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'Mediatrician' Dr. Michael Rich on A Joyful Approach to Raising Healthy, Smart, Kind Kids in a Screen-Saturated World
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- [00:04]
A
I'm Larry Magid and this is Are We Doing Tech Right? A podcast from Connect Safely where we speak with experts from tech education, government and academia about tech policies, platforms and habits that affect our daily lives. And if you like what you hear, please subscribe and Visit us@connectsafely.org I'm really excited to be talking to my friend Michael Rich. Dr. Michael Rich Rich, who is an associate professor of pediatrics at Harvard Medical School and practices adolescent medicine at Boston Children's Hospital. He's a pediatrician, but he's known throughout the world as the mediatrician, a term that I think he made up many years ago. And he's now director of the Digital Wellness Lab and the Clinic for Interactive Media and Internet Disorders at Boston Children's Hospital. And he has a brand new book called the Media Attrition's Guide. A Joyful approach to raising Healthy, Smart, kind Kids in a screen saturated world. Dr. Rich, great to see you. How you doing?
- [01:12]
B
I'm doing great, thanks.
- [01:14]
A
And if this interview turns out familiar, it's because Michael and I, I called him Dr. Rich. I normally call him Michael. We have been colleagues for many years on a number of boards together, safety advisory boards going back years, have had numerous conversations over the years, and he's always been a close friend and ally of Connect Safely. So we are first of all happy not only to welcome to the podcast, but welcome the Digital Wellness Lab, which has only been around for a couple of years, although punching way beyond its weight. And you know, I'm really excited to talk about your new book. Let's first of all, I think the world needs to know what is a media attrition and why that term?
- [01:54]
B
Well, as you know, Larry, but your listeners don't yet, I spent my wicked youth in the film industry. I was a screenwriter and filmmaker. I got to work for two years at the elbow of Akira Kurosawa in Japan as his assistant director and then on coming back to Hollywood, had a midlife crisis and decided to go to medical school. So I came into pediatrics, or I came into medicine wanting to do pediatrics because I love kids and teenagers. But more so I knew something about the way screens worked. And this was right about the time when the American Academy of Pediatrics was starting to get concerned about then TV watching where kids becoming couch potatoes, getting fat, stupid and violent, sitting on the couch watching tv. And I felt like we needed to build an evidence base for how we are changed by the screens we use and how we use them. And of course that was all before the Internet penetrated our lives and really took them over. So a mediatrician is really a pediatrician who understands media and the way they work on us in positive and negative ways.
- [03:08]
A
So in the blurb that I wrote, and thank you for inviting me to write a blurb for your book, it was honored. Although I didn't make the COVID I think Sanjay Gupta and some other really famous person made your cover. That's okay. I called you the Dr. Spock of the digital age. I hope you took that as a compliment. But tell me a little bit about the work that you do with teens to help them do their work.
- [03:29]
B
That's a really interesting question. Because their work is growing up. Their work is being healthy and moving from infancy through childhood, through adolescence to adulthood, hopefully as healthy in mind, body and spirit. And interestingly, I've really centered on adolescent medicine because adolescent medicine is, in short, healthcare. For people healthy from the neck down, it's the sex, drugs and rock and roll that get a lot of them into trouble. And their body's about as good as it's going to be. It really is important to understand that childhood is a process of really building, you know, neuron by neuron, synapse by synapse, and you know, experience by experience, how they're going to be human. And this is really important because now we're concerned, or many are concerned, that the amount of time spent on screens instead of interacting with others, playing, getting outsource outdoors and really expanding their world, that these kids lives are being diminished in various ways.
- [04:38]
A
You talk about the Surgeon General's relatively recent report. I think it's advisory was called our epidemic of loneliness and isolation. Yes, talk to me about that. How has social media in a negative way perhaps, or maybe it was a pandemic or maybe something else. What's going on that would cause the Surgeon General to issue such an alarming report?
- [04:59]
B
I think it goes without saying that this started before the pandemic, but that the pandemic served as something of an accelerant and an amplifier of the issues. In the sense that we've actually been formally seeing patients in the clinic for interactive media and Internet disorders since 2017 and had been seeing them informally prior to that for about 10 years. And what we seem to have done as a society really is because we have these amazingly powerful tools for connecting with each other, for connecting with the larger world. We have kind of traded away our deep and meaningful and sustaining connectedness with others for this near infinite connectivity, which is by its very nature much more Attenuated, much weaker than our connection with people in real life, which is more difficult, more unpredictable, and often, particularly for adolescents and kids, more awkward. Yet it leads to greater intimacy.
- [06:03]
A
But, you know, on the other hand, certainly during the pandemic, and even now, to some extent, many of us, and right now, I'm speaking for adults, but I think kids are also included in this, have replaced what used to be in person time with Zoom, digital time, whatever it is, and maybe even enhanced. I mean, I may be spending more time, and again, I know I'm an adult, not a kid, spending more time interacting with people these days than I used to because it's just so easy. A couple of clicks and I'm there. And they could be around, across the country, around the world.
- [06:36]
B
Yeah, absolutely. That's for sure. You and I have spent more time together on Zoom than we ever did in person. But I would argue that it's less rich, it's less full of the kind of connectedness that happens when you're, you know, sitting down and having a meal together or just taking a walk together. And. And I think that we have to realize that in some ways, what we have seen as bridges to each other are actually in some ways walls, because we're only transmitting not just the top one quarter of our bodies, but we're only transmitting what can be seen and heard on a flat screen. And I think a lot is lost when we are not with each other in person.
- [07:21]
A
You and I, if you add up our ages, have more than a century of life experience, but teenagers obviously have far less. Did that play a role, in other words, does that make it even worse, the fact that they're younger and still their brains are developing?
- [07:36]
B
Absolutely. Because we do know that environmental influences change our brain development. We learned that when the tragedy of the Romanian orphanages were discovered, when the Ceausescu regime died and people walked in and these kids had been warehoused and their brains were significantly harmed, significantly stunted by lack of human interaction and that. Couple that with the fact that kids are learning about the world the way it is. And do we learn about the world from seeing pictures on a screen, two dimensional pictures on a screen, or from being out there in the world? They are also hampered by the fact that they're still developing their executive functions until their mid to late twenties of impulse control and future thinking. So this environment leads itself to taking chances or doing things that you would never do in person because you feel a little bit invulnerable.
- [08:38]
A
Let's talk about some advice to Parents. And the one that really struck me was a statement in your book, and I'm going to read it out loud. If you're not ready to talk openly about pornography, racism, fraud and more online, you're probably not ready to give your child a smartphone. Some of these are hard conversations. I mean, the pornography conversation is really hard. I had to have that with my son when he was much younger. Isn't that kind of a big lift you're asking of parents?
- [09:06]
B
Yeah, absolutely. No one ever said parenting was an easy job and no one ever really prepared us effectively for it. We jumped in and we just did it. But the reason I say that is that a smartphone, which is over a million times more powerful than the computer that landed Apollo 11 on the moon, is in kids pockets and it has essentially near infinite access to everything online. All of those things that are hard to talk about are online and available. Kids can buy fentanyl online. Kids can get to the most extreme pornography online with a click or two. And so I think that we have to be very open and transparent, both with ourselves and with our kids about what we are embarking on with them. By handing them a smartphone, we are handing them an entryway to all of those things. So unless we are able to say these things are there, that they are not going to be healthy or helpful to you. But if you go there, I'm not going to be angry at you. But we need to talk about it. If you run into something that upsets you, scares you, confuses you, I want to be an open door. I want to be side by side with you to help you learn this space and make informed choices about whether you want to go there.
- [10:33]
A
Okay, I'm asking you a tough question. What if instead of scaring them, what if it pleases them but you still deem it's unhealthy? And that could be anything from pornography to extreme political rhetoric.
- [10:44]
B
Indeed, it often does. And that's where one has to be first of all, open and transparent with the young person throughout their lives from the very beginning. We also have to model the kind of behaviors online and offline that we hope to see in them. And we need to be actively involved in their digital lives the way we are actively involved in their physical lives, because they now live in a seamless, physical digital environment that they move back and forth between or live in simultaneously.
- [11:19]
A
You also talk in the book about parental guilt. How does that manifest itself? Why is it a problem and what do you do about it?
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B
Well, I think it's in part the result of pediatricians like me for years saying, you know, be beware of screens. They can be, you know, dangerous to kids and painting a very negative picture of what first television and then the Internet could bring to their children. And I think that what that has done has not been to actually effectively help people to use these screens in effective and responsible and respecting ways, but has actually made them feel guilty that they're not doing that or they're not educating their kids, or that particularly that they're not limiting their kids screen time. One of the things that sort of is actually a vestige of the days of television is this concept that kids should be limited to one to two hours of quality educational screen time a day. I argue that screen time is an obsolete concept. It's really not relevant anymore. When we live in a world that have screens and multiple screens in every physical environment we're in, they're in our pockets or on our wrists. I think that we need to take a step back and understand that it's not the amount of screen time they use, but it is how they use their screen time and what they are not doing because they're on screens. Yeah.
- [12:48]
A
And what do you see as sort of the biggest mistakes that parents make when it comes to their kids in digital media?
- [12:54]
B
Well, I think it's tied in with the guilt thing is they sort of make the automatic assumption that whatever a kid is doing online is toxic, is problematic, or is just frivolous. And that that gives rise to the guilt, but it also gives rise to a lot of tension. One of the interesting things our research at the Digital Wellness Lab found during the lockdown is that while parents and kids durations on screen went up, that the remote learning that kids did actually improved in all areas except social emotional learning. But in the didactic learning, and what was interesting was math, science and language arts actually did better on average. And one of the things that we realize it's because in person teaching the teacher is actually often disproportionately focused on the kids who are struggling the most and the kids who are doing exceptionally. And the huge middle of kids kind of get ignored or get shortchanged a bit. But when they were all on one screen, very democratically and very horizontally seen, those kids rose up and did even better. But here's what really happened is parents reported that the amount and the severity of fights they had with kids over screen time, half of them said it's worse, we've gotten worse, we've gotten more severe, we've gotten more Angry. We're more tense around it. And so it's all tied together with this concept that screens are in some ways inherently toxic. And we have to move past that because we live on these screens, as you mentioned.
- [14:40]
A
Well, could it be that lockdowns are inherently toxic and that, you know, we were also going through that at the same time?
- [14:45]
B
Absolutely, absolutely. Yeah. I mean, we were all in a state of anxiety. We did not know what to do. We did not know how to do it, and we actually reached out to each other. Actually, one of the other interesting findings we had during. On that same study we did, where we were looking at parents fights with kids around screen time, is when we asked them how they felt social media was affecting their kids, there were more of them who were in the positive, you know, we had better connection with friends and family, et cetera, than were in the negative saying it was. It was harming them.
- [15:23]
A
Yeah, I believe that. I know in my family, we had regular game nights. Yeah, we never had game night. Maybe once or twice a year, we had them, like every Monday night, I think was. And when I'm talking about family, I mean, my kids, who are adults who live elsewhere. You mentioned anxiety. And mental health is on so many people's minds right now. The pandemic, although it still exists medically, but it socially, it seems to be over. Everywhere I go. Everything's crowded these days. Yet mental health, I don't know if it's getting worse, continuing to get worse, but people. People are talking about it in terms of being a crisis. And I'm curious what's contributing to that in 2024? I kind of get it in 2020, 2021, 2024. Why aren't we healthy again? Or were we ever healthy?
- [16:08]
B
Well, there are a couple of things going on. One is that we are more openly talking about mental health issues than we ever used to. Everything from police shootings of, you know, people who are struggling with a mental health issue instead of getting a clinic through to what's going on in the schools. I think that in many ways, the way we are using things like social media, particularly kids are using social media, can be really problematic because, you know, they go to social media seeking connection with others, but they also seek that connection by essentially showing off, showing the best parts of themselves. Only the great vacation they went on, or their hot new boyfriend or their dad's new sports car. And yet the people who come to that, who know all of their strengths and limitations and fears and concerns, do upward social comparison and feel, you know, Inadequate next to it, even the people who are bragging. So I think there that it's not social media doing something to these kids so much as what they are doing with it. Because they feel invulnerable, because they feel like it's an opportunity to market themselves to the world, that they are trading that away or trading for that, but trading away the opportunity to be together in person.
- [17:31]
A
Term, I've heard, is compare and despair. You know that, right?
- [17:34]
B
Exactly.
- [17:35]
A
It's so easy to compare your life with other people. As I was looking through the book, a number of your chapters or subheads kind of caught my mind. And one that really got me interested because it actually reflects something my wife has said many times as a parent and as an educator, which is bring back boredom. Now, boredom is something that most people try to avoid, but in fact, I think you're suggesting that it has value.
- [18:00]
B
Absolutely. We are averse to boredom to the point where we can't get into an elevator or a bus without pulling our phones out and filling our minds with whatever happens to be there, whether they be news or memes or whatever. I actually recall leaving the hospital a few months ago, exhausted, at the end of a long clinical day. Turned up the street toward my part where my car was parked and there was a brilliant sunset and everyone on the street was staring at their phones. Completely missed. And I realized that we have now, you know, given away our attention to those who paid lots and lots of money to grab our attention for free. And we are losing touch with both each other and our natural world. Try walking down the street and smiling at a stranger. You know, that used to be a good thing, and now you're a creep, right?
- [18:53]
A
Well, not only that, try asking a question, like, try asking for directions, and probably the person's wearing earbuds, looking at their phone. They're oblivious to people around them.
- [19:03]
B
Yeah, exactly. Exactly. But, you know, boredom is actually the place where creativity and imagination happen. Not just because you're creating that empty space, but because that empty space. Space is a little uncomfortable. So you fill it with dreams and thoughts and memories and put things together. And one of the things that I try to remind people of is that about 100 years ago, there was a lowly patent clerk in Switzerland who used to walk to work and stamp a bunch of meaningless papers all day long, walk back home, go upstairs and write up not just one or two, but the four most important papers in theoretical physics in the space of one year, called the miraculous year among historians, when late in his life, Einstein Was asked, how did you do that? You didn't have a lab, you weren't in a university, you weren't talking to people. He said, because I was bored and my mind could travel through time and space.
- [20:08]
A
Wow. And that sort of brings up another point that I was looking at in the book, which is play isn't frivolous, it's joyful brain building. So again, something that many adults tend to dispute. Oh, you're either working or playing. But you're saying playing is work, right?
- [20:24]
B
Playing is the most important work a child does, if you think about it. And why is it important? Because it's spontaneous, it's not goal oriented. It is play for play's sake. And what happens with play for play's sake is you interact with people you like, maybe you don't like, and you have to negotiate that. You have to figure out the rules as you go along. You interact, you imagine and you create. And you know, in many ways it is a dress rehearsal for life. Right, that how do I get along with other people? How do I work out sticky situations? How do I challenge myself and push myself, push others? How do I create a team to work together toward a goal? This is essential stuff to work together. And in many ways it's not just the screens. It's also organized sports and things that are all very adult goal oriented and adult driven. As opposed to the kids just playing.
- [21:23]
A
Yeah. You know, it's interesting you, you mentioned people you don't like. I remember when my kids were little, there was a TV show called Barney and Barney's message is you have to love everyone around you. Well, the reality is you probably aren't going to like everybody around you. So the question is, then leads to what do you do if you encounter someone online or offline? You're a child and you just don't particularly like them. I mean, is that okay? Is it okay to have people in your life that you don't particularly like?
- [21:51]
B
I think that not only is it okay, but it's almost necessary because if you're just like everybody and accept everything, there's no structure to society. There's no way of knowing what is healthy, what is unhealthy, what makes me feel good, what hurts me. And so it's important to figure out it's not the people that are bad, but maybe what they are doing that is bad. And, and how do we, you know, create a better world?
- [22:18]
A
It's funny. I just want to interrupt you something. That's why at Connect Safely, we don't Use the term bully. We refer to bullying behavior, but we don't refer to, we don't label children as bullies.
- [22:28]
B
Right.
- [22:29]
A
And back to you now. But I just wanted to.
- [22:31]
B
I think. No, I think that's, that's absolutely right. Because, you know, and for example, we don't, in medicine, we don't call kids asthmatics. We say they have asthma because it's not their identity, it's not who they are, it's what they're doing. And I think that's really wise of you to not use the word bully. However, in bullying situations, there is usually a bully, a victim, and bystanders. Right. You know, that are acting in certain
- [23:01]
A
ways at the moment, but that doesn't define them forever. The bully.
- [23:04]
B
Yeah, exactly. In that moment. But if you can't label it in that moment, you can't change it, you know, otherwise it's all acceptable. So I think it's really important. Words really, really matter in this case. And in fact, one of the places that words really matter that applies to this is the idea that you can be addicted to video games or the Internet. And one of the things that we've discovered in our clinic time and time again is that addiction is not a good model for this for a number of reasons. And the first of which is that if you think of addiction, which is frankly not a medical term but a social term, as use of a pleasurable but unnecessary substance that you continue to do despite negative consequences, you often continue to increase, despite negative consequences, that physiologically changes you when using and also when withdrawing our approach to the use of opioids, of tobacco, of, you know, alcohol is abstinence. The way you take care of it is abstinence. Now with the Internet, we can't abstain. We need this, this is a necessary resource to life in the 21st century to be able to learn to communicate, to connect, to work. And also what we are finding is that these kids in every case have an underlying driver of that behavior, whether it be attention deficit hyperactivity disorder, kids on the autism spectrum, anxiety, depression, and they are seeking out this environment because it helps them feel safer, more in control, more a master of their environment. And when we can address that underlying driver of their behaviors, the so called addictive or compulsive behaviors with gaming or social media either go away spontaneously or become very accessible to behavioral modification.
- [25:06]
A
Is there also a difference between the physical addiction you get from substances like tobacco and alcohol and opioids versus the psychological obsessiveness or whatever you want to call it in lieu of addiction that you get from pleasurable experiences that, again, may be, for whatever reason, harmful.
- [25:25]
B
Sure. Well, I mean, everybody talks about the dopamine hit, you know, getting the dopamine hit of a video game. Here's the reality. Dopamine is not, not just or not simply a pleasure neurotransmitter. It's actually a fulfillment. One feels good, you feel confident. You get dopamine hits from eating a good meal. You get dopamine hits from having a conversation like we're having now.
- [25:50]
A
I'm having it right now. I'm as high as it can.
- [25:52]
B
Exactly, exactly. And so, yes, we are often in search of that dopamine hit. So that's not necessarily a bad thing. And it's not the same thing as addiction. It is something that is part of our lives. You know, a good meal, sex, all these things give rise to dopamine. The difference here is that when we remove the underlying discomfort, whether that is anxiety or depression, then the need for that discomfort, dopamine to overcome that becomes less and you can seek more healthy dopamine surges like we're having right now.
- [26:30]
A
So we need to wrap up, but I do want to end with going over your digital wellness primer, some of the easy to follow action items that you can give to parents. It's kind of a goodbye present for having to at some point put an end to this really great podcast. But that dopamine, I've got to calm my dopamine high now and go back to the real world.
- [26:50]
B
Yeah, well, the, the primer is really designed to be sort of tips to parents at each stage of a child's life, from infancy right through to young adulthood. And it, you know, and this may be why, you know, you characterize me as Dr. Spock, because like Dr. Spock's infant and Child Care, it follows the developmental arc of childhood, but looks at it in relation to the screens in their lives. In what ways are the screens helping them and helping them grow up in other ways? And what ways can screens become problematic in their lives? And so it's really about distilling what I've talked about in the earlier stages of the book, which are categorized into what is going on. So what? And now what? And, you know, this is really the culmination of the now what. And it's also a quick reference guide for parents who are, you know, looking for, you know, just the facts. Just tell me what to do about this kid at this point in time. The other thing I will say is that as with any book, what is there is is fundamentals, but some of the details are going to change in this constantly evolving digital ecosystem. And so in addition to the primer in the book, there is on the Digital Wellness Lab website, which is digitalwellnesslab.org, a primer that follows through from infancy right through to young adulthood. As the primer does the ways that screens influence in positive and negative ways, their optimal development. Unlike the book that's able to be constantly updated as the digital ecosystem evolves and as we all evolve in our use of the digital ecosystem.
- [28:41]
A
Well, Michael, you've already given me more time than any doctor has ever during an office visit, so I want to thank you. And again, Dr. Michael Rich, the author of the Mediatrician's Guide, A Joyful Approach to Raising Healthy, Smart, Kind Kids in a Screen Saturated World. Thanks so much.
- [29:00]
B
Thank you, Larry.
- [29:02]
A
Are We Doing Tech Right? Is produced by Christopher Lee. Maureen Cochan is the executive producer. Theme music by Will Maggot. I'm Larry Maggott.