Our Chronic State of High Alert

Alfred Sommer, MD, MHS

There is little evidence that cell phones cause cancer, but plenty of reasons to be concerned that modern telecommunications might affect our mental health.

There was once a time (about 15 years ago) when correspondence was remarkably orderly and digestible. Letters from Burma could take a week to arrive, while those from California could take even longer. No need to rush a reply: Who knew how long the original had taken to reach you? Time provided an opportunity for thought and common civility (as in, "How are the spouse and kids?").

Then the fax arrived. You and the sender both knew exactly when a fax was received — simultaneously with when it was sent. Faxes were sufficiently novel (and long distance phone rates sufficiently high) that their arrival demanded an urgent response — if "urgency" wasn't needed, it wouldn't have been faxed! The great communications race was on, but few of us recognized it.

Enter e-mail. I began using it, largely for internal communications, about 12 years ago. It seemed a quick and efficient means of communicating with a specific individual for a specific purpose, mostly on a limited intranet shared by a few others in the same institution.

Six years ago, e-mail traffic began to take off. At first, e-mail seemed not only innocuous, but a real time-saver. Faculty and staff could send me a quick note about an issue, and I could respond when I was free, eliminating two to six fruitless telephone tags.

The real revolution began only two years ago. "Snail mail" disappeared — which would have been fine if e-mail had simply replaced it. Instead, e-mail changed the entire nature of written communication. First, you didn't just e-mail the principal correspondent; you also e-mailed 12 potential "respondents" and their 200 closest friends. Why leave anyone out of the loop when a simple click of the mouse could capture the universe? The sheer magnitude of e-mail rose dramatically. Five years ago, the School processed 20,000 e-mails a day. Last year, it processed 350,000 a day. It's true that my first Wang word processor could generate "personalized" form letters and "bcc"s by the dozen, but the tendency to involve this radical new capability was held in check by the need to feed the printer, sign and fold each letter, and address and stamp each envelope.

The second consequence of the e-mail revolution was to increase dependency. People perfectly capable of making the most complicated decisions suddenly became dependent upon the advice of dozens of colleagues and the agreement of their titular boss. This is reminiscent of claims that the invention of the telegraph brought down the British Empire: People in the field needed to consult with London before making any decisions, something that had been impossible when letters took three months to circle the globe.

The net result? Another quantum jump in the quantity of e-mail traffic. How in the world does one cope with 100 or more e-mails a day? I've absolutely no idea, but it dominated discussions at a recent meeting of deans of schools of public health. I am certain we will soon enjoy a plethora of self-help books on the subject.

If e-mail were not bad enough, it's been joined by the cell phone. Personally, I have mine off except when I need to make an urgent call. But that hardly helps. One is constantly surrounded by these chirping, musical machines; and by train passengers engaged in (generally) boisterous descriptions of their latest business plans, meals, or life conquests.

The bottom line? We are tethered to an overwhelming volume of communication. Attempts to find a time and place for thought and deliberation are often thwarted by others. Except for remote mountaintops, there is virtually no escape from incessant messages, whether they are your colleague's latest thoughts, your fellow passenger's stock picks, or the inevitable dinnertime solicitations.

If extreme shyness ("social anxiety syndrome") is the newest "major mental health problem," allegedly afflicting 10 million Americans, what can we expect of our frazzled society when its mental health is next assessed? I remember what it was like to be on call as an intern, sometimes for as long as three days at a time. We are all now "on call" around the clock: 24 by 365.