My dear friend Amy says she first suspected I was mad two months into our first year at university. It was the incident with the laptop camera that did it.
We were living on the same corridor, and one autumn afternoon Amy witnessed my descent into an anxious meltdown after a green light next to the webcam began flashing unexpectedly. The flash turned out to be the product of a random software glitch, but I became consumed by the fear that someone had hacked into my computer and had been spying on me for weeks.
With much reassurance from Amy, I eventually got over that particular worry. But I carry lower-level concerns about being watched, tracked or recorded around with me everywhere. I often compulsively check or turn off my phone to ensure it isn’t recording my conversations (which, in the age of surveillance capitalism, isn’t an entirely irrational paranoia).
Obsessions around being watched, monitored or scrutinised are common in people with OCD. There are various theories as to why this fear is so prevalent, one of which is that low self-esteem leads sufferers to fear that others will scrutinise us as harshly as we judge ourselves. The lack of sleep that often accompanies anxiety can also make us hypervigilant and more afraid of other people’s motives.
OCD sufferers are not the only mad people afflicted by this “scopophobia”. It is also a feature of conditions like schizophrenia and post-natal depression. For many of us, being watched represents one of our worst fears, and I can’t imagine anything more anxiety-provoking than being filmed or recorded in my moments of panic. So I am becoming increasingly worried about the growing use of surveillance-based technology in mental health inpatient and acute settings—places where people are at their most vulnerable, and are least able to advocate for their rights.
The rollout of surveillance-based technology in mental health is often justified on the basis that it is a cost-effective way to ensure patient safety. In settings where there is a high risk of self-harm and suicide, the idea is that cameras and sensors can augment the capacity of staff to monitor patients—and in ways that are supposedly sometimes less invasive than human-led welfare checks.
One example is the Oxevision system now being introduced in nearly half of all NHS mental health trusts in the UK. It is installed in patient bedrooms with the idea that it will reduce the number of times staff need to make welfare checks on patients during the night. The system comprises a high-sensitivity camera and infrared sensors that can detect a patient’s vital signs, such as their pulse and breathing. The camera is on constantly but only relays 15 seconds of video to staff when they are performing a check or responding to an alert.
While some patients appreciate not being woken up for a welfare check, many have voiced deep unease at the invasion of their dignity and privacy that the system represents, creating a campaign group called StopOxevision. For many former patients in the campaign, the sense of surveillance was so upsetting and triggering that it made them unable to form therapeutic relationships with staff. “I tried to sleep out of sight of the camera,” one former patient said. “Then later, under the desk—where I realised I could circumvent the technology, in communal areas or even the garden, such was my level of distress.”
Patients also report their concerns about the system being dismissed and ignored, and in some NHS trusts admission to an inpatient ward being taken as implicit consent to use of the system. There is no position more vulnerable and voiceless than being a patient under section, and any use of new technology in mental health settings needs to be implemented with care and caution given the sensitive human rights context. If I was ever admitted to an inpatient ward for OCD, I cannot conceive of anything that would make me more scared, more distrustful and less likely to recover than having an infrared sensor and camera in my room.
