UF expert tackles youth mental health

A recent U.S. Surgeon General’s report on youth mental health in America revealed depression and anxiety symptoms doubled during the COVID-19 pandemic.

In an interview with Dr. Michael Shapiro, a UF Health child psychiatrist, he points to both the isolation caused by the pandemic and social media as two main factors facing youth mental health and ways this generation can battle daily stress. The interview has been edited for length and clarity.

Question: What effect has social media had on youth?

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Shapiro: I do want to say that some kids find [social media] very helpful. I think it depends on how it’s used. When it's used to make connections to other people, and to feel understood by others, and to actually keep in touch, it seems to be helpful.

When it is used to compare yourself to others or when you end up feeling socially isolated, or excluded, because you're seeing what other people are doing without you, that can make someone more likely to experience depression, low self esteem, and body image issues.

Q: Do youth have trouble disconnecting from the fantasy world that social media presents?

Shapiro: I think they find it very difficult. It's probably worse since COVID, but it was bad before COVID anyway. But if you think about what happened with COVID, this is like their only way to socially interact with people. So when they were quarantining, it was either this or nothing, and social interactions and peer relationships are most important, primarily to early adolescents and teenagers. I think sometimes just telling them to unplug to them feels like, well, just don't have any friends.

Now, what I actually talk to them about is sometimes it is OK to not provide instant gratification. Unfortunately, I think they were all sort of used to it, that if their friend reaches out to text them, there's this pressure to respond immediately, and if they don't, then they risk possibly hurting somebody's feelings or they think that they're a bad friend, but they almost all feel that way. So it doesn't seem like sometimes they know how to negotiate the “I'm busy right now,” or “I need time to myself and I can't be at everyone else's immediate disposal,” otherwise they think they're being selfish.

Part of the other thing that I find with social media is because all of their actions and conversations are sort of public, that reinforces the pressure to appear almost saintly or perfect. And they're on display, so they always have to be on their best behavior or show up for their friends, and that's not psychologically helpful. Being an adolescent, according to psychological theory, is a time where no one expects you to be perfect. You're supposed to explore your identity or sometimes do stuff that people don't want you to do.

UF Health child psychiatrist Dr. Michael Shapiro

There's a psychologist named Erik Erikson, who developed this theory about stages of psychosocial development, and the one for teenagers is identity formation. He came up with this idea that adolescence is supposed to sort of be a moratorium on facing severe real consequences for minor experimenting when you're a teenager.

What happens is when your minor experimenting is on social media and everybody sees it, and everybody shames you for it, it can feel very real and permanent. Or there's so much pressure to not be a real human being with faults and imperfections, that the person that you are displaying on social media is a fake version of you, in which case, whatever connections you make to other people don't feel particularly of a good quality because they're not connecting to a real part of you.

There's a lot of pressure to sort of maintain this version of yourself that's constantly on display instead of a version of yourself that you explore privately, with limited consequences, so that when you're adults, you sort of know yourself better. But there's a lot of consequences nowadays when all of your thoughts and feelings and behaviors are visible to everybody else, and I don't think that's the healthiest way to grow up.

Q: Should comments posted when you are young be used against you years later as an adult?

Shapiro: When you’re 14 years old, you don’t need the same level of scrutiny as people running for public office, but that’s basically what happens. It’s really an excess amount of scrutiny that’s disproportionate to what the developmental task is.

They've done research on cyber bullying and the issue with bullying is that bullying is perceived as the most harmful when it is public and anonymous. Technically it's not being online that does make it necessarily worse, but it is much easier to have public anonymous bullying that's online. It's just the easiest forum for sort of public humiliation without any recourse. If it's anonymous, they can't go tell somebody all the time to get them in trouble and because they can just pop up a new screen name or whatever. So there are a lot of psychological detrimental things that happen in these social online communities that, if you're not aware of them, can be very harmful.

Now I will also say that I've had lots of patients feel like sometimes social media can be useful to validate their experience of having a mental illness. Other kids find that not helpful. But at least some feel that if there are other people going through what they're going through, that provides some sort of hope or optimism that they can make it. That's helpful and some kids use social media for that.

Q: Have you felt like there are certain social media platforms that are more detrimental than others?

Shapiro: I don’t know if I have enough information to comment. To be honest, it seems to be more by age bracket. Certain formats are more popular among others in certain age brackets.

It’s Facebook for my generation, which, by the way, I got off Facebook many years ago because it was also making me unhappy.

That's another thing, going back to the idea of a moratorium and not having permanent consequences for stuff you do, it is also normal development to be able to grow and move past some of your own past. It's not always helpful to be constantly reminded of bad things, or things that you feel like are bad, like former relationships. Part of the trouble is that when you're on social media, it's just constantly reminding you of things that you might prefer to distance yourself from. Sometimes it's stuff you just want to forget and move on from, but social media doesn't want you to do that because it'll remind you, “Hey, this is what was going on a year ago,” and you didn't really want that memory.

Q: What can youth do to help themselves in this high tech culture?

Shapiro: I remember growing up without a cellphone or social media. Now I clearly have a cellphone and I have an online calendar that I could not function without, so I feel like I can straddle both ends of not having a cellphone and being totally reliant on one and that sort of allows me to connect with kids a little bit. Sometimes I tell them I think it's helpful to remember what it was like when I was your age: If my friend wanted to call me and I wasn't home, the phone rang and nothing happened, and there was a lot less pressure to be immediately available. It was OK to not call someone or text someone in the middle of the night. They don't necessarily know what you're doing.

That's what I meant about being under so much scrutiny. Just because you have more information does not mean that it is crucial information, but our brains are not yet adapted to how much information is available at our fingertips digitally and what to do about it. I think this also applies to parents who have all the apps that allow them to track where their kids are.

Feeling like if my friend reaches out to me I'm obligated to respond, that did not exist when I was their age because there was no means to do it, and they just might not have known what I was doing. So just the fact that social media exists now, it's like if a kid wants to post what they're doing, then all their other friends know, and then they can be like, “Oh, that's what you were doing instead of returning my message?”

Ideally, I wish kids actually had more freedom from scrutiny to make their own decisions and not feel like someone else is always watching them and going to be disappointed with them. I don't think that's very helpful or realistic. So sometimes I do try to tell them you might just have to turn your phone off or imagine you're in the bathroom, or imagine you're in the movies. There are times where it is acceptable to not be on your phone. And you might have to pretend like that, to not feel guilty that you're not responding right away to somebody else.

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