This episode of Hub Dialogues features host Sean Speer in conversation with leading psychologist and addiction expert Dr. Nicholas Kardaras on his thought-provoking new book, Digital Madness: How Social Media Is Driving Our Mental Health Crisis—and How to Restore Our Sanity.
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SEAN SPEER: Welcome to Hub Dialogues. I’m your host, Sean Speer, editor-at-large at The Hub. I’m honoured to be joined today by Dr. Nicholas Kardaras, a leading psychologist and addiction expert, including in his current roles as the CEO and chief clinical officer of Maui Recovery in Hawaii and Omega Recovery in Austin, Texas. He’s also the author of the fascinating new book, Digital Madness: How Social Media Is Driving Our Mental Health Crisis—and How to Restore Our Sanity. I’m grateful to speak with him about the book and its key arguments regarding the perverse relationship between the rise of social media and the decline of our mental health.
Dr. Kardaras, thank you for joining us at Hub Dialogues, and congratulations on the book.
NICHOLAS KARDARAS: Well thank you so much for inviting me on. Pleasure to be here.
SEAN SPEER: Before we get into the role of digital technology and social media, I want to start with the idea that we’re facing a mental health crisis, because one often hears that but it’s not always defined or described in terms of its scale. What’s the nature of the crisis and what’s its magnitude?
NICHOLAS KARDARAS: I think that’s a great question. If we were to look at the mental health metrics or the psychiatric metrics, they were at their all-time worst before COVID. In 2019, if you were to look at some of the psychiatric metrics—and some of the numbers I’m going to quote are U.S.-specific—in the United States, depression was at an all-time record high. Also anxiety rates. Suicides topped 42,000. Overdoses were at over 70,000. ADHD. By every conceivable metric, we were at the worst juncture in our mental health that we’d ever been. Then COVID came, and COVID activates an amplifier where all these metrics then got even more exacerbated.
Just globally speaking, depression as a main driver or main metric, depression right now is the number one debilitating chronic illness in the world according to the World Health Organization. By every conceivable way that we have to measure mental health, we’re on fire and it’s been getting worse. It’s been getting worse over the last few years, and COVID was only kerosene to our already burning fire, so we’re not doing well mentally.
SEAN SPEER: Let me just pick up on that particular point. How much in your view is the rise of mental health issues a function of growing mental health problems in our society versus a decline in stigma and a greater propensity towards diagnosis? In other words, Dr. Kardaras, is our mental health worse than in the past, or we’re just more prepared to acknowledge it today?
NICHOLAS KARDARAS: That’s always one of the counterarguments, that we’re diagnosing it more. There’s more sensitization to certain issues. I definitely think we’re in worse shape than we’ve been before because of certain environmental and societal factors. There’s clear research that connects our immersion in technology, our love affair with technology, with some of those adverse mental health impacts. There’s clear research that shows the more tech used and more screen time, the more depressed you’re going to be. Depression really is the granddaddy of a lot of these other mental health byproducts.
One of the narratives that I really like to embrace—there’s a researcher, a depression researcher, Dr. Stephen Ilardi out of the University of Kansas, and he’s studied depression for the last 20 years globally. One of the clues that we got from his research that to me says that there’s a relationship between technology and depression, is that in his studies of global depression, he found, interestingly enough, that the least depressed people, the most mentally well people, were the least technologically advanced.
Indigenous peoples tended to have really, really healthy mental health rates. In fact, when they spent 10 years studying the Kaluli in Papua New Guinea and other Indigenous tribes in South America and Africa, these folks, who had extremely challenging lives, these were not people that were sitting in hammocks eating peeled grapes every day, were really mentally healthy. In fact, in Papua New Guinea they studied over 2,000 New Guineans for 10 years and there was not one case of clinical depression. He derived from his research that there was something called “therapeutic lifestyle changes”, that depression was a lifestyle byproduct of it.
If you look at it, and as a psychologist, we know that one of the best treatments for moderate depression is physical activity and socialization. Depression and a lot of mental illness thrive in isolation and that thrives from the person’s sedentary life. Because when you’re physically active, you increase your serotonin levels. When you’re socially connected, we know that we’re a social species genetically hardwired for connection, face-to-face connection, not the counterfeit digital connection.
Dr. Ilardi’s research showed that if you layer in just those two things—well he had a couple of other things in his protocols too—but the two main drivers were becoming more socially connected and more physically active. When you look at what the digital age has done, it’s been a nuclear bomb on face-to-face interpersonal connection and physical activity. We’re couch potatoes, we’re sedentary, and we’re isolated, and we’re screen staring. So that’s a big driver of depression on a very fundamental level.
SEAN SPEER: You come to your addiction expertise through the problem of substance abuse. What’s the addictive nature of social media? How does it compare to say street drugs in terms of its effect on people?
NICHOLAS KARDARAS: One of the main drivers of any kind of addiction is what we call the “dopaminergic effect”, or the dopamine reward loop. So anything that tickles our dopamine receptors tends to have the potential for us to get habituated to it. There’s been some really interesting research. Dr. Cope back in 1998 looked at how much things like food, sex, video games, cocaine, raise our dopamine levels, and they tended to correspond with the more dopamine-elevating something was the more potentially habituating it is.
We know that things that are hyper arousing and stimulating and things that give us little dopamine tickles, like likes and shares and all the little candy that we get when we’re wading into the digital water, those are things that really tickle that response. Now the difference with let’s call it historical marketing, or things that may have been made to engage us in the past, is that the big tech has used some of the most sophisticated behaviour modification techniques to really curate experiences for each individual that are targeted.
Social media is, I call it, a heat-seeking missile that targets many of our vulnerabilities, because we know that our vulnerabilities, our emotional reactivity, is what drives our engagement. It’s rubbernecking a car accident. We shouldn’t be looking but we can’t stop looking at it because it arouses our lizard brain, and social media folks know how to arouse our lizard brain.
SEAN SPEER: You’ve just unpacked three different factors that explain the relationship between digital technology and social media and the rising mental health crisis: the addictive nature through targeted content, the breakdown of real-life social connection, and then the extent to which it’s associated with a decline in physical activity. Are those the ways in which digital technology and social media are influencing the mental health crisis or are there other ways in which this perverse relationship manifests itself?
NICHOLAS KARDARAS: There is more, there are more layers to the onion and there’s more complexity to it than that. I think that’s kind of the 30,000-foot view, and then the playbook, let’s call it the “big tech playbook”, you just identified sort of steps one and two. Step one is habituation and step two is once you’re habituated now, you’re more vulnerable to other types of influences, shaping influences, behaviour modification, and psychiatric illness. I kind of analogize it that it’s almost like a boxing metaphor. I don’t know for boxing fan but the old thing used to be you weaken somebody up with body blows, and once you’ve weakened them up with body blows you go in for the knockout punch.
In the book, Digital Madness, I use the language of we all have a psychological immune system. Our psychological immune system has been compromised by our love affair with technology and specifically social media. Social media has now psychologically weakened our immune system. Now, we’re much more vulnerable to everything from ideological extremism to psychiatric types of disorders. It’s not just we weren’t meant to be sedentary and alone, and so I’m depressed, now it’s because I’m depressed and feel empty and meaningless in my life, I’m much more vulnerable to a lot of manipulation and shaping influences I wouldn’t normally be vulnerable to.
SEAN SPEER: On that point, this book and your previous one, Glow Kids, emphasize the negative impact of digital technologies on kids. One thing that struck me in the new book is the corrosive effects of trying to match up to so-called influencers. Do you want to talk a bit about the consequences for self-esteem, self-worth, and ultimately mental health, and in particular, the negative ideas and messages perpetuated on young girls?
NICHOLAS KARDARAS: Yes, so that’s really was the evolution for my last book, Glow Kids, that really built a foundation that. Because even six years ago, to me it was shocking that people thought it was a news flash that technology could be habit forming when now we know the curtain’s been pulled back. And by their own admission. If you watch The Social Dilemma or any other documentaries, some of the defectors from the tech world have said, “Look, this is addiction by design.” It was for monetization, and very clearly we did this on purpose.
What I think were some of the unanticipated consequences of this mental health effect was that when you have social media that’s algorithm-driven with predictive algorithms that are essentially looking to see what people’s proclivities are, it has an amplification effect and what we call an “extremification loop.” If I’m interested in right-wing political ideology, the algorithm is going to amplify or give me steroid-juiced-up content regarding that.
If I’m a vulnerable teenage girl who’s really concerned or vulnerable about my appearance or my weight, I’m going to start rubbernecking some content related to that. The problem is if I’m a psychologically vulnerable teenager and I rubberneck that content, it makes me more unwell. It increases my propensity to have any kind of an eating disorder, anorexia or bulimia. The part that I think is really shameful is it would’ve been one thing if some of the people behind big tech and social media didn’t know about this, right?
If this was just good old American capitalism where they’re just increasing monetization, we’ve done that ever since McDonald’s Happy Meals with jingles and all sorts of marketing tactics. But the Facebook whistleblower, Frances Haugen, who released internal emails along with a great expose by The Wall Street Journal, and she was on 60 Minutes and testified in front of Congress that they had their own internal research that showed Instagram increased suicidality amongst teenage girls, increased eating disorders by 17 percent. And there was dialogue internally, “Should we tweak the algorithm to make it less toxic and less vulnerability seeking?”
And the response was full steam ahead, to change the algorithm will be to reduce engagement. So I think there’s more culpability there now when you have knowledge of the damage that you’re doing. It’s one thing if you’re selling cigarettes and you don’t know that they were a carcinogen, but if you knew that they were a carcinogen and you’re still marketing Joe Camel to kids, then a pox on you, now you’re knowingly harming people.
That’s what’s come out over the last couple of years, that it’s harmful. And really the bottom line with a lot of this social media, I’ve really come to view this almost like a living organism. It feeds off of our most lizard brain vitriolic emotion, that’s what animates it. Then we feed the beast and then the beast, in turn, feeds us back this amplified vitriol because that’s what works. So when we speak about influencers, the coin of the realm in social media is emotional content. It’s the most over-the-top behaviour.
If you’re going to be a thoughtful person that wants to have discourse about any particular topic, you’re going to have two followers. But if you’re an over-the-top—and in the psychiatric world now, we’re seeing a whole sub-genre of psychiatrically-ill influencers who are really performative, who are very in their own way entertaining, and who are now having hundreds of millions of views. Here we’re talking about influencers with Tourette’s disorder, with dissociative identity disorder, with borderline personality disorder, who are having hundreds of millions of followers.
Now we’re seeing the social contagion effect where their followers are beginning to consciously or unconsciously manifest symptoms of their influencer’s behaviour. So this goes beyond Kylie Jenner and her vapid, shallow materialism, which is a pox unto itself, right? It’s shaping the values of so many of our young people who want to be YouTubers and they want to just be famous because their values are being shaped by their influencers. But now, we’re actually seeing psychiatric illness being mimicked online and through social contagion form.
SEAN SPEER: You mentioned earlier, Nicholas, that the book outlines the difference between online connections versus real-life social connections. Most listeners would probably instinctively think that the latter are healthier than the former, but they may not fully appreciate why or by how much. Do you want to talk a bit about the limits of online relationships and the importance of real-life social connections?
NICHOLAS KARDARAS: Yes. Again, we’re hardwired social animals because, again, evolutionarily, the tribes survived. We were not the fastest or the strongest or questionably the smartest species in the high desert in the Sahara. What kept us alive as a species was our ability to connect and to stay tribal, to stay as a group. There was strength in numbers, and so that got baked into our psychological DNA. They’ve done research going all the way back in the 1950s and Dr. Hebb looked at isolation experiments and boy, we do not do well when we’re alone. We go insane. We get mentally unwell. We get physically ill when we’re in isolation. We’re not meant to be isolated. I think—
SEAN SPEER: Sorry, to interrupt Dr. Kardaras. It’s why for instance, the enhanced interrogation techniques at Guantanamo Bay used forms of isolation.
NICHOLAS KARDARAS: Absolutely, absolutely. It’s antithetical to our natural state. Digital media creates a counter to the illusion of connection. It’s so funny because I think social media, which really should be called anti-social media because if anything it drives people deeper into isolation, under the pretense that “I’ve got 1,000 Facebook friends.” Meanwhile, there’s nobody that I can call if the you-know-what hits the fan.
Dr. Dunbar was an anthropologist who looked at, for people to be socially and emotionally well, we needed a certain number of people in our lives that we can really connect with. When things go wrong that we can have face-to-face conversations with them. That numbers between three to five people and if we don’t have that were alone. They’ve even done one study that was so fascinating that looked at the importance of eye contact. If you’re having even a face-to-face conversation with someone, and you’re not maintaining eye contact for at least 70 percent of that conversation, it doesn’t hit our psychological sweet spot. It doesn’t meet our social-emotional needs.
Now they’re finding out that people under 25, even when they’re face-to-face, they don’t make eye contact, and that’s really toxic for our emotional well-being. It’s affected the way we interact interpersonally but more importantly, it’s stopped our interacting interpersonally. Now, during COVID, let’s face it. It’s better to Zoom with grandma than not Zoom with grandma, but it shouldn’t be our natural way of connecting. We’ve seen that during COVID screentime doubled and the depression rates in some areas tripled. There’s that.
SEAN SPEER: I recently spoke to the British journalist, Charles Arthur, just in parentheses for listeners, that episode will be coming out shortly as well, about his book regarding how social media has polarized our politics. As part of our conversation, I asked him if social media was a net positive or net negative innovation—if we had been better off it had never been conceived. He thought that on balance, it was probably net positive, but he certainly wasn’t unequivocal. What do you think?
NICHOLAS KARDARAS: Oh, I’m equivocally negative, better than the beast never been created because the Frankenstein monster has broken free from the shackles of its creators in ways that I don’t think they anticipated. I don’t minimize when I analogize social media to a living organism because once you bake in certain algorithms, they go off in directions that they go off into an unintended consequence oftentimes.
This polarization I think has changed the architecture of people’s brains, especially young people who have grown up in this black and white world. Because if you think of the DNA of social media, because it lives on polarity, it lives on extremification, if I’m 7, 8 years old, 10, 12, 15, 17 years old, and I’ve grown up in just black and white, left, right—Marshall McLuhan had said the medium is the message. I think now the medium itself is baking us into inherently pathological thought patterns where we can only process information in polarity buckets.
A lot of the young people that I treat clinically, they’re not even able to understand nuance, the gray area of an evolved critically thinking conversation is beyond them. There’s a level of emotional reactivity that’s been baked into them where they can only put things in two buckets and those buckets are black and white. If you think even the genesis, Facebook at its birth was hot or not, when Zuckerberg invented it, it was binary thinking by design. It wasn’t, well, it might be pretty, sometimes. Even the definition of the word digital means ones and zeros, no fractions in that equation.
I’m afraid that it’s made us into black and white thinkers, which is toxic for politics and really unhealthy for our mental health. We’re seeing it, we’re seeing our political divide greater than—I’m 58 and it’s wider than it’s ever been since I’ve been alive in the United States. I think social media’s been a big driver of that.
SEAN SPEER: In dealing with these issues, what’s the role for individuals versus companies or the government? Let’s start with individuals. What should they do to protect themselves from these negative effects of social media?
NICHOLAS KARDARAS: In Digital Madness, I do talk about that because I don’t think we’re necessarily going to be able to change the ocean from being less turbulent. How do we become better swimmers in the turbulent ocean? I think the onus then falls on the individual, and as I talk about it in my book, I think part of the antidote to the modern we could find in the ancient.
There’s some ancient wisdom that we’ve forgotten in our modern, reactive, emotional, histrionic, empty-valued world. I’ve studied classical philosophy. Embedded in classical philosophy are the skill sets of critical thinking, reason, logic, civil discourse, civic responsibility, and ethics. These are all the skills, the tools in our toolbox that I think immunize a person and strengthen our psychological immune system.
We need to really lean into helping our children and ourselves develop a sense of psychological resilience, grit, and the ability to critically think. Because right now, a lot of the people that I work with are just living on that emotional outer layer of their reactivity skin. That’s part of it and that’s what feeds the beast. That’s what feeds more of the toxic content that then they are continuing to swim in. I use the archetypes of becoming philosopher warriors. That if we can all learn to find our inner philosopher and our inner warrior beat, whatever cultural orientation you may come from, whether it’s a Spartan warrior or a Zulu warrior, it doesn’t matter. We’ve got to toughen up, lean in, and use our minds.
SEAN SPEER: As I understand the point, it comes back to something you said earlier about strengthening our psychological immunity so we’re better prepared to respond to these targeted attacks on our psychology.
As I was preparing for this interview, I checked to see and observed that you don’t have a Twitter account. In effect, you’re living up to your own advice. But I would just say personally, having a Twitter account and being active on Twitter is effectively part of my professional life. What would you say to those who, on one hand, are persuaded by your arguments about some of the negative effects of participating on these different platforms and, on the other hand, see personal risks to fully withdrawing?
NICHOLAS KARDARAS: I’m not advocating for Ludditism or Amishness necessarily, if that’s a word. Same argument can be said with me and my smartphone I’ve got. I need to use it professionally. I’m not saying I’m going to communicate by carrier pigeon moving forward. I do think we need to be aware of the danger so we don’t fall down digital rabbit holes. That’s what we’ve seen happen because we were underaware of some of the pitfalls.
Going back to the larger, I think, conversation where you were talking about what can be done on the individual level versus the macro level, I’m a big free speech purist and I’m really troubled by the misinformation and disinformation. I don’t remember hearing those words quite honestly more than over a few years ago. These are new words that have a very Orwellian thing to me now. I get it that people are going to put out nonsense information, but there’s always been the National Enquirer. There’s always been nutty people out there that put out what I guess today we would call misinformation or disinformation, but we trusted the reader, the viewer, the citizen to be able to make their own informed opinions. Going back to radio, I was always an insomniac, so I always used to listen to Art Bell.
Art Bell kept me up many nights in college. Art Bell would have Brian Greene on one night, the respected quantum physicists talking about strength theory, and the next night he’d have some big foot chaser or UFO or whatever, and Art Bell never said, “Well, person A is legit, and person B is disinformation. I’m going to trust you to listener to discern that.” That’s what worries me if we start going down the pathway of censorship, who’s the arbiter, because I don’t fully trust the five or five titans of the tech oligarchs to be the gatekeepers, because they haven’t proven to be good stewards of their responsibility so far.
I do think there may be a role for government in terms of something like the FCC used to be back in the days of broadcast television. Having some regulatory oversight may be helpful. Maybe repealing section 230, because they are indeed publishers and not just a message board randomly posting people’s things, but at the end of the day, it’s the individual’s responsibility to fortify themselves to be able to swim through the morass.
SEAN SPEER: As throughout our conversation, you anticipated my next and penultimate question about the role of the state: You mentioned some possible reforms that governments around the world might pursue, but what about the idea of antitrust? Do you think the time has come to possibly break some of these organizations up?
NICHOLAS KARDARAS: Yes, beyond so. It’s the Ma Bell/Baby Bell paradigm that needs to be copied because they have become too monolithic and too all-powerful. In my book, I’ve written at length about how they’ve abused—they took the Rockefeller Standard Oil playbook on steroids. The problem is when JD Rockefeller was the richest man in the world, he controlled one commodity: oil. These folks control everything, and they control information, so they’re the gatekeepers of what we think, what we feel, how we vote, how we emote, how we live our lives, and so to have such a small handful of people have so much power is extremely troubling.
So, I know that there’s been a movement now that President Biden’s secretary who is an antitrust expert and she’s looking at a “defang the beast” through antitrust legislation. I think that’s a necessary thing because they have grown too big, too monolithic, and too all-consuming in our lives to our detriment.
SEAN SPEER: Final question: Nicholas, do you think your books are making a difference in this regard? There does seem to be a changing perspective in the general public and even among policymakers. What’s your sense?
NICHOLAS KARDARAS: Yeah, I will say that I definitely saw a change of shift in culture and in clinical perception. When Glow Kids first came out I was a Paul Revere voice in the wilderness, and I wrote an op-ed called “digital heroin” with the New York Post. I had quite a few national media, Good Morning America saying really it’s like heroin and not as lethal in that sense, but as habit forming. Now, we’ve accepted it. I’ve seen movement and accepting some of the harms that might be happening.
I’ve had thousands of families reach out saying thank you because we were seeing our children getting affected and no clinician understood that this was a real thing and now it’s a real diagnosis and accepted by the World Health Organization. I think similarly, in terms of raising awareness, I do see a grassroots awakening where people are realizing that we’ve been manipulated.
I’m a big fan of Neil Postman, the media theorist professor from NYU who wrote Amusing Ourselves to Death back in 1985. He warned of the new visual medium becoming the soma, the distracting sedating soma that would keep us naval gazing while Rome was burning. I’m mixing many metaphors here, but essentially that’s what happens. If we’re all numb and sedated and are gaming or on social media, we’re not awake. We’re not truly awake to the sociopolitical environments, or to what’s happening geopolitically, and so I do think that people are beginning to awaken to the fact that we have to stop getting lost in digital rabbit holes and really look around and see what’s really happening in the world, and there’s a lot of dramatic shifts happening in the world that we need to be aware of right now.
SEAN SPEER: The book is Digital Madness: How Social Media Is Driving Our Mental Health Crisis—and How to Restore Our Sanity. Dr. Nicholas Kardaras, thank you for joining us at Hub Dialogues.
NICHOLAS KARDARAS: Thank you for having me.
