Surgeon general’s advisory: Let’s take stock

US Surgeon General Vivek Murthy advises that “we are experiencing a youth mental health crisis.” Based on the data, there’s no question about that. Where there is a question is whether tech and media are the cause. Some scholars simply assert they are (see the sidebar below), but neither the surgeon general nor the American Psychological Association asserts that, and the APA just wrote in its health advisory that “using social media is not inherently beneficial or harmful to young people.” So what’s a parent to do? Here’s my synthesis of what we’re hearing and what might be helpful to parents….

 

The words of the surgeon general’s advisory on social media and youth mental health were chosen carefully.

In the report’s two-paragraph summary, we’re advised that “robust independent safety analyses on the impact of social media on youth have not yet been conducted,” that “more research is needed to fully understand the impact of social media” and that, “at this time, we do not yet have enough evidence to determine if social media is sufficiently safe for children and adolescents.” He writes that “social media may have benefits for some children and adolescents” as well as risks and, when he refers to the downside – consistent with research going back over a decade – he uses the words “potential harm” and “risk of harm” (emphasis mine).

The biggest take-away

So what we’re hearing is that, though we don’t know enough yet about social media’s effects, we have a serious mental health crisis on our hands and we can’t afford to wait to do something about it, so we must act quickly to limit whatever harm social media is doing. What one can only wish is that we also act intelligently and across disciplines, understanding the complexities and listening to kids as experts on their own experiences with tech and media.

In 2011, the EU Kids Online researchers concluded years of study with: “Risk must be distinguished from harm. As with riding a bike or crossing the road, everyday activities online carry a risk of harm, but this harm is far from inevitable.” They added that whether harm occurs depends a great deal on an individual child’s circumstances, to which both the surgeon general and the APA agree.

More than a decade later, we have a lot of research representing both ends and everything in between on the benefit-risk spectrum, as well as what UK and EU researchers called the risk-opportunity spectrum of young people’s Internet use. In fact, a psychiatrist and two psychologists just wrote that social media is a triple-edged sword, 1) creating “previously unimaginable opportunities for learning development and personal exploration and growth,” 2) opening “children and young people up to a range of serious social, intellectual and mental health risks,” and 3) “increasingly successfully being harnessed for the identification and treatment of mental health problems.”

Nearly 20 years in

So neither the problem nor the solution – or for that matter children’s experience with media – is getting simpler. I can say that partly because I just finished co-editing a book on youth, social media and mental health with scholars at Stanford University, a volume representing the work of more than three dozen researchers in multiple countries writing on media, neuroscience, eating disorders, sexuality, bullying, misinformation and much more. All of them speak to the double- or triple-edged sword of social media, and this is work coming out next year.

In fact, it’s likely we’ll never know enough about the effects of all social media on all children because social media has many forms and all children aren’t equally at risk in using it, the latter a finding that surfaced in the youth online risk research 14 years ago. It was a key finding of a comprehensive literature review published by a national task force I served on in 2009 – along with another finding that a child’s psychosocial makeup and home and school environments predict online risk as much as or better than the tech or media a child uses. The surgeon general now similarly reports, “Importantly, different children and adolescents are affected by social media in different ways, based on their individual strengths and vulnerabilities, and based on cultural, historical, and socio-economic factors.”

And researchers he cites who are using new methodologies that “enable studying the effects of social media on each individual adolescent” (emphasis mine), have found that social media “affects different teens’ self-esteem, depression, anxiety, and stress in different ways” and that spending more time on social media actually enhanced wellbeing for 46% of teens surveyed, undermined wellbeing for 10% and had no effect on 44%.

Where does the ambiguity end?

So where does the ambiguity end? With your own child(ren) in your home or classroom. “We believe that personalized interventions may have stronger impact than general interventions at the population level,” write those award-winning researchers elsewhere. One thing that might help parents is a note of caution from clinical psychologist Lisa Damour against pathologizing distress, which she says is not necessarily a sign of mental ill health.

Speaking with New York Times columnist Ezra Klein in a recent podcast, she said, “So often, psychological distress is rolled up with mental health concern as though they are one and the same [she later explains when they are]. And we have never, as academic or clinical psychologists, seen it that way.” Distress can actually be “evidence of mental health,” she added. “And what I mean by that is, there are lots of circumstances in daily life where we fully expect to see distress. If a kid’s best friend moves away, we expect to see sadness. We are more concerned about its absence. If a kid has a huge test … we expect to see anxiety. That is actually what we would rather see than a kid who is indifferent.”

And here’s where parents can take a tip from clinicians: When psychologists assess kids’ mental health, “We’re looking for two things,” Damour continued. “Do the feelings fit the situation, even if they are negative, unwanted, unpleasant? And then, second, and perhaps more important, are they managed effectively? Are they managed [by the child] in a way that brings relief and does no harm, or are they managed in a way that does bring relief but is going to come at a cost?” This is where social media – e.g., endless scrolling through video shorts or excessive videogame play – comes in. Is the activity being used to bring relief at a cost?

Parents and kids can think together on what the cost might be. If they want to go further, they can, again together, “map” what sparks the anxiety and the response and then figure out a better alternative– “how they can give their brain something more rewarding,” based on the work of psychiatrist Judson Brewer at Brown University.

Many inputs

But it’s not helpful to talk about teens in a vacuum. Damour worries about parents too. “There needs to be a shoring up of adults,” she said. “It’s important for adults to be in good shape if we want teens in good shape.” New York Times columnist David French echoed this in a recent column. “There’s a factor that’s received insufficient attention in the debate over external factors in teenage suffering: What if the call is also coming from inside the house?” he asked. “Just as parents are upset about their children’s anxiety and depression, children are anxious about their parents’ mental health.”

What we don’t hear in the news media is that “the same year that 44% of teenagers reported suffering from serious sadness, according to the Centers for Disease Control and Prevention, 41.5% of adults reported ‘recent symptoms of an anxiety or depressive disorder,'” French continued, “an increase from an already high baseline of 36.4% just months before.” He suggested that we think about the impact of our own sadness or anxiety on our children. What pressures do we put on them? What pressure do our fears for them around social media use put on them?

“This isn’t to say parents are the full story,” French wrote. “I’m open to the smartphone thesis (and the secularization thesis and the political thesis) as providing the primary explanation for teenage unhappiness, but I’m not convinced that the kids will ever be all right as long as Mom and Dad suffer from their own profound problems.”

Help parents help young people

It’s as if he’s in dialog with Damour. Because she told Ezra Klein, “So the job, here – and I think about this all the time – is how do we shore up parents, given all they’ve been through, so that, when their kid walks in the door after a really rough day, the parent can serve in the role of a steady presence, even if they maybe don’t feel that way inside all the time so that they can help that young person use the incident of distress as a training ground for figuring out how to manage distress well and not be scared of it.”

We don’t want them to be scared of the distress, and we don’t want ourselves to be. Because if we overreact, they shut down and it gets really hard to help them. “It’s an extraordinarily difficult time to be a parent,” Damour said. “Parents are tired and raw as a function of what they’ve been through, and then in walks their kid who’s had a really lousy day, and their kid is suffering. That’s a lot going on in a kitchen, and I have a lot of room for parents who just want to shut it down or make it stop…. But … those feelings are happening, whether we want them to or not. And they may have real value. And if we cannot tolerate our kids’ distress, they will not be able to develop the capacity to tolerate their own distress.”

She’s pointing to something very important that has largely gone missing in the online safety discourse: We need to help young people grow their agency, their capacity to act, make positive change – for themselves and each other.

What serves young people

“High agency and positive mindsets are positively associated with well-being,” according to scholars at Stanford University’s Social Media Lab. “People who viewed themselves as in control of their social media use not only reported greater life satisfaction and perceived social support, but also less depression, anxiety, and stress. In contrast, people with the mindset they had little control over their social media use experienced more psychological distress” – which is why laws that attempt to assert control over young people’s media use or ban it are not helpful.

As for parenting, I keep coming back to Damour’s words “steady presence.” This is real love in challenging times and spaces, is it not? I’d argue that being that presence goes far in helping children (and all family members) cope with distress, develop resilience and heal.

“The finding that helps me sleep at night,” Damour told Klein, in answer to his questions about social media and youth wellbeing, “is the knowledge that the strongest force for adolescent mental health is caring relationships with loving adults – adults who get them, back them and are connected with them.”

Hard to find anything to add. I only suggest, in support of that: social media is one part of how our kids navigate growing up, and it challenges us to think about how we care for ourselves so we can help them do that in the digital, and now the AI, age.

SIDEBAR: The elephant in the room

What about the very persuasive arguments of Drs. Jean Twenge and Jonathan Haidt – persuasive because of their credentials and I think partly and understandably because of our great concern about the youth mental health crisis?

I wholeheartedly agree with them, as well as the surgeon general, that the mental health numbers are frightening and need to be addressed. But where we always seem to go from arguments like theirs is controlling, banning or surveilling kids’ media (and kids) – in home, school and government policymaking – which other research indicates to me does not advance their wellbeing. Where my concern is focused is on a business model that makes children’s safety a cost center and keeps leaders of corporations, which have in some ways become global social institutions, from seeing human (and children’s) rights as a necessary part of doing business in the digital and now AI age. This, I feel, is what laws need to address, without reducing children’s rights of agency, voice and participation.

Regulation needs the granularity that we’re seeing in new research methodologies and the work of people who work directly with children at an individual level. So this is the bias I bring to reading the arguments of Drs. Twenge, Haidt and even Murthy. I am not an academic researcher and so not equipped like the scholars I mention above to counter their data or methodologies, nor would I want to. Certainly, issues they and whistleblower and nonprofit founder Frances Haugen point to, such as those about girls and social comparison (remember “am I pretty” videos?) are important for parents of girls in that vulnerable age group to know about, but I find their arguments reinforce adults’ fears and jeopardize children’s rights (hear what clinical psychologist Lisa Damour says about this). If I’m wrong or seeing them only through my own bias, consider this a cautionary note against believing…

1. That we can talk about kids’ social media use as one thing to all kids, some sort of undifferentiated practice like the way we’ve been talking about “screen time“
2. That all kids are similarly at risk in/with social media and digital devices, so we can extrapolate from the headlines what our own kids’ experience is and don’t need their – our kids’ – perspectives and expertise
3. That the way we adults have long been doing sociality, education, etc. is the best/ healthiest/ right/ only way (e.g., the way teachers have always taught and managed classrooms or the way we socialized before we had digital stuff), so figuring out – as we go and as they grow and mature – the respectful, meaningful communication, education, participation, etc. that each of our children need concerning digital tech and media somehow isn’t needed.

These assumptions derail positive, productive change at both societal and child levels, fuel moral panic, and challenge children’s full participation. I hope my readers understand this is not an argument for social media, phones in classrooms, etc.; it’s a provocation, a suggestion that, because we need to take action – with children – for children’s wellbeing, we need to be thoughtful, not fearful, and question our assumptions. And we need to ask the question, What is needed to help parents, educators and caregivers be a steady presence in the lives of children?

Related links

• Important resource for teens and policymakers added later: “Mental Health & Digital Skills: 8 Findings by Young People” for their peers and policymakers (at home, school and in government). The resource “explains their “experiences of mental health online and offers messages that young people want young people and adults … clinicians, parents, teachers and policymakers to understand.” In addition to the teens’ findings, the resource links to “help and support available in English, Portuguese, Dutch, French, Norwegian, Finnish, Polish, German and Italian,” as described by two leading researchers in the ySKILLS consortium of 15 universities and European Schoolnet which participated in the research and publishing.
• A thorough, thoughtful look at all of this at The Atlantic, which has also published commentaries by Jean Twenge and Jonathan Haidt: “No One Knows Exactly What Social Media is Doing to Teens,” by Kaitlyn Tiffany
• The APA’s advisory on “Social Media Use in Adolescence,” with great perspective from clinicians who work directly with youth – released the same month as the surgeon general’s (last month) but shorter and more accessible
• Researcher David Stein’s 7 “main disagreements” with Jonathan Haidt’s argument that social media use is the primary cause of the adolescent mental health crisis, offering brief explanations and promising to go more in depth in future posts.
• “Most kids are fine online,” my post on and linking to research out of University of Wisconsin that gets at the household circumstances and policies that help make the majority – “family-engaged adolescents” – fine
• About how our children can help us when we tap into their expertise, as researchers Emily Weinstein and Carrie James demonstrated in their book Behind Their Screens.
• Sneak peek from our forthcoming book for the other APA (American Psychiatric Association): “Teens who believe that their social media use is an addiction could be understood as having a low-agency, negative mindset because they see themselves as having little control over their engagement with a harmful habit,” write scholars at Stanford University’s Social Media Lab. “On the other hand, teens who see their social media as something they can use to pursue meaningful goals – like social connection—have a high-agency, positive mindset. High agency and positive mindsets are positively associated with well-being.”