Harm Reduction and Social Media: A Way to Save Lives


Should social media come with warning labels? 

In the view of surgeon Vivek Murthy, the answer is yes. As he argued in his recent column for The New York Times (which I posted as an Around The Web), too many young people are being damaged too much by its harms: the bullying, the body-shaming, the endless rabbit holes that suck youths into the depths.

Comparing the risks with tobacco or driving a car, he writes: “It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents.” It wouldn’t solve the problem, he says. But it would be a step in the right direction, along with other efforts to create safeguards and parental oversight of their children’s online use.

Back in February I wrote an article addressing social media’s impact on youth mental health, and here on Mad in the Family I’ve posted piles of other content on the topic. I also urge you to read Zoe Cunniffe’s new, deeply reported piece on the “TikTokification” of mental health on campus. 

So the saga of social media is complex and ongoing, with more and more voices chiming in and more and more calls for change. School districts and state attorneys general around the country have filed lawsuits against companies like TikTok and Meta, which owns Facebook and Instagram; in Congress, senators Richard Blumenthal (D-CT) and Marsha Blackburn (R-TN) have introduced the Kids Online Safety Act (KOSA), a bill that calls for safeguards and other measures “in the design and operation of products or services used by minors to prevent and mitigate certain harms.”

And yet some argue that social media isn’t all evil and might even be good. As Murthy himself acknowledges in his piece, some teens find community on such platforms  — particularly LGBTQ+ youth in less-than-welcoming physical locales who are desperate to find a place, however virtual, where they can feel more accepted for who they are. But social media can also have the opposite effect, increasing the sense of isolation as the hours spent online reduce the time enjoying in-person social interactions. 

And according to research, three-dimensional social connections can offer an enormous lift to our mental health. As the authors argued in a 2017 paper in the American Journal of Lifestyle Medicine, “Humans are wired to connect.” Among other things, feelings of connection and support can “decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality.” 

So what’s the answer? Is it all or nothing, or something in the middle? Should we be eliminating youth access to social media entirely, or dialing it down? Back when my kids were young, they were allotted one hour of “screen time” a day — but they only had flip phones through high school. These days, with the explosion of social-media platforms alongside the ubiquity of kids carrying smartphones, the challenge for parents isn’t merely a matter of parceling out their children’s time online. It’s even being aware of what their kids are doing on their phones and tablets, and for how long. 

How can you know? How do you monitor it? How do you control it? How can you wipe away all of social media’s harms? You can’t. As Murthy further writes: “There is no seatbelt for parents to click, no helmet to snap in place, no assurance that trusted experts have investigated and ensured that these platforms are safe for our kids. There are just parents and their children, trying to figure it out on their own, pitted against some of the best product engineers and most well-resourced companies in the world.”

And yet the interesting thing, to me, is that seatbelts don’t eliminate every risk associated with being in a moving vehicle — whether you’re a passenger or behind the wheel. Even once we buckle up, driving is still the riskiest thing we do on a regular basis. But it’s less risky with a seatbelt. For all the people who die in car crashes, more people survive these days than they did before states started requiring seatbelt use in the mid-1980s. 

Any harm reduction effort, whether employed in needle exchanges during the AIDS epidemic or social distancing during COVID, do not minimize the  tragedy of anyone who dies or the pain of those who grieve. What they do is reduce the number of such tragedies. And however the arguments over social media’s pros and cons play out — whether Murthy gets his warning label, and whether laws get passed that regulate tech companies and set age limits — there is still benefit to be found in making whatever adjustments we can. 

There might not be some magic wand, some perfect fix, that makes social media 100 percent safe for kids, but even the smallest of changes can help make it just a little bit safer for a few more youths. And saving a few more lives is always worth it. 

After describing a grieving mother who lost her daughter to suicide after being bullied on social media, Murthy writes: “One of the worst things for a parent is to know your children are in danger yet be unable to do anything about it. That is how parents tell me they feel when it comes to social media — helpless and alone in the face of toxic content and hidden harms.”

Such harms include the cyberbullying and sexual exploitation of minors, including doctored images and “sextortion”—that is, a threat to post explicit photos. As the grieving families who founded Parents for Safe Online Spaces explain on their website, “We refuse to let any other family experience this devastation. We are empowered by the memories of our beautiful children, turning pain into action.” 

That action includes supporting KOSA. Would it help? Would warning labels help? Maybe. 

Maybe those and other efforts to reduce such harms would yield, for kids and families, a little less time online. A little more time in three dimensions. A little delay in access to TikTok or Instagram for younger kids. A little less exposure to toxicity, bullying, sextortion. And a little more acknowledgement of social media’s harms and parents’ concerns — all while keeping the connection-making, identity-affirming aspects available to kids who need it. 

No one knows, in the end, what will work and what won’t. But something needs to be done. Perhaps many things. And if some of those things mean fewer kids suffer and die, and fewer parents grieve, that’s a step in the right direction. 

—Amy Biancolli, Family Editor 

[email protected]


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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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