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Read the AMA’s latest policy on social media and its impact on mental health.
In this episode, AMA Chief Experience Officer Todd Unger talks with best-selling author Jonathan Haidt, PhD, about his latest book, “The Anxious Generation,” including the pivotal role physicians can play in addressing the impact of social media on children’s mental health. For more about “The Anxious Generation,” visit: anxiousgeneration.com.
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Speaker
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Jonathan Haidt, PhD, New York Times best-selling author, “The Anxious Generation”
Transcript
Haidt: Right now, I think we're seeing the greatest destruction of human capital and potential in human history outside of the two world wars, because this is happening on a vast scale. Young people have basically given up all their attention to a few companies.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have a special AMA Update with Jonathan Haidt, best-selling author and Thomas Cooley professor of ethical leadership at the NYU Stern School of Business in New York. He's here today to discuss his newest book, "The Anxious Generation—How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness". He'll also talk about the important role that physicians and the medical community can play in addressing and even reversing this epidemic.
I'm Todd Unger, AMA's chief experience officer in Chicago. Professor Haidt, thank you so much for joining us today.
Haidt: What a pleasure. It's a great honor and I'm just thrilled to be able to talk to the medical community. What we're going through is, well, we need your help. We need doctors on board advising parents about what's going on.
Unger: Well, your book really hit home with me as the father of two Gen Z daughters. I could really relate to it on a personal level, as I'm sure so many people in our audience will as well. Professor Haidt, we talked a lot on the AMA Update about the dramatic increase in depression, anxiety and suicide among young people, but it's really been with a pandemic as a backdrop. But in your book, "The Anxious Generation," you identify something else that was happening before the pandemic, and you call it the great rewiring of childhood. Talk to us about that?
Haidt: Sure. So, in 2019, when I really started this project, it was clear something terrible was happening. This was pre-COVID. My previous book was called "The Coddling of the American Mind," and it was about how we've been overprotecting our kids for a long time. They don't become anti-fragile. They become fragile. They don't develop independence. They're still dependent when they arrive at universities.
So I was already looking at how over-supervision, the loss of play was leading to an increase in depression, anxiety. But there was something else going on. As I gathered all the data I could, I gathered all the studies, I gathered all the graphs of mental health trends, something amazing came out of it.
Jean Twenge, the other social psychologist, had already shown these sort of hockey stick-shaped curves. If you graph out levels of anxiety, depression especially, anything internalizing disorders, anxiety, depression, what you find is that rates for teenagers were actually very stable from the late '90s all the way through 2010 or 2011. There was no sign of a problem. And all of a sudden in 2012, someone turns on a light switch and the numbers go shooting up, the rates, especially for girls, the rates anywhere from 50% to 100% increases depending on what measures you're using. So that was already known from Jean Twenge's work around 2017. She came out with that.
But what I began to discover is that the same thing was happening in the UK, Canada, Australia. It's happening in Scandinavia, and it all points to something around 2012, plus or minus a couple of years. Now, you never see that. I mean, that would seem to indicate either somebody released a chemical in the air in that year that somehow interfered with child development or something happened that changed childhood around the world.
And so that's where I really began focusing on what were their digital habits? How was childhood changing? And when you put it all together, what you see is the early internet in the '90s was marvelous, wonderful, amazing. Millennials grew up using it. Their mental health was fine.
But it really changed between 2010 and 2015. This is the great rewiring. In 2010, hardly anyone had a smartphone. Teenagers—it was just coming in, but they all had flip phones mostly. There was no Instagram. There was no front-facing camera. Most people didn't have high speed internet. So you could not spend 10 hours a day on your flip phone.
Teens would use it to connect, and that's good. They can contact their friends. They meet up. That's great. That's 2010. 2015, everything's different. Now the great majority have a smartphone, not a flip phone. They have high speed internet with unlimited data plans. They have a front-facing camera. The girls especially are all on Instagram. And now they're not getting together anymore.
The numbers that we now have are about 8 to 10 hours a day is what they spend on screens just for entertainment. We're not talking school or schoolwork. And half of all of our teenagers say that they are online almost all the time, which means they're not spending time with other kids. They're not putting their arm around other kids. They're not laughing with other kids. They're doing this all day long.
And so I tried to put all that together in the book to convey this was not a gradual thing. Something was transformed around 2012 and is hitting us all over the world. Teens, especially girls, are checking into psychiatric emergency wards. And we've got to roll this back.
Unger: Now, I think a lot of people kind of forget that quick rollout of all those technologies that you just talked about and what the kind of accumulative impact has been. And you mention kind of some of the harms that have been caused by that combination there. Talk to us a little bit about the four ways that you outline in the book that have translated into really affecting this generation.
Haidt: Yeah, so I made a long list of all the harms that I could find, all the studies that pointed to various harms. And I realized some are particular to girls, some are particular to boys. But there are four that are hitting everyone. Once you move from a play-based childhood based in the real world with experience to a phone-based childhood where almost everything is just looking at your screen, four big things happen to everyone, boys and girls.
So the first is sleep deprivation. It's that simple. I mean, we all know if you take half an hour of sleep a night away from kids, there's a long-term effect of that. And a lot of kids, the heavy users—we got to remember about 5% to 12% of girls have what's called problematic use of social media. 5% to 12%, something like that, of boys have problematic use of video games. And I can't get a clear number for porn. It's probably in the same ballpark.
So even if most kids aren't being harmed, 5% to 12% is a lot to have their lives taken over by this. So for the heavy users, it interferes with sleep. Actually, for a lot of them it interferes with sleep. That's one. And that's just so basic. We've got to stop that.
So you can definitely advise your patients, no screens in the bedroom. When you and I were kids, most families had a rule you can't have a television in a kid's bedroom. That would be crazy. But now they have everything in their bedroom. So, sleep deprivation.
The other is possibly the most important of all in terms of widespread effects. That's social deprivation. It used to be that teenagers spent a lot of time with their friends. And there's the American Time Use Survey, where we can chart out how much time people spend with their friends or eating or sleeping. We got really good data on that in the United States. And what you see is that teenagers used to spend two hours a day with their friends, on average, while older people spent like 45 minutes because we're married, we're busy.
Well, guess what happens as soon as you get the great rewiring, as soon as they get smartphones and social media? Time with friends plummets, plummets before COVID. In fact, when COVID comes in and you got the lockdowns, you barely see any acceleration of the decline because Gen Z was social distancing since 2012. They began social distancing as soon as they got their smartphones.
And we all know, and the Surgeon General has been so eloquent on this, loneliness is a killer. Loneliness is more deadly than cigarettes in some studies. So our kids are so lonely. Gen Z is the most connected generation in history, which means they're not spending time with other human beings. They are so lonely.
The third harm is attention fragmentation. And that is imagine if you never went four minutes without interruption. Imagine what life would be like. It's hard to imagine. Although, we older people, we're getting there with group texts and texts coming in. But imagine if from the time you were nine, when you got your first smartphone and you start going on social media—your friends and strangers are messaging you and you have to respond.
So the inability to pay attention is really devastating for cognitive development and for academics. School achievement is declining around the world, not since COVID, since 2012. So we're getting sicker and stupider, frankly. This is true across the developed world. So attention fragmentation is the third harm.
And the fourth harm is addiction, which I already mentioned. There's a debate, is it truly addiction? Well, if gambling is an addiction—gambling is a behavioral addiction. And if you're willing to say that some people have compulsive gambling. They ruin their fortunes. They ruin their family. They can't stop—well, guess what? Social media was literally designed to copy slot machines. The thing where you pull down, it kind of bounces up? That was literally taken from slot machines as a design feature.
So these things are designed to be addictive. They've been under refinement in the addiction labs of Meta and other companies. They're very good at what they do. And 5% to 15% of our kids are, I think, truly addicted in ways that are severely damaging their development.
Unger: So what you've outlined in the book is this combination of, we'll call it over protection in the real world and under protection in the online world. You said maybe no TV in the bedroom, but they still have access to everything. Talk to us a little bit about the dangerousness of that combination?
Haidt: Yeah, so all mammals play, and they play a lot. And human children play a lot. And humans are really playful all the way up through their teen years. Even in their 20s, young people are very playful. And it's not a luxury. It's like you have to play to wire up the brain. And so, kids should be out playing in the real world. The healthiest kind of play research seems to show is unsupervised free play, mixed age groups. You have to play different roles. You have to work out the conflicts. You learn to work things out.
That's the healthiest for social and physical development. And when everything moves onto the online platforms, now there's no movement, just one finger. We're starting to get neck problems. Myopia is surging around the world because young people, they're supposed to get sunlight. They're supposed to have long visions through the forest, across a field. But there's much less time outdoors, much less time in nature, much less sunlight getting into their eyes and on their skin.
And so it's affecting development in a lot of ways. What I came to see in writing the book, I thought it was going to originally be a book about social media harming girls because that's where the evidence is clearest. But as I tried to tell the story and as I tried to figure out the parallel story for boys, I realized it's not just girls on social media, boys on video games and porn.
Normal, healthy human childhood, which we evolved for and which we've had more or less for 50 million years as long as however far back mammals go, it's that ending in a very short period of time. And part of why it ended is that in the 1990s, Americans—it began in the '80s—we freaked out about child abduction. It's extremely rare, but we saw more stories about it on the news. And many people remember the milk cartons, the pictures on milk cartons of missing kids.
So we freaked out about child abduction. We stopped letting our kids out. We didn't trust our neighbors anymore. And this was really in the '90s when this really happens. But guess what? Oh, we have a PC and we have a modem. And here, kid, you can go explore the virtual world.
And at first, it was marvelous. The early internet was amazing. And again, Millennials loved it and they came out fine. And so this is why we were fooled. Most of us were techno optimists. We thought the internet is amazing. And I still think that, I love the internet.
The internet is amazing. It's good for kids, we thought. Well, maybe the early internet was. But now after time, everything gets corrupted. Sexual predators, extortion rings, just all—I mean, the idea that our children are in communication with strangers around the world, that we have no idea, we can't monitor it even, is completely insane.
So my point is, we have vastly overprotected our kids in the real world where they need a lot more experience. We need to send them out. And we vastly under-protected them in the virtual world, which has zero safeguards. Zero. The government has said companies are not responsible for age verification and you can't sue them. If they show your daughter a lot of suicide stuff, what can we say? Section 230, they can show whatever they want.
So again, we're in a completely unbelievable situation regarding the threats to our children from the online world when they'd be much safer if we sent them out to play unsupervised.
Unger: So you have this huge disruption to the play-based childhood being substituted through this phone-based childhood. And it's clear from the statistics that you point out in the book that there has been a lot of damage. What can we do to help the young people who have been affected? And is that a different set of steps than to prevent this from those going forward?
Haidt: Yeah. So an ounce of prevention is worth a pound of cure. And for parents whose kids are still in elementary school, it's so easy what to do. You just have to delay entry. Don't get into the game of, 'Well, we gave them a phone. But we put on these controls and he got around the controls.' So delay is the only way.
Delay when they get a smartphone. Delay that till high school. No kid before high school should have a smartphone. Give them a flip phone. And delay when they get on social media at least to 16. So, it's easy for the younger kids.
Now, what do we do for the older Gen Z? My kids are 14 and 18. What do we do for the kids who had phones and been on social media? What I'm finding, because I teach a course at NYU, at Stern, in the business school, I teach a course called Flourishing. And it's 35 undergraduate students. They're mostly sophomores, about 19-years-old. And most of them have real problems with their phone.
One student in my class was using just TikTok with six hours a day. Just TikTok. Just TikTok. Imagine six hours a day of 15 second videos. There's no time for anything else. And the things it does to the reinforcement system, the dopamine neurons. I mean, so a lot of them are having trouble.
And it's very hard to fix this by yourself. Like, what are you going to do? Say, I'm going to get off social media and then I'm alone? But if you do it in a small group, then it's actually much easier. And so what I found from teaching this course for a number of years now is the most essential first step is young people, they have to regain their attention.
Most of them have given away all of their attention. They never have a moment to think, to reflect, to daydream, because they have to be consuming content all day long. Again, half of all teens say they're online almost constantly, almost every minute. iPhones are waterproof now. I'm told that actually some kids take it into the shower so you can keep swiping while you're in the shower. Imagine never having a moment to think.
So there's no hope if that's the way your life is. You're not going to amount to much and you're at much higher risk for anxiety and just social dysfunction. So that's the first thing, is I say let's turn off almost all your notifications. I get them to see that their attention is the most precious resource they have and they can't get more of it.
So who are you going to give it away to? You going to give away to every company that pings you 20 times a day? So regain control your attention. Get social media off of your phone. If you need it on your computer, for starters, do that. And eventually, some of them get off entirely.
Once they regain 3 to 5 hours a day of time, now there's room to do things like more exercise or going out with friends more or practicing their social skills. A lot of them are very shy. A funny thing about Gen Z is that a lot of them are very afraid to make a phone call because that's live. That's awkward. They're used to texting, which is asynchronous. So they know that they need to practice their skills.
So anyway, my point is, if you went through puberty with a phone-based childhood, it probably changed your brain. That's what sensitive periods are. Puberty is massive, rapid brain rewiring. It probably change your brain. But if you work on it in your early 20s, your brain is still plastic enough that I think—we get amazing results in the class, so there definitely is hope. But if you don't do anything, if you just continue on spending five hours a day on social media, I think you're going to be less than you would have been.
And right now, I think we're seeing the greatest destruction of human capital and potential in human history outside of the two world wars, because this is happening on a vast scale. Young people have basically given up all their attention to a few companies. Meta and TikTok and then Google and YouTube, they largely own almost all young people. I don't know about almost all, but more than half of their conscious attention, something like that, something in that ballpark. So that has to change.
Unger: Professor Haidt, not surprisingly, physicians are seeing the impact of this mental health epidemic. And with a shortage of specialists, a lot of pediatricians and primary care physicians have had to deal with increasingly complex mental health issues. How can physicians better screen for or address the negative impacts of social media during routine visits? It's not like there's a lot of time in these visits. What advice do you have for them?
Haidt: Well, first, I mean, the biggest impact you could have—again, prevention is so much more powerful here than therapy or cure. The biggest impact you could have is to speak up. If the AMA, the American Association of Pediatrics, speak up about this. You know, do your internal research. I'll help you. I'll point you to the research.
Make a statement that kids just should not be doing this. They should not be on social media. They should not be having a phone-based childhood. So making public statements.
If doctors get on board here. The Surgeon General has been fantastic here. If the AMA and individual doctors would back him up and say, look, what we're seeing tells us the Surgeon General is right, that's the most important thing for the country. Now, as for your individual practices, I think it's very important to talk to the parents about the habits—talk to the parents and the kids, young people about their digital habits.
Addicts will lie. So if a boy has a porn addiction, he's not going to tell you. Now, the parents might not know. But if a boy has a video game addiction, the parents will know. They'll know that he's spending five, six hours a day on video games. That has to stop.
There's no way to go through adolescence five hours a day of video games. I shouldn't say no way, but there are going to be effects and they're going to be limiting or reducing. So first, you have to get a handle on their digital consumption and digital addictions, or at least problematic use. I wouldn't even focus so much on content. What are you watching is important. But I would especially look for what's taking up your time. If there's anything that is taking up three, four hours a day like YouTube videos or anything else, even if they're nice videos, that's a real problem.
Conversely, what's their activity level? Are they playing sports? Are they having time in person with their friends? You want to look, to what extent does this kid have a play-based childhood versus a phone-based childhood? And if it's phone-based, I would urge you to talk with the parents and the kid to try to cultivate healthier habits and to as much as possible delay the phone-based childhood.
Give the brain a chance to wire up. Early puberty is so sensitive, so delicate, so important. We can't give early puberty to random strangers on TikTok.
Unger: Now, we've talked a lot about the harms of social media potentially for young people. But what about the positive side of this? Do you have any kind of guidance to have a more positive relationship with social media?
Haidt: Yeah, I keep hearing about the benefits, but no one can really tell me what they are. That is, they say, 'Well, it makes them feel more connected.' Well, yes, it does that by taking all of their attention and decimating their in-person contact. So the more connected a kid is, especially it's more of a groupish thing. The more connected a generation group is, the lonelier they're going to be if they're connected through addiction-based, algorithm-driven platforms.
So I don't buy for a moment that it actually makes them more connected. It gives them very low quality connections. Imagine having low quality connections to 1,000 people versus high quality connections to three people. Which kid is healthier? So I don't believe that.
Oh, and then 'Oh, it helps them find information.' Really, Google couldn't do that? You have to have an algorithm-driven addiction design thing to give you content? What's another one that they say? Those are some of the main ones.
So if we're talking about 18-year-olds or 21-year-olds, we adults, we can use these platforms for our purposes. I'm on Twitter because it's useful to me. I can network on Twitter.
When my son was 12, he had no need to network. He had no need to talk to strangers. He had no need to communicate with his friends through, again, an algorithm-driven platform. Let him call them up and talk on the phone and get together. So I really don't buy it.
I have to go through so much to prove the harms. And people say, "Oh well, you can't prove it." It's correlation, not causation. So, I'm going through so much to prove the harms. But on the benefit side, people just say well, it makes them more creative, it makes them more connected. Like no, it doesn't. Show me the evidence that Gen Z is more creative.
Unger: Not surprisingly, Professor Haidt, you see this as more than a book. You see your work as part of a movement that's very, very important. When you see states starting to make changes, or yesterday a big article in the Washington Post outlining some of these regulations that are changing, do you feel like your message is getting traction?
Haidt: Oh my goodness, yes. It's been so wonderful to see that the world was ready for change. I just happen to be very lucky in my timing. The world was ready for change. All over the developed world, family life has become a fight over screen time. Everyone hates it. Everyone could see something was wrong.
We could all see an 11-year-old kid, a girl will go off to her bedroom and not come out for hours. You don't know what she was doing there. You don't know who she was talking to. Something's wrong. Everybody could see this.
And what's especially exciting is in red states, they could see this and their governors are acting. In blue states, they could see this and their governors are acting. In Congress, they can see this and there's bipartisan support for the Kids Online Safety Act and the new versions of it. So, I'm actually absolutely thrilled at what's happening because it's not just here. Same thing is happening in the UK, Australia. There's movement in a lot of other European countries and Brazil.
So this is a global rebellion against these 3 or 4 companies that have somehow taken our children's attention and childhood and they won't give it back. And so, we have to have age gating. We have to work together. If we act collectively—I think the key to the success of my book was I didn't just—as you can see, I'm pretty gloomy about what's happened. But it wasn't just a gloom and doom book, because part four of the book, the last part is no matter what's happened so far, we actually can fix it.
We can get out. It doesn't cost any money. We just have to do four norms. With four norms, we can escape, because we have to do it collectively. The reason that everybody gives their 10 or 11-year-old a smartphone is because everybody else gave them a smartphone and we don't want our kid to be left out. So with four norms, we can roll this back.
Norm number one, no smartphone before high school. Norm number two, no social media before 16. Norm number three, phone-free schools. And that's happening very rapidly across the country and around the world. And number four, far more independence, free play and responsibility in the real world.
And that's really crucial because if we're going to take the phones away and delay so that 10-year-olds aren't spending 10 hours a day on their phone, what are they going to do? We have to give them back a real childhood in the real world. Oh, and here's another area where an AMA and AAP could be so helpful to make very clear statements on the importance of play—outdoor play, risky play. I'm not sure if you can say that, but risk is actually an essential feature of childhood play.
Kids need risk. They seek it out. Once they master a skill, they make it a little harder. They climb a little higher. They try juggling four things. I mean, they need challenge and risk. And so, anything that doctors can do to make it clear to parents, like if you want your kid to be healthy, you have to gradually let go. You have to give them more independence, let them have more free play.
Unger: I loved your story about why trees didn't work in the biosphere—because they didn't have wind and it made it hard to grow strong root systems. What a great parable. Professor Haidt, thank you so much for joining us today. This work is just so critical, and physicians really do have a powerful role to play here.
I encourage everyone out there to pick up a copy of "The Anxious Generation" online or in bookstores nationwide and check out the episode description for more information. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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