys on the same treatment keychain to unlock the variety of barriers to optimal health and wellbeing.
In this publication, digital technology was discussed as one of those keys. The current state of advantages and disadvantages of this key were presented and analysed. It is important to highlight that digital technology should not be considered as a solution to the problems in the metal health care system. It is simply means of addressing some of the challenges in regard to mental health treatment.
In terms of PTSD, there is a valid controversy that as a clinical disorder that often presents comorbidity with other conditions (such as substance abuse, anxiety, depression, self-harm), it is inappropriate to be treated without medical supervision. The complexity of interrelated factors that contribute to PTSD would require an expert psychological assessment in order to determine adequate approach of treatment. This implies that a self-paced digital-based intervention would be a malpractice with high risk of re-traumatisation.
Contrary to the established conventional view on trauma as a brain injury causing a dis-order, some authors lean on latest neuroscientific discoveries to re-define trauma as a re-order of the neurological patterns affecting the whole body in response to an abnormal situation. The core cause for the reorder is threat which triggers the basic survival mechanisms of the organism which have been heavily researched and commonly understood in the neuroscience field. Latest advances in neuroimaging technology allows for even better knowledge of the neurological reactions to danger uncovering understanding of the root cause of trauma and how to undo it. This implies that from neurological view the initial patterns in response to threat are the same, however, if left unattended, the specific circumstances of the particular person (upbringing, environment factors, social support, personal inclinations, resilience level) will affect the development of trauma leading to the complexity of factors constituting PTSD.
To recap: clinicians who see trauma as a irreversible disorder will treat it as such offering treatment to help tolerate symptoms and manage their implications. An Analogy of this is to see some trash in a room, take it apart, and organise it by shape, size, and colour.
Clinicians who recognise trauma as a reversible condition will treat it as such by addressing the root-cause and not the symptomatic expression of the trauma. To use the same analogy — they would just take the trash out of the room without digging too much into it.
Following the scientific explanation that behavioural patterns related to trauma are tied to the neurological reordering in response to the threat, it can be implied that with sufficient knowledge individuals can recognise the change and address it. Considering the ubiquity of traumatic events and the limited possibility to prevent them, trauma should be considered as something to be anticipated and acted upon accordingly rather than something to be stigmatised.
For the reasons discussed above, the main argument of this paper is that the knowledge about trauma should be unlocked from the hardly accessible clinical domain and distributed to diversified service levels in society in easy reach to the people who need it. Based on the research for this study, the primary reflection is that trauma should be understood as common sense in society and not as specialised expertise of psychiatry.
Design is particularly suited discipline to facilitate this transition in two ways:
- experience design — to formulate suited strategies for people to apply in regard to trauma
- service design — to distribute these strategies among the population in an adequate way. An example can be introducing instructions on what to do if something traumatic happens to parent education classes, kindergarten or school classes to prepare individuals at early formative age and prevent stigmatisation of the topic.
The experience of trauma has to do with being out of control. So the design challenge is how to provide people with sense of control over their own life domain. It was the purpose of this study to explore a potential opportunity in this direction bundled in twelve experiences. These are envisioned as a toolbox system easily available for a person to rely on for guidance in moments of overwhelm. Further development work and testing should be undertaken to validate efficacy.
The recommendation for further research is to continue forging in the direction of empowering individuals with knowledge to enable them to take control over potential trauma implications and sustain their wellbeing. Hereby a broad design brief for further exploration:
How might we help society consider the handling of trauma as a basic life skill?
