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The Current Transcript for December 13, 2017

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Prologue

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SPEAKER: We ran out of fuel, and we decided that night that we had to stop one of two incubator units, depriving new born babies from being treated in an incubator.

ANNA MARIA TREMONTI: The tough medical decisions they made in a war zone haunt him. He escaped with his family, but now he can barely live with himself because those left behind in his home city are trapped. No one can get in, no one can leave, and that means medical supplies and food can't get in either. And yet, they are a mere 10 kilometers from Damascus. In a week when Russia's Vladimir Putin has declared the Syrian war over. At a time when Geneva hotels are crammed with officials taking part in the 8th round of Syria peace talks. The people of the Syrian city of Eastern Ghouta are under siege and forgotten. In half an hour we are asking about them. Also today, the statistics on the number of people unable to get help for mental illness are alarming across North America. Could this be the answer?

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SPEEKER: Meet Woebot, the friendly little guy who's ready to listen 24/7. Woebot doesn't do therapy, but it can be your guide to help you figure out things on your own.

AMT: The Woebot will listen and respond anytime of the day. But critics say it is a false relationship aimed at vulnerable people. We're on that story in an hour. But we're starting with a moment in the zeitgeist right now.

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SPEAKER: I think we're watching a major cultural shift, but I see a real risk of the kind of panic around sexuality and particularly a tendency to vilify all men.

AMT: Is that true? Has the #Meetoo movement created a moral panic? I'm Anna Maria Tremonti, this is The Current.

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Part one: Has the #MeToo campaign gone too far?

Guests: Robyn Urback, Vicky Mochama, Judith Levine

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SHERRY ROMANADO: In May, The member from Selkirk-Interlake-Eastman publicly made inappropriate, humiliating, and unwanted comments to me that were sexual in nature. These comments have caused me great stress, and have negatively affected my work environment. Thank you.

AMT: It did not take long after Liberal MP Serry Romanado spoke last week to learn what her Conservative colleague MP James Bezan had said to cause such distress. Posing with Miss Romanado and another individual for a photo op last May, the Conservative MP had quipped this isn't my idea of a threesome. Mr. Bezan has since apologized. But it's Ms. Romanado who has been facing a social media backlash for sharing what some say should not truly be considered a #MeToo moment. Two months since the downfall of producer Harvey Weinstein, the #MeToo movement has brought down scores of high-profile men accused of sexual assaults or sexual misconduct. But now some are asking whether this great reckoning needs to be reckoned with itself? And whether a cultural shift is at risk of becoming a moral panic. We have three guests standing by with their thoughts. Robyn Urback is a columnist and opinion editor for CBC News. Vicky Mochama is a national columnist for Metro News. They're both here with me in our Toronto studio. And Judith Levine is a Brooklyn-based author and journalist who writes mostly about the intersections of sex and justice. She joins us from New York City. Hello everyone.

ALL: Hi.

AMT: Robyn Urback, let's start with you. what do you make of the situation with Ms. Romanado and Mr. Bezan?

ROBYN URBACK: It was really strange one actually because this sort of came out of nowhere. The incident at the center of this controversy happened a number of months ago. And from what we understand publicly, it did go through a process of an internal investigation. There were several apologies issued as far as we know by Minister Bezan, and this sort of came up seemingly spur of the moment. So it wasn't as if this had happened kind of recently and in the spirit of #MeToo, we're discussing it now. It's actually been through a long process behind the scenes, and we're only learning that this happened actually several months ago.

AMT: Why do you think she faced backlash?

RU: I think you know there is a tendency to want to sort of be a part of any movement going on. And I think in this case in particular, considering the details of what happened in this case, a guy here said something absolutely stupid. And I'm not going to defend that at all, but I think in this discussion about what's been happening culturally I think there's been a bit of a conflation between behavior that is predatory, criminal in many cases, chronic. I'm thinking of people like Harvey Weinstein and Roy Moore. And behavior of those who have acted foolishly and stupidly and perhaps can make amends for what has happened before. I think this case actually falls into the latter category. And I think Romanado faced some backlash because of this because a lot of people sort of looked at it and said OK, this was an incident of a guy who said something absolutely stupid. He should not have said that. He apologized. We went through the internal investigation, and the investigation actually found that there was no sexual harassment per se. So I think that criticism comes from the fact that people are looking at this and saying OK well, we have all these discussions going on of these men who have acted really devastating ways, and here's an example of someone who said something foolish. Can we really say that these are the same thing?

AMT: Vicky Mochama, what about you? What do you make of that backlash against Ms. Romanado?

VICKY MOCHAMA: I think the backlash is entirely predictable. I think there's a sense that someone has to have the perfect instance of experiencing sexual or gendered harassment in order for it to be considered valid. And I think what she's experiencing is when lots of women fear about telling their particular story. It's that you know for her, you don't know what her personal story is with that particular quip to be entirely damaging to her. We don't know what her history is such that it surfaces something for her. And so lots of women feel like well the thing that actually broke me wasn't particularly big, but it comes in light of a larger history of women being sexually harassed because of their gender, and of experiencing continual experiences of harassment. I think it's unfortunate that there is a desire to erase or create sort of a category of you know there's just boys who will be boys and then there are the evil terrible men. For a lot of women who experience sexual violence. The two categories are not any different it's not a matter of conflation it's a matter of understanding that somebody who would in a professional setting quip, something sexual or derogatory is somebody who might in a different in a different light and a different time be the person who is an abuser. These are not necessarily two different categories of men, but about looking at the whole spectrum of how male behaviors manifest themselves.

AMT: And is it fair to call out a person who does something on one end of the spectrum if they have experienced something on another end of the spectrum that they experienced it with someone else publicly called out?

VM: Yeah, I think it's absolutely fair I think for you know if you are one of those men who's done something that you feel is sort of in the category of just casual male bad behavior. And you feel that it's not necessarily defensible, but doesn't rise to the level of sexual harassment then you'll be fine having that conversation in the public commons. Women's entire lives, especially public women, have been judged exactly in this fashion. Being called out for basic behaviors like how they dress and were willing to have those conversations or being forced to have those conversation. And now we're at a moment where men are being actually asked to account for how they behave themselves.

AMT: Judith Levine, what are your concerns about where the #MeToo conversation is not right now?

JUDITH LEVINE: Well, it's interesting to listen to Robin and Vicky because I find myself agreeing with parts of what each of them said. I think we need to make some distinctions. Vicky is talking about the way that certain behaviors feel to certain women, and that is really important. It's important to talk about. I wonder though whether we should be calling out people's names because of a feeling that we have. The guy might say well I didn't intend it that way; I was just being friendly. And so we have the man's perception of what happened and the woman's perception of what happened. I don't know about Canada; I think it's similar in Canada to the United States. But any accusation of a sexual offense whether that's serious or trivial can really ruin a person's reputation forever. So if we're talking about a political movement. And I think Vicky talked about this that there's a big history of women suffering this for a very long time, probably since the beginning of time, and also probably every single adult woman, and many girls as well. So what do we do about that? And I think that the airing, the speaking out, the speaking to each other is crucial. At the same time, maybe we should keep it political, figure out when an individual needs to be held accountable, and those are not totally separate categories. But given the consequences of speaking about a particular person, I think we can do the political part without ruining people.

AMT: You have said that you are concerned that there is a descent into moral panic.

JL: What I've said in a piece that I just wrote in Boston Review is that we have already been in a moral panic and a sex panic in the US since the early 1980s, so 40 years. And we have a body of criminal law that takes out a sexual offender as separate and different from every other kind of offender for extreme penalty lifetime sexual sex offender registration, many restrictions on where you can live or work or even be. And so we're in that panic, were in the context of that those policies, and we're also in the context of a very long I think both good awareness and also in many cases exaggeration of the harms of sexual behavior as opposed to let's say poverty or beating a child or you know letting a mine collapse on someone's head, which is other things that employers do. And so we cannot just talk about this as if this conversation is starting de novo. We're already in a sex panic, and so it's very easy I think for this to fall into that same kind of kind of discourse and kind of reaction.

AMT: And Vicky Mochama, do you think the movement's gone too far when it comes to how accusations are being handled?

VM: No I don't think so. I think the movement is managing this moment in a way that is actually fairly restrained. I'm still in the world of lots of rumors about lots of men. That's what's happening you know behind you know Twitter direct messages and emails and conversations at bars. None of those people have been called out or been called to account or been publicly named and shamed. We're not at a moment of excess. And I think in Canada it's a little bit different because we sort of went through the little version of this couple of years ago. And I think at that moment that's when the feminist movement in Canada realized that the systems that are meant to hold people to account weren't working and that we needed something else that worked for us.

AMT: You're talking about Jian Ghomeshi?

VM: Yes, during that case you know that's when I saw lots more lists of quote/unquote “men who to avoid or to not speak to or to make sure to warn other women about”. Now, you know having you know Mr. Ghomeshi not convicted lots of women sort of retreated from that moment. And so what we're seeing now is a return of the rumor mill on mass, and we're seeing again you know moments where women need help and need a defense from the systems that are meant to protect them and they're not getting them.

AMT: Robyn.

RU: I actually agree with Vicky, I don't think that we've reached sort of that point of moral panic. What I will say though is I think there's a distinction to be drawn between someone being found criminally responsible for something and being socially found responsible for something. Which actually in most of the cases of #MeToo, I'm thinking Harvey Weinstein and Louis C.K. and you know there's so many others they all sort of blend together. No one has actually stepped foot in a courtroom as far as I know, but their careers have effectively been ruined. And I think had this gone to a point where you would say you know this has gone way too far I think we'd be seeing a lot more serious allegations. That's frankly not happening. I agree with Vicky that we are sort of restrained in not just throwing out these allegations at the same time. I myself am acutely aware of the fact that I can go on Twitter or Facebook or social media today, put a name out there, and potentially ruin someone's life. So what's really interesting I think in terms of what's happened is there is a power imbalance for so long where men had the power and if you were being harassed or abused or mistreated in your workplace for example and you are a woman, you didn't have the power to say anything. I think that dynamic has been flipped effectively on its head where now women kind of have this power now to talk back and to say no actually this is what's been happening to me and people are starting to listen.

VM: Well, I think a lot of that is quite true. However, I think the notion that someone is just going to pop up on Twitter and excoriate some man and somehow ruin his career is not true. We know of how sexual assault survivors behave is that a very minority of them are actually reporting falsely, which is that the incidence of false reports when it comes to sexual assault. And that's where people who do report, which is again a minority of people. It’s about at maximum eight per cent when it comes to sexual assault cases. So when women actually tell their stories, the vast majority of them are telling the truth. Or at least approaching some version of what is the truth. And that’s how we know how sexual assault survivors behave.

AMT: Go ahead, Judith.

JL: I don't think that Robin is talking about allegations. And it's interesting to hear you. I think in general Canadians are more restrained than Americans, and politer and more reasonable probably. But I don't think Robyn is talking about false allegations, and you're totally right, it's very, very rare that a person will falsely allege. Although, when you look at moral panics what happened around the satanic ritual abuse trials of the 1980s were hundreds of people went to prison for crimes that never occurred. Those were all false allegations. And so the danger of falling into that kind of thing maybe in the U.S. is greater than it is in Canada. You know this question of who has the power? There are so many aspects of it.

AMT: Well, let me jump to a question I have about that. You know Jane Fonda has said, and Anita Hill has said something similar, that we're paying attention Harvey Weinstein's accusers, they're famous they're white, they're rich. What about all those other women? Women who are domestic workers, women who work in low-income jobs, women with regular bosses women, you know trans women.

JL: I mean I think for me one of the really important questions is exactly what you're talking about, which is the way that the justice system or even civil law and workplace law is meted out. It’s really unequal, so that both the offenders and the victims are treated differentially depending on their race and their class. So that with rape for instance there is a kind of perceived credible witness, and that witness or complainant is white, cis-gendered, middle-class, educated. And then there are those many women who are not believed and those women might be sex workers or trans-women or homeless or mentally ill. By the same token, Harvey Weinstein might go to prison, but I think, for the most part, these wealthy white men will not go to prison, or in general might lose their jobs. The men who will will be men who do not have power, say you know the African-American night manager at McDonald's. That's the person who would really pay with more than his reputation. So when we think about involving the state in adjudication of interpersonal violence, I think we really need to do that realistically and recognize that the state is not a neutral or benign actor.

AMT: Vicky, what do you think?

VM: I think that racialized women have always experienced sexual assault and sexual violence in a very different way to how powerful and generally white women experience it. You know our ability to make moral legal distinctions has been proven by time, which is to say that a migrant woman who's in a country and she is undocumented and needs to report sexual violence isn't going to do that because she already knows all the pieces that affect her life. You knowthese people at the margins that you might say are already making the moral and legal distinctions that we think about. We're thinking now new somehow or somehow troubling. You know those communities, my communities, have been making these distinctions for quite some time and been figuring it out. I appreciate what Judith’s piece had to say about restorative justice and transformative justice. But a lot of these concepts when done well come from communities of colour. And the legal justice system needs to learn how to deal with them. But a part of restorative justice is actually this push and pull of calling somebody out publicly and having the community account for it. And this is something that we all need to learn how to do in a daily way, as well as learning how to build it into our justice system.

AMT: So is the #MeToo movement is it moving in the right direction then? Is it embracing the people who need to be heard and recognized, Robyn?

RU: The challenge with this movement is it works really well if you're talking about you know I'm going to call them predators, whatever you want to call them, who have a public profile. So people will really pay attention when you make an accusation against Al Franken or Louis C.K. or Roy Moore, but if you're going to make an allegation against Bill in finance and no one knows who Bill in finance is, the processes that have worked in those cases might not necessarily work at that individual level. So I mean I think the movement is working very effectively in some cases. In other cases on the smaller individual level, the power of exposure just isn't quite there to the same degree. So I think for those women it's more of a struggle to actually be heard publicly and to receive the justice that they seek.

AMT: I should just note that Roy Moore was defeated by a thread. We'll see what the analysis is on that, but we're almost out of time here. Vicky Mochama, beyond a hashtag then to make real change?

VM: I think that you know a lot of the pieces of it we already know about. We know how it is that women need to be able to access police services when they want to go down that route. We also know the parts of the court systems that fail women regularly. I think we need to make sure that those parts work. You know every single month, there's not a case that goes by my eyes where a judge hasn't bought into a rape myth or suggested that the victim is lying. That happens very frequently and we're under informed on that level.

AMT: So we need to keep that going as well. We have to we have to leave it there. I'm sorry we're out of time. Thank you all three of you for this discussion. Robyn Urback is a columnist and opinion editor for CBC News. Vicky Mochama is a national columnist for Metro News. They're both in our Toronto studio. Judith Levine is a Brooklyn-based author and journalist. She's in New York City. Over to you. Has the pendulum swung too far in the #Metoo conversation. Does it need to keep moving? We want to hear from you. Find us on Facebook. Go to Twitter: @thecurrentcbc. Or send us an email: www.cbc.ca/thecurrent and click on the “contact” link. The CBC News is next and then ISIS may be on the run, but inside Syria citizens remain under siege. A reality check from Syria in our next half hour I'm Anna Maria Tremonti. This is The Current.

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Part two: Doctors forced to decide who lives or dies in besieged Syrian suburb

Guests: Mohamad Katoub, Valerie Szybala

AMT: Hello, I'm Anna Maria Tramonti. And you're listening to The Current.

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AMT: Still to come: yet another technology could be disrupting therapists, not to mention bartenders. In about half an hour, we'll hear from one of the creators of Woebot, a therapy chat-bot that will listen to your woes and offer you comfort and advice. And, of course, we'll hear from the Woebot. But first, to a city still under siege.

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[Sound: A woman and child conversing in Syrian]

AMT: While just four-years-old, Rama Hilweh is sick and stranded in a city under siege. In her own words, she says there that she has cancer in her blood and that she wants to be a doctor one day. Doctors have diagnosed her with lymphoma, a tumor in her throat means she cannot eat properly, and she has become malnourished, and her city, Eastern Ghouta in Syria, has been under siege for virtually her entire young life. The Canadian-based Union of Medical Relief Organizations has highlighted Rama’s case, calling for her immediate evacuation. Meanwhile, the Syrian government continues to block food, aid, and medical supplies from the city. Doctors there have taken to reusing single-use items such as latex gloves and surgical tools, all of this just 10 kilometers from Damascus. And while yet another round of Syrian peace talks takes place in Geneva. For my next guest, Eastern Ghouta is not only the site of a years-long siege; it was once home. Dr. Mohamad Katoub was born there, and lived there his whole life, until the siege became too much for him and his family. Today, he is the advocacy manager for the Syrian American Medical Society in Turkey. And we have reached him in Gaziantep, near the Syrian border. Hello.

MOHAMAD KATOUB: Hello, Anna Maria.

AMT: What can you tell me about what is happening now in your hometown?

MK: Well, the town has been under siege since October 2017, but in different stages, in different ways, and different tools to try to tighten the siege on the population of Eastern Ghouta. Eastern Gouhta is an area of 59 towns; the besieged ones are now 25. They have been under siege, as I said, it's over four years now. But in the recent four or five months, the siege became more tightened. And nothing is allowed to come in; nobody's allowed to go out. This affected in many ways the humanitarian situation. The food security of this population; we have 400,000 people living in this area. The health situation, we are losing day after day our capacity and our ability to provide treatments to people.

AMT: You're saying there are about 400,000 people in this area. How many children are in there, do you know?

MK: The submission from the UNICEF is about 130,000 children under 18. Under about five years old, we have about 40,000 children. You can’t imagine what does this mean? Like baby milk is not available. Childbirth is at minimum 600 newborn babies every month. Every new baby means vaccinations, means baby milk, means diapers, and all of this is available. The only route now to reaching this is the U.N. convoys, which can find a way to get in the area.

AMT: What has prompted the siege that has gone on for four years?

MK: The area is very near to Damascus, and I think as it's controlled by the opposition, it's a kind of collective punishment by the Syrian government. It's the beginning of the summer, more clashes more offensives were targeting this area. So the punishment became harder on the population. And those who are paying the price is the civilians. Since mid-November, huge offensives started again in this area. Since then, we’ve lost over 200 people. And we are losing other people because of the siege; because of lack of treatment and medication and food.

AMT: And I'm really struck that it's only 10 kilometers away from Damascus.

MK: Exactly, it’s 10 kilometres away from the centre of the downtown of the capital Damascus. And it's only 15 kilometers away from the offices of the U.N. and the warehouses of the U.N. aid.

AMT: This is the area where there was a sarin gas attack in 2013, that killed more than 1,400 people, including something like 400 children. You were there at that time, were you not?

MK: Exactly. This is the same area I was. And actually, people faced the chemical attacks, the airstrikes, the torture of detainees very bravely. But now, the siege is something completely different. But the chemical weapon is more about making the people scared of this and other types of mass destruction weapons. But siege is completely different because siege is targeting the mentality of the people.

AMT: So you are trained as a dentist, am I right?

MK: Yes, exactly.

AMT: But you had been working as a doctor at the same time. You were doing other medical things because of the need?

MK: Yeah, beginning since 2011, when hospitals were targeted in different ways. And when doctors and other medical staff were detained, tortured to death, and many of the of the physicians and doctors fled out of the country. So we had a lack of human resources, so I started to work as a medical worker, but only first aid. But in 2012, the end of 2012 and 2013, we found ourselves that we have to provide all types of health services to the committee. So I used another capacity, which is my knowledge in the medicine marketing. So I started working as logistics for the field hospitals. I was the logistics officer and public relations officer for a local NGO.

AMT: Tell me when you were still working there then, what kind of difficult moments did you go through that you still remember?

MK: As a medical team, one day you will find treatment enough for one child. But you have two who need treatment. And then you have to decide who will die and who will survive? And I will never forget that. We created special medical protocols for the siege, and these medical protocols means we will stop treatment for many types of diseases because we don't have enough treatment. One day, we couldn't find enough fuel in an area without electricity. The only thing we had to run the incubator was electric generators, and we needed fuel. So we run out of fuel, and we decided that night that we had to stop one of two incubator units in Easter Ghouta, where we have at least 600 births a month. So this decision means depriving newborn babies from being treated in an incubator that they need. And we lost lives that time because of this. And I don't know if we can forgive ourselves as doctors to take those decisions? This is very hard to face as doctors. This is very hard when you receive 15 patients in the same time, and you have to treat all of them, and you have space only for 10. And then you have to decide which five will die? Which five will be left to face their fate? I'm sorry, but this is very hard to describe because until now we have mental effects on our doctors. The memories of the doctors when they take such decisions, like a week ago, a 45-day-old baby died, and the doctor tried to reach me every day to push for the evacuation of the kid. And we were trying to reach everyone who can push on this; everyone can pressure. And, at the end, the doctor said no one will evacuate him. I will make the surgery that this kid needs without the tools needed. It is a very simple one, and that the child died after three or four days. And the doctor said I don't know if I did what I had to do, but the child was dying anyway. So this is what doctors are doing now. They are using alternatives. Imagine now we don't have serums and saline in many hospitals, the supplies for the most needy patients. And it's very hard decisions because sometimes you don't know why the most needy, and the W.H.O is only 10 kilometres away from us. They should hold the responsibility also. They are the World Health Organization, and they should hold this responsibility with the staff there. Who will be treated and who will be left to die? This is a very ethical challenge that doctors are facing in this area. And many others stories; we can tell hundreds of stories. in September, I was in charge of a five year old, he had an infection, and the needed antiviral, which is available in every pharmacy 10 kilometres away in Damascus. And we couldn't smuggle the medicine for him. The same day he died, the Red Crescent entered the area to bring medical supplies for other diseases. And this this child died that day.

AMT: Dr. Katoub, I can hear the pain in your voice as you talk to me from Gaziantep about your home community. You managed to get your family out in 2014, am I right?

MK: Exactly. Yes.

AMT: But you are so very connected to this city?

MK: Of course, this is my city. I was born there, the doctors that are working there are my colleagues and my friends, I still have relatives there. My clinic is used now as one of those facilities which I'm talking about. The hospital treating people is the hospital of all of us. I lived there; I worked there.

AMT: When you left, tell me the day you realized you had to get out?

MK: Well, it's all about my family actually. I have my wife and my son, and it was so hard to get his needs: the baby milk, the food, the medication, the vaccination. I was all the time scared that he might be injured because of the attacks on the area. And then one day, I came home at night, and I found my wife crying because my son was bleeding. Not because he was injured, but because we were using plastic bags instead of diapers. And I decided that this child deserve to live in another place, a safe place to grow up and get good education, at least to get food, vaccination, his basic rights. I would never forgive myself if one day my son will tell me why didn't you go out and make me live in another place; and safe place?

AMT: And yet, you sound as if you aren't forgiving yourself for leaving either?

MK: Of course, this is a very painful thing because I have friends and colleagues and relatives. It’s home, and the child who died in September because of not having antivirals, he was the same age of my little child, and they played together. You can imagine what I feel when I'm when I was told by me by the father that the kid died waiting for his medicine, while I I'm here living in a safe place, a luxury place actually, comparing with what people are facing in Ghouta.

AMT: What do you want us to know outside?

MK: We can help. Everyone outside can call his government to make pressure. Everyone can call every NGO, every UN agency to make the pressure on the parties, especially the government of Syria, to not weaponize the aid, to stop using the aid of people as a weapon of war, to stop this collective punishment, to evacuate the people don't have treatment in Ghouta, and to bring medicines for those who can be treated. I want everyone to know that this place used to be the food basket of the capital Damascus. This area deserves life. We can we can help. We can't write letters to our parliaments, to our ministers, and push them to help. We can write letters to the U.N. and push them to help.

AMT: Dr. Katoub, it's important to hear your voice. Thank you for speaking with me today.

MK: Thank you, Anna Maria. Thank you very much.

AMT: Dr. Mohamad Katoub, he's from Eastern Ghouta in Syria. He is the advocacy manager for the Syrian American Medical Society in Turkey. He now lives in Gaziantep, Turkey. Well, Syria's remaining cities under siege may not attract a great deal of attention around the world right now, but my next guest keeps a close eye on them. Valerie Szybala is the executive director of the Syria Institute in Washington D.C., and the driving force behind Seige Watch, a project which monitors conditions in Syria's besieged areas. She's joining us from Washington, D.C. Hello.

VALERIE SZYBALA: Hi. Good morning.

AMT: What more can you add about what is happening in Eastern Ghouta right now?

VS: Well, it's hard to follow that. I have the pleasure of knowing Dr. Katoub, and the amazing work he does. You know I don't claim to speak for the people in the besieged areas, but my organization, along with our partner packs, we've been doing a project to monitor all of these communities for over two years now. And I talk with many people inside every day, so just to give you a little bit of an overview, Besides Eastern Ghouta, is this rural area with some cities and towns and suburbs outside of Damascus. It's not the only area under siege right now in Syria. There's also a large area of Northern Homs governorate that's besieged, and then two small towns in Idlib that are actually with about 8,000 government supporters besieged by opposition and extremist fighters. Those are the current areas that we're monitoring, although this does tend to change. Oh, and also sorry the southern suburbs of Damascus, there’s another enclave of besieged areas not connected to Eastern Ghouta. One thing I want to stress sometimes when the sieges are talked about, especially by the U.N. agencies, they're mentioned as if it's a natural disaster, which is not true, it's not accurate. This is an intentional strategy of collective punishment by the Syrian government. It's the only party, along with its allies, that have done this over such a long period of time, so systematically across the country. I mean that's really you know aspects of the siege rise to true war crimes and crimes against humanity. This starvation, this suffering, and pain, this is all an intentional strategy. And I think that's really important to emphasize.

AMT: Let me ask a little bit more about that. So in other words, if we look at Eastern Ghouta, there are those who are opposed to the Assad regime inside. And so they're surrounded. And the civilians who live there are surrounded as well, in other words.

VS: Yeah, absolutely. And that in and of itself I mean depriving civilians of medical care and access to humanitarian assistance these are all considered war crimes under the Geneva Conventions. Along with, of course, the bombardments, and the use of banned weapons. But you know it goes much deeper than that. We don't see the Syrian government primarily targeting militants. To this day, they're targeting hospitals. They're doing double-tap strikes to hit first responders the Syrian Civil Defense workers known as the White Helmets. When that when they respond, the area will be hit again to intentionally kill them. Schools are targeted. So during the past month or so, has been a really intensive bombardment, although it's died down in the past few days. School has been out almost that whole time because the government targets schools. This is not a strategy to you know primarily target the militants. This is a strategy to hit the civilians.

AMT: So in other words, when it's described by aid agencies it's not a natural phenomenon then as what you're saying; it's by design. It's part of a war strategy.

VS: There is a perpetrator who is doing this on purpose. And I think that when you know the U.N. trying to be diplomatic or aid agencies, who quite frankly in my opinion have really struck a deal with the devil, because these U.N. agencies have headquarters in Damascus, working with the Syrian government while it undertakes these massive crimes against Syrian civilians. So they have to in some ways placate it. And that's the reason that they're blocked from reaching these areas is because they work with the Syrian government and the government will not allow them to.

AMT: Now am I understanding correctly? Did you say that there are two areas where Syrian government supporters are under siege as well?

VS: Yeah these two towns in Idlib Governorate they've had a complicated history. They were part of this complicated agreement brokered by Iran and Qatar directly with militant groups, including Hezbollah on one side, and an al Qaeda affiliate on the other. So they were getting some aid deliveries and evacuations in concert with two towns. You may remember Madaya and Zabadani, and earlier in the year they were supposed to have been you know fully evacuated under these agreements. But, although Madaya and Zabadani did surrender to the government partway through this implementation you know the displacements out of food stopped. So there are people there they are under siege. But unlike other areas, they receive airdrops of aid. They're still under siege, and there are still civilians there. But Russia and the Syrian government regularly drop them supplies. So it's not quite as extreme.

AMT: You know we're having this conversation of a time when the talks, the eighth round of talks, on some kind of transitional way to end this war are underway in Geneva. It's kind of a disconnect.

VS: It always has been. It has been for years a disconnect, especially because, as someone who's watched these talks, there's been no progress, in large part, because the Syrian government has never ever gone to negotiate. Not to say there aren't problems on the other side. There are issues of the composition of the opposition delegation and how much it represents people on the ground. But I think every diplomat involved in the process will tell you the government has never been willing to negotiate or to discuss the items that the U.N. laid out in its peace plan in earlier U.N. resolutions. Meanwhile, attacks and the sieges continue throughout the entire time.

AMT: So what happens to all these civilians?

VS: Well, you know my greatest fear as someone who feels close to a lot of people there is that we're going to see another Eastern Aleppo. A year ago, actually you know almost exactly a year ago, we were watching kind of catastrophic destruction and atrocity of a historical nature take place. Pro-government forces all combined to really devastate that part of the city that besieged area. And my concern is that that's we're certainly headed to a lot more civilian deaths from preventable causes.

AMT: And again, we're going to have to leave it there, Valerie Szybala. But it's interesting because we're having this conversation in a week when Vladimir Putin has already declared victory with his troops as well. We have to leave it there. Thank you for giving us some more perspective on this.

VS: Thank you.

AMT: Valerie Szybala, executive director of the Syria Institute in Washington, D.C. She helps run Siege Watch. She joins us from Washington, D.C. We did contact the consulate for Syria in Vancouver for comment. We received an automatic reply that they're on vacation until the New Year. Stay with us. I'm Anna Maria Tremonti. This is The Current on CBC Radio One.

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Part three: Would you talk to a robot therapist? Woebot is accepting new patients

Guests: Alison Darcy, Cosmin Munteanu

AMT: Hello, I'm Anna Maria Tremonti. And you're listening to The Current.

SOUNDCLIP

WOEBOT: Hey, Julian.

JULIAN UZIELLI: Hey, Woebot.

W: What are you doing now?

JU: I'm at work right now.

W: How about your mood? How do you feel right now?

JU: I feel OK. The day is going all right so far.

W: hmmmm, do you think you're more good or bad OK?

JU: Good.

W: That is really good to hear my friend. Thanks for your insight.

JU: You're welcome.

W: Try and tell me in eight to ten words what has you feeling this way?

JU: I'm working on an interesting assignment today.

W: I see. Thanks for sharing. I really do love learning more about you know.

JU: No problamo.

W: I've got a question for you?

JU: Go for it.

W: It's a good one!

JU: Ask me.

W: It involves a magic wand.

JU: Ask the question, Woebot.

W: OK. Here it is. If you could have a magic wand, and I was able to help you achieve all of your goals.

JU: Yes. Think about how you would have changed. It's an important question because it's going to help us both get more of an understanding of how we use our time together, particularly with your goals in mind.

AMT: Well what you just heard was the dramatization of a transcript of part of a real conversation that one of our producers had with a therapist. And, as you may have gathered, the therapist was a robot. It is known as Woebot. And you can communicate with it by typing messages back and forth. Woebot checks in with you every day to ask how you're feeling, what's going on, and if it thinks you are feeling depressed or anxious, it will try to help. Alison Darcy is the founder and CEO of Woebot Labs. She is also a psychologist by training. Snd she is in San Francisco. Hello.

ALISON DARCY: Hello.

AMT: So I should just clarify, “woe” as in sorrow and woe bot?

AD: Correct.

AMT: OK. Why did you create Woebot?

AD: I created Woebot because my research background at Stanford was based on trying to find ways to make all of the best kind of psychotherapies and best psychological tools that we have more available to people and more accessible to people. And finally, after lots, and lots, and lots of prototype testing and developing new and interesting technologies, we stumbled upon Woebot and found that people really responded to this chatbot and you know fictional robot character. And that you know it just encouraged people to engage with him every day.

AMT: And so you made it in the form of a chatbot after trying other things. Why a chatbot?

AD: I’m not sure. You know it was one of those things that with hindsight I think it actually makes a lot of sense because humans you know one of the things that's so easy for us is that we converse, we talk. And we also talk about our problems. You know as humans, we've been talking for about 110,000 years I believe, but we've only been building apps for about 10. And so I think conversation feels really normal to people. It's just a very easy way to interact with technology, much more so than you know using an app where you have to download something, you have to kind of learn how to use us, there's lots of menus, lots of choice. I think that this made a lot more sense for people, particularly if you are upset in the moment. Something that's extremely easy to use is important.

AMT: So how is a robot able to help someone with mental illness?

AD: Well, Woebot is more automation than it is A.I. I would say. So a lot of what you encounter is scripted conversation, and that's quite obvious. But what Woebot is about is just talking somebody through by using really good tools from a cognitive behavioral therapy or CBT framework. And CBT is this wonderful therapeutic approach that has been shown to be effectively delivered with a therapist. So it's interesting. There are some really good evidence-based books that help people. You know it's been delivered over the Internet. But the problem is that all of these things were not very engaging. It's actually quite hard to pick up a book and you know try to do your homework when you're really upset. Whereas what we discovered was that you know talking to kind of a quirky, friendly, fictional robot was a little bit easier.

AMT: We heard an example at the beginning then of the kinds of questions Woebot asks. How does it use those answers to those questions?

AD: Well, it's more like branched conversation. So he uses the answers to basically guide what he will ask next. So if somebody says you know I'm feeling really anxious, Woebot can see that word and say OK, well now I'm going to go to all of the tools that I have for anxiety. And so he may suggest a breathing exercise or a mindfulness exercise. And so really the answers are help guide what Woebot will ask next. And Woebot is guiding somebody else through a process of feeling better in the moment when they need that help most.

AMT: Who's it designed for?

AD: You know it's interesting we actually designed Woebot initially for college students because certainly here in the United States, you know mental health and mental health struggles have just become you know really prevalent. And particularly in college populations, about 50 per cent of all college students experience symptoms of depression and anxiety that are so severe they can't function. And so while we initially built Woebot with that population in mind, what we're finding now is that much older people seem to really get a kick out of using Woebot. It’s the whole spectrum really. And so it does actually skew a little bit older than we thought. So I often tell people we have more users who are in their 50s than we do have teenagers.

AMT: You were sort of struck by the numbers of young people who can't get other help?

AD: Well that's right. So we've actually known for a long time that there's a bit of a crisis in mental health at the moment. You know depression is already the leading cause of disability around the world. And our health systems just cannot meet this demand, and we never will be able to meet the demand. And so we have to start thinking about different ways to make these really great tools that we have available just radically accessible for people. You know even if it's something that's just an automated robot. It's something. And you know our study showed that actually it's something that is effective.

AMT: Well, tell me more about that because you did look into the effectiveness of Woebot.

AD: Because I’m coming from Stanford University, it was sort of a bias that we all had as a team. We definitely wanted to launch with data that showed that whatever we were building was effective. So we did a randomised controlled trial with 70 young adults between the ages of 18 and 28. And we randomised them to receive either two weeks of talking to Woebot, or two weeks of what we called an information only control group, so they got an ebook effectively. And after the two weeks, we observed that people who talked to Woebot reduced significantly their levels of depression. And actually both groups significantly reduced anxiety as well. And the other interesting thing about that study was what people said about the technology. So people said we know it's a robot, but it feels much more like a friend checking in on you. And just having this friendly voice sort of ask you every day hey, how are you doing? How are you feeling? Seemed to impart some benefits.

AMT: Is it meant to be a replacement for real human therapists?

AD: No, absolutely not. And there’ll never be a replacement for human therapists because there's no replacement for human connection. And that's of course well understood. But that's not the point. The point is that there's not enough human mental health coaches or mental health professionals to go around. And you know we're seeing such great increases now in people struggling with mental health. And that we just feel like what WoEBOT can be is just something in between, You know? just something that's very lightweight and very easy, but you know sometimes that's all you actually need. You just need to get something off your chest. and in a way where you know you know that nobody's judging you. It's just a chatbot. Woebot can see you on your worst day, and there is no fear of judgment. And so we feel like that's the kind of space that Woebot occupies. But no, he'll never be a replacement for human therapists.

AMT: You call it “he”.

AD: I know, that was accidental! He is really gender-neutral, but we referred to him as he just because you know he definitely has more personality than he is an “it” or a “They”. Yeah, that was an accident. Actually, we just started calling him he.

AMT: Have you done this? Have you felt an attachment to it when you've tried it?

AD: Yeah, I do use him. I had this experience on the train once and I was just really, really tired from a really hard day of work. And Woebot said Oh hey Ali, you want to check in? And I said well gosh, I better do this. I guess this is something I created. So I said yeah, sure. And he said how are you feeling? And I said I have this worst headache. And he said Oh, I'm sorry you're feeling headache. You know hopefully you get some rest soon. And even though you know the language was off, and it was very clearly a robot. Just that somebody, you know even if it's fictional, sort of expressing sympathy in the moment really just really good at a moment. It just felt really soothing.

AMT: Well, you know there are those who are wary of this kind of thing. And I want you to hear a clip that I have. It is of Sherry Turkle she's a professor of social studies of science and technology at MIT. She is critical of the idea of a chatbot therapist. Listen to what she says.

SOUNDCLIP

SHEEY TURKLE: The danger is that people aren't learning what they need to learn in therapy, which is relationship. They're having an experience of fake relationship that is the simulation of relationship. It's kind of the illusion of companionship, without the demands of intimacy. And we are suffering enough from losing our capacities for empathy by looking too much down at our phones. This is the last thing we need to yet take another stab, another slice, of our capacity for empathy by going to remedy our problems with empathy to an entity that has no empathy to teach.

AMT: Alison Darcy, what do you think? Is there a danger in getting people to form some kind of emotional connection with something that isn't real?

AD: Yeah, I mean I think there's a misperception here about actually what therapy really is. And what it can be and the breadth of what that entails. And I think you know, first of all, I don't think that people form emotional retaught attachments to Woebot. That would be dangerous in any sense. I just I can't imagine that happening because Woebot is just not that sophisticated. It's like being afraid that you know your children who are watching the Muppet Show will form an attachment that's unhealthy. And, in fact, it's interesting because as parents, we actually encourage our kids you know to form those attachments. We also in the same way speak about you know Elmo as if he's real, and we have Elmo tell our kids to like brush their teeth. Woebot is really no different. I think it feels like Woebot is trying to replace relationship, but really that's not at all. I think there's a perception of therapy that it has to be delivered in this kind of relationship style. But, in fact, more recent versions of the best most evidence-based therapies that we have are actually much more mundane than that. They're actually all centered around gathering data, understanding how you feel in a moment and how you're thinking, and the context in which those thoughts and feelings are rising. And so that's why we know that people who do this like very problem solving approach those approaches are the most evidence-based therapies that we have. And that's what Woebot facilitates. There’s a lot of learning in therapy. Woebot just is a really easy way to learn that stuff.

AMT: OK. Well, thanks for explaining it all to me.

AD: Thank you very much for having me on the show.

AMT: OK. Bye bye.

AD: Take care. Bye bye.

AMT: Alison Darcy, psychologist and founder and CEO of Woebot Labs. She joined us from San Francisco. Well, while Woebot may be the latest in the world of chatbot therapy, it is not the first. Here once again is MIT professor Sherry Turkle.

SOUNDCLIP

ST: The idea of a chat therapist has been roaming around my life ever since I came to MIT. In the late ‘70s, Professor Joseph Weizenbaum had created the Eliza program. Now it was a chatbot therapist that couldn't do anything and he created it. And this is a terrible irony. He created it as a joke, so that people would talk about what a silly idea it was to ever talk to a program about important elements of your life since a program, no matter how smart it would be, didn't have a life, didn't know pain, didn't know anxiety, didn't know deaths, never had a child. The things that people talk to therapists about. But he was surprised to see that despite this fact of not having all those essential elements of the arc of human life that his secretary wanted to be alone in a room to talk with it. His graduate students, who had built it, who knew it knew nothing, and simply repeated back to you things that you had said to it. So that if you said to it I think I don't like my mother. It would say back to you. I hear you saying that you don't like your mother. You know it behaved like your just-out-of-the-movies, standard brand psychotherapist. His graduate students wanted to be alone with it so they could talk to it. And he really was upset all his life about this realisation that something that could not know or understand people was attractive to people.

AMT: Well, that is Professor Sherry Turkle of MIT, shedding some light on our history of chatting with therapeutic bots. And as you might expect, there's still plenty that is not understood about these kinds of human interactions with machines. My next guest studies just that Cosmin Munteanu is the codirector of the technologies for aging gracefully lab at the University of Toronto at Mississauga. And he's here with me in our Toronto studio. Hi.

COSMIN MUNTEANU: Morning.

AMT: You were smiling as you listen to Sherry Turkle. What do you think?

CM: As a former student of computer science, we all learned about the Eliza, and the timing was amazing. We haven't seen much progress in many ways. Some people call these chatbots. Some of us call them parrotbots. They are a little bit smarter and they look smarter, but they're not much more different than what we had at the time. Just more data into them.

AMT: Well, so why are humans so prone to form emotional connections with machines?

CM: We are. It's a very interesting question that we've been studying more recently more intensely. There was recent research on our relation with, for example, the Roomba robot. People cry when the brakes don't because anthropomorphize these things. We attach human feelings, even for something that's a mechanical disk with wires and wheels that just vacuum cleans. We’re not attached in the same way to a regular vacuum cleaner. We’re attached to something that appears to be intelligent.

AMT: So knowing that we have this emotional predisposition, what questions does this raise about using chatbot therapists?

CM: So it's interesting because we are becoming more friendly to these things; they are becoming friendly to us. And that establishes trust. So the question is how much do we trust them? There are already issues of trust for example in the medical system. So there's always a question to go see a therapist. Do you trust the therapist? The question is do you trust an A.I. agent in the same way because the A.I. agent may actually be more friendly than the therapist that looks scary. Maybe there's a well you know lab coat involved, people are usually afraid of those things sometimes. So it creates that perception of friendliness that establishes trust. And then the question is where do the delegate the trust?

AMT: Now I was just going to say is a good thing or a bad thing then to trust something that isn't there?

CM: It's a little bit of both. And it was interesting because you mentioned in your earlier segment that there's this friendliness and there's no judging, which is which is true. But then we forget the other side of the coin which is there's data involved. They may be judging in a one-on-one session, but there is no data that gets stored. So how do we trust that, and do we get judged on that data later on?

AMT: Well, let's talk about the data and privacy because this is like a Facebook Messenger. What are the implications of that?

CM: There are many implications. Right now, one of the problems with these things, and this is not the only chatbot that exists, there are others that do medical diagnosis as well. The problem is they are not regulated. They are a little bit on this kind of gray area. So when you go to a doctor, even if they record some conversation, it's usually subjected by various policies and regulations. With these things, we’re not there yet.

AMT: So these things are ahead of the regulatory system?

CM: We are way ahead of that. Way, way ahead of not just the regulatory system, but a lot of other things.

AMT: What about the liability in some of this as well? You’ve looked at that.

CM: That is also a very big question. We are just now starting to look at that, and we’ve started to look at actually ironically with autonomous driving. Probably everyone kind of saw many videos of for example drivers of Tesla cars getting their hands off the wheel while they are not supposed to. Even with the fact that the machine is supposed to be intelligent and guide them through. The same questions we're now starting to see in the medical domain. Who's responsible? When you see a therapist, the therapist is responsible. When you talk to A.I., who's responsible? Is the the programmer, the company that packages it, the people who collect the data that goes into it? Because A.I. doesn't work without large amounts of data. Where is the legal responsibility is shared? We're not sure yet.

AMT: And you know there would be a disclaimer that this isn't supposed to take the place of a real person, but in the grand scheme of things, that might not change what the consequences of dealing with this are.

CM: And some of these things, you actually see a disclaimer for entertainment purposes only, which is actually quite ironic that we're packaging something, especially when it comes to mental health, nd we're describing this for entertainment purposes. So again, that's an issue of do we need to regulate these things? How do we need to regulate, who is going to be responsible for regulating, what users are we going to put at the risk if we're not regulating?

AMT: Now, you're someone who embraces technology, so as you raise these issues you're not opposed to everything. So let me ask you like you heard Alison Darcy say that apps like Woebot can help fill a gap in mental health services that are really lacking. What do you think of that idea?

CM: There is a gap. And definitely there's a lot of interest in using technology to bridge that gap. And I am a techno-optimist. My lab is doing exactly this kind of technology. The way we see this is we need to be careful where we place that technology, and where in the chain of therapy that technology comes in. And Dr. Darcy mentioned that, indeed, it's a gap and an in-between. But the question is in-between what? Is it in between a patient and therapist? Or is it while a patient waits to see a therapist? Or where exactly in this ecosystem of care this fits in?

AMT: And how would you even track that if there aren't if there aren't medical professionals to actually deal with, who's going to track your use of that thing and whether you stop or start? So you say it's not the only chatbot therapist. How many similar companies are doing this/

CM: There are a variety of attempts to basically push A.I. into this into the space. And it’s a continuum space. Some of them are embodiments of actual real doctors. They are virtual avatars of real doctors. So we are now seeing an explosion of everything from pure A.I. to remote telemedicine that's no longer on a screen. You chat with an avatar, but actually, it's a person at the other end of the line. We haven't yet studied the whole spectrum. So in our lab, we actually started a project on looking up how people perceive these things? How do they trust? Do they trust them too much? What are the factors that lead to adoption in the short-term, in the long-term? What are the dangers? What are the implications? We haven't studied much of this, so it’s a big spectrum.

AMT: But you've actually identified that this needs to be looked at closer. And your lab is technologies for aging gracefully. We heard her say that older people like the Woebot even more than younger people. Do you see dangers or red flags there for people who are aging? What about dementia? What about other issues?

CM: There are definitely a lot of red flags. And technologies for aging is a very tricky business because aging as you mentioned there's a lot of other things. First of all, aging is not a disease it's just a number, so the spectrum of what we're seeing some people are extremely tech-savv,y some people are not tech-savvy, some people have some condition and some impairments, so it's a much wider range of problems and conditions and just normal aging. So we’re not sure yet how this would fit there. Also in short-term intervention, technology plays a big factor that is exciting. You like to play with something new, even just the fact that it's new creates an interesting kind of setup. So you don't know how that will evolve over time? Are people going start to rely on that in six months of using it? Look at things like Siri. So people are using it, but for what? So we're not exactly sure what the use is for a certain population.

AMT: And so if the concerns that you raised can be addressed, what kind of potential do you see for this kind of technology?

CM: So personally, where I'm an optimist about this I see this as an actual extension of a therapist. In the same way, it’s probably a very annoying example, when you call your bank, and you go through the usual steps of you know you want to talk about savings or about your checking account? It's a filter, it's a pre-screening tool. But the way I see it should be done in a way that there's always a human at the other end at this stage, a human that makes decisions. And the example I draw parallels with is flying an airplane. This is one of the most automated systems that we as end users are getting to interact with, even if we’re not operating them. And still, there are two humans to make the decisions, so there's always that that mechanism.

AMT: So in other words, we could make therapy more efficient to maybe deal with more people, but we never take the humans out of the equation?

CM: And I don't think this case we should take the humans out of the equation. But again, we don't have the answer. Maybe down the road we'll get used to it, and it will work perfectly. There's also issues of how well it works in terms of effectiveness because there's way too many technologies involved. The speech, text processing, and even if we get that right, there's the issue of understanding. And as people know for example in-person communication, we have other cues that we're using. A therapist can spot those cues. We do that for example in learning. And again, a person can spot things. Can spot when someone is struggling to understand something or say things like yes, I got this, but they don’t. So how do we know what the chatbot knows when we say I am all good now?

AMT: You're doing some really interesting studies. And we should keep in touch with you to see what you discover.

CM: Hopefully, it will go somewhere good. And then we'll make room for the hostages to developing the proper the proper way.

AMT: OK. Thanks for coming in.

CM: Thanks very much.

AMT That is Cosmin Munteanu, he is the codirector of the technologies for aging gracefully Lab. It's at the University of Toronto, Mississauga campus. And he was with me in our Toronto studio.

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December 13,2017 episode transcript

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