Harriet At Forty-Eight

If you never read the novel Harriet the Spy, I hope you will ASAP.    My hope is that most children, parents and therapists have had a chance to read it already, because it has a lot to teach us about digital citizenship.  You can get it on Amazon here.

Harriet spends a lot of time writing down things in her notebook.  Truthful things.  Unflattering things.  And one day the notebook falls into the hands of her classmates, who read these things, and respond to her with anger.  What I find interesting is the way Harriet’s friends, teachers, and parents respond.  Their initial response is to take, or try to take, Harriet’s notebook.  Of course Harriet gets another one.  That’s not the problem.

Harriet the Spy was published in 1964.  According to Wikipedia, at least one variation of the technology of the notebook had been around since 1888, and there are examples of its common usage in the early 1900s.  This technology was prevalent long before the 1960s.  No one says to Harriet that she has a “notebook addiction,” although her usage of it becomes problematic.  In fact, her redemption in the book also comes from the same technology of the written word.

One of my favorite moments in Harriet the Spy comes in Chapter 14, when Harriet has her initial appointment with a psychiatrist.  As they settle down to play a game, the psychiatrist takes out his analytic pad:

Harriet stared at the notebook.  “What’s that?”

“A notebook.”

“I KNOW that,” she shouted.

I just take a few notes now and then.  You don’t mind, do you?”

“Depends on what they are.”

“What do you mean?”

“Are they mean, nasty notes, or just ordinary notes?”


“Well, I just thought I’d warn you.  Nasty ones are pretty hard to get by these days.”

“Oh I see what you mean.  Thank you for the advice.  No, they’re quite ordinary notes.”

“Nobody ever takes it away from you, I bet, do they?”


This vignette illustrates how the clinician is not above or apart from technology.  Harriet’s psychiatrist uses it himself.  And his response to her struggle and worry about using technology is an approach I’ve come to see as key:  He doesn’t try to restrict her from using the technology, he engages her around its use and thinking about its use.  He actually gives her a notebook, and then respects her usage of it when he lets her leave the office without taking it back or asking to see it.

He then recommends that her parents talk to the school about allowing her to use technology to amplify her thoughts and expression there, via the school newspaper.  He also suggests that they use technology in the form of a letter written by Harriet’s old nanny to give her some advice and connection.  Many will say that Ole Golly’s letter is the pivot point for Harriet in the story, but I’d suggest that the pivotal moment comes when the mental health practitioner doesn’t demonize technology (the notebook) or pathologize its usage, but rather leans on technology as an avenue into the patient’s forward edge transference.

Technology, as Howard Rheingold reminds us, is a mind amplifier.  It can be used to amplify our memory in the form of notes, for example.  It can also be a voice amplifier, for better or for worse.

If Harriet was around today, I imagine she would be on LiveJournal, perhaps with her settings on private, but on LiveJournal nevertheless.  In fact, her LiveJournal notebook would probably be more secure than a notebook carried around on her person without encryption.  But maybe she’d also be on Facebook, Twitter, and Tumblr.  And unless she had parents or teachers who talked to her about digital literacy, she might not know or care about privacy settings or mindful use of technology.

Every day, on Facebook or Twitter or other social media, people young and old post, and “drop their notebook” to be read by hundreds or thousands of people, who can amplify the notebook even further by liking, pasting, sharing or tweeting it.  By comparison, Harriet’s class of 10-15 students seems paltry.  When an adolescent complains about her ADHD medication on her status, or when a parent tweets how proud he is of his Asperger’s child, these nuggets of information, of expression, of identity formation are sent out into the world and amplified.  Our work as therapists needs to be to help our patients understand the significance of what they are about to do to themselves and others when that happens.  And to do that we need to understand the technology ourselves.

Few of us would consider giving Harriet a notebook as “feeding her addiction,” or giving her a hair of the dog that bit her.  Yet, we level such technophobic claims on the social media and technology of our time, trying to focus on technology as an addictive substance rather than as a tool, and pathologizing its use far too quickly and easily.  And we often join technophobia with adultism, when we try to intrude or control the use of technology by children and adolescents (note that I said “often,” not “always”)

When you look at some of the stories Harriet prints in the school newspaper, you have to marvel at the bravery of the educators in that school!  How many of school administrators would allow entries like “JACK PETERS (LAURA PETER’S FATHER) WAS STONED OUT OF HIS MIND AT THE PETERS’ PARTY LAST SATURDAY NIGHT.  MILLY ANDREWS (CARRIE ANDREWS’ MOTHER) JUST SMILED AT HIM LIKE AN IDIOT.”  Can you imagine the parental phone calls, even though the parents were both the behavioral and quoted source for this story?  Can you imagine kids being allowed to experience communication and learning with this minimal form of adult curation?  But also, can you imagine parents saying that the problem is allowing access to the technology of writing a newspaper, and that the idea of a school paper should be abolished?

When you think about it, we live in an amazing era of the amplification of human thought and expression.  Our children will need to learn how to manage that amplification in a way we still struggle to understand ourselves.  I remember one notebook I dropped, when I was managing a staff of guidance counselors.  I was very frustrated with the response of one of them to something, and wanted to share that with my supervisor.  I thought it would be important to share my emotional response to this with someone I understood to have the role of helping me sort this stuff out, and I was being impulsive and cranky.  I ended up sending the email to the staff instead.  Boy, did that torpedo those relationships.  But I did learn a lot about how to pay more attention to the power of technology, and that part of being a good digital citizen requires thoughtful use of ampliying your words and ideas!

Most of us probably have a notebook-we-dropped story we’d rather forget, but we need to remember them and share those stories with the up and coming generations as cautionary tales, and examples of good and poor digital citizenship.  Ole Golly tells us, “Remember that writing is to put love in the world, not to use against your friends.”  Writing, a technology we have come to understand a bit better since Gutenberg, can be used for good or ill; but we don’t ban it.  Now we are all learning, albeit uncomfortably at times, how to handle the newer technologies of social media, digital communication, and video games.  It may be a bit utopian to suggest that texting/tweeting/gaming/Facebook/blogging is to put love in the world.  But the alternative seems to be that while some of us ignore, avoid or fear it, other people, governments and corporations will learn how to use it against our friends.

Embedded in Harriet the Spy is a quote from Lewis Carroll, which aptly describes where we find ourselves in the 21st century of social media: “‘The time has come,’ the Walrus said,/’To talk of many things:”  Indeed, the chatter can be deafening, impulsive, hurtful and confusing.  But the solution is to choose our words carefully, not to stop talking altogether.

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The Kids Are All Right

image courtesy of gamerfit.com

image courtesy of gamerfit.com

Last week some family friends came over to our house for dinner. The children, we’ll call them Larry, Curly and Moesha, were ages 12, 4, and 8 respectively. As you may imagine, children enjoy coming over to the Gamer Therapist house, which has 3 gaming consoles and a dedicated big-screen TV. After a quick tour of the gaming room, Larry and Moesha sorted through my games and located Portal 2, and within minutes had set themselves up to play cooperative mode. Curly was content to sit between them, and the adults retired to the first floor to hang out and prepare dinner.

Throughout the evening we could hear the sounds of the happy gamers and the game, while my friend Rebecca talked frankly about her ambivalence about their gameplay. The ambivalence sprang primarily from a well-meaning friend who had criticized her parenting style. Another set of parents had told them that their children wouldn’t be able to play with them anymore because they thought that the children were picking up bad messages from video games.

This conversation was interrupted by the children twice, both by Moesha. The first time she came down to inform us that Larry had succeeded in unlocking a very difficult achievement. The second time she came down to ask me if I could join them and help them solve a puzzle in the game they had been struggling with. I went up, and within a few minutes a fresh perspective and Larry having some patience as I familiarized myself with the controls had advanced them to the next level. A polite thank you let me know that I was no longer required, and I returned to our conversation.

A discussion about education and video games was in full swing, and a debate about how much screen time is too much. At this juncture I pointed out how hard it is for us to catch children when they are doing things right. I observed that for the past 2 hours children, siblings, spanning an age difference of 8 years had been engaged in cooperative learning. What’s more they had voluntarily engaged with the adults on two occasions. The first was for one child to express pride in the achievement of her sibling. The second was to request adult assistance with some problem solving. And all along our parental ears had heard not one whit of conflict or argument. Yet all of this would have been easy to miss, or worse, dismiss as “parking the children in front of a screen.”

Every day, parents like Rebecca are bombarded with much-hyped exposes on how dangerous video games are to children. Horror stories like the one my colleague at BC psychologist Peter Gray blogs about are touted, in which a South Korean young man plays for 50 hours straight and dies after going into cardiac arrest. Gray goes on to put this tragedy in perspective: There are 7 billion people on the planet, and this incident represents 0.000000014% of the population. It is by contrast far more difficult to catch the number of children and adult gamers doing things like learning physics, researching a vaccine for HIV, or gaming to raise money for hospitals.

And although studies linking the dangerous connection video games have to childhood obesity, the media somehow never manages to pickup ones like this that showed that children who had electronic devices in their room were more likely to engage in outdoor play. Perhaps the Obama administration did read this study though, as they are moving to a more gamer-friendly position with the appointment of Constance Steinkhueler to study the civic potential of playing games (Thanks to my colleague Uriah Gilford for calling my attention to this.) The video game danger is overhyped.

Parents are playing a game far more dangerous than any video game, and that is the “Who Is Parenting Best” game. Over and over I hear conversations about what the best school district is, how to set privacy settings and enrichment activities. This despite, as Rob Evans EdD. points out in his book Family Matters that by age 18 children and adolescents will have only spent about 10% of their total lives in school. Setting privacy settings is the first and most minimal step to helping children navigate the 21st century community that relies on the internet. And enrichment activities are unfortunately often activities that appeal to what a parent wants quality time to look like, rather than what a child enjoys.

In discussing school districts, privacy settings and quality time, parents are often missing the point. Worse, they are confusing worry with effort.

We need to stop “phoning it in” with our kids, finding the “right” school, program or setting to park them on so we don’t need to worry. It is human nature to want to get to a safe spot to relax and stop changing: We need to fight it.

Often when I speak with parents who complain about the amount of time their offspring are spending playing I ask them if they have ever played the game with their child. The answer is invariably that they haven’t, even though a recent study showed that girls who gamed with their fathers reported lower levels of depression. Quality time always has to be some Puritanical ideal: a bracing hike, the symphony, or a museum. I love doing all of those things, which is why I do them. That doesn’t mean that a child or adolescent will have them as a preferred activity.

I know, I’m criticizing your parenting, please bear with me. Because you can take it, and your children need you to stop playing the Who Is Parenting Best Game. They need you to try playing Portal 2 with them if that is what they’re into. If you fumble with the controller, all the better, because we adults have forgotten how clumsy and awkward learning makes children feel. Education has gone taught us to find a safe spot and stop learning about anything that is outside that comfort zone.

We have long known that one of the strongest protective factors for children is an involved parent, but somewhere along the line we have gotten the mistaken idea that that means control. To be clear, parental control does not equal parental involvement. At best it is one element of involvement, at worst it is phoning it in.

Does this mean schools have no responsibility? Absolutely not. But I would like to suggest we return to Larry, Curly, and Moesha for a different example, namely a curatorial model. That means setting up a place for them to explore and negotiate things on their own for the most part, while we are constantly available for engagement. Yes that is a tall order, and one that requires that we think beyond the nuclear family and school as factory models.

I am fortunate to belong to massivelyminecraft.org a server where children and adults from the UK, US, Australia and other places play the sandbox game Minecraft together. It is not segregated by age, but vetted by the server moderators, who require parental permission for children to join. Within the game world, you can see adults and children learning and playing together at any hour of the day or night. They are voluntarily learning about geometry, math, physics, animal husbandry, chemistry, geology, economy, social skills, communication and a host of other things, in a way that is curatorial rather than proscriptive. Adults are there and occasionally on chat or via Skype will step in to mediate a conflict between two children, or if help with a task is requested.

Why can’t 21st century education be like this? Imagine a virtual classroom where parents and teachers can privately chat while both observing unobtrusively a child’s progress. Imagine homework at the table replaced by building a virtual pyramid together. Imagine virtual trips to Paris in Second Life, where no one is too poor to come along. Imagine time on learning that is maximizing the child’s engagement and minimizing unnecessary supervision. Imagine adolescents finally having educational settings that run synchronously with their biological clocks. Imagine a collaborative effort that doesn’t segregate human beings by rigid grades, parent/teacher roles or socioeconomic status. Imagine recess that can happen year-round, sometimes in a field, sometimes on the Wii Fit or Kinnect.

I believe the research is showing more and more that these things are possible. And I believe that our children are counting on us taking a leadership role in technology and education rather than a fear-based ones.

I leave you with this image. As he was leaving my house, Larry looked at me and declared that I “wasn’t entirely horrible” for an adult. What parent wouldn’t love to hear such high praise from their tween?

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The Uses of Disenchantment

Magic fulfills the wish that we could have powers to be beyond who we sadly suspect we are. As children, magic explains the inexplicable nature of external forces (i.e. parents, teachers, death) and internal ones (unconscious drives, nameless attachments, inconsolable sorrows and consuming rages.)

Anyone who plays WoW, Elder Scrolls, or Dungeons & Dragons, knows that enchanted weapons and armor are valuable items to be gotten. They raise our stats, make us stronger, more intelligent agile, or resistant to harm. They fulfill the wish that we could be more than we are.

That being the case, the profession of Enchanting is a very valuable one to master. To do so is to be able to craft our own items for use or to sell. And to master the skill requires not only enchanting practice, but also the act of disenchantment.

Disenchantment is the breaking down of an enchanted item into its component reagents. In Skyrim this consists of taking the enchanted item and destroying it, which allows you to discover the enchantment. So, for example, if you come across an Iron Battleaxe of Scorching, you have a choice. You can enjoy your new battleaxe which will add fire damage to the physical damage you do using it. Or you can disenchant it, and learn how to imbue any weapon with the ability to do fire damage.

In World of Warcraft disenchanting items is necessary to provide you with the reagents, or raw materials, to do other enchantments. Learning the enchantment is done separately, by training or reading a recipe, but disenchantment is still necessary to break down enchanted items into components you can use for other enchantments. Enchantment operates in the domain of creation and destruction, attachment and loss. I can remember feeling many the hesitation as I was about to take an Epic staff I’d used for months and dissolve into Abyss Crystals. Even though I knew that I was going to get a new weapon with a strong enchantment out of it, disenchantment required sacrafice.

Many patients labor under the illusion that the purpose of therapy is to make you feel good. I have always maintained that that is not true. Therapy is not about making you feel good, but rather about learning how to not to feel good. It’s about learning how to experience and tolerate those unpleasant feelings in a different way than we’ve learned to previously. People abuse substances, food, sex, and yes, occasionally video games because they cannot tolerate feelings that don’t feel “good.” Who wants to feel inconsolable sorrow, thwarted passion, grief, terror, or hopelessness?

And so people come to us wanting symptom reduction, not character building; relief, not the raising of unmentionable wishes and fears to consciousness. At first, we often provide those other things to be sure. A compassionate ear to listen, a calming influence, a holding environment. But in the end, therapists are alchemists and enchanters: Nothing new can be created by our patients without something being destroyed. Something must be given up to create something else.

Consider this: Neurosis is like an enchanted armor that we can no longer use. Maybe we have outgrown it. Maybe it never really fit well but it was the best compromise we could come up with. Maybe it buffed up our strength stats when we really needed more intelligence to play our class effectively. For whatever reason, it is no longer helping us, in fact it has created distress.

Symptom reduction alone won’t solve this problem. It may alleviate our distress for the moment, relieve pain enough to create the “space” between feeling and behavior so that we can begin to do the longer-term work.

That’s where disenchantment comes in. We need to take the item, the neurotic conflict, and break it down into the components that create it. What is the wish and the worry? What causes the guilt? Just what are we so afraid of that we can’t look at it directly?

This doesn’t always have to be painful, and therapists shouldn’t use this as a justification for brutality. But to think that the process of therapy is not going to be uncomfortable and difficult; is not going to take some time and hard work is pretty much delusional. If our enchantments could have gotten us any farther we wouldn’t have given them up. Most addicts and alcoholics would have used longer if they could have. If they could have enjoyed one more binge, party or high, they would have.

Insurance companies love to focus on symptom reduction, and a narrow view of what evidence-based treatment really is. Symptoms are problems to be solved, rather than signposts pointing towards underlying issues. And although this is short-sighted, it is understandable: 10 sessions costs a lot less than weekly sessions. And yet, the most recent research I’ve read indicates that psychodynamic therapy is as effective as CBT and other therapies, and in fact more effective in sustaining longterm change.

Bruno Bettelheim, a psychoanalytic thinker, is perhaps best known for his book The Uses of Enchantment. In it he discusses how the themes of fairy tales often symbolize the real emotional and psychological struggles that children go through. Through the projections of stories, children are able to work through their fears in remote and tolerable ways. In a similar way, Klein speaks of the paranoid-schizoid position where the parent is split into good and bad objects, the fairy godmothers and evil witches of fairy tales.

Disenchantment, from a Kleinian lens, leads to the depressive position. It is where we hopefully get to, despite the depressing name, that point when we realize that people are not either all-good, or all-bad, but both good and bad, nurturing and depriving, gratifying and frustrating. In other words, human. The world seems less magical in some ways, and that is experienced as a loss. Sounds depressing, eh? So what is gained?

There is a practice in Tibetan Buddhism called tonglen. In this form of meditation, you begin by touching the tender spot of whatever is sorrowing or distressing to you. Say you’ve lost your loved one. Allow yourself to feel that grief for a moment, really feel it. What an awful wrenching feeling that is. You may reflect that nobody should have to feel what you’re feeling right now. And yet, all over the world, there are those who have felt that, may be feeling it even as you are right now. So you breathe in, and imagine breathing in all of that grief as if for that moment you could take it into your heart so that nobody else would have to feel it. And then you imagine yourself breathing out comfort and security and everything that is the opposite of grief and suffering to the world and to all those in it who need it. You reverse the cycle of trying to avoid pain and grasp pleasure, and in doing so generate compassion.

That is the use of disenchantment; breaking down our fantasies that we can avoid pain and transmuting it into compassion for others. Imagine if you were to really accept that everyone is human and fallible and mortal. If you were able to walk around tomorrow and remain conscious that everyone you meet is dying, would you treat them in the same way as you did today?

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What Google+ Could Mean For Therapy

Every technology reveals the hand that shaped it.  The technology of the 21st Century is no exception:  Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms.  And the explosion of access to information was detonated by our own curiosity.

For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it.  Listservs are a great example:  They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level.  Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.

And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board.  The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them.  The online world expanded exponentially, and in fact that interactivity and information became overwhleming.

Which brings us to Google+.

For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media.  Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds.  If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it.  But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.

So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.


The Google+ system of circles is as powerful as it is flexible.  Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”



The interface let’s you drag the name and image of different people located on the top to one or more of the circles below.  When you mouse over the circle it expands to give you an idea of who you have put in it.  And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself.  For example, I have a circle for “Minions.”  I’ve always wanted minions.

This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life.  This can be especially useful with patients on the autistic spectrum.  We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of.  Who goes where?  Is everyone a friend?  Can we put people in more than one circle?  Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”?  What sort of circles might we want to create that Google+ didn’t give us?

People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful.  Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be.  Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further.  Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention.  We could help them explore and decide how to set up their own personal boundaries and affectional investment.

Or imagine for a second you are working on emotional regulation issues with a patient.  You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle.  Do some people go in more than one circle of affect?  Do they notice that they are taking people in and out of circles frequently, or never?

Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to.  They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those.  And all of a sudden they also have a visual list of who they can call when they are trying to socialize.

Last example, working with trauma and/or substance abuse.  Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc.  Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis.  It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one?  What do you think you could do about that?”

So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.


In Google+ circles go hand in hand with your Stream or Streams.  A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles.  It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back.  And you can set each circle to have different levels of access to your posts.  In other words, circles and streams together allow you to learn and set boundaries.  Here’s what a Stream can look like:

This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes.  Much like Twitter, or like life.  If we had to pay attention to everyone all the time in the same way, we would become very fatigued.  Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times.  Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them.  But it gets even more interesting.

If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc.  Now if you click on any of those circles, the Stream changes.  Specifically, it changes to list only the posts from the people in any given circle clicked.  This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.

Imagine working with an adolescent and reviewing their streams together.  What sorts of media, comments, and concerns are streaming through their lives at any given moment?  And what is the consequence of having 500 “friends” in their friend circle?  Do they feel intimate or able to attend to all of these friends?  Or are there some times that they may be more interested in attending to some friends than others?  If so, why?  Might it be time to start to rethink what it means to be a friend?  Is it ok to select who they attend to at certain times?  Do they really find the content they get from A interesting?  And if it is consistently uninteresting, does that say anything about their relationship?  Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.

For a second example, let’s return to the patient with ADHD.  Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way.  That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor.  If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done.  Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do.  But these types of decisions and focussing techniques may be crucial to staying on task.  (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment.  It’s not always just “playing on the computer” now.)

Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles.  Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?”  Maybe they’d rather tune into a steady Stream from their “Supports” circle instead?  And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways?  Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?

We make these decisions all the time, we just aren’t always conscious or overt about it.  And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves.  We need to have boundaries and filters.  We need to be able to focus and set limits and values.  These needs have begun to be more clearly revealed by the technology of Google+.  Knowing about that technology may improve our ability to treat our patients.

Children, Mental Illness & Video Games

Photography by Mykl Roventine

I hesitated to use the above title, because I can imagine my gamer audience rolling their eyes already.  Bear with me please, it’s not what you think.

A new study has come out reporting that children are using video games “pathologically,” and that this is a global problem.  The study, summarized here, reported that out of a sample of 3,034 children, 9% of them could be considered “pathological” in their play, which the researchers found “some serious problems – including depression, anxiety, social phobias and lower school performance – seemed to be outcomes of their pathological play.”  And so the media has already begun to hype this up as video games cause mental illness in children, as well as video game addiction is a problem.

So let’s think this through together.

First, there is the problem of cultural translation.  The study was conducted in Singapore, and as one of the researchers acknowledges, “”In the US, we didn’t follow the kids across time, so we don’t know where that threshold is across each culture or if there is a certain amount that is too much.”  And we also don’t know the cultural variables when we compare Singapore, a city-state, with other countries.  Children in urban areas often play more video games due to the safety concerns of living in an urban area.

But more importantly, let me share with you some other statistics, more close to home.  The National Institute for Mental Health as recently as last September released this information.  Using a sample of over 10,000 teens ages 13-18, they found that over their lifetimes 20% of the children had “suffered from a mental disorder with symptoms severe enough to impair their daily lives.”  An earlier study with over 3000 younger children found that 13% of the children met the criteria for one or more mental disorder.  This figure, by the way is down from the Joint Commission on the Mental Health of Children, which in 1969 found that 13.6% of all children had “emotional disturbance.”  So that’s long before Pong, people, and the statistics if anything have gone down with the advent of better treatment.

Let me share with you one more statistic, from the Pew Research Center which found in 2009 that 99% of boys and 94% of girls play video games.  So yes, close to 100% of children in the U.S. play video games, and yes, somewhere between 13-20% of U.S. children have some mental health issue, but that’s because the statistic correlates to a pretty consistent percentage of the population over time predating video games entirely.  And if the first study from Singapore were comparable, we could make the argument that kids in Singapore play more video games and have less mental health issues than kids in the U.S.  So go Singapore!

If you think you game more than you’d like, feel free to change that, but don’t do it because someone in Singapore says you should.

But if I stopped my rant here, I think that would be doing a large percentage of the population a disservice, namely, those 26.2% of Americans who live with some form of mental illness.  Haven’t we stigmatized these folks enough?  The constant warcry of “video games are bad,” leans on the ableist stereotype that “mental illness is bad.”  It’s not.  Mental illness can be challenging, heartbreaking, costly and different from a societal norm, but it is not bad.  It is a prevalent health condition, like other prevalent health conditions like, per the CDC statistics, p. 292, Diabetes (10.1%,)High Cholesterol (15.6%,)  Hypertension (30.5%,) and Low Back Pain (25.6%.)  Whether it be providing adequate health coverage and parity, or taking away the moral overtones, it’s time we stopped treating mental illness like it is something different than other health concerns.

Gamers and people with mental illness do have something in common:  They are both marginalized and socially stigmatized by the larger population.  So whether you play Super Mario or live with PTSD; whether you play WoW or keep challenging your Depression; whether you have ADHD, Asperger’s or a PS3, game on!  There’s nothing bad about you all, any of you, no matter what the experts say.