I ain't lookin' for praise or pity / I ain't comin' 'round searchin' for a crutch /
I just want someone to talk to / And a little of that Human Touch (Bruce Springsteen)
I’m going to quote at length, out of admiration but also for my own purposes, from Eve Tushnet’s article (at The American Conservative) “The Right to Look Your Judge in the Eye”:
Last month a Michigan appeals court considered the case of a man convicted of methamphetamine possession. Although the man received an unusually harsh sentence (30 to 120 months in prison, based in part on his prior record), the decision of the three appellate judges addresses not only the length of the sentence but also, and at greater length, the way it was delivered: via videoconferencing. The defendant was in the county jail when he was sentenced; he never shared a courtroom with the judge who determined his fate.
On a basic legal level, the court noted that Michigan law specifies when you can sentence via videoconferencing, and it’s not an option in felony cases. But the appeals court’s decision raises deeper philosophical issues. The three appellate judges provide a stirring defense of the antimodern belief that human dignity inheres not solely in the mind or the will, but in the body.
All men are not created equal in intellect, in temperament, or in freedom of choice. But all of us share the body’s fevers and its final silence. This recognition that human equality is found in the brute fact that we are individual, embodied human beings drives the pro-life movement: before we’re even capable of thought, our mute bodies speak our dignity and our infinite worth.
Liberalism tends to treat the body as an instrument of the will; the Michigan case makes little sense unless you acknowledge that the body is an icon.
In the gaze of the defendant the judge encounters a human dignity and equality that go beyond what rationalistic discourse can prove; they must be experienced. Like all sacred things they must be submitted to rather than comprehended.
“The right to look your judge in the eye” is an attempt to put into words something of that irreducible encounter. The judge has a “duty to acknowledge the humanity of even a convicted felon,” the court says: to recognize him- or herself in the eyes of the defendant.
And so defendants stand in court, and judges must meet their gaze—it’s intensely difficult to meet the eyes of someone you’re being asked to judge—in order to unsettle the judges, in order to remind them that their judgment is merely temporal and provisional.
The Michigan case, and the reasoning behind it, should also affect how we view the increasing use of videoconferencing in other criminal-justice settings, especially prison visits. Videoconferencing is increasingly used as an alternative to in-person prison visits—some prisons have banned in-person visits entirely. The inflated costs of the new technology, as always, are borne by the loved ones of the prisoner. Videoconferencing is better than nothing, and having it as an option makes sense; but as the Michigan decision notes, quoting an earlier case, “virtual reality is rarely a substitute for actual presence.”
The willingness to share physical space with someone, to confront them in person and meet their gaze, can be profoundly humbling. The unwillingness to do this–the use of power to prevent it—is always dehumanizing. This is part of what it means to be human: to keep body and soul together.
Allow me now to juxtapose against Ms. Tushnet’s wise and eminently humane perspective the following self-serving (and poorly written) defense (from Genoa Telepsychiatry) of “telepsychiatry”:
Because technology use has become an essential human activity, the future of telepsychiatry is assured. Telepsychiatry leverages cutting edge technology to modernize the health care industry and respond to a number of challenges that currently exist. Though we’ve seen an increase in telemedicine in general, the future for telepsychiatry is particularly bright.
Unlike most other medical professionals, psychiatrists do not have to be in the same room as their patients in order to conduct a comprehensive evaluation and administer high-quality care.
While using online videoconferencing, psychiatrists maintain their ability to observe patients’ range of facial expressions, hygiene, tone, rate of speech and a host of other subtle nonverbal cues and behaviors. As a result, the quality of care delivered through this medium is not compromised.
Studies have shown that telepsychiatry is as effective as, and in some cases even more effective than, the standard, face-to-face model of care (Hilty, Ferrer, Burke Parish, Johnston, Callahan, & Yellowlees, 2013;Zoler, 2012). Though there are certainly differences between traditional, in-person psychiatry and telepsychiatry, the pros indisputably outweigh the cons. Hospitals, clinics, providers, patients and whole communities stand to benefit from psychiatric services offered via telecommunication.
What Eve Tushnet objects to in the criminal justice system is increasingly hailed as the future of psychiatry and of the provision of mental-health services—especially in places like my home state of Montana, where psychiatrists are scarce and the distances one must travel to access them are formidable.
I have met my fair share of psychiatrists whose human warmth and bedside manner left much to be desired—but at least my dislike for them (and, for all I know, theirs for me) was formed by in-person interactions. While psychiatrists and counselors do not technically stand in judgment of clients, the relationship often feels—from the client’s perspective—like being on trial. And just as criminal defendants face a judge from a position of perceived inferiority, so too do clients/patients receiving mental health services: like a judge, a psychiatrist has the advantage in status, in education, in specialized training, usually in social class, and—most significantly—in being presumed sane where the client is presumed otherwise.
If, on top of all that, you add a physical separation between provider and client—that is, you arrange it so the provider is not even “breathing the same air” as the person being diagnosed—you underscore the imbalances in the relationship and reinforce the client’s sense of unworthiness.
Clients with resources, of course, will continue to be seen in person by psychiatrists and counselors. It will be the poor, and especially the non-urban poor, who will be consigned to the status of “teleclients”. As Eve Tushnet says, such services are better than no services at all, but it’s a sad commentary if that’s in fact the best we can do to help people struggling with mental and emotional issues. And if we’ve come increasingly to believe that human presence is a dispensable factor in the practice of law, medicine, psychiatry, and education (online learning, no campus needed!): then we’re in danger of leaving ourselves no answer at all to the question, what are people for?