How social media relate to unhappiness, other problems in young people
Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Social media has been in the news a lot lately. So today I'll be talking about the risks and benefits of social media with psychiatrist, Christopher Lucas. He's the vice chair of psychiatry services for Upstate University Hospital. Welcome back to The Informed Patient, Dr. Lucas.
Christopher Lucas, MD: Thank you for inviting me.
Host Amber Smith: During Congressional testimony last year, a whistleblower from Facebook talked about studies of teen girls who used Instagram -- that's the platform where people share photos, in some cases, photos that are heavily edited. One study saw an increase in suicidal thoughts. Another showed girls with eating disorders that got worse after they used Instagram. And about a third of the teen girls in one study said Instagram made them feel worse about their bodies. Is the solution to prevent kids and teens from using Instagram?
Christopher Lucas, MD: You know, I think that horse has bolted, in many ways. And if one social media platform gets closed down or restricted, kids will just move on to another one. I think the key is for the social media companies to have some responsibility for the content that they host, and parents need responsibility to monitor the social media use of their kids.
Host Amber Smith: Are there features that you think a social media platform could have that would help it not be detrimental to teens?
Christopher Lucas, MD: I think they need to be aware of the ways that social media can damage children's self-esteem, so things to do with athletic accomplishments, body image, achievements, so anything where you're being compared to someone else, or because of your own mental health issues, you compare yourself to others, and the evaluation of others becomes very important. So I think all of these things factor into it. Particularly when photos are involved, then the issues of body image become a very strong. You know, there've been studies of adolescents with eating disorders, and even without Photoshopping, they interpret photos of bodies being divorced from reality, so they will see other people's figures being thinner than the figure of themselves. So it's very much a sore area and an area to be concerned about.
Host Amber Smith: So some of these platforms let you do a lot of editing, and there's tools to make your waist thinner or your eyes bigger or your lips bigger, or whatever. Does that help or hurt?
Christopher Lucas, MD: It probably hurts. But again, it's not something necessarily that's possible to control. I think that it's more a matter of being aware of the potential negative impact of those things.There are certain ages that appear to have greater vulnerability. Around the time of puberty, when body changes are occurring, particularly to females that becomes an acutely sensitive area for when kids will be affected by seeing pictures of other people.
Host Amber Smith: Now, during the congressional hearings last year, a lot of the focus has been on kids and teens because they're young and impressionable. Do you think adults and seniors have some of the same criticisms or concerns using these platforms?
Christopher Lucas, MD: I think so, a little bit, probably to a smaller extent. I think that the times around puberty, as I said, but also the times around earlier adulthood when someone is really trying to have an independent life and comparing their life to the lives of other people. So a lot of adolescents, young adults, say, you know, "I must have achieved this by this age." And then they judge their own performance and their own accomplishments in the light of others. You know people generally post on Facebook success and good things. So that when you are witnessing everybody else having a good time, everybody going to parties, everybody else having perfectly created lunches, and you're eating that tired old sandwich, then potentially it could really have a negative effect on your mood.
Host Amber Smith: During the pandemic, especially, a lot of people used social media to stay connected.Does Facebook helped people feel less lonely, or does it do the reverse when they're seeing all of their friends doing these amazing adventures...?
Christopher Lucas, MD: I think it does both. I think it both can connect, and it can also make things worse. I think we saw a lot over the pandemic the importance of social connectedness and how that was impacted negatively by not being able to hang out with people at school or on the corner of the street. So those social internet connections became important, but again, they have their dark side as well.
Host Amber Smith: What about privacy? Do you think people are lured into sharing things or details about their lives that they wouldn't have shared before?
Christopher Lucas, MD: I think particularly teenagers don't realize the permanence of information that gets onto the internet, and there is a sense of anonymity, but actually there is a reality of very little anonymity. So you can share something that you think that it's sort of going to be restricted to only people who will appreciate it. And it can end up being shared much more widely, with damaging negative consequences down the line.
Host Amber Smith: Do you have concerns about people who feel like they're addicted to social media?
Christopher Lucas, MD: Not only is social media, I think, but also addiction to cell phone usage. The social network companies are driven by getting advertising from people clicking on posts. So they do things that make people want to interact frequently. So, people's self-esteem can be negatively impacted by the number of likes a post gets, or the number of times some funny video has been shared. All of this is trying to drive the business model of the social networks, but also has the potential to make people feel inadequate or unaccomplished compared to other people.
Host Amber Smith: This is Upstate's The informed Patient podcast. I'm your host, Amber Smith, talking with Dr. Christopher Lucas. He's an associate professor of psychiatry and behavioral sciences at Upstate.
Now, during the hearings on Capitol Hill, we heard a lot about algorithms, that determines which posts will be featured in an individual's Facebook feed. And it's based on a mysterious combination of those likes and other interactions a post receives. Instead of posts appearing in chronological order, Facebook's engagement based formula helps the most sensational content be seen by the most people. Do you think people using Facebook realize how their feed is produced?
Christopher Lucas, MD: I don't think so. I think also, often there is a sensational aspect or for a post that has very polarizing opinions. So those will be preferentially placed before a viewer, rather than necessarily the most rational or liked post. We've seen that a lot with news media in terms of misinformation, disinformation being promoted to people, so they only see the selected pieces of information that their previous engagement patterns lead them to be given -- not necessarily the most balanced way to look at the safety of vaccines or other important information.
Host Amber Smith: Do you think that behavior on Facebook has an influence over how people interact with one another in real life?
Christopher Lucas, MD: I don't think it's necessarily just Facebook. And again, Facebook is rapidly becoming a social media platform for old people. So, I think that when someone has deficiencies in their actual social interactions, then they can be drawn toward social media such as Facebook. But then it becomes a two-edged sword in terms of the more that someone interacts online, the less opportunities there are for them to interact with their family or their siblings or their friends down the street.
Host Amber Smith: During the pandemic reports emerged of a number of teen girls who developed tics, these jerking movements and verbal outbursts. Several articles in medical journals have concluded that these tics have something to do with TikTok influencers who said in their video clips that they had Tourette syndrome. I'm curious if you've heard about this or seen any patients who were afflicted?
Christopher Lucas, MD: I've not seen any patients who have presented with ticks as a result of that. I have looked at some of the Tourette's postings on TikTok, and many of them appear to be real Tourette syndrome. However, Tourette syndrome is a real spectrum, and the ones that seem to be highlighted on social media are obviously the most dramatic. One of the more embarrassing symptoms of Tourette's is something called coprolalia, which is talking dirty, so that they would curse in voluntarily or say forbidden words or shameful things. And those are the ones that tend to get preferentially posted on TikTok, rather than the full spectrum of tics. Tics themselves affect up to 10% of the population. If you've ever studied tics and then sat on a bus or a subway, you'll be amazed by how many motor tics you could see in other people once you start looking. So they are incredibly common but the various severe Tourette's syndrome with multiple motor and vocal tics is rare. Undoubtedly, there are going to be some cases where people will be influenced to display certain behaviors that looked like Tourette's. But we've had a long history of people having so-called hysterical symptoms, or functional symptoms that are induced by witnessing them in other people. In the medieval times, the whole villages of teenage girls fainted all at the same time. And this was sort of a mass hysteria. So I think this is the modern version of this, in many ways, that some of these symptoms are induced by witnessing them in others. And people's incredible suggestibility. You know, think about a stage hypnotist who can get people to do all manner of bizarre movements through suggestion. I think this has some elements of that.
Host Amber Smith: So not all tics are Tourette syndrome?
Christopher Lucas, MD: Oh by no means. They are the very extreme, severe end of the spectrum. Most tics will be as simple as just a recurrent eye blinking or a sniffing or a nose wrinkling, just affecting one muscle group in the body, typically in the face. Tourette's is a much bigger spectrum of multiple tics affecting different motor segments of the body, together with noises or vocalizations, which could be as simple as sniffing or grunting, or could be as complex as saying a sentence.
Host Amber Smith: Is Tourette syndrome, though, the real Tourette syndrome, that's not a contagious disease?
Christopher Lucas, MD: It is not contagious. It's a neurological condition, and is essentially affecting the motor centers of the brain, so that involuntary movements. You know the brain always wants to make movements, and there are various mechanisms within the brain that suppress those movements. And the best understanding of tics and Tourette's is that those suppressive mechanisms are not sufficiently strong. So the movements which you would otherwise make become involuntary.
Host Amber Smith: On TikTok, there are all of these videos...
Christopher Lucas, MD: Sort of an ironic name, isn't it?
Host Amber Smith: It is ironic. Exactly. ... There's a lot of these videos that are hashtagged with Tourette's, so they're not all showing legitimate people with Tourette's?
Christopher Lucas, MD: Again, you know, I've not had an extensive research of this, but from my cursory examination, there appear to be 10 or 20 people who are key celebrity Tourette syndrome sufferers who post funny videos of them, either trying to sing while having tics or perform ordinary functions. And then there are even some ironic ones that make mockeries of those Tourette's videos, in terms of how it's possible to live a normal life despite having Tourette's. So, it's very much has, I think has become an entertainment industry rather than necessarily away for disseminating knowledge about Tourette's and motor tics.
Host Amber Smith: If someone developed vocal tics or body movements that are not tied to an underlying disease, and maybe it's because they were watching these videos on TikTok or whatever, what's the strategy for treating those? If parents are bringing their kids to emergency rooms all over the country with these tics, what's being done?
Christopher Lucas, MD: I'm not necessarily sure that the emergency room is the best place to take a child with tics anyway. It's not really an emergency and many tics don't even need treating anyway, because they cause no disability. I think the most important thing to think about when there's any symptom that's not grounded in a biological process underneath is what are the stresses leading someone to manifest those symptoms? So it could be a tic, it could be a paralysis, it could be an inability to have some sort of sensation. There's usually some underlying stress or conflict. This is the way the body responds, sometimes consciously, sometimes unconsciously. So the treatment is to address the underlying stress conflict, or difficulty, and give the patient a graceful way to exit from the behaviors, so that they don't have to say, "oh, I was making it up." But no, these exercises will help this go away. Let's deal with the stress at school that's making this more likely to happen.
Host Amber Smith: A large, multi-year British study showed that young people are particularly sensitive to heavy social media use early in puberty, like you were mentioning, and then again at about age 19 as they leave high school. The study showed that a year after these sensitive periods, heavy social media users showed more unhappiness with life. And while the study suggests that most teens are not effected much by social media, a small subset could be harmed by it. What, if anything, would you make of this?
Christopher Lucas, MD: Well, I think that study is really very interesting because there's been a frequent association between social media use and negative mental health, whether it be anxiety or depression. But an association can work both ways. It could be the social media use makes people depressed, or it could be people who are depressed use more social media. Trying to work out the causal pathway is very difficult in many types of research. However, this study studied kids every year for, I think, 10 or 12 years, and could see whether social media usage in year X led to changes in depression or anxiety in year X plus one. So they could definitely see that a change in social media use predicted the occurrence of depression later. And it wasn't the other way around. So I think this study was really interesting. Again, the other thing was that there were these two developmental periods that seemed to be the most damaging, that heavy social media use predicted more problems with self-esteem and life satisfaction. And those two time periods mirror, almost exactly, the two top periods of presentation for adolescents with eating disorders. So those years are the two peak times of life when typically girls present with eating disorders. So 12, 13, 14, and then 18, 19 20. So that was really interesting. The other thing that other research has shown is that the COVID pandemic and the increased use of social connectedness via the internet has affected girls more than it's affected males. I think a lot of the social support that occurs with female adolescents occurs between other girls in person, so that when this has been moved over to being online, I think it's become much more toxic.
Host Amber Smith: You mentioned during puberty and early adulthood, are those just because they're stressful times of a person's life? I mean, why would eating disorders peak at those times?
Christopher Lucas, MD: So I think, probably the pubertal one is because there are changes in body shape and body size that may not be that perceived ideal. I think the later adolescence / early adult one is probably a function of being no longer within a household and living independently and having more control over what you can do.
Host Amber Smith: Well, getting back to this British study that looked at like the unhappiness and the time spent on social media. Is it saying that technology is a coping mechanism or is it causing people to be gloomy?
Christopher Lucas, MD: I think that it's a little bit of a Goldilocks syndrome in terms of too little of it is probably a bad thing. Too much of it is definitely a bad thing. An appropriate use in the middle is probably a fine thing. And again, some people will be unduly influenced and affected more than other people based on pre-existing conditions and experiences that happened to them. The other part of the study that we've seen is just really, what is the magnitude of the impact of social media? And it really was fairly modest. Much bigger effects were seen by physical ill health, bullying, academic problems. Theye were much stronger influences for wellbeing than using social media.
Host Amber Smith: So what might a parent take away from these studies in terms of their teens' online behavior? I think, as ever, they need to monitor dose. So how much time are they spending? What is suffering as a result of so much use? And so are they not going to bed on time? Are they having trouble finishing their homework? Are they getting unduly distracted? So how much time are they using? I see a lot of the kids in the emergency department who have had an aggressive outburst and attacked someone, their parents or their siblings because their phone was taken away from them, for some disciplinary action. So it's a real motivating, driving force for a lot of kid behavior. And I think parents need to be aware that they need to restrict and make appropriate amounts of time, you know, maybe just scheduling certain set times when people do this, rather than having it being a constant companion.
Well, that brings up, getting back to cell phone addiction. How can you raise a child who's not addicted to their cell phone, who will come to the table without it, or who will do things, go outside and play rather than playing on their phone?
Christopher Lucas, MD: A lot of it may actually be modeling yourself. You know, I know I'm not great about putting my phone down when I should, so I think some of it is parents modeling appropriate use of technology. But the basic elements would be: put yourself on the schedule for when you can use the phone, how often you check it. The phones have been manufactured to do things called push notifications, where you get a little chirp or pop-up screen when something happens, and you don't need to be interrupted by every "like" that your Instagram posts gets. So, cutting down on the number of no push notifications for as many apps as you can. Try and take off the apps from your home screen that are the most distracting or the most that get in the way of the things that you really want to do. Something simple, like putting the most important apps on your home screen and putting all the other ones on a different screen so that you actually have to make a conscious decision to look for that screen. Somebody had a suggestion of turning the time-wasting apps -- you can actually stop them being color, and you can make the icon for them gray and unattractive so that people would be less likely to be distracted by them.
I think one of the most pernicious components of using cell phones is using them late at night whilst you're in bed just before trying to get to sleep. Although there have been some efforts to try and reduce the light emissions and the spectrum of the light that doesn't affect sleep, just using the phone prior to sleep is likely to make it harder to sleep.
If you really want to have a technology use, rather than the cell phone, maybe have a smart speaker, such as an Amazon Echo or a Google Home, and ask questions rather than having to use your phone, trying to have other ways to get the information that you need. As with any behavior that you're trying to change, you really want to try and monitor it. So there are a variety of apps, such as Quality Time or Moment that can judge how much you're using your phone and what for so that you then could set a goal about how much you want to use something and then see how well you stick to that goal. But it's always a tricky process because all of these phones and all of this software and all of this social media is engineered to try and get you addicted, to keep using so that you'll buy more phones, you'll upgrade your phone and you'll provide more advertising dollars to the various sites that you look at.
Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Lucas.
Christopher Lucas, MD: You're very welcome. Thank you.
Host Amber Smith: My guest has been Upstate associate professor of psychiatry and behavioral sciences, Dr. Christopher Lucas. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.