Social Network Systems and Identity:

From managing identity to managing fair use

Introduction: Online Identities and Social Consequences

As social networking systems (SNS’s) become ubiquitous, our engagement with these systems increasingly impacts significant aspects of our lives in unexpected ways. In 2007, an American banking intern was terminated after a photo posted to the social networking system revealed he missed work to attend a Halloween party (Owen, 2007). Public officials have been compelled to resign after expressing personal views on social networking platforms, in July of 2009 an aid to a city official in Manhattan resigned over posting controversial views to facebook (Chan, 2009). In October of 2009, MIT researchers created a program that analyzes public information about a Facebook user’s friends to accurately predict their sexual orientation. The shocking implication of this particular study is that a social network activity such as the friends one chooses, a fundamental and requisite form of engagement, could be used to effectively “out” a users sexual orientation against his will (Jernigan & Mistree, 2009).

Do privacy controls limit expression of identity?
SNS’s have been quick to identify emerging problems with managing our online identities and self-published content. Early interventions by engineers & designers focused on developing robust privacy controls to offer high-level management of access to personal information. Facebook, for example, now allows you to assign custom levels of privacy for individuals and groups of friends. Individuals can be assigned to custom groups like co-worker, family, or friend with each group having a pre-determined privacy setting.

Clearly, these identity management tools are valuable for those who use SNS’s. Over the last few years, a mini industry has risen to instruct users on sculpting their presentation and cultivating their identities to leverage social networking systems personal PR opportunities to maximize professional opportunities and hirability.

Beyond identity management for personal PR purposes, some have argued that sophisticated identity management affordances are necessary to authentically represent construction of identity. In 2005, Alice Marwick criticized the strictly representational model of early SNS’s as a “problem of authentiticity”. She writes, “Social networking sites overall presume that each user has a single ‘authentic’ identity that can be presented accurately.” Marwick views this singular construction of identity as a direct contradiction to the way in which we perform identity in everyday life; we present ourselves in various ways depending on the audience and context (Marwick, 2005).

Looking forward at emerging technology, it’s easy to imagine a rise in active identity management. A November 2009, Atlantic Monthly essay by Jamais Cascio imagines ubiquitous augmented reality systems that when coupled with advances in facial-recognition technology push self-published social information to unprecedented prominence. Personal beliefs, views, and values become visually inseparable from the face of each person you meet and become a fundamental component of the visual landscape. Cascio goes on to imagine a rising demand for “reality filters” that eliminate unwanted information and opposing viewpoints. The real problem with identity management, as Cascio sees it, is less about technology and more about our society’s inability to tolerate diverse viewpoints (Cascio, 2009).

Unequal power dynamics and leveling the identity field
One aspect of this problem space involves power dynamics. Individuals in positions of power can use self-published information on SNS’s against others. Because of this, users of SNS’s are pressured to manage, stifle, and censor authentic expression of identity in order to protect themselves from those who would exercise power informed by prejudice and intolerance to discriminate against and oppress them. Though there is a clear ethical value in designing SNS’s systems that allow marginalized peoples to protect themselves and their identity from these forces, designers also have an ethical obligation to develop this technology in such a way that maximizes opportunities for individuals to authentically express themselves and aims to transcend these oppressive structures. By simply transcribing real life self-limiting identity management techniques into social network technology we miss the opportunity to ethically reform these interactions and level power dynamics.

New expectations of personal identity management can create new set of pressures and demands on stakeholders. As we present many different optimized versions of ourselves to diverse and demanding audiences our understanding of who we are can become diminished and becomes more and more linked with how others want us to be. Presently, the burden is on the user to predict aspects of their identity that may be uncomfortable for others and manage, filter, and hide those aspects. By focusing on identity control and management, SNS’s risk perpetuating restrictive and oppressive limitations on authentic expression. Like Bill Clinton’s well known “don’t ask don’t tell” compromise, are designers of SNS’s contributing to a climate that encourages marginalized groups and populations to suppress themselves, while allowing people in positions of power to maintain intolerant and oppressive prejudices and judgments?

A June 2009 article by Caryn Brooks chronicles the benefits of coming out on facebook.

Coming out used to be an exhausting process. You had to come out again and again and again to all your friends at different times. Nowadays, even with social networking, gays still have to come out, but one of the key differences between our pre-profile selves and our new online presentations is that now (finally!) the burden is also on our friends to discover and digest our identities. For the lesbian, gay, bisexual and transgender (LGBT) community, Facebook et al have finally leveled the identity field, and it's kinda nice.

SNS’s and other social technological innovations have tremendous opportunity to shape new trends in social engagement and contribute to new achievements in stakeholders ability to understand themselves and articulate their identity.

The implicated value

Identity as understanding ourselves
Leaders in Value Sensitive Design, such as Batya Friedman have researched and presented key ethical values that should be considered in this problem space. This value of identity is most directly implicated in this socio-technological problem space. Friedman’s value of identity refers to “people’s understanding of who they are over time”. (Friedman, 2007).

This definition of identity has been researched extensively across analogous sociotechnological problem spaces. The rise of virtual simulations like second life and semi-anonyms social games have been widely studied as systems that implicate identity and people’s understanding of who they are over time. These systems allow individuals new opportunities and freedoms to project multiple constructions and liberating simulations of their identity. Sherry Turkles has written extensively on the importance of viewing construction of identity not as a calculation, but more of a simulation, where the self is conceived as a “multiple, distributed system”. Turkle writes:

Without a deep understanding of the many selves that we express in the virtual, we cannot use our experiences there to enrich the real. If we cultivate our awareness of what stands behind our screen personae, we are more likely to succeed in using virtual experience for personal transformation. (Turkle, 1996)

Identity management in virtual “games” versus social network systems
Turkles and others who have studied how multiple projections and simulations of identity contribute to an enhanced understanding of the self over time were writing exclusively about social games and virtual simulations. These virtual simulations are still widely used and these new ideas of identity issues are still relevant. However, unlike games and virtual playgrounds where users explore and experiment with the construction of their identities, managing and controlling multiple identities in SNS’s may undermine users positive formation of identity. Key figures from user’s daily life, including authority figures such co-workers, teachers, supervisors, parents, and others are highly aware of their every thought and move and poised to judge and discriminate. So it may be that when stakeholders in SNS’s are encouraged to project and simulate their identities to conform to the expectations of people in position of power they are diminishing their ability to understand who they are. Another way of thinking about it, is that new privacy controls in SNSs may be designed in such a way that stakeholders are pressured to cede control of their understanding of who they are to oppressive figures.

Identity as a dynamic integrated process
Defining Identity as the understanding of who we are over time is an important ethical value in this problem space, but this definition is not enough. Stakeholders have ethical rights that extend beyond understanding their identity. For SNS’s we need an expansive view of identity includes utilizing technology to both understand who we are and to freely express this authentic identity to others and thereby integrate this authentic identity into everyday life.

For this reason it is useful to apply Abraham Maslow’s humanist concept of self-actualization. Maslow conceived of 5 stages of human needs with the peak need being self-actualization. “A musician must make music, an artist must paint, a poet must write, if he is to be ultimately happy. What a man can be, he must be. This need we may call self-actualization”. (Maslow, 1943).

Vivian Cass presents an identity model that outlines six stages of gay and lesbian identity development. The stages include confusion, comparison, self-tolerance, self-acceptance, pride, and finally identity synthesis. Identity syntheis is achieved when the individual can “integrate gay and lesbian identity so that instead of being the identity, it is an aspect of self.” (Cass, 1979)

So for this paper we define our value not only as people’s understanding of who they are. We also incorporate the dynamic interactions involved in expressing, understanding, constructing, and integrating our identity with and through others as formulated by applying the models developed by Maslow and Cass.

Key Stakeholders

Direct Stakeholders
All current users of SNS’s and anyone who self-publishes personal information about themselves via the web can benefit and derive value from an authentic and dynamic expression of identity and are therefore direct stakeholders in this problem space.

Of particular ethical interest are individuals of marginalized groups and populations or people with minority beliefs and values. These stakeholders have legitimate concerns that fully engaging in social network systems could make them vulnerable to judgments, inequity, and discrimination. While advanced privacy filters can be utilized to protect these individuals from judgment, there is a value in these individuals utilizing social networks as a tool to more effectively express themselves and more authentically integrate and communicate all aspects of their identity.

Indirect Stakeholders
1. Investigators - Security professionals, prosecutors, government agents, and other individuals who’s professional duties include identifying potential threats to national security or domestic criminal activity. These individuals create judgments and inferences on behaviors of groups and individuals on SNSs and have an interest in this information being widely available.

2. Informants - Individuals who’s professional activity include leveraging SNS’s to unethically and perhaps illegally discriminate against others. For example, consulting firms that research SNS’s and attempt to predict and identify characteristics of job candidates such as ethnicity, sexual orientation, political views, pregnancy, psychological profiles, medical conditions and other characteristics that can be used to illegally discriminate against hiring them.

In both of the above cases, it’s important to note that the interests of these indirect stakeholders is in opposition to the interests of the direct stakeholders. For this reason it is of high ethical value to allow the direct stakeholders to establish expectations and guidelines over the use of such information and for lawmakers to make sure the activity of the indirect stakeholders in fair and in line with universal human rights, core constitutional protections, and all relevant civic laws.

3. Intolerants - Individuals who engage in SNSs and are intolerant, uncomfortable, and threatened by thoughts, ideas, and activities that are not consistent with their beliefs. These individuals have a stake in privacy controls that pressure individuals with marginalized views and behavior to censor themselves and at the same time have a stake in being able to freely express their own views that are backed by historical institutions of oppression.

4. Designers - Programmers and employees of SNSs who have an interest in protecting the corporations from privacy concerns and other perceived limitations by users. This individuals also have an interest in conceptualizing social identity in terms of profit and commoditizing social information over a concept of liberating ethical rights of their constituents.


Implications for Design

From broadcast to eavesdrop – reconsidering models of information sharing
Another aspect of this problem space is that many use inappropriate models to apply norms and expectations. For SNS’s the metaphor of broadcasting their views or identity may not be entirely appropriate. This is the same metaphor we use for radio, television, and newspapers. Comparing a user updating their profile on a SNS to the dedicated actions of a large media conglomerate or corporation may place unfair and inappropriate limitations on how people should express their identity. Instead, we could think of users contributions of personal information as a creative act of producing and contributing social intelligence to the SNS system. Likewise, it may be useful to extend the metaphor to the experience of receiving updates about others via a social network. Instead of the view that we are being bombarded with unwanted and uncomfortable information, we could take accountability for constructing and integrating information and judgments about others. It may be more accurate to say we are collecting, digesting, and synthesizing information about others in our selected network. The concept of eavesdropping versus broadcasting changes key assumptions that are involved in the actionable legal aspects of this information including terminating, prosecuting, or discriminating against others based on this information. These new metaphors, arguably more representative of the true functionalities and interactions of SNS’s, allow for new possibilities in imagining a shifting of the burden of increasingly complex management and filtering of authentic identity from the individual, to an issue of context and expectations, lawmaking, human rights, and fair use of this potentially valuable information. How can HCI professionals and academics shape the perception of SNSs with respect to these models in a way that is equitable and promotes the ethical value of identity?

From managing identity to managing fair use
In an analogous problem space, the photo sharing site Flickr address users interests in protecting the ownership of their self-published pictures and goes further by empowering users to transgress traditional views of access, use, and ownership by granting specific permissions for reuse, remixing, and derivative works. By utilizing the creative commons licensing standard, Flickr encourages its users to explore new ways to derive value from sharing (in addition to selling) their work. Similarly SNS’s could imagine new ways for users to articulate expectations of privacy and permissions on the rights and reuse of their information.

Currently in SNS’s users can communicate to a particular individual and this information is available to all with that contextual information. Expressing a political view to my mother that others hear is very different than me expressing a political view to the world. This contextual information shapes how others view this information and ultimately, whether or not I can get fired for it. Intelligent processing systems can be used to make the contextual information and expectations for use just as prominent as the information itself. There is potential for creative and transformative ideas from HCI professionals and academics. It is ethically important and consistent with free flow of information that these systems depend on to prioritize developments in these technologies over technologies that block, filter, and hide. Personal information about others identity and beliefs only becomes unwanted “spam” when we are overwhelmed and don’t have adequate processing tools. With the right tools, this information can increase our tolerance and understanding of each other and contribute to shaping a fair, ethical, and humanistic social landscape.

Works Sited

Brooks, Caryn (June 02, 2009). “How to Come Out on Facebook” Time Magazine
Link: www.time.com/time/nation/article/0,8599,1901909,00.html

Chan, Sewell. Aide Resigns Over Facebook Posts on Harvard Arrest. July 28, 2009 in The New York Times
Link: http://cityroom.blogs.nytimes.com/2009/07/28/aide-resigns-over-facebook-posts-on-harvard-arrest/

Friedman, B., Kahn, P. H., Jr., & Borning, A. “Value Sensitive Design and information systems.” In P. Zhang & D. Galletta (eds.), Human-Computer Interaction in Management Information Systems: Foundations, (348-372). Armonk, New York: M.E. Sharpe, 2006.

Jernigan, Carter and Mistree, Behram. Gaydar: Facebook friendships expose sexual orientation in First Monday, Peer Reviewed Journal on the Internet. Volume 14, Number 10 - 5 October 2009.
Link: www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/2611/2302

Marwick, A. (2005). “I’m More Than Just a Friendster Profile: Identity, Authenticity, and Power in Social Networking Services.” Association for Internet Researchers, Chicago, IL.

A. H. Maslow A Theory of Human Motivation(1943) Originally Published in Psychological Review, 50, 370-396.

Thomas, Owen. Bank intern busted by Facebook in Valleywag. October 2007. Link: http://valleywag.gawker.com/321802/bank-intern-busted-by-facebook

Turkle, S. Life on the Screen: Identity in the Age of the Internet. New York: Simon and Schuster, 1996. (1996)

A Value Sensitive Design Approach to Indigenous Knowledge Management Systems

A brief overview of the socio-technical problem space

Indigenous cultures across the planet are disappearing. In 2007, Wade Davis, a Harvard-trained ethnobotanist, presented at the TED conference on the subject of endangered cultures (http://tinyurl.com/wadedavis). He said, “When each of you in this room were born, there were 6,000 languages spoken on the planet . . . and of those 6,000 languages, as we sit here today in Monterrey, fully half are no longer being whispered into the ears of children. They are no longer being taught to babies. Which means, effectively, unless something changes, they're already dead.” Arguably, when the language dies, so do other aspects of the culture: ways of knowing, history, stories and other aspects of ephemeral culture that wither if not actively nurtured. Of the many reasons for this cultural scenario, modernity – with its interest in technology – has played a large part. Modern transportation draws people away from the villages while telephones and televisions bring the outside world in. Information and communication technologies invite new practices into the cultural terrain that violate or replace traditional protocol. A curious socio-technical problem space emerges when one considers how technology instead might serve to sustain and stimulate traditional indigenous ways. Specifically, this conceptual investigation will focus on technological solutions for storing Indigenous knowledge.

In terms of Indigenous knowledge management, typical database structures often do not work for storing cultural knowledge. For instance, when recording oral traditions, the usual metadata tags regarding ownership (author, copyright data, publishing information, etc.) do not apply. Primarily oral cultures that do not ascribe ownership of knowledge to individuals, that do not recognize the 'right to copy' in the way Western cultures do, and that do not publish but rather perform their stories, histories, and ceremonies, would find little use for such metadata. Knowledge management is made more complex by the very nature of orality. The term oral “indicates both speech and reception, and implies face-to-face interaction. With its coloration by tradition, oral also indicates a degree of informality. It does not refer to scripted expression, but rather unscripted expression, marked by improvisation and characterized by variation” (Tangherlini, 136). How does one catalog unscripted expression? How does one account for the possibilities of variation? Similarly, for cultures that understand the power of images differently than Western cultures do, the storage and retrieval of photographs (especially of ancestors) is problematic. A guiding question that informs this investigation then is how does one construct a knowledge management system that respects the various ways in which Indigenous peoples interact with their own sense of cultural memory?

Implicated Human Values

Friedman, et al offer a list of human values with ethical import that are often implicated in system design (364). Several of those values become implicated when considering the ways technology can be used to facilitate the traditional processes of Indigenous peoples. Among them, human welfare, ownership and property, privacy, trust and identity rank high. Martin Nakata lists other issues that arise within the frame of this discussion as well: “the classification of information about Indigneous peoples' collection, storage, retrieval, access, copyright, intellectual property, the sensitivities of culturally different clients and communities, the politics, funding, distance issues, networking issues, the concerns about historical texts – and the list can go on” (281).

The value this investigation focuses on, and one which contains and overlaps a few of those listed, is that of respect for cultural ways – that is, the explicit consideration of how a proposed technological solution adheres to the cultural practices and ways of knowing endemic to the Indigenous population using that technology. Respect in this context might mean honoring traditions having to do with gender, role, or ceremony for example. Some knowledge is meant only for particular audiences under specific circumstances. As in the example from above, some knowledge artifacts contain power, such as photographs. Storage, retrieval and access of photographs must respectfully factor in these cultural attitudes.

Direct and Indirect Stakeholders

I. Direct Stakeholders

Members of an Indigenous community. This category is shaped by subsections that will differ among the communities concerned. For example, in the Haudenosaunee tradition (the Six Nations of the Iroquois in and around New York State) there are the customs of the Long House which apply only to men. Men would then constitute a subgroup whose knowledge must remain accessible only to those who by traditional rights, and under specific circumstances, should have access to it. In this sense, access is tied to the notion of respect, since violations of this protocol would have critical cultural repercussions. A knowledge management system for sustaining Amur oral tradition in China, should respect the fact that, “the majority of traditional storytellers are women, a reflection of their long history as carries of oral tradition” (Van Deusen, xxi). Also, in many cultures, oral traditions carry knowledge that has age limits – some stories are not meant for young children. To remain respectful of this, the knowledge management system must take into account what subjects and forms of knowledge are appropriate for audiences at different ages.

II. Indirect Stakeholders

Future generations of the Indigenous community. Part of the idea of creating Indigenous knowledge management systems, is maintaining traditions at risk of being lost for future generations to enjoy and derive benefit. This group of stakeholders will be topologically similar to the subgroups listed above for any specific Indigenous community. In other words, whatever system design considerations are put in place for the present population will necessarily apply to the future generations of users.

Ancestors. This subgroup doesn't make much sense to the Western mind, however, since knowledge implies a historical context, respect for the past and the people who lived in it is a subject of concern for many Indigenous populations. In this sense, respect may have to do with maintaining historical accuracy, preserving reputations, protecting spirits, honoring the dead, and so on. A popular caveat on Australian aboriginal historical resource websites reads with variation: “Warning! This site contains images of indigenous people now deceased!” Taking this idea further, respect for ancestors might take the shape of being able to “specify temporal access restrictions, either for a set duration from a start time or recurring (on a monthly or yearly basis). This functionality has been provided to support customs such as sorrow business, in which photographs or video recordings of recently deceased people are inaccessible for a mourning period” (Hunter, 118).

The 'outside' world. The outside world is a broad category including any non-Indigenous audience. From the perspective of the direct Indigenous community stakeholders, of special concern are outsiders whose interest in the Indigenous knowledge would be disrespectful or exploitative.

Works Cited

Friedman, B., Kahn, P. H., Jr., & Borning, A. “Value Sensitive Design and information systems.” In P. Zhang & D. Galletta (eds.), Human-Computer Interaction in Management Information Systems: Foundations, (348-372). Armonk, New York: M.E. Sharpe, 2006.

Hunter, J. “The Role of Information Knowledge Management.” In M. Nakata & M. Langton (eds.), Australian Indigenous Knowledge and Libraries, (109-124). Canberra: Australian Academic & Research Libraries, 2005.

Nakata, M. “Indigenous Knowledge and the Cultural Interface: underlying issues at the intersection of knowledge and information systems.” IFLA Journal, Vol. 28, No. 5-6, 281-291 (2002).

Tangherlini, T. “Oral Tradition" in a Technologically Advanced World.” Oral Tradition Vol. 18, No. 1, 136-138 (2003).

Van Deusen, K. The flying tiger: women shamans and storytellers of the Amur. Montreal: McGill-Queen's University Press, March 2001.

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by Mark Oppenneer

Value Sensitive Design & Teaching Critical Thinking using WoW

VALUING TIME: a conceptual analysis of value sensitive design considerations related to a hypothetical proposal to teach critical thinking using World of Warcraft

Matt Rolph

INTRODUCTION

According to a recent press release from the game's publisher, Blizzard Entertainment, "since launching in November 2004, World of Warcraft has become the world's most popular MMORPG, with more than 10.9 million subscribers." The game is divided into servers, each containing a 'realm' or copy of the game world and hosting a maximum of approximately 30,000 players (with less than half of that number being optimal), of whom up to about 6,000 could be logged in at any given time, though lower numbers in the hundreds or thousands are more likely. Any challenge has the potential to provoke critical thought and, just as any real world meeting space could potentially serve as a classroom, any venue where people can interact over distance in chat and in virtual person has potential as a vehicle for educational purposes, but when we begin to consider teaching critical thinking inside WoW, a variety of value-related questions from a wide spectrum of stakeholders quickly arise. In this brief conceptual investigation of value sensitive design, we'll consider an initial proposal, identify the direct and indirect stakeholders, define the problem space associated with such a non-traditional experiment in online education, consider implicated time-related values, examine a handful of the associated conflicts and possible solutions, and see how the proposal would have to change in order to address the concerns of the majority of the stakeholders.

INITIAL DRAFT PROPOSAL FOR THE EXPERIMENT

I -- a teacher of critical thinking -- would spend a couple of hours a week inside WoW with a selected group of critical thinking students for a few months, observe them, and then ask them to reflect critically in writing on their experiences. I'd also ask them to participate on a dedicated social network / bulletin board website where they can ask each other questions, for help, message each other, etc., all on the record, and to make a note of any posts they make to outside sites, such as the official World of Warcraft forums. At the end of the process, I should have written data from each student, and also my observations of them in game. My expectations are that spending time reflecting on any experience can be valuable, and that my writing prompts will be also to evoke critical thought from most students, therefore that they will show improvement. Further, I assume that, as the game is engaging and a contemporary phenomenon, this approach might work where, for example, reading A Tale of Two Cities by Charles Dickens together might be less effective (though I have great respect for that work and for the study of literature as a means of improving a variety of literacies).

From here, the proposal can be refined and considered using the conceptual aspect of value sensitive design.

IDENTIFYING STAKEHOLDERS

As with any game, the most immediately apparent stakeholders include the players, who compete with the game itself and with each other for progress, victories, and virtual goods, and the publisher, whose business it is to keep players there, attract more, and make real world money over time in the process. The phrase over time is key to our understanding, as a player is not simply one, fixed variable, but a person whose needs will change over time, one with whom the publisher specifically wishes to cultivate a long term relationship. As the term multiplayer suggests, players band together within the game in a variety of types of groups, something that has a pronounced effect on their experience of the game: a cohort, which we might define a group of people who are at roughly the same level in the game and thus share certain needs; a party, which is a short term association dedicated to meeting a particular objective; and a guild, which is a longer term association, in theory built around mutual needs and interests. In an educational experience, the most immediately apparent stakeholders are the students, whose forward progress is the stated purpose of the exercise, and the teacher, whose purpose it is to supervise the process and to evaluate and assess student progress and, in some cases, to deliver certain information, referred to as content. In our experiment, both students and teachers, in order to be present in the context, must become players in addition to their other roles, entering a relationship with the third party, the publisher.

Less direct stakeholders include player's peers, both those who are pro-game but who do not play this particular game and those who do not play this type of game at all; their parents and family, including present and future dependents; teachers and other educators, whose goal we presume it is to advance their educations outside of WoW; doctors and others focused on player health; representatives of government and others who fund and oversee education; player's current and future employers; other publishers and vendors, anyone who wants to market to players; and other members of society who coexist with players, including those who have very different aesthetic theories and values. Other people in society as a category might also include people who are in any sense competing with players and the publisher for resources at any level -- for example, competitors for the electrical power or for the resources used to create it, for the resources used to make and maintain the infrastructure of the internet, and so on.

VALUES

All stakeholders value time here, most specifically student/player time. Some are in general agreement about how time should be spent, as are, for example, the players, who usually want to play, and the publisher, who wants players to play (up to a certain point, as their managing their resources effectively relies on players' time in game falling within a certain range of activity), where all other stakeholders may be always or occasionally be in active competition for available time, and, in some cases, for other resources as well.

Let's deal with other resources first, as these competing demands are more easily addressed. In a democracy with a relatively free market, there are a number of parties who make use of the internet and pay for the privilege, and the number of nodes and connections continues to grow to meet demand; likewise, many vendors have an interest in selling the equipment necessary to connect to the game, which has a wide variety of other uses. It's also true that the typical American nuclear family, according to a 2008 Pew Internet and American Life Project survey, are more likely to have the equipment:

Sixty-six percent of married-with-children households have a high-speed broadband Internet connection at home, ... well above the national average for all households of 52 percent. ... spouses and at least one child go online in 65 percent of married-with-children households and 58 percent of married-with-children households contain two or more desktop or laptop computers.

So although alternative uses for this infrastructure are conceivable, in the United States the market is likely to decide whether they'll prevail, and, even if they do, to support Blizzard's business model, i.e. allow the infrastructure to be used in more than one way, including playing games. One key to WoW's success may have to do with the minimum system requirements, which are far less demanding than many competitors (see appendix A). Many schools, however, have limited funds and thus fewer and older machines and also, out of concern for liability and as a matter of general policy, enforce rules that prohibit the installation of unapproved software and censor access to all but selected sites. It means that running this experiment in the context of a classroom or computer cluster would be far more difficult. Blizzard's terms of service require legal adulthood, though each subscriber may, at their discretion, allow "(1) minor child for whom you are a parent or guardian and whom you have authorized to use the account you create on the Service", meaning that parents would have to consent and subscribe or the students in the teaching-critical-thinking-in-WoW experiment group would need to be 18 or older. We'll consider the values of parents, teachers, doctors, and other adults in a moment, but we can already see that it is more difficult to run this experiment by the book with high school students.

That's probably okay, however, as survey data collected by the Daedalus Project in 2005 suggest that "the average age of the WoW player is 28.3 (SD = 8.4). 84% of players are male. 16% are female. Female players are significantly older (M = 32.5, SD = 10.0) than male players (M = 28.0, SD = 8.4)" Though we don't know the margin of error, and it's possible that, as the game's popularity has grown, these demographics have changed, it's likely that players are typically older than students in high school. They may even be older than typical undergraduates. It doesn't mean we couldn't run the experiment with students of any age, but this information supports some stakeholders’ reservations.

Returning to time as a value, there is general data of interest. The average human lifespan is about 71 years, with variations between genders (women tend to live longer). Of that time, men spend 10.5 years sleeping and women 27 years. Men spend three years, about 40 minutes a day, in the bathroom strictly for biological needs, and women spend only about six months. Women spend longer on the phone, 5.5 years compared to 4 for men, eating lunch, 4.5 years compared to 4, watching TV (at least in England, where this particular data set was gathered), at 13 years compared to 10, and also more years shopping, cooking, doing chores, and 'getting ready', which includes shaving, applying makeup, and so on. As you can see from this sample data, values are reflected in the way we spend our time, though we aren't necessarily aware of the way it adds up. Student time in school, however, is prescribed by statute or policy, and thus more carefully tracked. New York, according to the Thomas B. Fordham institute, has an average school day length of 6 hours, 54 minutes, amounting to 1,271 hours per year, a little more than average. For comparison, the average American youth spends 900 hours in school (and 1500 hours per year watching television, according to the A.C. Nielsen Co. -- though television viewing numbers are changing, the average American still watches for 4 hours a day or 9 out of 65 years). This changes, of course, in college. At an accredited college or university, credit totals for each course roughly reflect the numbers of hours spent in the classroom or laboratory, with a 3 credit class requiring, in theory, about 3 hours per week in class. Faculty expect that for each hour in class, a student will spend a certain amount of time in study, reading, preparing, and completing homework assignments. The First Year Council at Plymouth State University in Plymouth, NH, found in Spring 2005 that most faculty believed they required 3-5 hours or more outside class per classroom hour and most fulltime students (taking an average of 5 classes) reported spending less than 10 hours per week outside class on all of their classes, i.e. 2 hours per class per week.

On average, again from the Daedalus Project survey, "WoW players spend 22.7 (SD = 14.1) hours per week playing the game ... [with] no gender differences in hours played per week."

The concept of opportunity cost is drawn from economic theory, and presumes that when a choice is made -- in our case, the choice to spend time in a particular way as opposed to another -- there is a cost that can be compared to the cost or benefit of other available options. Although the stakeholders we've identified are not likely to be trained economists, they are likely to instinctually grasp this concept of opportunity cost, and, if they all value time as we've suggested, they will perceive an analytical cost-benefit comparison through the filter of their other values.

LIKELY STAKEHOLDER CONCERNS

Student/players, students who also play the game, may welcome a chance to play on the record, and to receive credit for reflecting on their experiences. Some few, however, express concern regarding their own time management skills and the addicting nature of the game: "I'm worried about being sucked back in." The question of addiction comes up when considering other stakeholders at well, as we'll see in a moment. To be sensitive to students who are concerned about their ability to manage their time and their susceptibility to addiction, whether or not the term is clinically appropriate, we'd need to screen students in our test group, asking them to attest that they are not now and have not been in the past unable to control the amount of time they spend in the game. The question of game addiction would need to be evaluated, and a determination about informed consent reached by the institutional review board, human subjects committee, or comparable body. If the experiment falls outside such oversight for any reason, the teacher and any others engaged in this research must consider the ethical questions raised by the possibility of addiction. A self-selected group as opposed to a random sample does mean that the data gathered may be skewed.

Blizzard, the game's publisher, wants subscribers, and nothing in our proposal violates their terms of service. In order to play together, to be in the game world at the same time, players will need separate accounts. If we were considering anything involving account sharing, in which more than one student used the same account (only possible if we intended for them to access the game asynchronously) or if we intended to give minors access to the game without the consent of their guardians, only then might Blizzard be concerned, should they get wind of our plans. As we've noted, the publisher wants players to spend time in the game, with few restrictions. Though it's possible to imagine a company forbidding an activity that might result in negative criticism of their game (students are asked to reflect and could write anything they wish), this one is confident enough about its product to allow fans and players to comment freely on the public internet even in cases where their terms of service, which specify trademark and copyrights to game characters, concepts, and so on, might be used in an attempt to suppress commentary.

The teacher is also a player, and, in theory, will have the same concerns as other players. The teacher overseeing the experiment would need to be someone comfortable with something along these lines, with access to the appropriate equipment and so on. Again, this brings bias into the mix, as a person willing to try this is more likely to view it in a favorable light. Teaching is a time-consuming business, and teachers are generally concerned with efficient and effective use of time. What is defined as effective often depends on the method of assessment and the context. In contexts where the teacher can evaluate and assess independently, as in more common at the college level and above, tolerance for risk is greater. If the students’ progress is to be determined by a standardized assessment, such as the California Critical Thinking Exam, the teacher may be much more concerned about whether this will be a wise experiment. In the absence of solid research supporting the experiment, i.e. studies equating these activities with improved exam scores, a teacher may be averse to spending time in this way. Teachers are also political animals, and, though methodologies and pedagogy vary, tend to be uniformly concerned with the other stakeholders concerns: at the high school level, "the kids may go for this, but I need to be able to explain it to the parents, the principle, or the school board" and at the college level "I want to be sure my class is not seen as a b*****it class, as a waste of time." The participation of the teacher is likely to be perceived as an endorsement of the game whatever he or she says. Many indirect stakeholders are likely to believe that medicine should be bitter, that rigorous education should not be fun or that because their own educations were not pleasurable, no good education can be, and winning over these people can be a challenge. Some teachers may have chosen their work out of unconscious or conscious motivation to be the center of attention, something that would be less likely if the tools used are more engaging. On the other hand, at the college level, an untenured instructor may feel the need to "publish or perish", to have conducted, document, and published on experiments, whether or not they directly benefit other stakeholders. Though it would be unethical to conduct research on students at the expense of their educational progress, it can be difficult to parse the various imperatives, especially in a case where the experiment has yet to be conducted. If the expectation is that the students will be more engaged, and the teacher believes, as I do, that engagement is key to learning, tolerance for the opportunity cost is increased. If the IRB approves the experiment and there is a chance it could result in a line on a curriculum vitae or publicity, self-justifying rationalizations are easier. In brief, this experiment is more likely in higher education than elsewhere.

Parents and family, including present and future dependents, have a stake in the player's use of time as well. If the players/students find themselves spending 14-23 hours a week in the game, a complete consideration of the opportunity cost including all of the other things they might be doing. Parent oriented publications are full of warning about the dangers of WoW like this one:

July 2008 - My son is 17 and was recently diagnosed w/ ADHD and LD by a neuropsychologist. We had him tested because we were concerned about his grades, which had been very good, but curved down to bottom by junior year. He is very intelligent, but does very little homework. He sees a therapist, a learning specialist and has a 504 plan at BHS. He plays World of Warcraft compulsively. Treatment by his therapists does not seem to help him come to the realization that his gaming is a problem. When we (the parents) take away the game, he goes on strike and doesn't go to school. Questions: Does anyone have any experience with World of Warcraft addiction? If so, what has helped your child? Are there any local therapists who specialize in this? What about residential treatment or boarding schools? I am at wit's end. Any advice or sharing of experience would be appreciated. Anon

Radical treatment is needed here. Get rid of his computer, admittedly difficult to do. Electronic screens in general, have become the malaise of American children. Call the BUSD attendance office and/or the Berkeley Police if necessary. It is nothing to feel shy or stigmatized about. You can't let your son control the situation. You need to rein him in. My own son has a degree of computer addiction (racing games). I sent him away to camp for 9 weeks this summer, largely to get him away from the computer. Bill Gates lets his daughter use the computer 45 minutes on school nights and 1 hour on weekend nights. If that's enough time for Bill Gates' child, it's enough time for our sons. Best of Luck and Don't Be Reticent! Berkeley Teacher and Mother

Of course, there are also a variety of more moderate answers and strategies. American parents are dealing with this and other situations in a broad spectrum of ways. Another parent quotes experts and points to resources:

First, Iowa State psychology professor Douglas Gentile says there are red flags to watch for when it comes to any video game addiction. It's not the hours, he says, it's the impact on the rest of life. ... World of Warcraft was a hot topic on a recent Q&A session we ran with CSU Dominguez Hills professor Larry Rosen, author of ''Me, Myspace and I'' (great book, by the way),Walnut Creek therapist Steven Freemire and Times video games blogger Danny Willis -- and Danny raised some particularly interesting points about why forcing a teen to go cold-turkey meets with the reception that, well, you've experienced. He says parents tend to think of these games like virtual solitaire, when they're more like varsity football. They're played in teams, so if your son doesn't show up to play, he's letting down real people to whom he made a commitment. So it may be helpful when you talk to your son, if you understand that to him, it's like being yanked off the varsity football team, or told he can only go to two practices a week -- in which case, the team will dump him. Your discussion will go better if he gets that you get it. Or at least, the door may not be slammed quite as hard.

Though there are reported cases in the mainstream press where WoW brings couples closer together (A Happy Warcraft Tale: http://www.worldofwar.net/n/415359/a-happy-warcraft-tale) or makes students more interested in school ('World of Warcraft' Gets Kids Interested in School by Jeremy Tsu: http://www.foxnews.com/story/0,2933,432383,00.html), fear tends to predominate. In a system where some schools or districts still ban books in deference to parent concerns, we can see that not everyone will accept or endorse our proposed experiment. The long term solution likely lies in discussions that involve parents, teachers, students, and others, and focus on facts, attempt to differentiate between more and less rational fears. In the shorter term, it's appropriate to build consensus and be sensitive, even if anxieties seem disproportionate or irrational.

Doctors today have general concerns about trends in obesity, which is epidemic in the US, and overall health, and some have specific concerns about WoW or comparable games. Dr. Maressa Hecht Orzack, a clinical psychologist at McLean Hospital in Massachusetts, claims that 40 percent of World of Warcraft players are addicted to the game. Dr. Orzack is the founder and coordinator of Computer Addiction Services, and likens computer addiction, also called internet addictive disorder or cyberaddiction, to pathological gambling and compulsive shopping. She recommends treatment using cognitive therapy, and that games bear warnings similar to cigarette packets. Though her publications on the subject seem to be from about a decade ago, the AMA does not quite recognize video game addiction as a distinct disorder, and the methodology she used to derive the 40% figure is not clear, she makes some very good points about the way MMORPG use variable ratio reinforcement to keep players engaged. "This isn't about willpower or restraint," she is quoted as saying, "These games are very elaborately designed to ease you in gently, entice you, and keep you there. And it's a cycle: people begin to spend too much time playing and their careers and personal relationships begin to deteriorate." Different types of doctors have different career arcs and different concerns, and careers in psychology can be made by speaking to an anxiety that is on the rise as opposed to one that is on the decline, but it is legitimate to consider the health concerns associated with our proposed experiment. Again, it means selecting a group that is prepared to sign an informed consent form, one made up of people from, if Dr. Orzack's figure is correct, the other 60%. We may also want to discuss screening for other things, in theory, such as obesity, depression, anxiety, and so on, noting that these are incredibly common in adolescence and early adulthood. To moderate concerns, we could run this experiment in conjunction with, for example, the requirement that participants engage in regular exercise. Exercise tends to have many positive effects, and, according to some research, to raise test scores on seemingly unrelated assessments.

Government is slow, but responsive to the concerns of the citizenry. It would be difficult to convince regressive school boards this is worthwhile, and current state and national law require particular forms of assessment. If this research can be conducted at the college level and it can be shown to have positive results across the board, then progress is possible, or, at least, we may be able to impede policy and law that prohibit this sort of thing. Uniformly positive results, however, are unusual and suspicious. Reliable data is likely to be more ambiguous.

Current employers would likely rather have the student learn something more directly applicable to their work. Future employers may be a little more open, as technical skill sets, work at distance, and achieving objectives in virtual environments may be more valuable in some sectors in the future. To address employer concerns, we'd need to focus on the aspects of the game that may incidentally prepare student players for work, such as in-game economics. We may also need to strongly suggest that our participants limit their time in game to far less than the average number of hours per week in favor of other activities. We could, for example, require participants to earn the money necessary to subscribe to the game themselves.

Finally, there are the other people in society who must coexist with the players. Dr. John Charlton of the England's University of Bolton and Ian Danforth of Whitman College in the United States suggest, on the basis of their research (sample included 391 players, 86% male), that "the closer the players got to [game] addiction the more likely they were to display negative personality traits. With stronger signs of game addiction came three personality traits that would usually be associated with Aspergers: neuroticism and lack of extraversion and agreeableness" (reported by Gamepolitics.com). Dr. Charlton is quoted as saying "The thinking in the field is that there is a scale along which people, even those considered to be 'normal', can be placed upon. And that people such as engineers, mathematicians and computer scientists are nearer to the non-empathizing, systemizing, end of the spectrum, with people with Aspergers syndrome even further along again. ... Our research supports the idea that people who are heavily involved in game playing may be nearer to autistic spectrum disorders than people who have no interest in gaming." The implication is that game addiction makes people less sociable. On the other hand, MMO are collaborative platforms and reinforce many basic skills of the "everything I needed to know I learned in kindergarten" variety. To be value sensitive, we need to carefully consider the experiment design, but, as we're screening to decrease the likelihood of reinforcing or creating addictions and this is a group project, it should be relatively simple to make the work collaborative. We can, for example, prompt students to reflect on the benefits of working with another or with a group to achieve an objective, in addition to allowing free reflective writing. This risk of Aspergers-like symptoms appears to be manageable.

THE REDESIGNED, MORE VALUE SENSITIVE EXPERIMENT PROPOSAL

A qualified teacher, a qualified therapist, and a group activity leader will invite students to be screened for a critical thinking experiment that will involve playing World of Warcraft. To be accepted student players must indicate that they will abide with the terms of participation, that they will take a standardized critical thinking examination (such as the International Critical Thinking Essay Test from the Foundation for Critical Thinking) to be scored by external evaluators at the beginning of the program and at the end, to earn the money the game subscription will cost either in group community service organized by the experiment's leaders or at a part-time job, and to state that they do not believe themselves to be or to have been addicted to online games. Participants will be briefed on the risks and sign an informed consent form. The group activity leader will be in charge of a light group (physical fitness) exercise program in which all participants are expected to participate. The therapist will review what participants write, meet with participants individually to discuss their progress through the program, and have the power to remove students from the program at any time. The teacher will discuss program objectives, and be on hand in the game world to observe and participate. Students are asked to play at designated times during the week and to work together to meet certain objectives within the game, then to reflect in writing, both in response to prompts written by the teacher and freely, at particular times during the experiment. Students are asked to agree not to play WoW except at these designated times, totaling a maximum of an agreed upon number of hours per week (say 3-6), and to reserve the characters they create in this program for use in this experiment. At the end of the experiment, student writing and test scores, along with teacher, therapist, and group activity leader research notes, will be aggregated into a data set to be made available for external review.

CONCLUSIONS

As you can see, the result of the conceptual investigation and sensitivity to the likely concerns of the direct and indirect stakeholders increases the specificity, and, perhaps, the quality of the proposed experiment. While it may still provoke anxiety in some quarters, and there are questions that this experiment will be less likely to answer as a result of the limited sample, it is arguably much more likely that the students involved will learn more. Whether their critical thinking skills will improve measurably or not, they'll become more aware of the discussion about the risks of online games, and have spent time reflecting individually and working together on virtual and real tasks. It is much harder to describe the refined proposal as reckless, and it is far more likely to appeal to the concerned stakeholders. There are cases in which sensitivity to too many stakeholders and their values can be paralyzing, but this is not one of them. This type of process can be used to consider and refine almost any design or endeavor.

Appendix A:

Minimum System Requirements
Windows® System 2000/XP OS:
Intel Pentium® III 800 MHz or AMD Athlon 800 MHz
512 MB or more of RAM
32 MB 3D graphics card with Hardware Transform and Lighting, such as NVIDIA® GeForce™ 2 class card or above
DirectX® 9.0c (included) and latest video drivers
6.0 GB available HD space
4x CD-ROM drive
A 56k or better Internet connection

Mac® OS X 10.3.9:
933 MHz or higher G4, or G5, or Intel processor
512 MB RAM or higher; DDR RAM recommended
ATI or NVIDIA® video hardware with 32 MB VRAM or more
6.0 GB available HD space
4x CD-Rom drive
56k or better Internet connection

Appendix B:

World of Warcraft: What is it?

· World's #1 selling "massively multiplayer" online role-playing game [MMORGP]

· Player Experience
o A "virtual reality" fantasy where thousands of players embark on adventures and discover a world together inside the rich Warcraft universe
o An escape from the routine, everyday world into a land of epic fantasy where you have the freedom to explore, be anyone you want, establish powerful social connections, and accomplish great tasks

· Technical Foundation
o Client/Server network game
o 'Game' resides in code and databases on servers
o Client renders the game on players' computer screens
o 9,000 Blizzard servers globally supporting WoW
o Over 1,300 Game Masters provide 24x7 customer support in 6 languages directly to player while playing the game

[Omitted chart: WoW customers in millions by quarter, east and west]

Published by Blizzard-Vivendi 2006


References

Berkely Parents Network. “World of Warcraft.” July 2008. Retrieved from: http://parents.berkeley.edu/recommend/arts/worldofwarcraft.html

Blizzard Entertainment. Press Release. September 15, 2008. Retrieved from: http://www.blizzard.com/us/press/080915.html

Boland, Lawrence A. “Economics in time vs time in economics: Building models so that time matters.” Simon Fraser University. Final Draft of Paper. Retrieved from: www.sfu.ca/~boland/HEI-time-draft.pdf

Chicago Tribune. “Enough time spent in school?” Oct 19, 2008. Chart shows information from the Thomas B. Fordham Institute. Retrieved from: www.chicagotribune.com/media/acrobat/2007-08/32172546.pdf

Foundation for Critical Thinking. “International Critical Thinking Essay Test.” 2008. Retrieved from: http://www.criticalthinking.org/store-page.cfm?P=products&ItemID=185&catalogID=226&cateID=132

Herr, Norman. “Television and Health.” Internet Resources to accompany The Sourcebook for Teaching Science. 2007. Quotes AC Nielsen Co statistics on American TV viewing. Retrieved from: http://www.csun.edu/science/health/docs/tv&health.html

“How long does the average person spend in the bathroom in their lifetime?” Unasked.com. Quotes from article from the Daily Mirror, UK demographics. Retrieved from: http://unasked.com/Question11177.htm

“How many players does a server hold?” Unofficial World of Warcraft Forums. Community Discussion. January 23, 2007. Retrieved from: http://www.worldofwar.net/forums/archive/index.php/t-386230.html

Klein, Christopher C. The Economics of Time as Resource. Middle Tennessee State University, Murfreesboro, TN. Department of Economics and Finance Working Paper Series, August 2007. Retrieved from: ideas.repec.org/p/mts/wpaper/200712.html

Orndorff, Patrick. “WoW Gamer is One-Man Raid Team.” Geekdad. Wired Blog Network. October 19, 2008. (information used in from the comments on this blog post). Retrieved from: http://blog.wired.com/geekdad/2008/10/wow-gamer-is-on.html

Orzack, Maressa Hect. Computer Addiction Services homepage. URL: http://www.computeraddiction.com/

Reimer, Jeremy. “Doctor claims 40 percent of World of Warcraft players are addicted.” Ars Technica: The Art of Technology. August 9, 2006. Retrieved from: http://arstechnica.com/news.ars/post/20060809-7459.html

Sirlin, David. “Soapbox: World of Warcraft Teaches the Wrong Things.” Gamasutra. February 22, 2006. Retrieved from: http://www.gamasutra.com/features/20060222/sirlin_01.shtml

Snow, Blake. “Parents suing Blizzard for World of Warcraft addiction.” Joystiq. November 18, 2005. Retrieved from: http://www.joystiq.com/2005/11/18/parents-suing-blizzard-for-world-of-warcraft-addiction/

“Study Links Video Game Addicts with Asperger’s Syndrome.” GamePolitics.com: Where Politics and Video Games Collide. April 3, 2008. Retrieved from: http://www.gamepolitics.com/2008/04/03/study-links-video-game-addicts-with-aspergers-syndrome

Terdiman, Daniel. “World of Warcraft bans raise players’ ire.” Cnet News. March 22, 2007. Retrieved from: http://news.cnet.com/2100-1043_3-6169517.html

US Bureau of Labor Statistics. “American Time Use Survey Summary, 2007 Results.” June 25, 2008. Retrieved from: http://www.bls.gov/news.release/atus.nr0.htm

“US nuclear family also technology family.” Agence France-Presse global news wire service. Yahoo! Tech News. October 19, 2008. Retrieved from: http://tech.yahoo.com/news/afp/20081019/tc_afp/lifestyleusitinternettechnology

“World of Warcraft.” Wikipedia. Wikimedia Foundation. Oct 19 2008. Retrieved from: http://en.wikipedia.org/wiki/World_of_Warcraft

“World of Warcraft brings a couple closer. Who knew?” Tech Digest. July 11, 2008. Retrieved from: http://www.techdigest.tv/2008/07/world_of_warcra_6.html

World of Warcraft Logo. Graphic retrieved from: 204.13.154.38/images/2wow-logo2800-med.jpg

Yee, Nick. “WoW Basic Demographics.” The Daedalus Project: The Psychology of MMORPGs. Blog Post. (Information in comments also used). July 28, 2005. Retrieved from: http://www.nickyee.com/daedalus/archives/001365.php

Value-Sensitive Design and Hospital Waiting Rooms

Jason Zalinger
Value-Sensitive Design
Conceptual Investigation

Socio-Technical System:‭ ‬Hospital‭
Problem Space:‭ ‬Waiting Room‭
Values:‭ ‬Empathy and Empowerment‭
Stakeholders:‭ ‬Patients,‭ ‬Family and Friends‭
Possible Solution:‭ ‬ Mobile Phone Game‭

Socio-Technical System:‭ ‬Hospital‭
Hospitals represent a strange paradox.‭ ‬ Their sole mission is to save lives and relieve pain.‭ ‬ However,‭ ‬they are also spaces that create intense anxiety and fear among patients,‭ ‬family and friends.‭ ‬ I do not blame hospitals.‭ ‬They must find a balance between‭ ‬helping humans and‭ ‬processing patients.‭ ‬Still,‭ ‬it is precisely this tension between helping and processing that causes anxiety among patients.‭ ‬This Value-Sensitive Design conceptual investigation describes and explores that tension and offers a possible solution to help relieve some of the anxiety hospitals unintentionally produce.‭ ‬Since hospitals are obviously complex systems,‭ ‬I am focusing my energy specifically on hospital‭ ‬waiting rooms.‭ ‬The direct stakeholders are obvious:‭ ‬Patients and their family and friends.‭ ‬The indirect stakeholders are the doctors,‭ ‬nurses and hospital staff whose interactions with patients might be easier if the waiting room environment helped direct stakeholders feel a stronger sense of empathy and empowerment.‭ ‬ ‭ ‬ ‭

A Brief Hospital Story‭
I went with a friend to the local hospital before she had surgery.‭ ‬We were there for almost three hours while various departments and nurses and information workers poked,‭ ‬pinched and processed her body and her medical records.‭ ‬Looking back,‭ ‬I realize the entire system actually‭ ‬worked.‭ ‬However,‭ ‬with each new department we journeyed to,‭ ‬we both ended up in a waiting room...waiting,‭ ‬with little information about what to expect or what we should be doing because in the waiting room,‭ ‬it seems like human nature dictates that you ought to be‭ ‬doing something besides sitting.‭ ‬Sometimes they let me in the exam rooms with her.‭ ‬Most of the time,‭ ‬I distracted myself with my laptop and tried not to look at the other people waiting.‭ ‬One of the waiting areas was large,‭ ‬with light pouring in from great big windows above.‭ ‬The natural light felt good,‭ ‬safe.‭ ‬But,‭ ‬insane as it sounds,‭ ‬it was the only waiting room I had been in that day‭ ‬with windows.‭ ‬Since this waiting area was a major hub of activity,‭ ‬it would have seemed like madness to cram lots of people into a windowless space.‭ ‬Although I believe that face-to-face communication is always more powerful than technologically mediated communication, ‭all the other people in that large waiting area did not make me feel a sense of communion:‭ ‬We are the waiting people.‭ ‬We wait as one‭!‬ Rather,‭ ‬I got the feeling of being nothing more than a member of the data herd,‭ ‬each patient branded with a unique hospital identifying number.‭ ‬ In the small,‭ ‬windowless waiting rooms the lights were dimly lit with bland chairs and wallpaper and carpeting.‭ ‬The rooms were clearly institutional, with a twist of Walmart chic.‭ ‬They made me sad.‭ ‬They reinforced the notion that this hospital—despite it's brilliant reputation for saving lives—was also unable to afford environments which could support the values of‭ ‬empathy and‭ ‬empowerment.‭ ‬It is only with the‭ ‬deepest respect that I offer some potential solutions to helping people immerse themselves in a game which could give them a deeper sense of empathy or empowerment.‭

Potential Solutions:‭ ‬Video Games‭
The immersive,‭ ‬imaginative quality of video games seem to be a good fit for supporting a sense of empathy or empowerment for anyone stuck in a waiting room.‭ ‬Thus,‭ ‬I propose a video game for mobile phones as a potential way to help stakeholders feel more supported.‭ ‬Many‭ “‬serious games‭” ‬exist which are aimed children and medicine.‭ ‬However,‭ ‬very few games seem to exist which deal with the hospital itself as a socio-technical environment.‭ ‬One example would be Hospital Tycoon published by CodeMasters in‭ ‬2007.‭ ‬Hospital Tycoon is a business simulation,‭ ‬however,‭ ‬the publishers included a story mode to add interest.‭ ‬They call the game a‭ “‬Medical-based soap opera.‭” ‬This type of simulation might be fun to play,‭ ‬but it does not address the specific values of empowerment and empathy in a waiting room.‭ ‬First,‭ ‬it is a PC game,‭ ‬so players would need their laptops.‭ ‬What I envision is a mobile phone game simply because of the ubiquity and convenience of the phone platform.‭ ‬In addition,‭ ‬a phone is,‭ ‬arguabley,‭ ‬less likely to be left at home than a handheld game system like a DS.‭ ‬Sitting in a waiting room requires periods of waiting,‭ ‬followed by burst of activity when your name is called.‭ ‬A mobile game can be quickly,‭ ‬easily paused or closed and put into one's pocket.‭ ‬Besides platform,‭ ‬I believe that the‭ ‬Waiting Room Game should be a series of mini games within which players can easily jump in and out.‭

In the hospital that day,‭ ‬my friend said to me,‭ “‬When they talk to you it makes you feel less helpless.‭” ‬Talking is the key to supporting a sense of empathy,‭ ‬thus talking‭ (‬or is it‭ ‬listening‭?) ‬must be built into the game.‭ ‬One way to do this would be for players to create a somewhat detailed profile before the game begins.‭ ‬When the player redesigns a waiting room,‭ ‬for example,‭ ‬a nurse would come out and cheer you on saying,‭ “‬the new carpet looks great,‭ ‬Jay‭!” ‬And if you select green as your favorite color in your profile,‭ ‬the doctor could be wearing a green tie and say,‭ “‬I wore this green tie for you‭!” ‬The goal is to humanize the patient-doctor-waiting room experience.‭ ‬Now that I have detailed the philosophy behind my conceptual investigation,‭ ‬here are some examples of possible mini games based on my experience that day in the hospital:‭

Waiting Room Designer:‭ ‬In this game,‭ ‬the player gets to design and decorate a waiting room.‭ ‬They can browse and choose from a variety of possibilities,‭ ‬such as,‭ ‬carpeting or hard wood,‭ ‬artwork,‭ ‬couches and chairs,‭ ‬lighting,‭ ‬flat screen TVs and so forth.‭ (‬the publisher of this conceptual game could probably make a lot of money using product placement from Pier‭ ‬1‭ ‬or Crate & Barrel) ‬Time limits could also be an option if,‭ ‬for example,‭ ‬a patient is told they will see the doctor in about five minutes,‭ ‬they could set a game for that time.‭ ‬The goal here is to empower patients in waiting rooms so that they feel a stronger sense of control over their environment.‭

Department Shuffle Puzzle:‭ ‬In this game,‭ ‬the player must solve a puzzle somewhere in the waiting room in order to get through to see the doctor or nurse.‭ ‬This could help stakeholders alleviate the nagging sense of‭ ‬feeling like they should be doing something.‭ ‬This gives them a chance to take control of the environment.‭ ‬It gives them a chance to solve the‭ ‬mystery of waiting.‭ ‬It makes the mystery more tangible and thus makes the patient feel more in control.‭

Paperwork Blaster:‭ ‬This game could be a side-scrolling shooter where flying‭ ‬paperwork‭ ‬monsters aggressively assault the player who is armed with heavy guns and special weapons.‭ ‬Paperwork monsters could include insurance forms,‭ ‬medical record items and,‭ ‬of course,‭ ‬hospital bills‭!‬

Obviously,‭ ‬there are many ways to expand upon this possible solution.‭ ‬For example,‭ ‬how do we account for children who are not worried about paying hospital bills or insurance forms‭? ‬Maybe the game could ask the players age,‭ ‬and if they are under eighteen,‭ ‬the game provides an alternative to‭ ‬Paperwork Blaster.‭ ‬This is where field work would be necessary for the game designer to create elements that kids would enjoy fighting their way through—without implying that these objects are necessarily evil or bad.‭ ‬They are simply part of the ecology of hospitals that most of us,‭ ‬at some point,‭ ‬have to deal with.‭ ‬If games can help direct and indirect stakeholders feel more empathy or empowerment then we ought to play.‭

Beauty & Pain

I thought I'd share this brief item from a mid-September issue of the New Scientist with you. I think there are implications for HCI, and a connection to value sensitive design. 

In pain? Take one masterpiece, three times a day
18 September 2008
From New Scientist Print Edition. Subscribe and get 4 free issues.

THE power of art to heal emotional wounds is well known, but could contemplating a beautiful painting have the same effect on physical pain?

To investigate, Marina de Tommaso and a team from the University of Bari in Italy asked 12 men and women to pick the 20 paintings they considered most ugly and most beautiful from a selection of 300 works by artists such as da Vinci and Botticelli.

They were then asked to contemplate either the beautiful paintings, or the ugly painting, or a blank panel while the team zapped a short laser pulse at their hand, creating a pricking sensation.

The subjects rated the pain as being a third less intense while they were viewing the beautiful paintings, compared with contemplating the ugly paintings or the blank panel. Electrodes measuring the brain's electrical activity suggested a reduced response to the pain when the subject looked at beautiful paintings (Consciousness and Cognition, DOI: 10.1016/j.concog.2008.07.002).

While distractions are known to reduce pain in hospital patients, de Tommaso says this is the first result to show that beauty plays a part. "Hospitals have been designed to be functional, but we think that their aesthetic aspects should be taken into account too," she says.

The Human Brain - With one hundred billion nerve cells, the complexity is mind-boggling. Learn more in our cutting edge special report.

From issue 2674 of New Scientist magazine, 18 September 2008, page 14

It would be interesting to design an experiment along these lines for an interface. 

a) present the test group with 20 interfaces, let them pick the most beautiful and the ugliest

b) assign each individual to focus on a blank screen, a beautiful interface, or an ugly one until a prompt appears

c) instead of a pain-inducing laser, use a 'critical failure' message, a 'something very bad has happened message'

d) ask the user to rate the level of pain/annoyance

Then determine whether the 'beautiful' interface moderates the effects of the error message ... or something along these lines. I bet you can think of a better experiment along these lines than I have! ~Matt Rolph

Is this a beautiful interface? Is the technology it serves as a gateway to more frustrating than average? Less? About the same? If an interface is beautiful, can that moderate frustration (presuming that what can go wrong always will, that there will be something frustrating about using even the best design)? Image from: http://www.physorg.com/newman/gfx/news/iphone_inhand.jpg