Are you Crazy? NYU's Online Sanity Test

That's why I was so surprised when, after honestly answering 10 simple multiple-choice questions?questions like, "Do you feel that things always go or will go wrong no matter how hard you try?" (Answer: "Most of the time"), my computer-generated psychiatric evaluation came up screaming, "My God, man! Get yourself locked up before you do any more damage!!"

Well okay, it didn't exactly say that. But it did say, "Your answers show the presence of prominent depressive symptoms. It is advised to seek a psychiatric consultation," followed by some links to various referral services.

NYU's Dept. of Psychiatry, it turns out, offers a whole slew of online screening tests for various troubles?anxiety, sexual disorders, attention deficit disorder and the like.

So just out of curiosity after seeing those results from the depression test, I went back and took the Online Anxiety Screening Test, which was listed just below the depression test. Answered a few yes-or-no questions, hit a button and waited for my evaluation to come up.

This time, the machine listed my symptoms ("Avoidance of social situations" and "Specific fears of certain objects," among several others) before telling me, "The above answer(s) are anxiety symptoms that might be part of an Anxiety Disorder. It is advised to seek a psychiatric consultation."

Things were not going so well, but I seemed to be on some kind of a roll. So I went back one last time and took the Online Personality Disorders Test. Fifteen years ago, upon my release from a Minneapolis psych ward, the doctor in charge noted in my file that I suffered from some kind of "mixed personality disorder," but gave no further details. Still, though, like I said, things seemed to be well under control of late. I wasn't too concerned.

Yet after answering a few more yes/no questions and receiving another long list of apparently ominous symptoms, I was diagnosed as schizoid.

Now that's no good at all. I've seen that Klaus Kinski movie, and being diagnosed as schizoid bodes nothing but trouble. The machine might just as well have said, "Pull down that stocking cap, throw on three extra coats and lose the shoes, boyo?you're on your own!"

Before things got completely out of control, I stopped. I hadn't yet taken the sexual dysfunction test or the attention deficit test. No, I think starting the day in a good mood and by 10 a.m. being labeled a depressive, anxiety-ridden schizoid is plenty enough.

Now, granted, all of these tests feature prominent disclaimers at the bottom stating that the test results are no replacement for an evaluation by a real-live psychiatrist, and that the results are only supposed to indicate whether or not you might have reason to seek a shrink's help. But still, to answer a few vague questions with the click of a mouse, then have a machine tell you that you're schizoid? Well that just seems nuts. And potentially dangerous for someone sitting alone in a darkened room, who perhaps didn't care to step outside or shell out the necessary cash to see a real shrink?someone who might later tell police, "The computer told me I was crazy."

Waguih William IsHak, MD, is an Academic/Administrative Fellow at NYU's Dept. of Psychiatry. Among his myriad other duties, Dr. IsHak has been central in putting these screening tests online, so I figured I'd ask him a few questions about what was behind it all.

According to Dr. IsHak, the tests were first posted on the Web in 1996. "Studies of depressive disorders reveal that there is a high number of unrecognized and untreated patients," he told me. "According to the American Psychiatric Association, the lifetime prevalence of Major Depressive Disorder is 10-25 percent for women and 12 percent for men. Results of the Epidemiologic Catchment Area study revealed that 46.1 percent of patients with unipolar major depression were not treated in the last 12 months."

The online tests, he explained, were designed to help catch a few of the stragglers. It seems to be doing the trick. "There were 96,000 visits per year to that screening test. Online availability of this self-administered test allows users in the privacy of their own locale, to self-evaluate symptoms of depression and obtain a referral if needed. This can extend the outreach of psychiatric services to individuals who are intimidated by conventional modes of referrals." It's especially useful, he said, for shut-ins, the disabled and the elderly?people who might have trouble getting to a regular clinic.

He also noted that the online tests themselves were something new?you don't get asked the same questions you'd receive in person on National Depression Screening Day. The NDSD questions are based on a test developed 30 years ago. The new tests, he told me, were based on recent findings by the American Psychiatric Association.

But isn't there a real danger in diagnosing psychiatric problems online?

"Again," he said, "it is important to emphasize the purpose of the tests. They aim at providing a preliminary idea before having to go through the whole comprehensive evaluation." But he also admitted that "the impact of online information about psychological problems remains understudied."

Along those lines, I wondered, does he have any indication as to how effective these online tests have been so far?

"We have not collected data on the use of the online screening tests," he said, "due to the fact that data collected online could be questioned for validity." As he explained it, "People might take the same test many times, they might change their answers around to 'test the test.'"

Along with the psychological screenings for the general population, Dr. IsHak has also posted some "test preparation" quizzes for medical students facing their Board Certification Exams and, in the future, hopes to expand the site's educational uses by including interactive patient scenarios for students, as well as professional psychiatrists.

You may test your own sanity at: http://www.med.nyu.edu/Psych/public.html.