Psychiatry & Psychotherapy Podcast - Is Social Media Good for Mental Health?

Episode Date: November 7, 2019

Since its introduction in the early 2000's, social media has become an integral part of our daily lives. It influences culture, current affairs, and connects us to the world like never before. As people spend more and more of their lives online, it's important for us to consider how this new online world is changing us. After all, healthy social connection is one of the key factors in good mental health and well-being. It's time to check in and find out: how does social media affect mental health?    Link to Resource Library 

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is email to you in seconds. Hello and welcome to the podcast. Today I am joined with Tori Berghardt. She is a fourth year medical student, an amazing candidate, and to psychiatry.

And she helped me put together this handout that we will be going through along with Jamie Ruddick. This is on social media. And we'll be talking about some of the prevalence of social media, like how vastly it's used. We'll talk about some of the arguments like, is social media good for mental health? has claimed on a Facebook website or is it detrimental to mental health? And we'll be going through some of those studies. And we'll also talk about, you know, is social media really social? And does screen time interfere with our sleep? And then we'll be going through some conclusions. So welcome to the podcast. It's good to be back. I loved being on last time. It was so much fun.

Social media is such a huge topic. It is huge. And I, full disclosure, I, am on social media. And so I am someone who's both a practitioner. I try to use it to forward some of the good information about mental health, reduced stigma. But let's go through some of the statistics on how much time is spent on social media. Yeah. So I had to do a lot of digging to get these numbers. They're not widely available or widely lauded because... You looked at like the quarterly statement. right? Yeah, I had to go digging into some, like, Facebook financial records. I definitely spent a lot of time on the SEC website.

It was an interesting sojourn into finances that I don't usually do. So let's do it. Yeah. So in the answer to the question, how many people use social media, it's a mind-blowing ridiculous number. There's a company that does kind of statistics and collects data. data about internet usage. And what they found was in their surveys that worldwide, the average time for using social media was about two hours and 15 minutes a day. And in the U.S.

is just under that, about two hours and five minutes. So when I was looking at the different companies, I first wanted to know how many users are on it every day. And so going through the list of Facebook was really up there. 1.59 billion daily active users, which my brain can't even handle that number. Instagram is about 500 million users per day, and YouTube is about 2 billion users per month, and then over about a billion hours of video is collectively watched per day. And we looked at Netflix, which has about 165.9 million. global paid memberships, about 60 million in the U.S.

For some context, I kind of compared that to the population of the U.S. So that's just under 20% of the population has a Netflix account. And about 140 million hours of content per day were watched in 2017. And this is from a Netflix kind of infographic that they released back in the day. We know that binging is going up. It's hard not to binge on some of these shows. What about TikTok? A lot of us older folk might not have heard of TikTok because it's kind of like potentially

the new Instagram. Yeah, it's really growing in younger users. It's basically a video app where you can upload small clips about seven to nine seconds. It's been compared to Vine in some ways. But they have templates that you can use. and recreate and a lot of stickers and bright, colorful things, which are attractive. And it's estimated that they have similar user numbers to Instagram. The company actually hasn't released a user number.

And I looked really hard to try and find it. But one thing they do publish is how many downloads is had on the app store, and that's about 800 million. So maybe similar to Instagram in size. Any other thing on just data on how often people are watching? Benging, using. Well, I think the funniest thing out of the data I found is that there was a Netflix user that watched Pirates of the Caribbean every day for an entire year.

So I just kept running across things like that that just made me really question the necessity of some of these services, even though I'm very guilty of using them. So it was a very interesting deep dive. Yeah, some of the most sort of interesting ones to me are how much it's used in the middle of the night. It's so common for people to like wake up and then they just jump on their phone for like, oh, half an hour, maybe longer or like keep pinching on some Netflix. Yeah, I definitely have had especially adolescent patients that I'll talk to them about their sleep and they'll say, oh, I wake up at like two or three in the morning every night. and then I say, well, what makes it harder for you to go back to sleep? We're like, oh, I was checking Instagram.

And I was like, at 2 a.m., you're checking Instagram. Yeah. But it's just become so widespread. Yeah, yeah. Why don't we actually jump ahead to, is social media really social? Because I think that's a really interesting thing. So is social media branded as social media, but should it be branded as something else? Like, how do people actually use social media?

media. Yeah. So this I thought was one of the most interesting things I looked at. And there are some studies. I think my favorite one was Hall 2018. And they took a group of like 120 college students and they had them use social media for 10 minutes and then they tracked kind of what they did over those 10 minutes and then they filled out a survey about their experience. And I thought the most interesting thing about that is that 75% of those surveyed didn't believe that they had socially interacted during that five to ten minutes of social media use. And then about half of them believe that they do socially interact on social media, but maybe not typically.

And then there are things that we think of as social, like chatting, sending messages, posting wall comments, as opposed to things like passive consumption, which are scrolling. And they found that chatting actually occupied less than 4% of the estimated time that users spent on social media during those monitored time. So I thought that was very interesting. Yeah. I think, I think remember that statistic for later because when we get to like some of the studies

that Facebook sites, that's, that's an interesting piece of information that really only 4% of the time are people actually chatting with another human being, you know, through the Facebook. What about this Hill and Zhang, 2018 article. What did they find? Yeah, so this was one of the more unique studies I found. Their methods

were different than the typical survey method that I was running across. So what they did is they took a collection of 40 images and these images had different things that they would categorize like a Facebook icon or a Twitter icon versus an activity that was social like hanging out with friends, playing game or a solitary activity like hiking. And what they did is they asked their responders to rate the content of the image on desirability, ignoring the aesthetics of the particular image. And they found that those who rated social media icons highly had a higher daily usage rate and those people related to images of solitary activities more highly.

So they picked those things that showed people doing stuff. alone. These people also in their surveys perceived that social media had a higher impact on their daily life and their real life social interactions. So it was very interesting to see their way they associate things has changed. Yeah. The branding is consistent. Their thoughts are consistent with the brand representation. How about this twinge 2019 article? and Twinch kept coming up in our digging. And I hope she can come on a future podcast. What do you find in this one?

Yeah. So a lot of her studies, they use data from different national surveys because there's a big longitudinal database with questions about mental health or how social media use when it came online back in the 2000s. I don't know the exact year, but these national surveys have that kind of data. So this 2019 study was actually taken from the MTF database, which is a nationally representative study of adolescents. It's a survey that's given out in schools to eighth, tenth, and twelfth graders.

And so one of the things they looked at was survey responses to certain questions on the survey itself and they found that when answering if a question represented them or not to the statement, a lot of times I feel lonely. 50% more seniors in high school in 2017 agreed to that statement. They said they agreed or mostly agreed to the statement. A lot of times I feel lonely, 50% more than they did in 2012. Yeah, and so this has been a time where people have, and this age group has had increased suicidality, increased ER visits, increased depression.

So one of the things we're looking at is what is the link between, you know, how people are spending their time? And it's interesting that this group of people feel more lonely. Yeah, and they actually found that the adolescents that were low in, in person, social interactions and high in social media use together, they reported the highest amounts of loneliness. Yeah, it doesn't seem like social media can really replace the value of the in-person interaction. No, I don't think so. But those who were high in social interaction, even if they had high social media use, they didn't report as much loneliness as those who had the low social interaction in person versus the high social media use.

Yeah. So people with high social media use and high in-person interaction are less lonely. Are less lonely. It's the people who don't have the in-person interaction that are more lonely. Okay. Exactly. Let's jump to, you know, these two basic arguments. The first one is that social media is a nothing burger, which is what Facebook is saying,

meaning that, you know, it doesn't really cause harm. It doesn't, you know, lead to depression or suicidality. It's not a big deal. And so on Facebook, I'd heard this before that Facebook had said actually social media was good for you. So I wanted to dig into those articles and make sure I, we were covering all of the evidence, right? So tell me a little bit about what you found there, and we'll have links to this in the resource library. Yeah, so I spent essentially a whole workday. I'm now in my mind calling it Facebook Friday, where I looked and I dig, Doug, and I found all

the studies on social media use and mental health that Facebook had conducted and went through other studies I could find. So one that was not published through Facebook that says that social media had no association with levels of depression is Jelenechek in 2012. So I thought this study was very interesting because they were using something called a PHQ9 as an assessment for in the moment feelings of depression. So, Dr. Peter, do you want to talk a little bit about the PHQ9? Right.

So the PHQ9 is a depression screening tool. And, you know, different surveys are meant for different things. And the PHQ9 was not really created to judge changes in, you know, week to week depression. It was just a screening tool to say, okay, this person might have some symptoms of depression that are concerning. So that would be my first critique of the study. The second is that it's a study of 190, 18 to 23-year-olds, which is pretty small compared to some of the other studies we'll look at. Some of the other studies that were smaller that I looked at tended to be on the experimental side of research, as opposed to the survey side of research, which I thought was really interesting. So if we look at the studies that Facebook has actually conducted through their media analysis and research branch, a lot of the studies have one author named Burke, and they also mention a lot of the times an author named Crout.

And one thing I thought was very interesting. when we get our medical education, we're taught to look into, like, the author and the author associations to make sure that they don't have some kind of incentive to skew the study results. Or conflict of interest, right? Conflict of interest.

Yep. So one thing I thought was very interesting is that Crout was on the thesis board that awarded Burke, her PhD. So, and, one of the studies that is cited by Facebook is actually her thesis for the PhD. So I thought that was quite interesting and just like a little thing to keep in mind. So the interesting thing about this study is that when they looked at how much chatting

with a close friend or a family member on Facebook increased well-being, they found that the correlation, even though positive, was actually pretty small. So the scale that you look at is relative, and it goes from zero to one as the highest. And the correlation that they found was 0.02, which is pretty close to zero. Yeah, pretty close to a nothing burger, which is why we would say this is a nothing burger. Yeah. Okay, so in conclusion, when we looked at the Facebook cited studies, we didn't find that much support. that social media is good for mental health.

And I think further study needs to be done in this area for specifically how people are using social media, like are two different people using social media differently? Because I do think that for a lot of people, social media, can be an important part of, you know, sort of connecting with others. But we're not finding the studies to support that on any meaningful way that it's linked to mental health.

So let's go into the studies that say that it's not good for mental well-being. Yeah. So these tended to be a little bit easier to find. Everyone's, it seems to be a bandwagon that people are jumping onto. But if we look at some of them and how they gather the results, they can be quite interesting. So we have this Primac at all at 2017. And so they compared about 1,800 adults between the ages of 19 and 32, and they counted how many social media platforms they used,

and they separated them into ranges from like zero to two, and had low use and high use. And they found that those who had between 7 and 11 different social media platforms had about three times the odds of reporting that they had increased. levels of depression and similar for anxiety. Yeah. So basic summary of the study was if you have a ton of different platforms, then you're at increased risk of depression, increased odds, three point two times more likely than if you have very, very few like zero to zero to two social media platforms. Okay.

And let's go through the next study, Lynn at all, 2016. So this was another survey study, and they looked at, again, young adults 19 to 32. And they found that when they spent more than 120 minutes a day, so it was two hours on social media, they're almost twice as likely to report higher levels of depression than participants that spent less than 30 minutes a day. And they also found that depression was independently related to the number of visits to social media site per day. So it's not necessarily clear cut as it is only time or this time and how many times you go back to check. In another study of 1,787 adults, 19 to 32-year-olds,

they found that those who used social media were more likely to report higher levels of depression, odds ratio, 1.6. And what was interesting about this one was that to get that odds ratio, they're comparing quartiles. Yeah. So they took all the respondents and they kind of sorted them by amount of time they spent on social media use and divided them into low, medium low, essentially. Four groups. Yeah, four groups. Highest, lowest and the two in between. So the highest group compared to the lowest group had increased rates.

of mental health issues. Mm-hmm. Okay, let's keep going. So daily social media use of more than two hours in adolescence was also independently associated with poor self-ratings of mental health and experiences of high levels

of psychological distress and suicidal ideation. Anything you want to add on this study? That's a pretty good summary. This actually is an older study, which I found interesting. So this results came from 2015. which it'd be interesting to see how the study would be if it was repeated today because it's just a couple years old.

But in social media, that few years it really makes a big difference. And so in another study, this was kind of like a challenge that the social media thing isn't a big deal. Huang at all 2017, it was a meta-analysis of psychological war. being with social media use. And they looked at the linear association between these two things. And they found that the R was only 0.07. Yeah. This study looked at, I want to say, 64 other studies.

And what they did is they took the outcome of the study and they put it on some kind of a grading scale and condense it. down to one number. And so it's interesting because these studies have different outcomes, different sizes of number of people that were in the study, and they're from different locations around the world. And their scales might not have been the same. But they condense the results down a lot.

Yeah, so the .07 is not a huge association. And so one of the things we're going to look at is, you know, model specification. So is the best specification model for social media use a linear relationship? And in this study, they show that there is that association that is statistically significant. It's a small association, 0.07, for the linear relationship. So you're looking at like a line that's like sort of put on the data. But I really think I'm going to jump ahead to this Twinge 2019 study that looked at, and this is a different one than we said before.

And in this study, it seems to be less of a linear relationship and more of a step relationship. And we'll explain that. But tell me the basics of this Twinge study. Yeah. So this is a separate study by Twinge. She apparently does a lot of work very quickly. But essentially they looked at data from SAMHSA, which is the National Mental Health Organization, and they took it from the National Survey on Drug Use and Health.

And so this survey has been going at least for the last 15 to 20 years. They asked similar questions to a range of adults and teenagers. and so this study was looking, well, what is the prevalence of mental health issues now compared to 2005, 2010? So the total number of people included in the study is about 600,000, which is quite large. It's a big study. And, you know, this is a study that's, I think, worth reading because it was really well done and the pictures tell the story better than we can probably do on a podcast.

And what it shows is that there has been increasing psychological distress, suicidality, especially since like, you know, in the last five, ten years, it's been increasing. Yeah, one of the number that I found kind of very poignant was that between 2010, where about 9.1% of adolescents met criteria, according to the survey for major depression, in 2017, that had increased to about 14.8%. And so that's actually a 63% increase in just seven years. In that 12 to 17 year range? From 2010 to 2017.

But specifically in like the high school age? Yeah. So this is adolescence, 12 to 17 year olds. Yeah. You know, and in that prior study, we also know that loneliness has increased 50%. So, you know, in the discussion she talks about, yes, opiates have increased, and mainly in people who are older than 25, but this depression and these mood issues seem to be across the board, all nationalities, all genders in the adolescent group specifically, which isn't something that we're seeing with the opiate epidemic.

So in this twinge article, what you'll see is that the curve really doesn't increase until you get somewhere between three to four hours of social media use or screen time. And so around two hours, it's kind of the bottom of the trough, like one to two hours. And it's a little bit higher, at least in this one, for suicide risk factors and for mental well-being. if you have no social media use, but somewhere around one half hour to two hours, it doesn't seem to increase the risk of, like, mood issues or suicidal risk. But then once you get past the two hours,

there seems to be a, the slope is increasing. And then once you get past four hours, it really increases all of a sudden. So this is what I'm talking about with like a step, stepwise approach and modeling the data in the most accurate way. So if you model this data, it wouldn't be just a linear line. No.

It would be a step down and then, you know, a little step down and then a flat and then a big step up once you reach that's around three to four hour plus range. Yeah. The line would look something like curbs on both sides of the road, you know, sidewalks on both sides of the road. where people who use it very minimally, their risk of suicide is on the lower, like a little bit up. But then you get to one hour, two hours. They seem to be slightly lower. And then about three, four hours, they go back up again.

Right. And at the three, four hours, I mean, the curve is a lot more steep than at the zero to one hours. but what's important to note about this is that when you're looking at studies where they're breaking them into quartiles and you compare the top quartile with the bottom quartile, there's a big jump, right? But if you look at the data altogether and you just create a linear line, then you might get something like the 0.08 like correlation, which is not that big. And so it's all about looking at the data and creating the correct model for how to

to interpret the data, which is something, it's a little bit more of an advanced concept, actually. I learned this as an attending, working with my mentor, my research mentor, Dr. Cashner, where we looked at the data and we're looking at trying to create the best model to fit the data, which is important. So, wow, what an amazing article and really helpful to see the big picture. I'm not 100% linking the increase in suicidality and depression to screen use, but I think screen use might be a part of it. And when people are using screens,

they're not doing things that they used to do like interact face-to-face. And we know that sports, religious activities in this one study, in-person interactions actually decreased risk. of things like depression and suicidality. So it seems like as there's been an increase in the use of more solitary things, there's been a decrease in more of the group activities in face-to-face in human activities. Yeah, there's actually an interesting study from Hall, Johnson, and Ross in 2019. And it was essentially a challenge to their about 180 participants.

And they logged their time throughout the day. And then they were also assigned a period of time where they could not use social media, like a week, two weeks. And what they found was when people were restricted from using social media, that they spent significantly more time doing other things. Admittedly, the first thing was browsing the internet, which is not too much different. but the second was working, things like caring for children, cooking, cleaning, those all were increased. Yeah. There was a good Nature article that I'll put in the research library.

I'll just briefly mention they were thinking about, you know, why is it that there might be this link between social media and mental health, especially in the adolescence. And they go through talking about how the brain is really developing during that time period and how the brain might be more sensitive to things like acceptance and reputation and impression management and, you know, being bullied and stuff like that. So there's theories on why there might be this link in that. I'll put that article there. Yeah.

And childhood exposure has been studied as well. The American Society of Pediatrics has this document with recommendations for pediatricians where they recommend, oh, you should get this much exercise a day and you should do this amount of things a day just as health recommendations. And screen time is actually pretty prominently featured. And it's actually one of the things that we're taught very early on in our pediatric's rotation in medical school right now because they've been seeing kids who have a large amount of screen time, their attention spans are much worse and they have trouble focusing things on things

that aren't screens. So it's actually one of the things that pediatricians will recommend to parents is to decrease screen time. Yeah. So is social media really social? We talked about that. We talked about social media overall.

Like it seems to be that once you get into those, you know, three to four hour range, there's an increase in the risk of different mental health issues. And now we're going to talk about screen time and how it interferes with sleep. And sleep is such a huge component of mood, just in general. Yeah, so if you were to summarize all of these articles and about screen time and sleep, what would be the big statement coming out of it?

The big statement would be using bright screens at night, makes it harder to fall asleep, harder to stay asleep, and you get less sleep. The interesting part when I was reading these is that people who use, their phones in bed and during the middle of the night were more likely to be heavier, have large waist circumference, and higher BMIs. Yeah, that's actually one really cool study. It's whips at all 2019, and they took a bunch of college students, and they actually did all these weight metrics, like waste, BMI, at the beginning of a semester, and then

they had them fill out surveys, do you use your phone in bed? you use it for like games, social media, et cetera. And then that's, and then they measured after a semester and found that they were heavier, had larger waist circumference and higher BMI. So they actually tracked these students over a semester with their weight metrics. And, you know, this makes sense to me because, you know, if you're not sleeping as well, you're going to have higher cortisol, you're going to have higher stress hormones. it's just harder to lose weight if you're stressed all the time.

Yeah. And I'm sure that playing games in bed at 1 a.m tends to lead to things like eating goldfish at 1 a.m. That's also a really good point, yeah. Yeah. Several of my friends in college are guilty of that. Oh, man. Okay, so anything else from these sleep studies that kind of jump out at you that you want to mention? Yeah.

So I thought this Lamola at all 2015 study was very relevant. And so they tracked adolescents with media use and related to how long they slept, any difficulty with sleeping and depressive symptoms. And they were able to find that teens that owned a smartphone and used it before bed had more difficulty falling asleep. It was correlated with increased depressive symptoms. Yeah. Yeah, that was really interesting.

And so in summary, make sure you screen your patients for, you know, how much they're using their screens in the middle of the night. I also think about sleep association. It's a big thing I want to screen for. It's like as you go to bed and you're sort of starting to drift off, what are you doing? if you are watching TV and you wake up in the middle of the night and you need to turn on the TV again to get that sleep association again to then go back to sleep. So how people fall asleep, it takes a couple, it takes about four or five days to change the sleep associations. But once you change those sleep associations, you'll have an easier time not waking up in the middle of the night and needing your phone to fall asleep again. So, like, if the only way for you to fall asleep is to scroll through Instagram or Facebook,

then when you wake up in those lighter stages of sleep, like, you may need to scroll through Facebook or Instagram to once again, like, lure your brain back to sleep, right? Because you have that behavioral cue that says, I want to fall asleep. I'm going to do what I did to fall asleep earlier, which is scroll. Yeah. Oh, man. Occasionally guilty. Okay.

So our conclusions, how you use your social media matters. I think that's one of my conclusions. Yeah. So if you're using it to actually be social, to connect with people, post on walls, chat, it's not as bad as just scrolling through, and it's actually quite positive experience. I've read some of the comments on your Instagram post, and it's a very lively and prolific discussion. Yeah, I think it's really important. I think if you're a professional having an Instagram can be a good thing.

Just, you know, people's attention is on social media. And but think about how to use your Instagram. You know, like are you mindlessly scrolling for hours? Probably not very helpful. Specifically, how much screen time creates a negative impact. We know that somewhere around greater than two hours a day, it's going to start to impair things. Oh, yeah. And one of the things to keep in mind is this is not work-related screen time.

So this is on your own looking at Facebook, looking at Instagram, just scrolling. One of the interesting things I dug up was that there's actually a proposed term for the anxiety associated with leaving your phone behind. I have this. I'm very guilty. It's called nomophobia. and no mobile phobia, I thought that was the funniest thing and I suffered from that. And the other was something called telepressure, which is the pressure that people feel

to respond to messages or text or calls immediately. Oh, yeah. Yeah. And I thought that was, it's interesting how it's kind of changing changing language and culture with it as well. Yeah, and coming back to like, okay, how do I use social media? Well, I usually post something about the podcast, engage questions, respond to comments.

If people who are patients send me messages and want me to solve their mental health issues, I've created a sort of a standard response with some suicide hotline numbers. you know, realizing that I cannot treat someone over social media. And I've only seen that pick up as my social media sort of popularity has picked up. So I don't think most of you would have that very much if you had a social media. But, you know, whether you think it's the greatest evil or not, I don't think it's the greatest evil. I think there's issues when the numbers get up beyond two hours. and they stop things like exercising,

stop things like doing maybe groups like spiritual groups or other group settings where you're interacting with people face-to-face, talking with people. When it gets in the way of those things, I think there's an issue. Yeah, an example from my own life is that Facebook is often used for class communications,

especially medical school, because we're all spread out between different clinical sites. So announcements get published. posted there a lot. And it's a good way to reach people quickly because some of our classmates may be guilty of not checking their email, but need to get a flu shot. So our class president will post, hey, flu shot clinic is today, which has actually been very, very useful as opposed to which I am guilty of this, scrolling through dog videos on Facebook. Yeah. And maybe that's like, I think one of my personal thoughts is I think people can start to idealize.

like this persona or this person on Instagram, which is not a real person. It's there's there's lots of famous people who do a lot of photoshopping. They do a lot of very staged pictures. And it can be, it can kind of get into your brain, you know. Jealousy and envy is there for a reason. It's there because like, you know, 10,000 years ago, if you didn't have that and you look, you didn't observe what your neighbor was doing, you might not be able to survive as well.

And so we're constantly looking at those who seem to be successful and we're trying to figure out, you know, are they doing something different than us? And the problem with social media is that so much of that can be fabricated or sort of, you know, branding and it's not like the real person.

So I think like we idealize people and we idealize actors, not based, on what they've really done, but based on very good branding. And our brains may not be able to discern the difference. Yeah. Actually, one of the things I found when I was looking through Instagram financial type stuff investor relations is that how they suggest that companies interact with

Instagram is that they find these micro-influencers. So they find people who have 50,000 to 100,000 followers and get them to promote their products. And that's actually had the most success for advertising. And that's been, I mean, it's been huge. Literally brands have been created in the past 10 years over micro-influencers and over YouTube influencers. And how we make our decisions nowadays. is if I'm going to buy something, I look on YouTube,

look at reviews, you know, look on different social media things, Google it, you know, and so like the way that we make our decisions is largely based on, you know,

kind of looking at what other people's opinions are of this product, right? Reviews and such like that. And I think as our generation is sort of getting more adept, we're becoming, we're becoming critics of the reviews and we can kind of spot when something is sponsored or something is like some bias in it.

Yeah. And so the comment section of the YouTube video becomes the place where it's like the review of the review, you know, where you kind of judge if the review is good. Yeah. I've seen this a lot on Amazon reviews. I've actually seen tutorials on how to tell that Amazon review is a real review or not.

And this is actually a culture where it's like, hey, we will pay you to promote our product on your verified user account. So that has been trending like the last couple of years. Yeah. It's the same for like, you know, how do you tell if someone's real on social media or not? You know, and interestingly, I had this one patient who said he started dating a girl. And once you found out that he wasn't on social media. media, she wouldn't date him anymore. Well, that's interesting.

Because she wasn't able to look at the social proof. She wasn't able to see his friend networks. And also an interesting thing I've heard from someone is like, they'll notice when someone stops liking their pictures. Sorry, that's really funny. And they'll notice also how the people in their friend group are liking other people's pictures, but not their pictures. Yeah.

And so it's kind of become like this. new way of socially interacting that. I think we should pay a little bit of attention to and have a little bit of curiosity about it. Yeah, we put so much weight into those likes that it's very interesting to me. It's also like the weight and the likes, it kind of teaches people over time

like what kind of peacock feathers they need to present. Yeah, what kind of content to post. Right. And, you know, some of that stuff just burns me out after a while. Like, I'm just like, I'm just going to post whatever I want. But I guess in summary, the answer to the question is, are people real on social media? The answer is no, generally.

Most of the time, no. But I would say that there's like a movement with people trying to be probably more real. But even then, it's like you're looking at the happiest picture of this family that they've ever had in the past year. And sometimes it's staged. And sometimes there's like bribes of candy afterwards if the kids smile. That sounds like experience speaking. And I guess, like, the way I kind of look at it is social media is like the social fact you see of someone in person. You're never going to know the whole story.

It's just a facet, you know. Right. Yeah. It's just a part of them. Like, I think it's like, yeah, that's a really good point. Yeah. Because I think you'd know me better if you met me in person and, you know, heard my podcast episodes or, knew my social media because you would know more about me what I'm passionate about.

Yeah. That's actually how I became interested in working with you. I met you in person. You gave a lecture for our class. Okay. And then you found me on Instagram. I found you on Instagram? Yes, you did.

I have proof. That's interesting. So yeah, there you go. How did I find you on Instagram? What's the proof? You DMed me about one of my drawings. Yeah. I saw one of your drawings.

I was impressed. And then I was like, I think I realized you were local. And I was like, yeah, you're like, wait, this person is one of the students at Loma Linda. Yeah.

Yeah. And but we had met in person before that. Right. So in summary, social media can both be connecting, but I think a lot of times it takes away from the in-person interaction, which is so important.

And if you're seeing patients, you know, be curious about how many hours a day they're actually spending on social media, what are they doing with their time on social media? I think it's different if someone's launching a business versus just mindlessly scrolling out of boredom. Are their friends real friends? Are they not real friends? I have some doubts about the way my cousins use Snapchat, my younger cousins. Oh dear. And, you know, is it just pure entertainment or are they actually connecting

with other human beings? And so I would like to see more studies in the future on how people are actually using social media, how people who are really suicidal, for example, are using it, like what they actually are doing on social media. I think that would be really interesting. Yeah, and it's really hard to find that kind of information. So it'll be a challenge to study it, but someone's going to do it soon and I really want to see the results. Cool. Well, we will leave it there for today. Thank you so much for coming on. I'll always a joy. And we'll leave all these in the resource library a lot of more notes than you. probably would like.

Definitely more notes. But if you're preparing for some presentation, then it'll get you at least 50 or 60% of the way ahead of maybe where you would have started otherwise. Yeah, it definitely will show you where the beginning of the rabbit hole is. That's good. All right. We'll leave it there.