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    • Social media and poor mental health. The association between the two has been discussed numerous times over the past few years, and it doesn't seem to be slowing down anytime soon.

      In today's latest entry to the conversation, an Australian woman got into debt to go to Disneyland, just to take photos to make her 700+ Instagram followers jealous.

      I might be in the minority here, but I believe that social media may actually act more like a tool to detect people who have poor mental health, rather than a causative agent. I think that people who display behaviour like the woman in the story above already suffer from some mental or emotional condition (I feel the word "illness" is too severe), and social media merely amplifies that by giving them a platform to exhibit said condition. Just like how video games don't cause violence or mass shootings, I don't think social media should be blamed for deteriorating mental health. Are they related? Almost certainly. Does social media contribute to mental health problems? Definitely plausible. But does social media cause mental health issues? Can owning a social media profile "infect" you with the desire to take a loan just to travel to take a few photos with the intention of making your online followers jealous? I doubt it.

      There's definitely a link between social media and mental health, but I think we should focus less on social media and more on other aspects of human life. When someone is clinically ill, you don't treat the symptom. You treat the cause of the disease. Similarly, if people are suffering from mental health issues, don't fixate on social media, look at the deeper cause of said mental issues.

      What say you? Is social media to be blamed for mental health issues? Or are people only blaming social media because they don't want to admit that society itself is the problem?

    • I find that many, many arguments that are presented as either/or are often impaired by their promoters refusal to look at the possibilites of neither, always, and maybe/probably or a bit of both.

      Life is complex sometimes, and doesn't fit in nice little binary boxes.

      I do agree that not all humans respond to conditioned responses in the way the programmers have planned, but that many do, usually. At least as long as the subjects are unaware of the intent of the programmers. How many psychology experiments can be repeated IF the subjects of the experiment are aware of the intent/interest of the psychologists running the experiment??? All/ none/ some/ a few/ or it varies a bit?

      When someone is ill, you treat them if you can obtain their permission. That is the LAW of the land. No one is treated against their will - ostensibly anyway.

    • “Life is complex sometimes, and doesn't fit in nice little binary boxes.”


      Because of this very point, I believe background checks for mental illness is ridiculous. Whoever thought that up has obviously never lived with one who is mentally ill! Mental illness is a very, very “slippery” thing. It is extremely difficult to pin it down—it’s not like pneumonia or like a broken bone. If only it was...

      (Sorry—I really did not mean to venture into the testy waters of gun control here. Just venting about how inexperienced people think they know all about mental illness.)

    • There was a time many years ago when I worked as an ER physician, and I can tell you that detecting human psychotic thought can be very very difficult at times. I was asked by a family member to see a patient for a psychiatric referral and I spend over 45 minutes talking to them ( so my readers won't know if they were male or female or their race ) and I thought they were very alert, oriented, and knew exactly who and where they were. I could not ellicit any apparent disorientation or hallucination or lack of awareness

      Then I was instructed to ask them what was in the dashboard compartment of their car.

      Now this is a VERY specific area that one doesn't generally discuss when meeting someone for the first time. Not that its wrong, but just doesn't seem that important or pertinent. A bit off center maybe...

      But for that indivdual, when I asked them what was inside their dashboard compartment - it wasn't a weapon, it wasn't a tool, it was a completely different doorway to a completely different world - not as time travel or space travel - but a completely different personality that was completely seperated from the reality most of us agree surrounds us.

      The individual was a seriously impaired schizophrenic, but it was ONLY apparent, when they were asked about their dashboard compartment. Other questions about location, time, presidents, feelings, etc were all responded to perfectly normally. It was only when the individual was encouraged to "ENTER" the dashboard compartment that one realized how confused and disoriented they truly were. I gained a major amount of respect for what my psychiatric colleagues were dealing with on a day to day basis, and how difficult it can be to be certain any of us are truly sane.

      With your history of an ill family member, you may relate to how subtle I describe it can be, especially for outsiders. Even family members may not see the illness immediately. Or some do, and some don't. Like you said, the symptoms can be very subtle at times.

      I suspect the day may come when referral for psychatric issues, with dangerous activities, may come from AI spiders crusing the web, but that will require a lot of changes with regard to privacy etc in our culture.

      On a side note, I am rereading Neil Stephenson's The Diamond age - written a long time ago, in 1995. He didn't call it AI -> Artificial Intelligence, he called it Pseudo Intelligence, and I think maybe he was on to something....

    • Slippery is a good way to describe it, and certainly there are many things that contribute to or exacerbate mental illness.

      I think one of the most dangerous things we can do is isolate people. Loneliness is rough and staying connected with others tends to help all of our mental health, but it’s especially important when it comes to support for seeking treatment.

      Does social media foster connection or inhibit (true) connection?

    • More binary boxes again?? 🙀.

      Posted with the most gentle intent to humor, I couldn't resist.

      I think the answer may be yes to both questions you posted, and no as well.

      It depends on both people on both ends of the connections, doesn't it?

      But the text box connection itself may contribute difficulties as well.

      I wonder if one day we won't dispense with text boxes entirely, and their loss of non verbal information that we typically do collect in face to face conversations. Or even in Skype boxes

      I think the non-verbal communication is even far far more important when dealing with mental illness, than when dealing with a conversation about a hobby. I am certain of it, in fact.

    • +++ As someone from a family with mental illness on all sides, I've thought it was deeply unfair to stigmatize the mentally ill even further, by scaring us into thinking they are violent. They rarely are.

      Isn't it more often someone who is driven by an ideology or misogyny who is driven to violence? It sounds like that can come from 8chan or YouTube.

    • I would like to know what draws us to different social media services and whether mental illness sometimes plays a role. What does it say about us if we're obsessed with Instagram?

    • The patient I was describing I think was harmlesss, but very confused as to a lot of things. I wrote my posts with an acute awareness that you and others here have had family members with serious mental health issues, and I was not trying to assert that violence is the result of mental illness. The causes of violence are many, and most psychiatric patients are pretty harmless, we have thousands of them walking among us untreated throughout the country.

      Truely violent people may not be "crazy" but most of us would say they are truly sociopathic - As a society, we don't try to treat sociopaths, we institutionalize them, or execute them, depending mostly on what state they are captured in. and why they came to governmental awareness. These are not necessarily my opinions, but a description of my perception of the world at this time in this country.

    • Oh, no worries, I wasn't thinking of your response. After I wrote mine, I remembered that my grandfather shot his wife and then turned the gun on himself. 😢 So I didn't mean to say they are never violent.

    • Speaking of suicide...

      Life is really strange - suicide is a common affliction of physicians, I knew of at least three as I passed through medical school and into practice. One of them was a nice quiet polite fellow who roomed with me for a year when I was a 2nd year resident and he was a 3rd year resident. About 7 months into my third year of residency I answered the door to my apartment one evening and was greeted by an Indiana State Police officer who wanted to ask me a few questions about my previous roommate in hopes that I could offer any information that might help explain why he parked his car one evening and ran a hose from his tailpipe to the interior and died of carbon monoxide inhalation shortly after beginning his practice.

      I had no idea, I knew he was quiet, and a bit reserved, but I never had any idea he was potentially suicidal. One would think I might have noticed something, but I didn't - nada. And I was a trained observer, ostensibly. I, at least, had spent three months on a psychatric rotation in medical school.

    • We have friends and a family member who are physicians and we often wonder about this. How is it even possible that the suicide rate among doctors is higher than any other profession?

      I sometimes hear that it used to be the most respected job in America, but now there are anti-vaxxers and the rise of online groups that question the medical establishment. Maybe that contributes?

    • Interesting link @Chris, and about what I had as a general understanding. It is a well known fact among most physicians.

      I don't know why physicians are so at risk, exactly, but I have a few ideas.

      I do think some of it may be related to the responsibilities involved. And some I think happens because they don't/won't ask for help, perhaps because they feel responsible or don't want to admit the depth of their problems. I don't think dentists are spared either. The stigma of asking for help may be a part of it.

      I think the responsiblities weigh more than many realize - as children many of us think of playing doctor, or surgeon. But when you finally realize - YOU - personally - have to sign the operative report and be legally and morally responsible for it - only then does one truly grasp it, and I think that is not easy for non-physicians to fully feel. You really can't understand someone elses challenges, unless you have walked miles in their moccasins, at night, in the dark,

      It was interesting that the risks are not unique to North American or Western Physicians, but seems to be a risk worldwide.

      Physicians marriages suffer from their own forms of stress as well, due to the stresses of the jobs for both parties.

      I do agree that social changes have changed the way physicians are thought of - On the early Star Trek The Original Series, Doc McCoy was a social equal of the captain and held in high regard. Later in Star Trek Next Generation he was a foreigner, slightly humorous, and not nearly a social equal to Picard. And then finally, in Star Trek Voyager the doctor was a software program pulled out when needed and then turned off when not needed any longer. I think the series writers were reflecting, kind of, changes they felt in society and its relations to physicians. Maybe I'm over-reacting, but I always thought the progression/regression of Physicians in the Star Trek series was not accidental, but intentional.

      Some of it is the harassment by insurance and governmental agencies converting the physican to a data aquisition device for the electronic medical records. While physicians appreciate good, accurate readable records, so much data is collected now ( much of it not even pertinent to the chief complaint), it is easy to get absolutely buried in detail trying to find a specific piece of information. Your Dr wants to know why the patient came to the office and gets a 15 page, single space PDF on a monitor that may take 30 seconds to go from page to page. And they wonder why doctors get fried. Not fired, FRIED. 🙀 Burned out, burned down, worn out early.

      The software firms always sold their software and said the reason physicians didn't like it was that we ( doctors ) weren't computer literate - I grew up with an Apple II, built dos and Windows machines in the 1980s, and I was insulted by being told I wasn't computer literate - but the truth was the software was horrible, obviously designed by someone in the billing dept or the insurance department, not by people who actually diagnosed and treated disease.

      Drs no longer look at their patients, they look at computer monitors, at least my Drs do. And the most important thing physicians do to make a diagnosis is to LOOK AT patients. BTDT

      Sorry, I have wandered off on a bit of a rant, but one I suspect some physicians might agree with me on many of these points.

      I loved practising, it was truly a great priviledge. After about 40 years, I have moved on to a new phase in my life. Many of my colleagues tell me they envy me.... I don't envy them.

      I do appreciate their care a great deal.

    • I asked a family physician’s wife the other day how her husband likes his job. She says generally he loves it besides the fact that doctors spend 30% if their time on soul-destroying insurance issues instead of actually tending to patients.

      But he is a family physician and there was one thing: people’s health is so profoundly affected by their mental states, he hears a lot about the life struggles they have. Being an empathetic person, it’s hard for him to carry those things with him.

      I don’t know why this wouldn’t be worse for social workers and psychiatrists, though

    • Psychiatrists are MDs, physicians...just like brain surgeons and internists.

      I am not certain about the suicide rates in sorted by medical specialties - so I went looking around and found this link - it is long and thoughtful and also has tables of suicide by specialty. AND Psychiatry rates are in the middle for suicide, not a high as some surgeons, but higher than average for all physicians

      Who knew? Pamela Wible MD did

      This is a much longer than average web page, but full of thoughtful and useful data if you are patient.

      I haven't looked at suicide among social workers rates yet.

    • What a great find!! I listened to the first 4 minutes of her speech and could tell I’m going to love it, so I saved it on my phone for this evening’s run. 🙏

    • She is a good speaker, and has a TED talk here - I don't agree with everything she says, but she certainly comes across as an intelligent, compassionate physician.

      And among social workers, the rates are higher for unmarried younger white males - as they are for unmarried younger white males generally.

      CBS had a brief note about suicide but without the data behind the findings, that I could find

      Enjoy Dr Wible's TED talk, its worth a listen.

    • Whew. That was a tough audio for me. I get that Dr. Wible is disgusted about the loss of life (aren’t we all?), but she came across to me as extremely judgmental and even a bit snarky. Ugh.

      I have relatives in med school and in residency right now. They are keenly aware of the suicide rates—this topic was addressed head-on early in their training, which started in 2014-2016, and continues. So none of what Dr. Wible is saying in this talk would surprise either of them at all. We’ve even had open conversations about it. I am surprised that Dr. Wible thinks this is such a hidden secret...

    • Yes, @lidja, she is not your typical physician, and is trying to be entertaining. Maybe trying a bit too hard, for my taste. But entertaining..or funny.. or really, snarky?

      I am not certain I fully understand the definition of snarky, but I get that it is sharp, maybe a bit demeaning, some might say supercilious. Did it really come off as rudely disrespectful to the audience? I didn't get that vibe, myself. An element of underlying hostility to some in her profession ( men maybe? ) I did perceive. And yet, she is has also written about the risks men in medicine seem to face, not only in the US but in many nations around the world.

      She did say she has received letters from colleagues, about acting more professional, and I do understand some colleagues feelings in that regard, including my own, but apparently she has patients who do seem to like her as well, which suggests a good relationship with her patients, perhaps.

      I don't agree with her choice of practice modalities, in its entirety, but as a patient myself, these days, I can easily understand many patients complaints about current office practices - the phone tree for our local physicians is abysmal despite the Pseduo Intelligence running it. Apparently the management feels it is cost effective, even if it drives patients away shaking their heads and their fists!

      I don't entirely believe I could run a better office without my staff dealing with scheduling, billing, patient flow, refraction measurement, and ordering and fitting of spectacles. But, if I were a GP, and refered many patients on to other offices for definitive treatment, maybe I might agree with her.

      I didn't wear a white coat either, and many pediatricians don't either as it can frighten some patients.

    • Y’know, I haven’t listened to her podcast yet as I had planned, but I did watch her TEDx. I could see what you meant by throwing off a vibe of arrogance and snarkiness, especially towards her patients who she had to ask to get naked.

      I did love what she was saying about getting more personal with her patients though.

      One thing that was startling to me, however, is the idea that a white coat or desk or receptionist creates distance. As a patient. that never entered my consciousness. I still can’t understand why I would feel that way about a lab coat. I don’t mean to be critical of anyone who does feel that way, it just never occurred to me.

      At my clinic, I see a nurse practitioner for most visits who would refer me to the doc if something were serious. I had a tick bite with a bullseye and Google said I would likely die a slow, awful death from Lyme disease. So I saw her with my worried wife, and she talked us through it in the most wonderful way.

      She had a coat and a receptionist, but she is simply a warm, caring listener with great knowledge who is honest about what she believes with what degree of confidence and why — and what to do in a couple days if it doesn’t behave as she predicts.

      We laughed and talked about the kids and it was wonderful.

      My male doc, however, whom I see for my crazy irregular heart, is all business and authoritative in his pronouncements. I come out of visits with him thinking today could be my last. I can see how the way he practices could be hard for him.

    • I distinctly recall a family dinner a year or two ago when my daughter (med student) suddenly realized she was “pimping” during our family conversation just as her superiors had been doing to her during rotations. (Dr. Wible mentions pimping in passing during her presentation—apparently it is a common “teaching technique” {shudder} in which the so-called teacher shoots questions at students that the teacher *knows* the students cannot answer, which rattles the students and shames them in front of peers. Speaking as a teacher here, this technique is especially cruel to do to students who are highly intelligent and tend to be perfectionists. It’s cruel and self-serving, and IMO, educational malpractice. And yet it is very common in medical training to the point of having a bizarre nickname.)

      I have seen how years of med school and residency are taking a huge emotional toll to the point of having a clear impact on personality. It’s as if the older generation (of whom I also have friends and relatives) perpetuates the misery they experienced in youth as a form of retribution on the younger ones coming through the system. Perhaps this is the source of Dr. Wible’s disgust. I don’t know. I just know as a teacher watching this process, my opinion of doctors has completely changed...

      Edit: it should be noted here that I am referring to the presentation Dr. Wible made about physician suicide—I have not watched her TED talks that @Chris mentions above.

    • Just like the police and the clergy, medicine recruits from the human race.

      Some physicians vastly overestimate their knowledge, and/or their importance. I interacted with some as I passed through in my career. Most, fortunately, were far more reality based, but not all. Not a trait that I think is unique to physicians.

      On the other hand, many patients have a very hard time dealing with answers that though they may be honest and accurate, seem to be less than 100% certain. Dealing with ambiguity is challenging in the best of times, let alone when one is ill. Patients prefer an air of certainty in their doctors, I know I do.

      Medicine is “practiced”, not performed, because their is a lot of inherent uncertainty in its practice, even with the best of training and knowledge.

      One thing a good education should teach us all, is how little we really know, and how much more we have to hope to learn someday, if research goes well, and just how much we may never really know. Or may even be unknowable. The illusion of certainty on the web is not always correct.

      A bit of humility goes a very long way in improving our humanity, methinks...

      I always tried to keep this in mind when I taught medical residents and medical students. My clinical openings for them always filled quickly, so I like to think I may have succeeded a bit. My purpose was to teach them how to deal with ophthalmic emergencies, and to not harm folks until the help arrives either, not to make them uncomfortable. Good physicians all know we don't know everything about every field. No one can, no matter how motivated or able.

      One other thought occurs to me - pimping CAN be malicious and I don't subscribe to it, but teaching folks who are going to be under pretty great strain at times to think on their feet isn't necessarily malicious, even if it feels like it some times.... The way to not get too excited in life and death situations is to fully understand and KNOW - in your bones - what the possibilities and choices and treatments for each are. Today we call this kind of knowledge algorithms, I think. One area where AI might be of great use. Algorithms prevent one from overlooking issues when excited......

      The emotional stress from being "pimped" by a professor or resident, is far less I would suggest, than the stress surgeons or emergency room physicians deal with on daily basis. Stress IS part of the profession. Dealing with life and death situations, child birth or death, or even blindness is challenging.

      Even as an ophthalmologist, I still recall a middle aged patient who came in for a routine exam, no problems, a friend of my wife. Her history and examination was perfectly normal, visual acuities were excellent, no spectacles needed, no cataracts, no glaucoma.

      I was just about to tell her everything was perfectly normal when I found in the far temporal retina of her left eye, what I was certain was a large malignant melanoma. Completely asymptomatic, and potentially fatal. I then realized I had bad news to tell her, as gently as possible, and that her life was going to change in unanticipated ways for the forseeable future. I would love to reassure her, but how do I do that and be honest? The stress of that afternoon was pretty minor to what physicians deal with on a daily basis. But I still remember it. I had some understanding of what my patient would experience, due to an experience of my own a couple years earlier.

      I had had some back pain, for which I had surgery a couple years earlier, recur. So I had an MRI of my lumbar spine for back pain, that was read by the radiologist as a large neoplastic mass, twice the size of my fist, along my iliospoas muscle on the right side. That's something very bad to hear in your doctors office, basically "You are going to die shortly!"

      Fortunately, my neurosurgeon had his doubts, and said we needed to do an immediate needle biopsy in his office that afternoon. OK - bad news, followed by invasive procedures - my afternoon wasn't going too well at that point.

      The needle aspiration biopsy was uneventful and sent off to pathology on a Thursday late afternoon. I got to wait a whole weekend contemplating a death sentence, until Monday afternoon when I got the biospy report that the mass was a simple blood clot, a hemorrhage, not a malignant tumor. Of course, the question was did the biopsy miss a tumor that caused the hemorrhage, and that question wouldn't be truly answered for several months as I waited for the blood to clear. Short answer, a decade later, my xray was obviously over read, but a large hematoma, without a history of trauma, is highly suggestive of neoplasty. I think I tore my psoas on a weight machine in retrospect, but I never did have acute pain with it. But I do have a healthy idea of what patients experience with serious diagnoses. How their whole world gets tossed upside down. I was very fortunate, my world remained less exciting.

      Reducing the stress on medical students is a worthy goal, and one I support, but stress at some level is a part of practicing medicine. And may, quite probably, contribute in some cases, to the higher suicide rates in physicians.