The Atlantic's June cover story, "The Perfected Self," is about how infamous Harvard psychologist B. F. Skinner, who became an industry scapegoat for his much-maligned "fascist and manipulative" behavior modification theory (which is, in a nutshell, that "gentle, punishment-free behavior-modification techniques could improve learning, modify destructive habits, and generally help people lead healthier, more satisfying, more productive lives" — more on how that got misconstrued later on), deserves credit for laying the foundation for our most successful weight-loss techniques (think Weight Watchers) and is making a comeback through a new slew of goal-oriented smartphone apps.
But when writer David H. Freeman asks whether we have to give up our "free will" to lose weight — "Should we be wary of utilities that try to shift our energy use or health insurers that try to change our diets?" — it seems like he's just trying to make a fascinating but straightforward story about the mobile-health field seem more controversial than it really is. Are there really people out there who feel "Big Brother" paranoia about apps that help people achieve their own goals by counting calories and marking miles?
"mHealth" — which is what "those in the know" call the mobile-health field — is rapidly growing and could save both customers and the health-care system billions of dollars. One study found that the savings in the United States and Canada from "mobile monitoring of patient health" could rise to $6 billion by 2014; if smartphone apps could cut our national obesity costs, we'd save $15 billion a year. And then there's all the people who can't afford fancy personal trainers or weight loss programs: for them, programs like Lose It, an app and Web site that formulates personal calorie and exercise programs based on how much weight you wait to lose and how much time you want to lose it in, are a godsend.
"Lose It ... lets users track their eating and physical activity, which they can do by holding their phones up to a food package's barcode, or by tapping the screen a few times at the start and end of a walk (the app offers a range of activity categories, including guitar strumming, household walking, and sex)," Freeman explains. "Lose It uses this data to provide clear, graphic feedback on users' daily progress-you might see at a glance that having dessert will send your numbers into the red, but that if you walk for 20 minutes after dessert, you'll go back into the green." Other behavioral modification apps include GymPact, which charges users at least $5 bucks every time they skip the gym and then divvies up the cash to the participants who made it on the treadmill; Urge, which helps users refrain from impulse shopping by tracking long-term savings; and Habit Maker, which allows users to decide which habits they want to break or improve on, like saying "thank you" or quitting smoking.
Support and encouragement have been proven to encourage participants to stick with challenging programs, which is why some of these apps allow people to work alongside friends. But Freeman believes the turning point will really come when "smartphone apps can automatically tailor their recommendations and feedback to an individual user's behavior, just as a real-life behavior analyst would." Imagine a more helpful Siri that would take into account your career field, your roommates, how stressed you are, your ethnicity, and what kinds of food, drinks, and activities you enjoy in order to help you get healthier. Jenny Craig, who?
So what does this all have to do with Skinner? A good portion of the Atlantic piece is about how deeply misunderstood he was within his field. "He became a whipping boy for cognitive scientists," psychologist Dean Keith Simonton told Freeman. "Psychology students were taught that his techniques didn't work, that it was a bad direction for psychology to go in, and that he was a bad person, though he wasn't. He just got kind of a bad rap." There were a few reasons for this: Most other academics working at the time behaviorism became prominent in the '50s and '60s were more interested in thoughts and emotions, so cognitive science luminaries like Noam Chomsky alleged that people were "too smart" to modify their behaviors. But the biggest problem was that people were creeped out by his theory that "communities should actively shape human behavior to promote social justice and harmony." Although 1971's A Clockwork Orange was based on Pavlovian, not Skinnerian conditioning, the movie further convinced people that government-controlled behavior modification was a real threat. Soon, Skinner even ended up on the cover of Time: "Skinner's Utopia: Panacea, or Path to Hell?"
While it's possible that the money-hungry diet and weight loss industry might want to launch an anti-Skinner smear campaign (joking!), it's doubtful that most people will connect his legacy to mHealth and therefore distrust goal-oriented apps. It's understandably frustrating for Skinner's supporters and family that, after years of having his work misunderstood, the psychologist still won't get the mainstream credit he deserves, but the more exciting story will be whether these apps will really be able to save the health-care system all those billions.