Digital innovation has the potential to be transformative to both clinical practice and academic research related to mental health. Recent advances in research and consumer-grade technology, combined with society’s rapid and widespread adoption of digital technology, has created an emerging and dynamic field attracting the interest of clinicians, researchers, and service-users alike. In this chapter we summarise potential applications of digital technology to mental health research and clinical practice, including digital phenotyping, smartphone applications, virtual reality, and teletherapy. We summarise how digital technologies might be applied to enhance psychiatric assessment and treatment, as well as in research settings. In particular, we outline the potential benefits of digital technology as clinical and research tools. We also explore the challenges associated with digital innovation in mental health, including ethical concerns, methodological considerations when critiquing research in this field, and considerations from the service-user perspective.

This chapter examines the evolution of freedom of expression doctrines in the context of digital media. It focuses on how the European Court of Human Rights has adapted traditional doctrines, rooted in Article 10 of the European Convention on Human Rights, to address challenges in the new media environment. The authors explore how freedom of expression, vital to democracy, must balance individual rights, societal interests, and the regulation of disinformation and hate speech in the digital age. The Court’s defence of democracy has evolved from responding to authoritarian threats in Europe’s past to addressing new risks in the digital realm. Principles such as proportionality, the prohibition of abuse of rights (Article 17), and preventing the misuse of democratic freedoms (Article 18) guide limitations on expression, ensuring they are justified and not misused for political suppression. Social media has expanded the concept of ‘public watchdogs’ beyond traditional media to include non-governmental organisations, bloggers, and activists. This evolution demands rethinking the liability and freedom of expression doctrines for platforms.

Chapter 5 explains the persistence of the impunity agenda. It argues that Trump’s resurgence in 2024 has already thrust the agenda back to the forefront and that it could even be self-executing after Trump eventually leaves office. Sections 5.1 and 5.2 show how the conservative media space and an emboldened right wing in Congress discourage advocates from backing away from publicly testing IHL. Section 5.3 traces the expanding coalition of the impunity movement, which now not only includes Fox News and Republican lawmakers but also lobbyist organizations and troops granted clemency by Trump. Section 5.4 describes how close-knit professional and social networks amplify the power of the impunity coalition, even more now given Trump’s re-ascendance to the White House and Pete Hegseth’s selection as Defense Secretary.

Regardless of where you sit, digital is here to stay, and hiding from it won’t change that. Rather, understand it, learn, and accept the benefits and risks as inseparable entities. By understanding digital, we may just understand our patient a little more too. Stepping beyond the patient, and looking at it from a clinical perspective, the world of digital and its application to healthcare has so much more to offer. For mental health services in particular, there is a wide range of digital opportunities to support teams to work differently. This can range from apps, chatbots, online assessments, monitoring and therapies, virtual reality, virtual administration, electronic prescribing and much more. Obviously, it is paramount we consider issues such as safeguarding, cybersecurity and privacy, but the genie is out of the bottle and digital is here to stay!

Many of the psychological topics we have discussed have focused on the mind of the individual, but humans are a fundamentally social species. Recently, the nature of our social interactions has transformed, through our new abilities to connect with people online. This chapter discusses psychological principles of social networks, and how to quantify social networks via graph theory. The chapter examines the small-world phenomenon and the role of social ties via these graph theory measures. We then look at the case of online social networks, what can be learned about you from your profile, and how their use impacts psychological measures. The chapter concludes by showcasing findings on social network representations in the brain, and touching on ethical questions related to social media privacy concerns and AI-based social interactions.

Misinformation on social media is a recognized threat to societies. Research has shown that social media users play an important role in the spread of misinformation. It is crucial to understand how misinformation affects user online interaction behavior and the factors that contribute to it. In this study, we employ an AI deep learning model to analyze emotions in user online social media conversations about misinformation during the COVID-19 pandemic. We further apply the Stimuli–Organism–Response framework to examine the relationship between the presence of misinformation, emotions, and social bonding behavior. Our findings highlight the usefulness of AI deep learning models to analyze emotions in social media posts and enhance the understanding of online social bonding behavior around health-related misinformation.

This chapter examines conservative attacks on social media, and their validity. Conservatives have long accused the major social media platforms of left-leaning bias, claiming that platform content moderation policies unfairly target conservative content for blocking, labeling, and deamplification. They point in particular to events during the COVID-19 lockdowns, as well as President Trump’s deplatforming, as proof of such bias. In 2021, these accusations led both Florida and Texas to adopt laws regulating platform content moderation in order to combat the alleged bias. But a closer examination of the evidence raises serious doubts about whether such bias actually exists. An equally plausible explanation for why conservatives perceive bias is that social media content moderation policies, in particular against medical disinformation and hate speech, are more likely to affect conservative than other content. For this reason, claims of platform bias remain unproven. Furthermore, modern conservative attacks on social media are strikingly inconsistent with the general conservative preference not to interfere with private businesses.

Section 230 of the Communications Decency Act is often called "The Twenty-Six Words That Created the Internet." This 1996 law grants platforms broad legal immunity against claims arising from both third-party content that they host, and good-faith content moderation decisions that they make. Most observers agree that without Section 230 immunity, or some variant of it, the modern internet and social media could not exist. Nonetheless, Section 230 has been subject to vociferous criticism, with both Presidents Biden and Trump having called for its repeal. Critics claim that Section 230 lets platforms have it both ways, leaving them free to host harmful content but also to block any content they object to. This chapter argues that criticisms of Section 230 are largely unwarranted. The diversity of the modern internet, and ability of ordinary individuals to reach broad audiences on the internet, would be impossible without platform immunity. As such, calls for repeal of or major amendments to Section 230 are deeply unwise. The chapter concludes by pointing to important limits on Section 230 immunity and identifying some narrow amendments to Section 230 that may be warranted.

As Chapter 1 discusses, one of the most consistent conservative critiques of social media platforms is that social media is biased against conservative content. A common policy proposal to address this is to regulate such platforms as common carriers. Doing so would require social media platforms to host, on a nondiscriminatory basis, all legal user content and to permit all users to access platforms on equal terms. While this seems an attractive idea – after all, who could object to nondiscrimination – it is not. For one thing, the Supreme Court has now recognized that social media platforms possess "editorial rights" under the First Amendment to control what content they carry, block, and emphasize in their feeds. So, regulating platforms as common carriers, as Texas and Florida have sought to do, is unconstitutional. It is also a terrible idea. Requiring platforms to carry all content on a nondiscriminatory basis, even if limited to legal content (which it would be hard to do) would flood user feeds with such lawful-but-awful content as pornography, hate speech, and terrorist propaganda. This in turn would destroy social media as a usable medium, to the detriment of everyone.

This brief conclusion summarizes the main thesis of the book, noting that both conservative and progressive critiques of social media lack strong empirical justifications, and that many if not most of the regulatory proposals directed at social media are not only likely to be found unconstitutional, but are also wrong-headed. It then argues that it is time we all accept that the old, pre-social media world of gatekeepers is over; and further, that this development has important, positive implications for the democratization of public discourse in ways that free speech theory supports. Finally, the Conclusion analogizes the modern hysteria over the growth of social media to earlier panics over changes in communications technology, such as the inventions of the printing press and of moving pictures. As with those earlier panics, this one too is overblown and ignores the positive potential impacts of technological change.

After having argued against most current regulatory reform proposals directed at social media, this final chapter considers some regulatory initiatives worthy of consideration. It begins, however, with a call for caution. The principle of "First, do no harm" in medical ethics is highly relevant here. Social media is too new, and too rapidly evolving, for regulators to be able to confidently predict either the current impact of regulation or its long term effects, so regulators must act with humility. That said, social media also is not a law-free zone. Long-standing bodies of law, such as antitrust, contract, tort, and even family law, can and should be applied to social media firms in the same way as other private actors. Furthermore, even Section 230 in its current form should not be sacrosanct, and there is also room to consider granting platform users modest procedural protections against arbitrary content moderation decisions. Finally, there are strong arguments for a federal data privacy law, not directed at social media in particular but certainly applicable to it. In short, social media should not be above the law – but nor should it be the target of lawfare.

In contrast to conservatives, progressives argue that platforms don’t block enough content. In particular, progressive critics point to the prevalence of allegedly harmful content on social media platforms, including politically manipulative content, mis- and disinformation (especially about medical issues), harassment and doxing, and hate speech. They argue that social media algorithms actively promote such content to increase engagement, resulting in many forms of social harm including greater political polarization. And they argue (along with conservatives) that social media platforms have been especially guilty of permitting materials harmful to children to remain accessible. As with conservative attacks however, the progressive war on social media is rife with exaggerations and rests on shaky empirical grounds. In particular, there is very little proof that that platform algorithms increase political polarization, or even proof that social media harms children. Moreover, while not all progressive attacks on social media lack a foundation, they are all rooted in an entirely unrealistic expectation that perfect content moderation is possible.

The primary progressive model for curing the perceived ills of social media – the failure to block harmful content – is to encourage or require social media platforms to act as gatekeepers. On this view, the institutional media, such as newspapers, radio, and television, historically ensured that the flow of information to citizens and consumers was "clean," meaning cleansed of falsehoods and malicious content. This in turn permitted a basic consensus to exist on facts and basic values, something essential for functional democracies. The rise of social media, however, destroyed the ability of institutional media to act as gatekeepers, and so, it is argued, it is incumbent on platforms to step into that role. This chapter argues that this is misguided. Traditional gatekeepers shared two key characteristics: scarcity and objectivity. Neither, however, characterizes the online world. And in any event, social media lack either the economic incentives or the expertise to be effective gatekeepers of information. Finally, and most fundamentally, the entire model of elite gatekeepers of knowledge is inconsistent with basic First Amendment principles and should be abandoned.

The area where social media has undoubtedly been most actively regulated is in their data and privacy practices. While no serious critic has proposed a flat ban on data collection and use (since that would destroy the algorithms that drive social media), a number of important jurisdictions including the European Union and California have imposed important restrictions on how websites (including social media) collect, process, and disclose data. Some privacy regulations are clearly justified, but insofar as data privacy laws become so strict as to threaten advertising-driven business models, the result will be that social media (and search and many other basic internet features) will stop being free, to the detriment of most users. In addition, privacy laws (and related rules such as the “right to be forgotten”) by definition restrict the flow of information, and so burden free expression. Sometimes that burden is justified, but especially when applied to information about public figures, suppressing unfavorable information undermines democracy. The chapter concludes by arguing that one area where stricter regulation is needed is protecting children’s data.