Tuesday, November 22, 2011

Guest Blogger Dr. Ron Pies on Internet Anonymity

Internet Anonymity: Is it Ever Justified?
Consider Meagan’s dilemma. She is a 30-year-old, separated store clerk who is now living in a shelter for battered women. Meagan was severely abused by her husband, and now takes care to conceal her whereabouts, lest he try to find her. Using the internet connection at her public library, Meagan finds a website that deals with issues of battering, including help for those women (or men) who want to obtain a restraining order against the abusing spouse. Meagan would like to participate in the online discussion, but is afraid to use her full name. She suspects that her husband “tracks” websites like this, and that he might retaliate violently if he sees her name. She chooses to use a pseudonym and posts a letter on the website.
Is Meagan justified in concealing her online identity? I would not hesitate in saying that she is. I would take the same position when someone faces reprisals from a totalitarian regime, such as protesters in Iran and Egypt; or in the case of a “whistleblower” who wants to expose a public danger online, without risking being fired.
But absent such compelling dangers to life, limb or livelihood, I am generally opposed to the use of pseudonyms or anonymous postings on the internet. Of course, there are exceptions beyond those I have noted, and each case must be considered individually. But as a rule, I believe that the burden of justification should be on the individual who chooses to conceal his or her identity, and that website monitors ought to be exceedingly selective in accepting unsigned or pseudonymous letters.
I am speaking, of course, from the perspective of a psychiatric physician who is used to posting my blogs with “full disclosure”—not only of my name, but also of my potential conflicts of interest. (Having retired recently from clinical practice, and having no financial connections to pharmaceutical companies, my only “conflicts” these days are the ones a psychoanalyst would explore—but for those who want to delve, my disclosure statement is viewable on the Psychiatric Times website, at:
The issue of personal disclosure bears on one reason I am opposed to anonymous blogs and postings: the general public has no way of determining what, if any, concealed agenda or conflicts of interest the anonymous blogger or commentator may have. I find this issue especially pertinent when the unidentified person launches a personal attack against someone who is identified by name, profession, etc. As a psychiatrist who blogs fairly often on both the Psychcentral and Psychiatric Times websites, it is especially upsetting when an alleged “health care professional” posts a highly critical, anonymous comment, in response to an article or essay I have written. In my view—barring some of the exceptional circumstances I outlined earlier—a physician, nurse, psychologist, social worker or other health care professional has no business concealing his or her identity when voicing an opinion on a professionally-related topic, especially when taking aim at a colleague. I consider such “drive-by flaming” both professionally irresponsible and ethically unjustifiable. It is also downright rude and inconsiderate—what my dad would have called “a cheap shot”!
So why do so many health professionals post anonymously, or sign their emails as “MiffedDoc” or “Irateinternist”?  I think that, in many cases, it is a simple wish to avoid embarrassment or discovery, either by patients or by colleagues. And, in my view, that excuse simply doesn’t cut it. My understanding of professional ethics is that you should be willing to stand behind anything you say in a professional context, and that your audience has a right to know who you are and who may be standing behind you—the American Medical Association? The Scientologists? The government of Iraq? Readers Digest?
Sure, there may be exceptions to this rule. I can imagine a health care professional who is revealing an extremely sensitive personal issue—let’s say, a problem with substance abuse—who does not want to disclose his or her name. Yet he or she believes that the message has important public health implications. So, Dr. X may be posting a message saying, “As a physician who has had a problem with alcohol abuse, I would urge all my colleagues to report obvious substance abuse problems among their colleagues to the appropriate authorities...” OK—anonymity in this context is understandable, Doc.
By the way, I also believe we have an ethical responsibility to avoid attacking another person’s character, engaging in gratuitous insults, casting aspersions, or just plain being rude! (For more on “internet ethics”, please see my essay originally posted on the Psychiatric Times website, and also viewable at: http://www.jeffpearlman.com/todays-cnn-com-column-3/). A good rule of thumb, which I try (not always successfully) to live by: if you wouldn’t be comfortable saying something to a person face-to-face, think twice about saying it in an anonymous internet message. (You might just run into that individual at a conference!).
Only when self-disclosure poses a great personal risk are we justified in hiding behind anonymity. In short, all of us have a responsibility not only to tell the truth, but to tell the truth about who we are.
Ronald Pies MD is Professor of Psychiatry and Lecturer on Bioethics & Humanities at SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry at Tufts University School of Medicine, Boston. The views expressed here are solely his own.
Note: Dr. Pies does not reply to unsigned, anonymous, or pseudonymous messages, except when the justification for anonymity is clear.