Podcast: Dr. Sanjay Gupta has a virtual house call with a “mediatrician” to talk about how much screen time is too much.

It just kind of started to really wear on me physically first, I think. Because that was when I was just scrolling for hours, you know, not going to sleep. It was taking hours out of my day.

The story I’m about to tell you will sound typical at first. It’s about a college student named Jerome Yankey. He was pulling a lot of all nighters, but he wasn’t cramming for exams. He wasn’t hanging out with friends.

It was hard to stop. It was as hard to say, okay, I’ve seen enough because there isn’t enough on TikTok. There’s no winning on TikTok. There’s no end point. So you just keep going.

And going and going. In many ways, it is the point of TikTok. Scroll and scroll. Right into a rabbit hole.

Add it all up, half an hour to an hour when I wake up, you know, a little bit in the free time during the day, maybe during a meal, another 2 hours during the day, maybe averaging 5 to 6 hours a day, even more if I had more free time.

This story did not unfold overnight. For Jerome, he initially started out just posting funny videos on the app, making skits.

I thought I was, you know, entertaining, intriguing. And I still think I am. But they weren’t crazy concepts.

As a college freshman, Jerome used the app to create a public persona, to redefine himself, to make new friends.

And it is that journey of saying that like, Hi, this is my TikTok account. I have zero followers. The only people I know on here are my friends, and I’m going to post and someone might see it because there is a chance. Because that’s how the TikTok algorithm works.

This was a story of a young man with big dreams of becoming an influencer, a Tik Tok star. But the story also has a typical ending, and it’s not a happy one. As with most people, Jerome’s videos never really took off, and that was frustrating. And now all that scrolling was just fueling a downward spiral.

I was simply watching, just scrolling, just kind of just droning on through endless content. That’s when I started to become less of a creative and more of a cynic, you know? All I would be doing is just reviewing content. I would see it and I would be like, Oh, I could be funnier than that. Or, Oh, they’re not even that good.

And then everything changed. Jerome had been scrolling away one night and he saw the sun come up. He hadn’t slept at all, and he was falling behind in school. And at that moment, he decided he had to break up with TikTok.

I quit cold turkey, you know, I just kind of uninstalled the app. I didn’t really look back.

Jerome says something deep inside of him stirred. Maybe it was an urge to simply look up from his phone and actually enjoy the real world around him. It was like emerging from a fog.

It wasn’t until I started taking time away from the app that I realized that I wasn’t unattractive, I wasn’t unsuccessful, I wasn’t, you know, unpopular. It was just the fact that I was comparing myself to the super ideals of every form.

That. That is the thing that really stuck with me about Jerome’s story. How innocently it all started. And if I’m being honest here, as a dad of three teenage daughters, I can’t help but think about how I can keep my daughters from going to that same place. Look, I see how much they enjoy the app. I do see the appeal. Heck, we’ve even made videos together. But here’s what worries me. As much as I work hard to protect them, in their real world, I do worry about their digital world and what might happen to my girls when they don’t have as many rules or supervision. My oldest, Sage, is about to head to college, which means soon she will be the same age Jerome was when this all happened to him. It’s hard to believe, but might the same thing happen to her? Thankfully, Jerome managed to figure it out on his own. But I know not everyone can do that. In fact, sometimes it gets so bad people need medical help.

It is there as a resource for helping those children and families who have really gone down the rabbit hole, if you will, of gaming, of social media and of what we call information bingeing.

So on today’s episode, I am going to see and experience the best medicine has to offer by turning to a self-described media-trician for advice.

We’re in a brave new world that we’re going to have to figure out as we go along. And it’s not even generational anymore. I mean, I have 17 year old patients who say, you know, I’m cool, but I really worry about my 14 year old sibling because this environment is morphing and evolving so rapidly.

I have questions, many, many questions. How much screen time is too much? What are the warning signs? Things are going wrong. Most importantly, what can you do about it? And he has lots of tips for kids and for parents and really for anyone trying to navigate this new world. I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is Chasing Life.

Jerome Yankee’s story may sound extreme, but as I said, it’s actually not that out of the ordinary. About 16% of teenagers in the United States say they use TikTok almost constantly. That’s mind blowing all of their time on a single app. And you know what? It’s not just TikTok. Or teens, for that matter. Three out of ten adults say they are online almost constantly as well. But here’s the thing. While this data is useful, it’s important. It doesn’t paint a complete picture. What these numbers don’t tell us is how all of that time on TikTok is actually impacting people’s mental or physical health negatively or positively. Or if those surveyed even consider themselves to be addicted like Jerome did. And here’s one thing that I learned. As much as we like to throw around the word addiction, we need to be careful here. For now at least, Internet addiction is not a thing. It’s not an official clinical diagnosis. There’s even still a lot of discussion on whether or not it even qualifies as a mental health disorder or even how to define it, how to measure it, how to test for it, and especially how to treat it. Most do agree, though, that regardless of the semantics here, whatever you want to call it, too much doomscrolling can be bad for you. And there are a lot of people who want help, who need help. And that’s where Dr. Michael Rich comes in.

Before the lockdown and we went to virtual visits. I had about a 30% no show rate on first visits for kids who are struggling with their interactive media use because the parents would wuss out and wait until the night before or the morning of and saying, we’re going to take you to a doctor, is going to take your video games away. And of course, the kids would say, no effin way, I’m out of here. As soon as we went virtual, our no show rate dropped to zero because they’re comfortable in this environment.

Dr. Rich is a self-described mediatrician at Boston Children’s Hospital. A mediatrician. That’s a fun way of saying that he treats young patients with what he calls problematic media use and what is problematic. Well, simply, these kids lives are being disrupted by the time they spend online. Now, in case you’re wondering, it is not lost on him that treating patients for problematic media use virtually via a screen is a little ironic. But this story has lots of twists and turns. In fact, before Dr. Rich got his start in medicine, he actually worked in media.

I spent my wicked youth in the film industry. You know, I love Screen Media, but I also respect it, you know? And I think that in any great love affair, there’s a deep respect as well.

After his career in film, Dr. Rich co-founded and now co-directs the Clinic for Interactive Media and Internet Disorders in Boston. The clinic was founded in 2017 and is one of few of its kind in the country. Now, in addition to leading the clinic, Dr. Rich also leads the digital Wellness Lab at Boston Children’s, which receives funding from social media companies like TikTok and Meta. Now, I had never heard of any of this before. So I decided to start at the beginning.

When you have a parent who is bringing a child in to see someone like you, they’re doing it because they’re worried, right? I mean, if a parent is taking their child to see the doctor, period, and leave alone for something like this, it’s because they’re worried. You know, they’ve been having pain, they’ve been unable to keep food down, whatever it may be. So they’re coming into you with a worry. What is the worry? Exactly. Like I get the worry is that they, I think my kid is spending too much time on a screen. Ergo, what?

Well, what the parents see is the young person essentially withdrawing from various aspects of her or his life. You know, they are not getting up for school. Sometimes they’re staying up all night gaming or on social media or whatever. So they see the young person withdrawing actually from them most acutely. You know, the kid stays in their room. The kid, you know, is on screen. You know, instead of having meals together, instead of just spending time with the family. So I think that’s the pain point for parents.

Do you define for the patient and or the family what is too much, what is abnormal in this world? And we have to define within normal limits in medicine. That’s how you get lab results within normal limits. What is within normal limits here?

Where the problem comes in is when their day to day functions are impaired in some way. They’re not getting enough sleep. They are overeating. They are missing school or falling asleep in school. They are withdrawing from their friends. And actually, one of the things I do with these young people in the first visit, if I can, if they will let me through the chink in the armor is try to identify their pain points, the things that they wish were going better, whether it be school or. I wish I had more friends, etc. rather than having some ideal that sort of says over x number of hours is problematic, is impairing your life. I want to look more at what their life is from the time they wake up to the time they go to sleep. So I think that it really has been about how are you feeling in your life? How are you doing? Are you getting grades in school that are reflective of your capabilities? And almost invariably they’ll say no. And then we’ll explore why that might be.

Dr. Rich says that a lot of his patients have underlying conditions, like obsessive compulsive disorder, anxiety, sometimes just plain old stress from school or life. And what he believes is that their use of social media, or technology turns up the volume on those conditions. And I thought that was a really critically important point, because what he is saying is that for many of these children, social media did not cause the problem. It amplified it.

Their use of the screen media is really an attempt to self-care, to self-soothe, if you will, rather than a problem in and of itself. And it is not the social media or gaming doing something to them, it’s how they’re using it that becomes problematic.

One of your patients, if you were seeing them in a world where we did not have as much screen time or social media. 15 years ago. Did you know what, 20 years ago, whatever it may be. Would that child still be seeing you? But instead of social media, it would be ex, you know, TV watching or, you know, some other sort of hyper binge activity.

Yes, it would be TV watching or things like eating disorders, substance use disorders of various kinds. And what it has in common with those is that these are behaviors that are trying to make them feel better or feel more in control of things. And so I don’t really see social media or the Internet as, quote, causing anxiety, depression, etc., as as it has been framed by some so much as it is an enabler of anxiety and depression that may or may not have happened anyway at this stage of life. What the interactive media environment does for them is it provides them a place where those anxieties, depression, etc. can kind of manifest themselves even more, even if they were not noticed otherwise.

As I talked to Dr. Rich, what really stood out to me was his approach to treating his patients, his young patients.

In our experience, addiction is not an accurate or useful model for what’s going on here for a number of reasons, not the least of which is that the therapeutic goal in any addiction, as we call it, is abstinence. The therapeutic goal of treatment for problematic interactive media use cannot be abstinence. This is an essential tool, an essential skill of our time. And so we see this as much more akin to binge eating disorder in the sense that it’s overuse of a necessary resource that is driven by underlying psychological needs that are not otherwise being met.

While Dr. Rich recognizes that screens can feel addictive, he doesn’t think it’s the right way of describing it. Why? Because, like it or not, we need screens, just like we need food.

And that’s why I sort of move away from addiction as a model, because we as a society use the term addiction as pejorative. We think of addicts as weak people with weak character, etc., and we approach addiction, frankly, still as something to be punished rather than healed. These kids do have certainly short term problems withdrawing from these behaviors. But when one understands that it is not the behavior doing something to the young person, but the young person seeking out and pursuing this behavior because it makes her or him feel better because it is alleviating their anxiety or it is helping them who have ADHD and have spent the entire school day feeling behind Clueless, you know, like they’re dumb. Including their social interactions where they can’t keep on top of a conversation. They come home and they sit down in front of a screen and play a first person shooter. And not only are they in control of that universe, but in many ways they are better than so-called neurotypical kids at a game that actually reinforces and rewards distractibility, hyper vigilance, and all the aspects of ADHD that are problematic in a classroom setting.

That’s fascinating. That’s a really, especially that idea of how you might have a day like you described, where you’re feeling behind all day and then you come home and you can regain some sense of control. I mean, yeah, that sounds familiar, doc. Frankly, it sounds familiar in terms of what I may see with my kids, but even myself to some extent, you know, like I will find myself playing some silly game on planes, you know, and things because I’m. I need to regain some sense of control. Maybe I need some wins. I need a few wins because I’ve had a bunch of losses today, but I can beat this computer at this.

Right.

That last point from Dr. Rich really stopped me in my tracks and it stuck with me. When you treat someone who’s addicted to something like alcohol or cigarets, what you’re asking really is for people to give those things up. Abstinence, that makes sense. But again, for most people these days, that’s simply not realistic with technology, let’s face it. So Dr. Rich’s approach is let’s learn to live with it and along the way, respect it. Look, I know that’s a huge shift from the doom and gloom warnings. We often hear that social media is harming us like a bad drug and that it. Needs to be cut out of our lives.

I think that if we can take a step back and treat the smartphone or the tablet or the social media platform as the power tool it is, and think about it the way we think about our child driving a car, for example. Right? A car is something kids want to get. But that being said, I don’t think we would teach our child to drive either, because everyone else is doing it regardless of what their age is or in a way that is sort of a have at it, you know. But we will hand a four year old who’s screaming an iPad and say, you know, go play Angry Birds or something like that as a tool to calm them down without thinking about the implications. And so I think that we just have to treat these tools as tools and with more respect and also help these kids learn to use them, not in fear, not in stay safe, because we don’t teach driving a car by saying, don’t hit that tree, don’t run over pedestrians. We teach them to drive a car and in the process they learn to be safe. I think that we need to approach it not out of fear, but out of a sense of mastery of this powerful tool.

Thinking about it as a power tool, more like an automobile maybe, you know, sort of framing. I think it’s really interesting as my children are starting to drive. I think about that all the time as well. Like if you said, what is my biggest concern about screens with my teenagers? You know what I would say far and away, my biggest concern is they use it when they’re behind the wheel of a car far away, because that can be catastrophic in a millisecond. Do I worry about how much they’re using it overall? Sure. But I worry far more about when they are using it and what they are using it for.

What really matters here is content that we are both consuming and creating in this space and the context in which we are using it. So something that would be perfectly fine, you know, in the middle of the day between things you don’t want your kid doing at three in the morning, in in bed at night interrupting their sleep, or you don’t want them sitting at the dinner table, you know, online, etc.. We should really focus on the content. And is this healthy content? Is this helpful content or not? And what is the context in which they are doing it? And I think the one place that screen time comes in is really what is this displacing that I could be doing? Yeah. Could I be having a conversation at the kitchen table with mom or dad? Could I could I be out playing with my friends? And that is where the kind of seductiveness of the online space can get in the way of the rich and diverse menu of experience that is so helpful to growing up.

I’m not going to lie, so much of what Dr. Rich said was comforting to hear. Felt like I really needed to hear some of this as a dad of three teenagers. But there was something else to all of this as well, something that I think will sound familiar to many parents, and that is when I talk to my girls about cutting down on their screentime. Honestly, sometimes I just feel like a hypocrite, not just because I use my screens a lot as well, but for another reason. I often think, What would I have been like had I been born into a world of screens? And honestly, when I really sit down and think about it and knowing myself, I think my screen time probably would have looked pretty similar to theirs. That’s the truth. Think about that for yourselves. What would you have been like had you been born at this time? Reframing it this way is really helpful for me as a dad. It makes me far more empathetic to their situation. But it still leaves this question How should we be using our devices? Is there a best way to do it?

The Luddite approach is not going to work. Turning it off, limiting it is not going to work.

After the break, we’re going to hear how Dr. Ritch treats his patients directly from one of his patients.

What I found out is that I knew a lot more than my parents did about social media. Mostly, Dr. Rich said that my parents, they should listen to me when I say something about screens.

And I’m going to get his advice for improving my own family’s relationship with technology. Stay tuned. And now back to Chasing Life. Before we hear more from Dr. Rich, I want to first introduce you to one of his patients.

My name is Allison. I am 13 years old, in eighth grade, and I know way too much about horses.

Allison visited Dr. Rich for the first time as a preventive measure. There wasn’t yet a problem, but her mom, Amy, says that she was struggling to raise Allison and her siblings in a world that was so different from the one that she grew up in.

The TV was broken in the back of my dad’s closet, and it got fixed, quote unquote, when I had my tonsils out. And we didn’t have a TV in our house until I was about 16. So coming at that, you know, with screens everywhere, raising kids, it was definitely baptism by fire.

Like me, Allison’s parents had a lot of questions in their first session with Dr. Rich, but he started by gaining Allison’s trust.

What I found out is that I knew a lot more than my parents did about social media. Mostly, Dr. Rich said that my parents, they should listen to me when I say something about screens. They should trust me to be like, open with them because I’ve been open with them in the past. So my first impression was a lot of him supporting the things that I wanted and also trying to get my parents to understand why I wanted them and how they could be good and how they could be how they could support me. And what I wanted to have was through social media.

Today, Allison is the proud owner of a smartphone. But one of the things she’s done is create her own rules to keep track of her screen time.

I implemented downtime where I can’t use my phone until 715 in the morning and I can’t use it after 830 at night so I can wind down for bed and have my morning routine. But I also made app limits so I can only spend a certain amount of time on YouTube. I can only spend a certain amount of time doing games. I can only spend a certain amount of time on other apps. So that means that I don’t spend countless hours mindlessly scrolling.

It’s pretty impressive. And again, keep in mind, she’s only 13. Now, Allison, I have to tell you, I can really relate to your parents. We often think of going to the doctor for checkups to help prevent future health problems. And in many ways, that is what your parents did for you here as well. And for all your listeners. This is what the conversation with Dr. Rich on the podcast is supposed to do for you. Think of it as a wellness check for smartphone usage.

How do you gain the trust of the patients you treat? I mean, I’m not saying that they’re looking at you saying this guy is some old guy. You and I are the same age. I’m just saying that. How can they understand my world? How do you gain that trust?

I ask them what games they play, or what socia-, seriously. You know, and I show them that I am knowledgeable about it in ways that are not pejorative, that are not saying it’s a bad place. I’m approaching it as the world in which they live. And I think that’s a mistake that a lot of parents make, which is they’re sort of dealing with it as something else. They’re standing at the top of the basement stairs saying, turn off Grand Theft Auto. I hate that. What I encourage the parents to do is sit down next to their child and play Grand Theft Auto with them, because there’s some really interesting things that happen then. Number one is, instead of saying, I hate that, get rid of it, it’s bad for you, you’re saying, I love you, I care about you. I want to understand what engages you. I want to understand what you’re doing here. And then when you finally figure out the 47 different moves with your thumbs it takes to steal a car, and you ask your child, okay, I finally figured out how to steal cars. Let’s talk about why we might want to do that and rehearse it over and over and over again. Right. You’re coming from a very different place. You are that child’s student and you are learning that from them. You’re changing the power differential in ways that are really meaningful to the kid, which is, I care about what you do. I care about you, and you’re not wagging a finger at them so much as you’re saying, Let’s understand this together and you’re giving them a way of moving on. That is not a punishment so much as it is the next step.

People must come to you all the time and say, when you distill it all down, then is there a best way, not a right way, but is there a best way to raise kids in an increasingly digital world? Like, what are the other top sort of tips that you give?

I actually say to parents, instead of developing killer apps, we should be developing our killer Bs. And, those are be balanced in our on screen and off screen activities, in a sense of be aware of what is not happening because we’re on a screen and balancing that against the screen use. The second is to be mindful to use these screens, these power tools for what they do well in a focused, directed way, not in a way of it being a default behavior because I’m bored or because, I mean, you know, not to, you know, pull out our smartphone the moment we step onto an elevator, going down the street. And that’s where I say, you know, let’s be mindful in our use and let’s be aware of what we might be giving up because our kids really do want us to talk to them. Yeah. And that’s the final killer b which is be present, because having these screens in front of us does not allow us to be present. And frankly, the apple doesn’t fall far from the tree. And, you know, oftentimes the parent is staring at their smartphone while they’re sitting in a visit with me. And so and I will confess my own 16 year old, when he sees me in front of my computer or looking at my smartphone, says the mediatrician, you know, he just he gets right in my face.

Oh, well, that’s that’s to be expected.

At the end of the day, my biggest question for Dr. Rich wasn’t really about the data. I wanted to know as a fellow dad, fellow doctor, when he looks at where this is all headed. Does he feel hopeful?

I am hopeful. I will acknowledge the fact that as a pediatrician that’s kind of a occupational hazard is optimism. But I am hopeful because of what I hear from the kids. And so I think that we will get better. We will also encounter problems we don’t even anticipate yet. So I think that, yes, things are going to get better. And yes, there will be some potholes in the road. The real question comes down to will we be able to spot those potholes and steer around them? Or are we going to hit them and have to resolve them as problems? But either way, I’m confident that we can do this. We have to take a yes we can attitude toward this and be prepared for problems to occur and solve them without guilt.

I love that. I really do. Taking a yes we can attitude towards this big issue is a big reason why I wanted to do this season. I wanted to look at the impact that social media and technology was having on all of us. But I also wanted to make sure that the tone of our conversations were right. It’s not about being a bad parent. It’s not about being a bad kid. It’s not about right or wrong. I might not be making the right decisions as a parent all the time. I know that. But I think that’s okay because instead of right or wrong or true or false, it is about doing the best you can with the best intentions in mind. There is little doubt that we’re in the Wild West when it comes to these technologies. There is little doubt that we are making some of this up as we go along, but it’s all about learning what path works best for you. For some people like Allison and her mom, Amy, it did make sense to tackle these issues early before anything bad happens. Others, like Jerome were able to self-identify, they have a problem, and then one day just decide to stop cold turkey. And I do realize that for some of you listening, you may be still worried about your habits and still not clear what exactly you need to do to change. That’s why in our next episode, science journalist Catherine Price is going to teach us how to break up with our phones.

Get in the habit of taking a break, so that you can both better understand the effect that your relationship with technology is having on you, and then also appreciate its benefits more.

And, my oldest daughter, Sage. She’s going to weigh in on all of this.

Do you feel like if you needed to stop. Could you do it?

Yeah, I think I could quit Tik Tok and Instagram. Snapchat would be a little bit harder to give up because that’s my probably my main source of communication.

That’s coming up. Thanks for listening. Chasing Life is a production of CNN Audio. Our podcast is produced by Grace Walker, Xavier Lopez, Eryn Mathewson, and David Rind. Our senior producer is Haley Thomas. Andrea Kane is our medical writer and Tommy Bazarian is our engineer. Dan Dzula is our technical director. The executive producer of CNN Audio is Steve Lickteig. And a special thanks to Ben Tinker, Amanda Sealey and Nadia Kounang of CNN Health and Katie Hinman.