Psychiatric Annals

Computers and Psychiatry: An Historical Perspective

Howard P Rome, MD

Abstract

The 19b0s in many ways was a time of turbulence and innovation. The innovation which bridged the gap between burgeoning technology and biomedicine was the application of digital processing equipment - computer technology - to biomedical problems. Initially these were applications to primarily iterative processes which were inordinately time-consuming and hence formidably cosily. In September 1960, Dr. lames A. Shannon. Director of the National Institutes of Health, established the Advisory Committee on Computers in Research and thereby stressed the Public Health Service's intention to investigate and promote the growth of biomedical computing.

At about that time the IBM Corporation built its upper midwest plant in Rochester, Minnesota and geared up its Data Processing Division. This led to a future collaborative affiliation with the Mayo Clinic. The happy result was a synthesis of computer technology with biomedical research and clinical applications in such fields as electroencephalography, electrocardiography and clinical psychiatry-psychology. Further, the IBM Corporation, sensing the interest expressed by the nation's biomedical community, sponsored a series of symposia at its several eastern locations. This made it possible for groups of investigators in virtually all aspects of the rapidly expanding field of biomedicine to meet and share the new insights gained from sophisticated applications of this new technology. Out of these meetings came modern biotechnology.

It also happened at this time that there was an upward surge of requests for psychiatric consultative-liaison services to the other medical and surgical departments in general hospitals and outpatient clinics. These exceeded the capacity of the Consultation Services of the Section of Psychiatry of the Mayo Clinic to meet the taxing demand of requests in this sector of its clinical responsibilities. Moreover, the medical, surgical and other clinical sections pressed for alternatives to a formal psychiatric consultation. Historically, psychological assessment filled this role, bul it was soon apparent that the burden of such requests laxed the resources of the Section of Psychology as well.

A fortuitous solution was conceived in the acceptance of IBM Rochester's invitation to the Mayo staff to learn more about computer technology in its offer of evening seminars. Psychiatry-Psychology's problem in this regard was to find an automated solution to its service dilemma. The Minnesota Multiphasic Personality Inventory (MMPI) provided a ready-made solution, inasmuch as it was at that time the most widely used of standardized pencil and paper psychological inventories. Obviously, it needed considerable modification in its format in order to enable the hundreds of patients who seek treatment at the Mayo Clinic daily to complete the answers to the test's 5bb questions during the waiting period for their physical examinations. This necessitated a new booklet format for the test questions which could be machine processed. Ways and means were devised for explanation of the purpose of the list, instruction as to the test procedures and collection of the completed booklets as well as their delivery to the newly established computer center. The explanation given to the participating sections of the Mayo Clinic stressed the point that were the research project to be successful as an addition to the routine diagnostic evaluation, the results would provide each examining clinician with data suggesting the personality make-up of his patient. Further, it would greatly facilitate selecting those patients who were in need of psychiatric consultation. This would be accomplished by providing the next day. along with all other laboratory data, a psychologically sophisticated profile with its supportive data and also an interpretation of the data based on easily understood standardized evaluations. The preferential selection of those patients who required a psychiatric consultation was noted by the statement: "consider requesting psychiatric consultation." This sentence…

The 19b0s in many ways was a time of turbulence and innovation. The innovation which bridged the gap between burgeoning technology and biomedicine was the application of digital processing equipment - computer technology - to biomedical problems. Initially these were applications to primarily iterative processes which were inordinately time-consuming and hence formidably cosily. In September 1960, Dr. lames A. Shannon. Director of the National Institutes of Health, established the Advisory Committee on Computers in Research and thereby stressed the Public Health Service's intention to investigate and promote the growth of biomedical computing.

At about that time the IBM Corporation built its upper midwest plant in Rochester, Minnesota and geared up its Data Processing Division. This led to a future collaborative affiliation with the Mayo Clinic. The happy result was a synthesis of computer technology with biomedical research and clinical applications in such fields as electroencephalography, electrocardiography and clinical psychiatry-psychology. Further, the IBM Corporation, sensing the interest expressed by the nation's biomedical community, sponsored a series of symposia at its several eastern locations. This made it possible for groups of investigators in virtually all aspects of the rapidly expanding field of biomedicine to meet and share the new insights gained from sophisticated applications of this new technology. Out of these meetings came modern biotechnology.

It also happened at this time that there was an upward surge of requests for psychiatric consultative-liaison services to the other medical and surgical departments in general hospitals and outpatient clinics. These exceeded the capacity of the Consultation Services of the Section of Psychiatry of the Mayo Clinic to meet the taxing demand of requests in this sector of its clinical responsibilities. Moreover, the medical, surgical and other clinical sections pressed for alternatives to a formal psychiatric consultation. Historically, psychological assessment filled this role, bul it was soon apparent that the burden of such requests laxed the resources of the Section of Psychology as well.

A fortuitous solution was conceived in the acceptance of IBM Rochester's invitation to the Mayo staff to learn more about computer technology in its offer of evening seminars. Psychiatry-Psychology's problem in this regard was to find an automated solution to its service dilemma. The Minnesota Multiphasic Personality Inventory (MMPI) provided a ready-made solution, inasmuch as it was at that time the most widely used of standardized pencil and paper psychological inventories. Obviously, it needed considerable modification in its format in order to enable the hundreds of patients who seek treatment at the Mayo Clinic daily to complete the answers to the test's 5bb questions during the waiting period for their physical examinations. This necessitated a new booklet format for the test questions which could be machine processed. Ways and means were devised for explanation of the purpose of the list, instruction as to the test procedures and collection of the completed booklets as well as their delivery to the newly established computer center. The explanation given to the participating sections of the Mayo Clinic stressed the point that were the research project to be successful as an addition to the routine diagnostic evaluation, the results would provide each examining clinician with data suggesting the personality make-up of his patient. Further, it would greatly facilitate selecting those patients who were in need of psychiatric consultation. This would be accomplished by providing the next day. along with all other laboratory data, a psychologically sophisticated profile with its supportive data and also an interpretation of the data based on easily understood standardized evaluations. The preferential selection of those patients who required a psychiatric consultation was noted by the statement: "consider requesting psychiatric consultation." This sentence was triggered and appeared in the printout by a decision based on the elevation above two standard deviations of two or more scales of the MMPI profile. It would also provide the consultative psychiatry services with a better selection of patients in need of its services.

The benefits of this collaboration proved to be enormous. The research funding was through the approval of a grant application to the National Institutes of Mental Health. The IBM technical staff was enthusiastic in its cooperative efforts. Our colleagues in every section of medical, medical specialty, surgical, surgical specialty of the Mayo Clinic were contacted and gave their assistance in securing routine samples of their patients. We are deeply indebted to them and to our IBM associates for their valuable technical help, as well as to the thousands of patients who, over the years, singly and collectively, helped in launching this pioneer endeavor. From this 25-year perspective, as noted in the following pages, the venture has produced much needed normative data.

A quarter of a century later, computer literacy is an essential ingrethent of a truly educated citizenry. Almost every school child in the US will profit from its benefits. It has, in addition, closed the gaps which have separated the heretofore discreet operations which are now seen to be necessary parts of an undivided whole.

Specifically, in our own discipline of clinical psychiatry, computer technology with its compulsion, indeed its obligation, to use standardized, validated data, forces each of us to be more precise concerning the reliability of our erstwhile idiosyncratic opinions and conclusions. Moreover, there are other prospects on the horizon which promise equally enlightening insights. It remains only to mention one such prospect which has both benefits and problems. The possibility of the creation of Psinets to take advantage of currently available satellite and microwave transmission of data leads to the possibility of linkages of individual and epidemiological data containing all manner of lasercoded information. The aspect of confidentiality of these messages is in its beginning stages of resolution, but as yet it remains a bugaboo to be resolved. This issue provides a 25-ycar update on new norms and new uses of an automated version of the MMPI contributed by members of the Section of Psychology of the Mayo Clinic.

10.3928/0048-5713-19850901-04

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