Mental Health in the Digital Age | An Interview with Aaron Balick

Hello Dr. Balick.

First, we would like to thank you for giving us time to answer these questions for Mana Platform.

• In your book The Psychodynamics of Social Networking you focused on the concept of “Recognition” to analyze our behaviors as social individuals in both the real & virtual worlds; What can you tell us about the desire to be recognized by others?

I would go further than this and say that recognition is not just a desire but a necessity. It’s important to make the distinction between validation, which is superficial, and recognition, which is a more complex and profound and is therefore more relationally nourishing than validation. I like to think of validation as a donut, something that tastes good but has no real value as a food, whereas authentic recognition is more like a nourishing meal. There’s nothing wrong with donuts, but you can’t sustain yourself on donuts alone. To stretch the metaphor, if you mostly eat nourishing food, and have donuts as occasional treats, and you’ll be fine, but not the other way around.

Just as we require good nutrition for our physical development, authentic recognition from parents is a necessity for the healthy psychological and emotional development of children. Authentic recognition from parents is a form of unconditional love that lets kids know they are loved for who they are not just the stuff they do well, or the things that makes parents happy. This can help children develop a positive sense of self rather than one dependent on validation from others.

This need for recognition doesn’t end in childhood, it remains throughout the lifespan. The problem with social media is that it deploys validation (likes, shares, comments, followers, etc.) very well, but not recognition. I believe that people confuse validation with recognition and that’s why it can provoke such an insatiable need. They aren’t getting what they are actually looking for; they are getting the psychological/emotional equivalent of donuts when what they really need salad.

• From a clinical standpoint, where do you draw the line when it comes to harmful behaviors in seeking recognition?
  

The main issue here is the confusion between validation and recognition I mentioned above. Ideally, recognition comes from real relationships with those that are close to you in real life. You don’t need it from a crowd, one or two people are enough. So long as your basic relational needs are being met that way, it’s fine to get validation elsewhere. However, if your relational needs are not adequately met, you may seek validation to compensate for that – and a potential good source for that is on social media.

In psychoanalysis we have the concept of “the false self” which is a clunky term and not entirely accurate, but it essentially means the part of our self that we develop to keep others happy. The important point is that this is only a partial expression of who you are. When we’re young, we develop it to meet the needs of our parents, and when we’re older, it’s how we adapt to different social requirements. For example, when you go to meet the parents of your partner for the very first time, you’ll be on your best behaviour. There’s nothing wrong with that, but it is only a partial expression of who you are.

So long as we step in and out of our false-self as necessary, it’s fine. However, if we identify with it, or in other words if we come to believe that our false-self is the whole of us it’s a problem. That’s because the false-self is like a mask, and however much people like the mask, they aren’t seeing the person behind it (you see, that’s recognition). So you might have a wildly successful false-self which is actually a mask sitting on the face of a very unhappy person.

• So, what does the concept of “The False Self“ tell us about “Authenticity“? Can we express ourselves authentically in social media?

This simple answer to this is “yes” but it shows why the term “false-self” is so problematic (see above). You see, it’s not really “false” at all because it draws on the resources of your whole self in order to exist – it’s partial, not false. For example, if you are very funny on social media, it’s not inauthentic, it’s just not the whole of who you are, just a small part. So long as we are expressing ourselves on social media while knowing it’s a partial expression, that’s fine: it’s only when you believe that the mask is the whole thing that it’s a problem.

Being authentic doesn’t mean you have to show all parts of yourself all the time. We tend to share different parts of ourselves in different contexts, and this is completely appropriate. The fact that we only share a limited part of ourselves at work, for example, doesn’t make that inauthentic, just partial. We’ll show a different part at a casual evening with close friends, and yet another with someone we’ve just met. We tend to only bare our whole selves (and even then not entirely) only with those who are closest to us.

A healthy use of social media is knowing that what we are expressing is just a part, and not the whole. It helps to know that others are doing the same, which can reduce feelings of negative social comparison.

• You wrote in your book PSN (p. 81): “The way in which online social networking lends itself to the presentation of self encourages not narcissism, per se, but, rather, a presented self that looks for reflection from others (imagined audiences, networked publics), reflections that can be experienced as a “fix” for the narcissistic needs in all of us“; Could you please elaborate further on this point.

Good question! The answer is a little bit technical. The popular understanding of narcissism is that someone loves themselves a bit too much. In psychoanalysis, it’s quite the opposite. In psychoanalysis, narcissism is the consequence of inadequate recognition in childhood and is actually a defensive compensation for not feeling loved enough, narcissism is an empty kind of self-love.

It is also popularly understood that social media causes narcissism, but this is also technically incorrect, since the narcissistic capacity will be present long before anyone encounters social media. Social media alone is not likely to make someone a narcissist who doesn’t already have that proclivity already. However, due to its ubiquity, social media could enable, exacerbate, or activate latent narcissism in a similar way that drinking and smoking can be activated by ready and easy access to alcohol and cigarettes; non-smokers tend not to be endangered simply by the presence of cigarettes.

Because most forms of social media enable the outward leaning parts of the ego, those parts that are very aware of the gaze of others, this “presentational self” can be inflated by lots of social media use. We all have narcissistic needs to some degree, because even the best parents cannot authentically recognize their children completely. So that presentational self is validated online, it does scratch that narcissistic itch in all of us.

We all have to learn to be with the parts of ourselves that have felt unrecognized in the past, the parts that may feel unlovable. Getting validation and attention online can assuage that feeling for a short time, it can make us feel good, but it’s not a permanent fix. If we rely on that to feel okay, then we’re not addressing the underlying issue.

• Now let us talk about mental health as a popular topic in social media. How do you avoid the reduction tendencies of content-creation in platforms like (Twitter & TikTok) knowing that one size doesn’t fit all?

This is a problem inherent in the platforms because social media is inherently reductive and is not appropriate for therapy. So long as those using the platforms are aware of this, it’s absolutely fine, but of course this isn’t usually the case. There’s a lot of common-sense mental health information that is in fact perfectly appropriate for social media but it’s not particularly helpful because people know it already. Platitudes do little to help people who are struggling, though they are generally harmless.

The problem tends to be that there’s a lot of misinformation too, and that is not harmless. There is a proliferation of younger people seeking psychiatric diagnoses because they identify with a 30 second TikTok video about ADHD, for example. As soon as you start getting into self-diagnosis and treatment, social media platforms clearly are not up to the task. There is also the problem of “toxic positivity” which can dissuade people from taking their problems seriously, or even worse, blaming themselves for their emotional struggles.

On the other hand, social media can be a good source for psycho-education – giving people proper information about mental health and psychology. It can even be used to give tips, suggestions, and advice that will be a fit for most people (e.g. if you’re anxious slow down and breathe). So these forms of reductionistic psychological content might help by increasing understanding and pointing the direction for someone to get proper professional guidance.

• With the rise of pop-psychology discourses in social media, came the symbolic power of mental health professionals as the new sheikhs of modern times. Unfortunately, we see a lot of psychologists & psychiatrists today who are being exploitative and abusing this power for their personal gain. In your opinion, what is the best way for mental health professionals to engage in social media knowing that each post has a significant weight to the audience?

I would actually prefer to see more experts participating responsibly on social media as a way to counter the misinformation out there. In my experience, many psychological professionals don’t do so because the platforms don’t appeal to them, or they feel that they are not good at short form content. People who can produce high quality content in short form video who know also what they are talking about are rare, and I think we need more of them.

While I think that most professionals mean well, there are other highly influential people like Jordan Peterson who are putting out lots of damaging stuff, and the damage has a deeper impact because they have credentials that give them social capital. Then, as you suggest, there are others who use social media chiefly as a marketing device which can exploit people’s vulnerabilities. This sort of thing requires tighter regulation.

Ultimately it is the professional bodies that will have to create clear guidelines about what is and is not acceptable for professionals to post. I think that if professionals are posting material responsibly, it’s no bad thing. But as I said above, there’s a difference between sharing one-size-fits-all tips and accurate psycho-education – and what appears to be some form of quasi psychotherapy – which does not belong on such platforms. Setting oneself up as a guru with all the answers is also irresponsible – we do much better to be honest that there generally are not quick fixes or easy answers for anyone.

• When it comes to disagreements between professionals regarding sensitive matters to the audience, should it be done in public (social media) or private (the academia)? And how can we avoid the risk of presenting a fragmented field that could setback the effort of destigmatization?

This question reminds me of the maxim “don’t air your dirty laundry in public.” In recent years we have seen a proliferation of professional matters being aired in public that previously would have been addressed within professional circles like academic journals or professional conferences. Now, particularly on “Mental Health Twitter” or “Therapist Twitter” you can witness all matter of professional disagreement out in the public. While one might argue that this is good because it is more transparent and democratized, but I would mostly disagree.

Sadly, this issue isn’t just about professional differences of opinion or respectful debate. Such disagreements as enacted across Twitter often descend into bitter disputes, ad hominem attacks, and basic human nastiness. It seems that when it comes to the psychodynamics of Twitter, psychological professionals are not immune to their most pernicious consequences.

The primary cause for this is the fact that, due to its short-form structure, Twitter does not do nuance well, and professional debates in the field require a lot of nuance. The online disinhibition effect is a contributing factor which can exacerbate the potential for projection and transference and further enable the expression of anger online. The combination of these two effects means that complex argumentation is necessarily reduced to stereotype, leaving them vulnerable to straw-man rhetoric that all to frequently descends into ad hominem attack.

In a more private space such as an academic conference, there are conventions and structures in place to better hold and process disagreement. In Twitter these conventions do not exist, in fact, the structure of Twitter runs contrary to them. Furthermore, since the debates are happening in public, they can often turn into a “pile on” from a whole variety of different factions, which introduces a sense of chaos.

I use the term chaotic because while two professionals may be disagreeing about, say, DSM-5 diagnostics in a general sense, they will likely be passionately joined by individuals who have benefitted or been harmed by these diagnostics. Suddenly a general discussion is joined by those who are very personally affected which can subsequently turn the original debaters into protagonist and antagonist depending on which “side” you are on. It becomes like three-dimensional chess operating on multiple levels provoking crossed communications where individuals become victims and victimisers.

Sides and factions develop, individual participants become polarized, and any potential nuance gets sucked out of what could have been a fruitful debate in a different context. Instead, professionals and members of the public may resort to mud-slinging, and it becomes a brawl instead of a debate.

While I think it’s important that these debates are open more widely, especially where opportunities for professionals and patient groups interact more widely, Twitter simply does not seem to be the ideal place for it; there it can make our field look petty, childish, and reactive. Those who may be seeking help from a mental health professional may witness these rows and conclude not only that we are hopelessly divided and misguided, but that professionals in our field behave badly towards each other and members of the public. I think it ultimately harms confidence in the profession.

Professionals should be very mindful of what a platform like Twitter can deploy and limit themselves to using it for that purpose. Should the content of a debate tip outside of what Twitter can handle, then participants may be invited to continue a conversation offline, or in another kind of arena. If the platform is not up to the task, we should not continue to expect it to meet needs that it cannot.

Most importantly, I think that professionals should behave respectfully, even when they disagree. I simply don’t think that sniping at each other in public is a good look for professionals who are committed to supporting psychological, emotional, and interpersonal mental health.

• From an educational standpoint, what would you say to psychology students who are tempted by the ready-made information flooding social media?

I would say choose your sources carefully! The problem with a lot of social media today, particularly the short from video platforms like YouTube, Instagram, and TikTok is that the algorithms choose content for you – and those algorithms are not based on how accurate the content is. So if you are passively receiving information in that fashion, a good deal of what you are getting may be misinformation. However, there are plenty of people creating content that is accurate and there’s nothing essentially wrong with gaining information from a good source even if it’s on YouTube.

I personally enjoy making short form content and have done lots of short videos on defense mechanisms, psychoanalysis, and featured thinkers like Freud and Jung. The content is accurate, but you are not going to become a good psychologist by watching 90 second videos on defense mechanisms! However, I think they can be used as a gateway, like a secondary text. If you were to watch some simple videos about defense mechanisms before reading the academic texts, they may give you a better handle on what you are about to read because you have a basic understanding. But they are just a start, not the whole thing.

We keep coming back to the maxim that there are no quick fixes. You have to put the work in. By all means educate yourself from a variety of sources and media – you must think critically and do the work. Education and information on a platform, real work with a real professional.

• As a psychotherapist, what do you think of virtual therapy sessions provided by mental health applications? And what is the cost of this virtuality on the therapeutic relationship?

There has now been quite a lot of research on delivering therapy remotely and the main “take home” is that online therapy is not the functional equivalent of face-to-face work. That simply means that it’s still therapy, it’s just different. The way those differences are activated have to do with the character of the patient, their needs, as well as the characteristics of the therapist and the way that they work.

For me the most important thing is that a clinical judgement is made when deciding whether to do therapy face-to-face or online. I have mostly identified that it is not the case that clinical judgement is coming first, especially post-pandemic where people are more accustomed to online work. For individual clients and practitioners, the choice is made from convenience, not clinical judgment. For larger organisations and for commercial enterprises, online work via an app is generally chosen because it is more economical to provide. While these are important considerations, obviously the clinical judgement must come first.

Some people will find that they are less inhibited when working online, which can promote deeper work. Others respond better to being co-present with a therapist. I find the that increased interpersonal complexity of face-to-face work is a great advantage for longer term deeper work. Short term therapeutic work, CBT for example, will probably do just fine online – though again a clinical judgement should be made for each case.

Some research has shown that online sessions are more forgettable – people (therapists and patients) are more likely to forget a booked session and fail to show up. Even the content is more forgettable and material can be lost between sessions. When working online therapists should set different boundaries to mitigate these variables. For example, it should be agreed that neither part multi-tasks (e.g. turn off all other applications while engaged in therapy) as well as advising intentional breaks before and after sessions so individuals aren’t just diving back into spreadsheets or emails after a therapy session.

• With the recent developments in Al technology, do you think there is a way for psychotherapists to utilize it in providing better services?

Until recently I think therapists thought that they were the exception to the possibility of losing their jobs to AI. This is no longer the case, but we can explore that another time. I think where AI can be very important is the way it can analyze and synthesize lots and lots of data very accurately. We are already seeing this in the medical health field. I can see a place where AI can be used to closely examine several data sets at once including tone of voice, volume, the words that are used, pauses between words, variation of voice, breathing, hesitations, and pauses. Should patients wish to be hooked up to monitoring devices you could add in heartrate, heartrate variability, galvanic skin response, oxygenation of blood, etc.

While it’s unlikely that this information would be used in vivo it could be of great use to therapists and patients to manage progress. AI could make treatment suggestions based on aggregated data that could then be evaluated by the therapist who could then make a judgement based on that. This may sound scary to many people, but the advances that AI has made in identifying medical conditions that are missed by doctors indicates the possibility for a very positive application of AI to psychotherapy.

Having said all that, I’m still very much a believer in “old school” psychotherapy without all the bells and whistles. Psychotherapy, especially in the depth, humanistic, and existential traditions, are all about self-discovery rather than cure. This only needs two people, sitting in a room, committed to that task.

• To end on a less serious note; you posted a picture of Sigmund Freud’s collected works in Twitter, and it was magnificent; I can’t help but wonder, what if Freud was alive today, does that mean we will have a podcast instead of all these books?

This is a wonderful question! I think that Freud was a very committed and focused man, and I would guess that he, unlike the rest of us, would not be so distracted by social media. If Twitter got in the way of his Complete Works it would be a great loss to society.

One of the main things that I think would have happened if Freud were here today, is that he would be alive to the major currents in contemporary culture and be writing about them. So his theory would probably not have developed around sexuality, which was driving a lot of material during his time because of the degree to which it was being suppressed, but around recognition.

I don’t think it’s an accident that psychoanalysis moved in this direction anyway because things have changed in the past 74 years. Freud would have been very interested in technology and its effects on the human mind. I think he probably wouldn’t choose to have a Twitter account or a podcast but I imagine he would be very much in demand by people producing podcasts and YouTube channels.

In Freud’s day you had to work a lot harder to get your material out into the public consciousness. The first print of his famous book, The Interpretation of Dreams published in 1900 only sold just over 400 copies. He was already over forty at that time and it took a while for him to make a name for himself and psychoanalysis, but he kept working at it. Today, it’s the opposite, it’s very easy to get something out there, but then you are competing with tens of thousands of voices.

If Freud had been around today I am almost certain we wouldn’t all know who he was, he’d be one of thousands of voices. We’d hear from more Petersons than Freuds. Sure, he may have appeared on the Tim Ferris Show podcast, but only as a guest. The other thing working against him would be that old chestnut, the quick fix. Quick fixes sell on social media: hard long-term work does not. Freud was much more about the latter than the former.

• Thinking about Freud and how he would develop his theory around recognition could give us 5 more questions, but I’ll hold those to our next interview Insha’Allah. I hope till then AI won’t take my job, because I had an amazing time working on this interview. I would like to conclude by asking you about your current projects, or the ones that we might see in the foreseeable future.

Thank you Muath, I have enjoyed it too!

As usual, I am developing in a few different directions. It is now almost ten years since I published The Psychodynamics of Social Networking, and a lot has developed since then. Because that book was focused so much on individual and interpersonal psychodynamics, I left the socio-political context largely unexplored. Now I see that these two spheres cannot really be separate from each other and I’ve been thinking a lot about that lately.

I have recently published an article that starts to address this entitled Social Media, Identity, and Careful Culture: How Online Social Networks Limit Identity, Amplify Difference, and Diminish Social Cohesion. This article is somewhat less optimistic than my book as it addresses more of the pernicious social impacts I’m seeing in social media – like those addressed in your question about professionals on social media platforms like Twitter. Mind you, I’m not dystopian about it either, but I am certainly more mindful of the bigger picture.

I have also been thinking a great deal about the development of generative AI such as ChatGPT which I think is already starting to provoke enormous change that is going to happen very fast. I would like to devote some time to looking into this further and developing a psychoanalytic perspective on it. How this develops, I don’t know yet. I have been considering fully updating PSN, but whether I will include AI or whether that is a new book all together I don’t know yet. Watch this space!

Outside of technology I have an abiding interest in what psychoanalysis can contribute to modern life, and I continue to believe that not enough people really know how wonderfully psychoanalysis can be applied today. Part of the problem is that its theories can seem quite obscure and inaccessible to people who aren’t familiar with it. I am very interested in making it more accessible and interesting to people.

When I was young, I got very excited about Psychoanalysis after reading Freud’s “Mourning and Melancholia” which is my favourite essay by him. I am currently about 2/3 of the way through a book that will make this essay something that anybody can read and grow from without knowing a thing about psychoanalysis. I will be applying it to heartbreak and loss and show how Freud’s model can get us through both. I’m very excited about this project as it’s been on the backburner for years. I hope to get it out by the end of the year.

In the meantime, outside my private practice, my continuing passion is to share the ideas for depth psychology more widely so more people can benefit from it in more ways than just traditional therapy. So I will continue my training, consultation, and public speaking where I apply these ideas in a wide variety of contexts from tech (as we know) to leadership, business, and personal development.

I thank you for your time and thoughtfulness in asking these questions and am honored to have been able to take part in this with you.

– Thank You again Dr. Balick.