Episode 43: Social Media and Adolescent Development with Dr. Howard Liu

Dr. Howard Liu, M.D began focusing on the effects of social media quite early on in his career after watching how his own personal life was being affected by various platforms. Following a child psychiatry fellowship, he saw the need for both parents and children alike to have guidance in the face of an ever-growing sprawl of social media usage.  

This episode of Menninger Clinic’s Mind Dive Podcast features Dr. Liu, accomplished psychiatrist and professor, joining hosts Dr. Kerry Horrell  and Dr. Bob Boland for a conversation on how social media can affect the mental health of adolescents and how parents can be proactive in fostering a positive relationship with technology as their children grow. 

Dr. Howard Liu, MD, MBA, is a nationally recognized psychiatrist, educator, workforce expert, social media innovator, and equity advocate at the University of Nebraska Medical Center (UNMC). He serves as the chair of the UNMC Department of Psychiatry, a tenured professor in the UNMC College of Medicine, and as the immediate past president of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP). He is a distinguished fellow of the American Academy of Child & Adolescent Psychiatry and a member of the American College of Psychiatrists (ACP). 

“... Sometimes you use filters to change how those look and sometimes to look slimmer, look different, change different features, remove areas that you feel like you're less comfortable with. It's very highly edited,” said Dr. Liu, “When you put those pieces out there, it can sometimes warp your own sense of self and then your sense of what your peers are looking like every day, which clearly is a highly filtered look and different than normal.”  

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Transcript

Dr. Bob Boland: 0:02

Welcome to the mind dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland,

Dr. Kerry Horrell: 0:11

and Dr. Kerry Horrell. twice monthly, we dive into mental health topics that fascinate us as clinical professionals, and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in.

Dr. Bob Boland: 0:43

So today, we have Howard Liu, we're very lucky to have him. He's a psychiatrist, educator, workforce expert, while social media innovator and equity advocate at the University of Nebraska Medical Center. He serves as the chair of the UNMC Department of Psychiatry professor with tenure in the UNMC College of Medicine. He's also chair of the American Psychiatric Association's Council and communications is a past co chair of the world's I get her associations Working Group on medical students, and he's the past president of the Association of Directors of medical student education and psychiatry. So that's a lot of chairs. But of all the different things that you're expert in today, Dr. Liu, we're gonna be talking about your expertise in social media. And I saw him speaking about this just recently, so I'm really excited to hear more about it today. So welcome, welcome.

Dr. Howard Liu: 1:39

Thanks so much, really appreciate this invite that Boland Terrell and thrilled to talk about social media as well. I love

Dr. Kerry Horrell: 1:46

getting to talk about social media because you're a big, I'm a big user of social media. She kind of shamelessly I mean, I'm, I'm a millennial. I grew up on social media. I was on MySpace, girly, you know, back in the day

Dr. Bob Boland: 2:00

got MySpace? Yeah, I was. Yeah,

Dr. Kerry Horrell: 2:04

I remember who? Oh, Lourve. So again, I feel like I think one of the things we've talked about this a little bit in another episode, we've talked about this a little bit in episode we had on boundaries. And then we talked about this a little bit on an episode of gosh, no, I'm trying to remember it was maybe the app like like the apps when we talked about mental health apps.

Dr. Bob Boland: 2:26

Yeah, probably Dr. Lowe's, John Lowe's. Yeah. All this this anti was Dr.

Dr. Kerry Horrell: 2:30

Gabbard, who we talked about boundaries with? Oh, yeah, we've skirted around this issue, but I'm

Dr. Bob Boland: 2:34

deeply we haven't really taken on like, just the the good and bad about Yes.

Dr. Kerry Horrell: 2:39

And I think like, the reason why, again, I'm really excited about is because I tend to fall on the side of social media is such a double edged sword, like it is a super extrovert staying connected to people, especially for me staying connects people from California, where I'm from, like, that's super important. But yeah, I'm also like, I work with young adults. I work with adolescents. So I'm also very aware of like the downside of economies. I'm just really excited to jump in. Yeah.

Dr. Bob Boland: 3:05

I mean, and it's good thing about adolescence, because I think that's what we're concentrating on today. Yeah. And so for starters, since we've spent the whole time talking, maybe we should turn over to Dr. Liu, who can tell us go about, you know, how you got interested in mental health. And you know, just how the whole thing about social media, where that's come from?

Dr. Howard Liu: 3:23

Well, I guess I should disclose. I'm a child psychiatrist, as well. So I think that's part of my interest in mental health and teens. And then thinking about social media as both a positive and as negative. As Carrie said, I'm also a parent, I have four kids, and three of them are teenagers or tweens as well. So I've come by it, honestly. And I would say that there's no respect in the house for social media expertise from from the dad. This one established Stanford virally, early on, but, and frankly, because of that parenting piece, I know how that challenges as well beyond theory, and really trying to live day by day and just navigate the ups and downs, I would say that I got into social media a little bit more actively as a, as a healthcare professional. Just when I started to get busy in early career, just after graduating child psychiatry fellowship, I realized that I just didn't have the time to maintain all these different platforms, like Kerry I that was on other platforms, Facebook and other other pieces as well. But then I decided, you know, I'm just going to try to just focus on one. And that just happened to be Twitter, because it seemed to be like the least amount of time that I could put in. And also, frankly, we talked a little bit about boundaries in the opening just a little bit more boundary friendly in that there's a little bit less image based, so less sharing of your family, you know, yourself, you know, it could be more text based. And so I felt that that was what would be the least maintenance, frankly. And then I started using it every day and then I start to think about using it professionally and then I've used it ever since and I think sadly enough, I've been posted over 50,000 times since then, and just learned is the rules of the road through both errors and hopefully some benefit as well. Yeah.

Dr. Bob Boland: 5:09

And we will correct me if I'm wrong. But there's a there was a push for a while where like institutions and stuff, were kind of worried that they were behind the behind if they weren't sort of involved in Twitter and Facebook and things like that, and that we serve all needed. So they, it's kind of goes back and forth. But for a while, there's this kind of notion that like, well, we all need to be involved in this because it's how people communicate now.

Dr. Howard Liu: 5:29

Yeah. And I think that for institutions, there still is some onus for that, I would say, particularly in academic health care, where graduate medical education, still a lot of virtual interviewing, right, so when if you can't visit a campus, sometimes you have to show the culture online. And that's the only way to do it. And I feel like, in many ways, the residents and house officers are, are perhaps the most adept at it because they're living the life, right. And they're also tend to be digital natives. And they know the platform's pretty well. So it is important for somebody to use it. I think sometimes we like to set it and forget it, right? we designate someone and they just start posting in return residence. Right. Right. Right. But I think there has to be some guidance. And it's analogous, I think, to the parent and the teenagers, where the teenagers are better at it, frankly, than the parents. But the parents still have to know what's going on, right. And if something bad happens, just to understand how to troubleshoot those pieces, just like anything else,

Dr. Kerry Horrell: 6:25

you know, I think, especially in academic medicine, I could be wrong about this. But this is my sense, is we hear more about the dangers, and sort of like the precautions and the just like beware of social media, because there is research, you know, my research has been around sexism and a whole lot of stuff around that. And one of the things I remember seeing was that higher use of social media for teens tends to relate to more body objectification problems with body image. So again, I'm aware that even in my area of research, there's there's research about social media, and I'm sure, again, this is not my area of expertise. But there's a lot around depression, anxiety, things like this. So I wonder if you can tell us a little bit. Again, I'm, I reckon there's a whole lot of information you have on this, but what are some of the main points of what do we really know about social media? Especially the effect it has on adolescents? And what's out there so far?

Dr. Howard Liu: 7:22

Yeah, I think that the jury is out in terms of the final evidence, creating a causal link between social media use, for example, and suicide are definitely getting an eating disorder. But definitely, it's a risk factor. And so you mentioned carry just that there's a study on time, and time and social media. And I think there was a JAMA article a couple years ago, looking at a cohort study, I want to say it was 12 to 15 year olds, but three hours or more seem to be a challenge, right. And using more than three hours a day that that tended to be a little bit more a risk factor for internalizing type disorders, anxiety, depression, some of those pieces as well. Interestingly, too, there's some gender based differences and how teens are using social media as well. And more females are tend to be using a little bit more of a highly visual social media and interacting more with some of the photos there. Those are things like Instagram, and Snapchat, where you put on images of yourself. And sometimes you use filters to change how those look. And sometimes to look slimmer look different change different features, remove areas that you feel like you're less comfortable with. And so it's very highly edited, right. And when you put those pieces out there, it can sometimes warp your own sense of self. And then really your sense of what your peers are looking like every day, which clearly is a highly filtered and different lens than normal.

Dr. Kerry Horrell: 8:47

Does, you know how on iPhone, do you can screen record? Yeah, at least one time I screen recorded and I went into Snapchat, and I just did a bunch of the filters back to back and undo the filter and then take it off and do the filter and take it off. So that I could show people how much those filters change your face shape. Like it's subtle, it's subtle, but it likes leaves in your nose and it squeezes in your chin and it does stop. So I'd like to put it on and then I take it off to show the way like my face would change. Because I was like that's to me that's very problematic. That's very very problematic.

Dr. Bob Boland: 9:20

And we're kind of bizarre but some of

Dr. Kerry Horrell: 9:22

them are funny you know like the ones that are like it's a dog you've you're turned into a dog that was a popular one for a long time. But these some of these ones it's just these subtle changes your eyes are a little bigger your nose a little smaller. And I again i i have totally just on a personal level been like that feels super problematic because again, I think it also just shows that like what would be better you would look better if your eyes are slightly bigger your nose was slightly smaller your chin was slightly smaller. So anyways, I've totally played around with that before because I've and I just try not to use filters like that because I do think it's really easily could be prone to body dysmorphia and just feeling like you know Oh, my God, I noticed feels huge when it's like, no your notice your nose.

Dr. Bob Boland: 10:04

So I was just gonna say like this, how serious is the problem? I mean, because it seems I mean, you know, to just a part of me feels like, Well, every generation has some kind of like, you know, big, you know, big baddie of what the problem is. So like, you know, when I was a kid, it was it was television, we shouldn't be watching television, it's gonna turn us all into murderers or something. And I don't know, if you went to probably the 1800s They're probably complaining about kids with the telegraph. I don't know. I mean, you know, so it's always something that's like some new media, that's like destroying children's minds. I mean, is this any different than that? Or is there's something else about this, that makes us actually a bigger concern? That,

Dr. Howard Liu: 10:41

you know, I think the answer is yet to be determined Bob, and was a history major as well. And, you know, used to, to that medieval history. And certainly, there's always been rumors, and, you know, concerns and othering and blaming of peoples for bad things that happen, right, like going back to the Black Death and so on. But, you know, I think here, it's, it's subtle, but yet enough, because of other concerns about adolescent mental health, of course, that the Surgeon General has released an advisory. And I think part of the target of that might be clinicians. But I think even more so elected officials, just to think about, just like any other system, whether it's transportation, or, you know, airlines or other areas where you know, how much of the regulation needs to come from the companies themselves, how much of it needs to come from the consumers, right. And I think that's the balance. Much right now is being asked to the consumers going back to the parents who frankly, probably have the least literacy with these different platforms, less is being asked or it's being done state by state in a haphazard way to really say that the companies need to really share the data that they have, and make sure it is transparent, maybe what's a little bit different than what it was 50 years ago, or 75 years ago, it's just the ubiquity of access, right? You know, we have teens, that probably at least a third of them, are even getting up in the middle of the night to check on their devices, right, just to see if anyone has messaged them or sent them a Snapchat, whatever it is, it's so I think that you know, it is it's just constantly available. On the bullying frontier, we've certainly always had bullying going on and says this group knows, but here, it's a little bit less escapable, right. And it used to be have a little bit of respite, maybe during the school breaks, or summertime, if you could get away, but it's less likely that you can truly get away these days. And it might take different forms of bullying as well. Well,

Dr. Kerry Horrell: 12:33

it makes me think to you about the look, my mind goes to a few places one new unpopular social medias pop up all the time. Like even in the last year, there's been one called V real, which is, you know, an app where once a day, everybody who has the app is told to take a picture right at that time. The idea is you get to post once a day, and it's at that time, there's also a new ish one called lapse. It's supposed to be kind of like a throwback to to disposable cameras. I like the idea of this one, which is that you take pictures and you don't get to look at them right away. They go into like a dark room where you can't look at them right away. So you're not like taking pictures, and then immediately looking at them, you're supposed to just take the picture and not thinking about it till later. I mean, those just popped up over the last year or so. And I'm sure there's many more than I'm not aware of. Those are two that I feel I

Dr. Bob Boland: 13:27

you can carry. Yeah,

Dr. Kerry Horrell: 13:29

I'm on all of them. But mostly because I find that I do find them. Interesting. I find it fascinating. I think working with young adults I do. I also just like to keep up with what's mean, I do think it's kind of funny, as a therapist to just like, be a little bit social media illiterate, like I remember, you know, when our patients come into inpatient, they don't get to have their phone on, at least on the young adult unit. And for like a good handful of my patients, like one of the major stressors about that is they're going to lose their Snapchat streak. And so that that came up enough times that I had to be like, Guys, what's a Snapchat streak someone and tell me what is the social capital of the Snapchat streak. And I found out there's like, a whole culture behind this that like you and your best friends. You know, you snap each other every day, and then it counts how many days you've done that in a row. And that becomes like this kind of social capital that feels important. So I do like I think, I think understanding like what it is and how this influences my patients like social feelings, like it's really important.

Dr. Bob Boland: 14:32

I just say I imagine that that's another difference between like other sort of media in the past is that there is that reward factor to all these things where they built in kind of almost like a gamification of it.

Dr. Howard Liu: 14:42

It's immediate, immediate gratification as well. Yeah. I also just want to point out, Kerry that I think that you are role modeling, exactly what I'd recommend both for clinicians and also for parents, which is acknowledging that we probably are not up to date with the latest platforms, but then try trying to learn and and even stumbling along sometimes, right but but truly making an effort to be curious, and really trying to understand which instead of just belittling or dismissing, I think that's exactly what we should be doing.

Dr. Kerry Horrell: 15:13

Why I appreciate that too, so much because, you know, growing up and so again, I think I'm age wise, like well poised for this because like growing up the internet, you had to unplug the phone and plug it, they couldn't have access to the phone. It's not like, you know, I was still in that period of time. Yeah, and I remember, if we were on the phone, and my mom needed to get on the internet, or vice versa, you had to get off the phone to get off the internet. But like, right by the time I'm in middle school, MySpace, and the middle school, MySpace, it crapped up. And then Facebook happened when I was in high school. And I remember might be two people, my parents age were like, this is kind of stupid, and like, why does this matter to you, but it's cool. It mattered a lot. It mattered a lot in regard to social, I'm gonna just keep using the phrase social capital, like, yeah, and that and that mattered. And so again, I, I feel, yeah, just a sense of like, wanting to respect especially for adolescents and young adults that like there's something really important socially about social media. And I think families or parents are like, absolutely none of it. Like that has a social ramification for the kid. And that's a that's not the right answer for some of these kids. But like, I see that it has this effect on them. And then on the on the flip side, I also am watching how I mean, like, so many of the kids, I work with teens and young adults, something about what is brought them especially in the wake of COVID. And I would like to talk about COVID At some point around this conversation. Yeah, like the access to their friends and connection over social media, or on the flip side, bullying, or body dysmorphia, or whatever, like came up because of social media. So it does just be like this, a really, really double edged sword to

Dr. Bob Boland: 16:55

me, but that I mean, I think you bring up an important point, Carrie, and I don't know if you can comment on this, however, that it's now there are upsides, like during the pandemic, how would we have communicated with people, I suppose we could have called them but you know, you know, it's sort of became a main touchpoint, during, during times when you can't otherwise physically connect

Dr. Howard Liu: 17:14

100% agree. And, you know, if someone's in COVID, isolation, you know, it's a lonely time, and I've had a cup a couple times and been downstairs in the basement. And, and it's, you know, it can be quite isolating. If you don't have someone to talk to, I would say what's interesting too, in it probably started before the pandemic is just the the notion of how teens are gathering these days. And, for example, with gaming culture, a lot of people are putting their their best friends who many of them never met, you know, or different states or have moved away, but they still game online. And I think that for them is sort of the they don't like the term play date. But you know, that's like the social gathering now, it's really, it's the online, I think parents are trying to figure that out. Because you know, then what happens when it's your birthday? Do you? Who do you have over it? Do you even have people over? It's just a different? I would say it's a different environment. Now,

Dr. Bob Boland: 18:10

let's talk about I mean, what were parents supposed to do about all this? I mean, like, we just saw, like, what and like the news that like Meadows has been targeting children and stuff, you know, probably illegally, since they're, they can't give consent. You know, so we're up against billion dollar corporations. I mean, what can parents I mean, you're as a parent, and you've mentioned that, like, what advice would you have for other parents and what they're supposed to do about all

Dr. Howard Liu: 18:32

this? Well, it's complicated is the short answer. And I think all of us are stumbling along as best we can. So I don't want to claim that if children were on, they would not claim that I'm doing it perfectly, or anyone else is because it's always different. One thing that I try to encourage parents to think about, though, is that they don't have to follow the crowd. And when kids ask, because I think there's so influenced by peers, and then also by advertisements, frankly, pushed to them on their platforms to get a smartphone or other things. You don't have to cave in right away. Right. And so with my own kids, they had some peers that that early elementary already had cell phones, right? They were smartphones, and for my kids, I've made them wait. And and they've been not that they're not on their on through their school laptops and other ways on the platforms. But I think that's that's the difference is just deciding for your own thinking about the level of development of your kids to risk tolerance, all these different things. When do you want to introduce it? Right? There's mixed evidence about the truly taking a restricting access. I know that there are countries like China that are trying to really crack down on gaming, for example, so they're really trying to crack down on it. I've seen mixed outcomes on that as to whether that's actually working or not, because they're so concerned that young people were spending too much time and Internet gaming and so on. I think that really the metaphor I like to think about which I think a lot of parents have been through is just thinking about teaching Your teens had a drive, right, which is a dangerous activity, if done poorly. And oftentimes that there's a different sense of risk right between teens and parents as a driving. But the best thing to do is not just to warn them about traffic accidents, and you know, refer them to, you know, safety shows through, you know, drivers and that kind of thing. But honestly, the drive with them, and then in a terrifying way to sit now in the copilot seat and let them drive, right. And then sometimes bad things might happen, but trying to navigate for them. And then frankly, also realizing that throughout much of their childhood and teen years, they're watching us drive right and seeing what we actually do. And if you do have a social media platform that you use, either personally and professionally, they're seeing that as well. So I think we can either role model, what we hope them for them to to do. And also when we mess up to say, You know what, this was not not so good. And let me explain this. I was not my best self here, just like when you're driving. And he might have said something when someone cuts you off that kind of thing. I

Dr. Kerry Horrell: 21:04

love that analogy, because it is it's driving is dangerous. It's one of the things that kills people the most. And yet, not many families or parents would say, well, then we're just not gonna do that all together. It's how do you do it? Well, how do you do it safely? And how do we talk about it? I have a couple more thoughts that I'm, I think maybe I'm gonna if I want to finish the route or like, before we segue back to the positive benefits of social media, one of the like dangers or things that I'm noticing, and I'm curious, what you think about is stuff like attention, like we haven't talked about tick tock too much. But tick tock is one of the big social media platforms right now were both as a user of tick tock, myself, and then also as a psychologist, I'm like, a little bit nervous about it. The things that make me nervous about Tic Toc, the shortness of the videos, and our like our collective attention spans of like, just this kind of constant, like just only being able to pay attention to things for like 30 seconds, minutes at a time rather than watching things that are more full length. And then also, again, the we talked about this a little bit, but if the government's going to play a role, how can the government play a role in apps or things that are not housed in the United States or like that are that are that are global? Anyways, that that's those are two different things. But I'm maybe to start with attention. I wonder if you have thoughts on how social media, if at all, is influencing like attention and our young people?

Dr. Howard Liu: 22:31

Yeah, I think Tik Tok is really surging, right amongst teenagers, whereas Facebook is falling, and certainly Twitter and some of the older platforms as well. And I mean, it's a rush. If you use tick tock, you get the videos, and you can swipe within a nanosecond, if it's not interesting to you, right, carry to your point. And I do think it does probably reinforce the sense that well, you know, if I'm bored, I'm just going to move on to something else. Right. And I think there there is some risk for those pieces. I would also note that just there's a mental health, tic toc is a lot of misinformation out there as well, which actually, I'd say just from the American Psychiatric Association, and the council communications, I do think that it's important that we, in organized mental health, think about being on those platforms, because, you know, it's a different skill set to engage those eyeballs, you can't just post a news article and expect that people are going to, you know, not swipe upwards and go to the next video there. You have to it's a different skill set. But we have to be interacting with that generation because they're hungry for it. And in fact, there are a few psychiatrists, psychologists, other mental health professionals that have millions of followers, right on Tik Tok. And I think that they've learned to use the skill set of what they call the hook, which is that first minute or second that you see a video, right, where you really pull something in. And they've learned to do that, and then hook on a positive, accurate mental health message. So I think there's some benefits that can be made from that platform. But it definitely is a challenge. on the regulatory side to your point, Carrie, it is a Chinese based company. Right. And so that's a challenge. And there's been a lot of hearings in Congress about concerns about data privacy. Now, you know, what Bob referenced earlier? Frankly, you've got a lot of data privacy concerns about domestic social media companies as well. So they're probably all in a similar category. See it commodify that data. But if you think that one of the things that the Surgeon General's asked for that I think we can all ask for for elected officials is access to the company's data, because even the researchers, part of the reason they can't conclude definitively that a certain platform or app is damaging is that they don't have access to that background data. They can only guess as to the user platforms. And so they'll be like population studies where you know, introduction of Facebook into a whole country and they look at wellness data, which is pretty vague. Right, and then you can't really cause a find a causal link there. But if you can really dig into looking at the files from Tiktok, or from meta from these other companies and say, well look at this demographic of, you know, 14 to 17 year olds, or whatever it is, is there actually any data that you have? And would you share that in? Can we make sure it's, it's a little bit safer. And then frankly, there's also some other safeguards they can think about just in terms of what's the best age for kids, and then teens to have a platform handle on that platform, right, and then some other pieces as well. But I think that access to the data would be really important.

Dr. Bob Boland: 25:40

Is anyone working on that? Or is that because that's I imagine that that's, you know, will be hard to get them to do,

Dr. Howard Liu: 25:46

it's hard to get them to do and frankly, Bob, the most of our elected officials are not very proactive users of social media has typically their staffers, I think that run their social media accounts. They are not as Faasil with understanding what they're asking for. And unfortunately, a lot of the hearings are a bit of, from what I've seen that kind of grandstanding on, you know, concerns about national security, but I think they could lean on things. And, you know, the surgeon AI, which is a whole a whole other thing, right? Artificial Intelligence is another great example. Interestingly, many of the leading companies have signed on to statements, you know, with concerns about this could be a existential threat to humanity, which is a rare, rare thing for an industry to say, right? And yet, they have not called upon, or truly invited the government to regulate that industry in a way that they're saying that, you know, we can we can issue these warnings regulate ourselves, we see the dangers, but I think is challenging because of the unfortunately, the commercial allure of having more and more eyeballs.

Dr. Bob Boland: 26:56

Yeah, I think to your point, it sounds like companies actually are keeping data on sort of like some of the mental health effects and the wellness effects of these things. That's kind of the whistleblowers or reports we hear from men and places like that. What about I mean, back to us as clinicians? So what are we supposed to do about all this? You say we're supposed to be online more sounds like and in participates, we know we're dealing with anything else? Well,

Dr. Howard Liu: 27:19

I think just as we learn to take a cultural history, as well, as we are interviewing new patients, all ages, really, because we all have different experiences. And there's some older users, I don't want to be ageist here, that are experts, and some of them have millions of followers on Tiktok, for example, is carry with now to add, they're older adults, and they have various pieces, you know, that they put on there. So it's not just by age, but I think just including that as part of our social histories, were interviewing as clinicians, I think it's important, not faking it. And I would say it's constantly a humbling experiences, I asked, Well, tell me about this. And I thought, and you use the terminology wrong. And just, you know, just say, be patient with me, I'm trying to learn from you, you know, being curious about it. And oftentimes, if you can find the area that they're really proud of, then it really becomes a an affirming piece, just like you asked them about, you know, how they spend their free time, you know, and extracurriculars and so on. But understanding it's a whole world that you're asking about. And and if they're willing to guide you it's a huge privilege, right? And my understanding is they're generating safety plans that nowadays, you know, it's probably going to be might be texting or messaging through social media, their closest contacts as well. Right. So just thinking about all these different aspects, and how we do our clinical interviews, and just being curious and open to it and always being ready to be corrected. Right, and not faking it. Do you ever look at their accounts, you know, sometimes I if they want to show me something I don't I don't ever compel them to show me that their accounts, but I say, Well, if they tell me about something, and they want to show it to me, I certainly am open to that as well. And you know, a lot of them are proud of some of the things that they have on there. And sometimes they don't want to show show things. And I've also seen, you know, folks that have been, unfortunately, cyber bullied or victimized through sexual extortion or other type pieces, which unfortunately, is happening a little bit more often these days as well, the FBI put out an advisory on that. Lets us know, there are more and more teens, particularly boys actually recently as well, that have been sort of catfished right where it seems like they're talking to an attractive person, and then that person shares the photo with them, ask them to share an explicit photo back and as soon as they do this scammer whether the US or international says well, if you don't send me to this account, you know, X dollars, I will send this to your parents, to your school to everybody. There's been a couple of high profile suicides as a result of this. And so the FBI has actually put out an advisory or warning which probably must Parents are not aware of, to think about this. So that's something the other piece has generated headlines above and curious, I'm sure you've seen is AI generated false nude photos of classmates, which are also sort of making the rounds and are easy to do. And just understanding again, going back to what can elected officials do the laws, lag, typically the technology, so some of these things may not be illegal, depending on where they're occurring. And so I think, really just making sure that elected officials are aware that these are risks that are happening, and then can cause both direct trauma and probably secondary trauma to our patients.

Dr. Kerry Horrell: 30:40

I will say that first one, I've had a number of patients who that's happened to where that exact scenario they've had, they've sent pictures to a seemingly random person who seems interested in them, and then they've been basically blackmailed. And it's been incredibly stressful.

Dr. Bob Boland: 30:55

I can only imagine. Yeah, I wonder if we have time

Dr. Kerry Horrell: 30:57

just just for one more moment to open up. But go ahead. Thank you. Thank you for that. Is there research, like on the benefits of social media and access to? Because I, I feel like research tends to focus on the downside, but like, Is there research on the upside? Especially again, during COVID? Like, imagine

Dr. Bob Boland: 31:17

companies might want to do that?

Dr. Howard Liu: 31:18

Yeah. I mean, I think the overwhelming benefit is in connectedness, right. And there is research on that piece. And many teenagers do find it to be helpful. I think particularly. And you imagine that you're in, I see a lot of military families and move around a lot of families moving for jobs to smaller towns, places, maybe where there's more or less diversity from where they were before. Staying connected is important. And then sometimes finding people, maybe you are coming out as an LGBTQ individual, and there's nobody in your middle school that you know, really has done that in your class and you want to connect to others, that might be a way where you can really find somebody that shares that interest. You know, I think just that sense of connectedness is the greatest thing I just want to put out there. Even as a child psychiatrist, I'm an advocate for social media overall, I feel like that it's again, and back to those, you know, we all are lifelong learners in academia, we talk about that. This has to be an area where we also apply those same skills, right, just that humility, that oh, gosh, you know, what I knew was out of date. Now I gotta learn. The teachers here are not the professors, you know, the teachers are the the tweens and the teens that are driving the industries, right. And so to learn from them, when they're willing, is really a privilege. And to know that the firm can be very affirming. Now, it's always kind of a double edged in that if you look at some of the psychological autopsy studies, I saw one from the Netherlands of teens that had died of suicide, and some of them were accessing social media, all of them are on social media, but some of them were accessing it in different ways. You know, the only really directly negative pieces when it when they were cyber bullied, some of them did find support. And then but the support can be a little bit double edged as well, because sometimes you'd find these groups talking about depression, anxiety, and so on. And sometimes you'll they'll get pushed images of people self harming in real time and other things. So it's a little bit of a dangerous road out there. Going back to the driving analogy, and just being aware of that, trying to process that maybe checking in during family dinners, whatever it is, I think just making sure it's part of our dialogue and our landscape. I think that's the best thing we can do. Well,

Dr. Kerry Horrell: 33:33

we don't I know, we don't have time to get into this at this moment. But the other thing we've talked about, actually, in another episode was some times like kind of the social contagion aspect, like there is a pop. I don't know how to say that, right? There's like a, there's a way in which right now, having mental health issues can be kind of popular, like we're seeing more and more handles of like, suicidal chick 42. Or, like, you know, like just different things that so again, I'm I'm just appreciating you know, maybe I'll end my my rant here is I really appreciating is the level of greatness or like ability to stay in the complexity of this without foreclosing on either end like that, to me, as psychologists as a person is so important. I think social media much like anything else, like that's where we have to be, we have to be interested, we have to recognize like, this is a huge part of our especially young adult and adolescent patients life and how do we stay curious and also help them think about how to do this? Well, I can I can, I can think of so many of my patients, I wouldn't say honestly, probably about half were like some part of their presenting problem related in some way to social media, like this is so like helping them also learn and think about how to do this in a way that will help them be healthy too. So I'm really appreciating your perspective and stance on this. Yeah.

Dr. Bob Boland: 34:49

Well, we really appreciate you coming on and talking. This has been a fascinating discussion. That's probably why why we've been talking so much. But thanks so much. Really appreciate it and

Dr. Howard Liu: 34:59

who hope that we can all be out there and show in the way and really walk in besides our teens but thank you for the invite love being on the podcast and look forward to chatting in the future. All

Dr. Bob Boland: 35:09

right, well, that's that's the last word. You've been listening to the mind dive podcast. I'm your host Bob Boland, M.

Dr. Kerry Horrell: 35:16

Kerry Horrell and Thanks for downloading typing in the mind dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Bob Boland: 35:30

For more episodes like this, visit www dot Menninger clinic.org.

Dr. Kerry Horrell: 35:35

To submit a topic for discussion, send us an email at podcast@menninger.edu