Questions from (Congressional) Sapiens

If a psychologist gives a congressional testimony, and no one is listening to it, does it make a sound?

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Energy and Commerce is a committee of the U.S. House of Representatives that focuses on a range of issues, few of which appear to involve energy and/or commerce. Most relevant to us is their focus on “health care, including mental health and substance abuse.” Within this committee is a subcommittee called Oversight and Investigations. They’re responsible for, as you might guess, providing oversight (and conducting investigations) on the programs that fall under Energy and Commerce.

Last week, this subcommittee held a hearing called “Americans in Need: Responding to the National Mental Health Crisis.” Somehow, that morning, I found myself once again testifying—this time on the national stage. So, I slipped on a blazer, strategically positioned the camera on my laptop, and turned on a sound machine to drown out, from the other room, the sounds of a mechanical bunny toy that maniacally screams playing with you is fun! I was excited. I was sleep-deprived.¹ I was terrified (even more so than I am of the mechanical bunny).

Each witness—myself and four others—was given five minutes for opening statements. Then, each of the 19 members of the subcommittee (plus a few members of other subcommittees who chose to “waive on”), had five minutes to ask questions of the witnesses. A countdown clock featured prominently on WebEx. This didn’t stop members from spending 3 to 4 minutes of their allotted time providing long-winded stories and opinions. Sometimes, they added a question mark at the end. At one point, a member fell asleep. At multiple points, members took phone calls or simply walked away.

As we marched steadily toward the third hour of lecturing, don’t you agree?’s, and prompts to give one-minute answers to questions better suited to hours- or days-long discussion, I was disillusioned. This felt different than the state congressional hearing at which I’d testified a few months ago. Less sincere. More performative. What was the point of this? Is it really an investigation if you’ve already made up your mind?  

As the hearing concluded, I felt conflicted. Friends asked me how it went. I don’t think I said anything too stupid, I concluded. But I’m also not sure I said anything particularly smart. I was there as an “expert witness,” but between the countdown clock and the members’ statements posing as questions, I wasn’t sure I’d taught anyone anything. I began wondering, with disappointment, if maybe that was the point.

Yet, the issues they spoke about—access to healthcare, youth mental health, the role of technology and social media—are things I care deeply about. And I’d like to think the representatives care deeply about these things too. For that reason, I was glad to be there.

Maybe this is just the way change happens. We all come together, hoping to make a difference by teaching others what we think we know. We use the limited time we’re given to do too much talking and too little listening. Maybe in that sea of chatter, of posturing and for the record’s and positioning of giant American flags in the background of our tiny WebEx squares², our voices, however small or rushed or uncertain, can be heard. Maybe that’s the point.

Below: a few snippets from the Q&A portion of the hearing. Note that in most cases, I’ve considerably reduced the length of members’ questions. I’ve also included the text of my oral testimony. If you’re so inclined, you can find my written testimony, and all three (!) hours of video footage, here.

Questions from (Congressional) Sapiens

Chair Diana DeGette (D-CO): There's no single solution [to mental health issues in this country]... Given the range of experts and experiences among the witnesses today, I want to ask you–you can think about it while the others are answering–what key actions do you think Congress should take to address this crisis?…Dr. Nesi, what about you?

Me: My expertise is as a psychologist and in the science behind social media, and so commenting on specific policy is really outside of my domain, but I will say that I think there are steps we can take when it comes to social media to better serve youth. Just two that I’ll highlight: I think that there's a lack of information and awareness among the public about these issues, and so educating the public, including parents, teachers, and teens themselves, on safer and healthier ways to engage with social media, is critical. I also think there are difficulties in conducting research on this topic, and that we need more research to better understand these issues.

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Rep. Jan Schakowsky (D-IL). Thank you Madam Chair for holding this very important hearing…In December, I had a hearing in my subcommittee of Consumer Protection and Commerce, and we heard from The Whistleblower Francis Haugen, who talked about some of the dangers there are for young people. Even though Facebook had made promises, had made its own statements that it doesn't lead to these kinds of harms, I think the time has come that the Internet needs to be regulated in a way that keeps our kids, in particular, safe…

And so, I wanted to ask Dr. Nesi, can you speak to the risks and the harms of certain uses of social media, and how exactly those harms contribute to mental illness and even suicide? 

Me: Thank you for that question. You know, I think that when it comes to things like suicide, this a really complex phenomenon, and so we know that there are a number of different factors that play a role. It’s rarely one single cause. When we think about the effects of social media, right now, the evidence would suggest that there are both benefits and risks. So when we think about the benefits of social media for suicidal thoughts, it would be things like: social support, getting access to resources, connecting with peers, which we know is essential. But, of course, there are risks, as you say, so risks would be: exposure to harmful content that might be related to suicide, cyber victimization, displacement of other activities that are important (things like sleep and exercise), and certainly exposure to things like hate speech and discrimination. All of these things we know can play a role in the risks of social media.

Rep Schakowsky: But would you say that it is time for the Congress to take a look at what kinds of things are allowed on the Internet, that certainly can have an adverse effect on, especially on, young people who get–because often, the platforms target and actually entice people to go into website that are dangerous for them?

Me: Yea, so you know, my expertise is in the research on this subject, and so I won’t comment specifically on policy here, but I do think that we know from the research that when teens are exposed to content like this, that it can be harmful. When they’re exposed to content that’s potentially even promoting suicide or self-injury, that is clearly harmful to them.

Rep Schakowsky: So I also wanted to ask a question—do I have time left?—about the LGBTQ community, and I just wondered if there are any online hazards that are there for our expert on that?

Me: When it comes to the LGBTQ community and use of social media, obviously all teens are different, and the way they’re using social media is different, and that’s true of LGBTQ teens as well. We know that benefits for those youth exist online, including opportunities to connect with peers that they might not have the opportunity to do in person, but we do see risks as well. I think one of the key risks we see there is exposure to discrimination and hate speech, to homophobic content, and things like that. 

Rep Schakowsky: Yea, bullying online is really a hazard. Thank you so much. I yield back.

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Rep. Gary Palmer (R-AL): [camera off]: …I yield back.

Chair DeGette: I was just informed by staff that members are supposed to have their cameras on under the house rules in these hearings, but I thought that–

Rep. Palmer: I have it on [indistinguishable].

Chair DeGette: No it’s—First of all, my name’s Diana, but second of all you’re not, it’s not coming on the screen. But that’s okay, we will—I thought your questions went great, and we will now go to our next questioner…

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Rep. Kim Schrier (D-WA): …As the only pediatrician in congress, I'm particularly concerned about the mental health of our nation's children…Yesterday, I spoke with a psychologist…and she echoed concerns about social media.

So Dr. Nesi, I know you've done so much research in this area, and I was wondering if you could talk more about the role that parents, therapists, pediatricians, and schools can play in helping teens kind of manage their social media use and navigate this brave new world and help them be more thoughtful about how and when they use it?

Me: Thanks for this question, I know that a lot of parents and schools are concerned about social media and how they can protect their kids’ mental health. Let's maybe focus on parents for a minute. I think what's going to work for each family is going to be a bit different, but there are some key principles, supported by research, that parents can keep in mind.

So, emphasizing open communication with teens about social media, engaging them in the process of learning what's working for them and not working for them is critical.

Setting reasonable limits and expectations—so, parents might consider setting limits by times of day, location that that their kids can use their phones, or maybe limiting certain content or activities in order to reduce exposure to harmful content.

I also think protecting sleep is critical. The evidence is pretty clear that nighttime device use can get in the way of sleep, and so parents need to help their teens ensure that they're getting adequate sleep.

And then finally, I think parents need to be aware of signs that their teen is really struggling, so if they're not themselves, you know, they're using technology in a way that seems excessive or is really interfering with their well-being, then they may need to get professional help and seek out therapy services for their teen.

Rep. Schrier: Thank you, and now we just have to coach parents how to do some of those things that require some technical expertise in themselves.

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Rep. Lori Traham (D-MA): On December 19, 2021, The New York Times published a story titled “Where the Despairing Log On and Learn Ways to Die.” Since then, my office has been conducting an investigation alongside Representative Mckinley and others on online suicide instruction forums… Dr. Nesi, what does the research tell us about the impact of online content related to death by suicide methods on young people who may be struggling with mental health?

Me: This is a really important question, and…when it comes to suicide-related content, I think that there are a lot of different types of content out there. Some of it can be helpful, for example, when it provides support, when it offers opportunities for intervention when kids are in crisis, or when it provides them information on resources like the Crisis Text Line or information from AFSP. But obviously there are cases where it can be really problematic, and that includes, as we discussed, cases where content might glamorize or even encourage suicide, and cases where methods are described in detail. We know that that can have a harmful effect on both young people and adults.

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Rep. Lisa Blunt Rochester (D-DE): Dr. Fortuna, I want to thank you, too, for your testimony on the impact of social media on our children. My bill The Detour Act seeks to address the impact of social media by regulating a phenomenon known as “dark patterns,” which are design practices that manipulate people, often children, to use social media platforms compulsively. Dr. Fortuna, why should we be concerned about these manipulative and compulsion-inducing practices when addressing a youth mental health crises?

[Note: at this point, Rep. Rochester confused me with another witness, Dr. Lisa Fortuna.]

Dr. Fortuna: I don't know if you want to give that to Dr. Nesi because I think she was covering that…

Rep. Rochester: Yes, yes, Dr. Nesi, if you would. Thank you so much, Dr. Fortuna.

Me: Thanks for this question. You know, I'm always hesitant to use the word “addiction” here, as I think that addiction typically falls under the realm of a diagnosed mental illness. But we do know that there are features of social media sites that that make them hard to stop using, so in some ways, can lead to compulsive behaviors in some youth and adults. That's things like endless scrolls, notifications, targeted recommendations. And we do know that those things make it harder to log off of these of these platforms for people of every age, but especially teens.

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Rep. Paul Tonko (D-NY): Thank you, Madame Chair. The pandemic undoubtably had an impact…[indistinguishable]

Chair DeGette: Mr. Tonko, we're having some difficulty hearing you. I think you've got some reception issues… I will recognize Dr. Ruiz for five minutes, and then and then you can work on—we’ll give you five minutes while you figure out your technology.

Rep. Raul Ruiz (D-CA): Thank you, and Representative Tanko, I'm sure he's dialing speed dialing his millennial and his office right now to come fix his tech, for the tech support, so best of luck to you my friend…

[later]

Chair DeGette: I don't know if Mr. Tonko's technological issues have been resolved. I don't see him, so I'm going to go to Ms. Schreier.

[later]

Chair DeGette: I want to thank Mr. Tonko for his perseverance. I understand that he's in a better place now, and I'll recognize him for five minutes.

Rep. Tonko: Okay thank you, Madam Chair. I hope so can you hear me okay.

My Opening Statement

Thank you Chair DeGette, Ranking Member Griffith, and members of the Subcommittee. My name is Dr. Jacqueline Nesi, and I am a Clinical Psychologist and an Assistant Professor at Brown University. I study the impact of technology and social media use on adolescent mental health.

Our nation is facing a mental health crisis among youth. Rates of depression, anxiety, and suicide have increased over the past two decades—and this crisis has only intensified since the start of the COVID-19 pandemic.

These rising rates of mental health concerns have coincided with another trend: the widespread adoption of social media. Today, nearly 97% of teens use social media platforms like TikTok, Instagram, YouTube, and Snapchat. Technology use has further increased during the pandemic, with adolescents now spending an average of seven hours per day using screens.

These co-occurring trends—of increasing social media use and rising mental health diagnoses—have led to concerns about a potential link. Is social media use causing mental health problems? Unfortunately, the current state of the research does not provide a simple, definitive answer.

What we know is that the relationship between social media use and mental health is complex. We also know that serious mental health concerns like depression, anxiety, eating disorders, and suicide are the result of a complicated interplay of genetic, developmental, and social factors, and cannot be attributed to a single cause. Social media alone does not cause mental illness in teens.

But does this mean that teens’ use of social media is irrelevant when it comes to their mental health? It does not. Social media plays a central role in our children’s mental health.

To date, research suggests that the amount of time teens spend on social media is less relevant than what teens are doing online and which teens are more susceptible to harm. Social media offers opportunities and benefits for teens, but it also creates real risks and challenges, especially for those who are already vulnerable.

In terms of benefits, social media offers adolescents a forum for social connection, friendship, and creative expression. It offers critical opportunities for social support, especially among teens who may not readily have access to communities of supportive peers in their offline lives, such as LGBTQ youth. It can also provide education and awareness, and reduce stigma. For youth struggling with suicidal thoughts, social media can offer unprecedented opportunities for support, access to resources, and intervention during a crisis. 

Despite these benefits, the potential risks of social media are significant. Social media provides an endless stream of photos and quantifiable indicators of social status—likes, views, comments—which may negatively affect youths’ self-esteem and body image. Nighttime use of screens has been shown to interfere with youth sleep. Cybervictimization, or the experience of being bullied online, is another risk, and is associated with a range of mental disorders. Youth of color and LGBTQ youth are also disproportionately likely to be affect by hate speech online.

When it comes to suicide-related social media content, the dangers can be profound. Exposure to harmful suicide-related content has been shown to increase risk for self-injury over time. In extreme cases, youth may even encounter messaging that actively encourages suicide or self-harm.

But evidence-based guidelines exist for safer social media posting about suicide. “Safe” posts about suicide should provide messages of hope and recovery, include links to resources, or indicate that suicide is preventable. In contrast, harmful posts about suicide are those that glamorize, sensationalize, or romanticize suicide; those that trivialize it or blame it on a single cause; those that describe it as desirable; and those that provide details about methods or locations of attempts.

More research is urgently needed to determine exactly how, when, and for whom social media is more harmful than helpful. But one overarching conclusion can be drawn from the current body of work: social media is central to the mental health of young people.

Addressing the youth mental health crisis must be a multifaceted effort, and ensuring access to services is a key component. Nearly half of adolescents with a mental disorder do not receive needed treatment, with those numbers even higher among youth of color. Improving access to mental health care—such as through schools and primary care facilities—is vital. 

Helping youth use technology and social media in healthier ways must also play a role. Legislators, social media companies, researchers and other stakeholders can work together to maximize the benefits of social media for youth, while minimizing the risks. We can educate youth on the dangers of hate speech and bullying. We can help youth protect time for activities outside of screens. We can provide youth opportunities to personalize their social media experiences, and give parents the tools to ensure their child’s safety. And we can guide youth toward helpful resources and content, and limit access to harmful content.

Thank you.

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In case you missed it…

• Body Image and Social Media: Interview with Dr. Sophia Choukas-Bradley

• Why do we believe the stuff we read online?

• Are we addicted to our phones?

• Congressional Hearings & Schoolhouse Rock

1. The timeline was short. Over the course of a single week, the whole process—from receiving the very first email to joining the hearing, was over. During that week, there were many email invitations—to meet with congressional staffers, to testify, to inform me that an official invitation to testify would be coming in the mail, etc. There were also a number of meetings. By the time I sorted through all the invitations and information, a written testimony and lots of paperwork were due. I then spent the next 48 hours writing my oral testimony and preparing for questions. I did not get a lot of sleep.

2. A number of members of congress, despite seeming to join the hearing from home, had giant American and state flags behind them, nicely framed by their WebEx cameras. I couldn’t stop thinking about this. How did the flags get there? What was that process like? I had visions of representatives wheeling a giant flag bases into their living room; sweating as they heaved a pole, carrying a 24-square-foot flag, into the base; carefully positioning their webcam to frame it behind them, as their families looked on. Their spouse: Honey, are you sure we need that here? Right in the middle of the house?