Conversations with patients: Social Media

In these essays, I feature interactions I have had with my patients that I have found to be meaningful and thought-provoking.  Any details about the patient’s identity have been modified to protect patient privacy and confidentiality.

Holly is a petite woman in her late teens.  She has curly blonde hair half of which she dyed a deep purple, the bottom half.  In sessions she will often respond to a comment with a hum that is also a melody.  Three notes that tell me she has registered what I have said and that she is giving it some thought.
Today she brings up a stressor she has been having with the mother of her ex-boyfriend.
"She has been messaging me weekly since June, saying lots of mean things and calling me a slut," she says.
"With text message?" I ask.
"No, on social media."
She tells me she has blocked her many times, but this woman keeps finding ways to post on her accounts, publicly, for her friends and family to see.
I ask her what social media she uses and she lists Facebook, Instagram, Pinterest, Twitter, Tiktok and Snapchat.
I am very honest with my ignorance and ask her, "how do you manage all these accounts?"
She tells me she will post on Facebook primarily.  "I really don't know what I do with the others," she says.  She is not sure when or why she signed up for them.  She even has older accounts that she no longer has access to, either because she had them closed or she has forgotten the passwords and usernames for them.
"His mother is mad that there is a video of me and her son on TikTok, but I don't have access to it anymore so I can't take it down.  I want to."  She says.
She is thinking of going to the police.  Because of how this person has found her on many platforms and repeatedly sent her insulting messages, this may count as stalking.  "But she is in Florida, I have never even met her."
She tells me how she takes exception with the word "slut".  That she has been receiving these messages for months and ignoring them for the most part, but she can not help but feel the sting of this slur.  I try to imagine for a moment what it must be like, to be attacked in a public way, by someone so far away, for a video from the past that no longer belongs to the people featured in it.  I make a few suggestions trying to be helpful.
What I realize is that she comes to me, not for solutions.  From the discussion so far, it is clear she and anyone else of her generation would be much more savvy about this than me.  She comes to me to be heard and understood and so that is what I attempt to do.

I have been taking younger patients into my care lately.  With the rise of mental illness in our youth, I want to better understand what young people are facing, to better understand this crisis in our communities.  So far, I have been humbled with the challenges in their lives that no other generation has ever had to contend with.  I am further stupefied with the enormity of the task.  How can we grasp, quantify, know the impact of this technology on the younger generations?
Holly realized in the conversation with me that though she engaged with social media with the best intentions, it has traumatized her.  Because of this, she recognizes she needs to be much more diligent and careful about how she uses it.  Why did she have so many accounts, many she was not even using?   What were the privacy settings?  Who would help her if she posted something she wanted to take down?  Only now did she see that with each account, she gave somebody, anybody who wanted it badly enough, access to her and her past.  She felt guilty, and chided herself for not knowing better, but how could she?  She was busy with school, work and saving to move out on her own.  She never imagined she would be trolled by a stranger hundreds of miles away, and the toll it would have on her.
When I think back to early adulthood, a time when bodies, priorities, identities are changing, I realize that I took for granted the very basic thing that made sure I felt secure, that I would be ok despite everything being in flux.  This was the freedom to make mistakes privately, anonymously, and forgetfully.  How dangerous growing up has become when these things are surreptitiously given up or taken from us.
The appointment ended with my sheepishly suggesting she go off social media altogether, even if it was only for a short time.  Gosh, did I feel like a dinosaur.
After her signature hum, she says, "I think I will Dr. Chan.  It is crazy how whenever I am online, I forget that what I have in real life is so much better and is more deserving of my time."