What do Toothbrushes teach us about Self Help?

Swish, swish, swish…spit. When you think about design, you probably think of things like fancy books, fancy clothes, fancy opera houses…and maybe your mind doesn’t automatically go to that bristly stick you use every morning to make sure your breath is minty fresh. But it turns out there’s a lot of design issues to consider when producing the humble toothbrush. More surprisingly, I think that there might be an interesting lesson for designing mental health treatments in there as well…

One of my absolute favourite podcasts is a series called 99% invisible by Roman Mars. The title refers to all aspects of design, with the implication that many aspects of design are invisible to us – either in terms of the amount of effort put into apparently minor details (one of my favourite examples being the intensive effort put into making your iPod click wheel sound juuuust right), or in terms of the implications of design being missed or ignored, with negative consequences for experience or efficiency.   One of the first episodes of the show is about designing toothbrushes. This is a classic example of something everyday and ubiquitous that we probably don’t often think about in terms of having a design or being designed, but actually there are a lot of design issues to consider – how people hold their toothbrush being one example.

It turns out there are six specific different kinds of grip (including one called the Death Grip – which is apparently more common in women) and so a well-designed toothbrush needs to be suitable for all six. In the podcast, Roman interviews designer John Edson, who was asked to redesign toothbrushes. He recalls that when they researched types of toothbrush, the most popular design was the angled ‘reach’ toothbrush, with the thin handle and the bend near the head. He goes on to say that he thinks the best thing they did in their redesign was to change that, because it turns out that having a straight, fat handle is much better in terms of ergonomic design.

OK. Man meets angled toothbrush, man straightens out angled toothbrush, healthy gums all over the world rejoice. But what exactly does this have to do with mental health research?  For me, the intriguing part was this: The only reason the brush was designed with an angled head was to make it look like a dental tool, like one of the scary metal bits of equipment that your dentist uses to get to the awkward bits in your mouth. But when you’re brushing your teeth yourself, the angled head actually doesn’t work well at all.

This reminds me of an issue that keeps coming up when we think about computerised self help therapies for mental health. A lot of the time, the programmes seem to have been designed to mimic what would happen if you met a ‘real’ therapist. The user sits through various exercises and answers various questions posed by the programme, like they would if they were working face to face with a therapist. Some programmes even ask you to complete a session for one hour each week, like you would if you had weekly appointments with a professional service. In other words, we make it look like the therapy you get from a professional. But maybe this is making the same mistake as the designers of those angled toothbrushes – this is what therapy looks like when someone else does it to you. But when you’re doing the therapy by yourself, for yourself – maybe it needs to look different.

When I think about existing technologies that people report as having therapeutic benefit, they are always doing something different – something beyond the traditional idea of ‘getting therapy’. I’m thinking about the shared expression and universality of sharing intimate secrets anonymously online, or the ability to connect with other people  having the same problems as you, or even just apps that offer novel ways of relaxing.  None of these mimic or replicate traditional therapy – they’re about doing things differently. I think that’s the lesson from the toothbrush. The design of treatments will be improved if we stop thinking about what therapy ‘look like’, and instead ask how people already use technologies to help themselves.

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