December 31, 2009

Television 3: Brave New World

Because I think television goes directly to our deepest unconscious, this post will have some provocative ideas I haven't heard before. Maybe you will have read it here first, and that seems like a good way to close out the year.

There's lots of evidence about all the correlations between TV viewing and all sorts of unfavorable impacts, some of which I have mentioned before. A few years ago, a friend from medical school told me about a study that showed that the more advertising a child was exposed to, the more they wanted fast food and popular toys. But this is a serious, deep bias.

Sure, we all hate advertising because it interrupts what we're focused on at the moment. And we don't like the idea that somebody thinks they can 'sell' us on something we don't already know we want. We really don't like the idea of some grown-up working for a multinational conglomerate selling something we don't want to feed or give to our innocent children.

But I think there's something else pervasive in advertising that hasn't hit the popular or political discourse on the evils of media exposure. It's the equally unrealistic positive portrayal of life. Typically the source of material for stand-up comedians, this outlook is what every ad agency wants to have you associate with their client's product. Maybe it's a frozen dinner that will result in your whole family sitting down to dinner together, including non-sullen teenagers and preschoolers for whom ice-cream would appear to be their only contact with meltdowns. The mother and teenage daughter who spend a leisurely walk on the beach laughing and sharing their tips on freshness. Yes, I'm very much making fun of these absurd caricatures of a life that nobody really has.

Television critics, however, can't have it both ways. There's lots of funding available to study all the ways in which television is harmful, exposure to media violence is harmful, exposure to advertising is harmful. It has so firmly become part of the common wisdom, that we take it for granted. So do the smartest scientists at the National Institutes of Health when they choose to fund these research projects.

There is no funding for researchers looking to show all the beneficial effects of television. Besides, they'd be risking their careers.

So though I made fun of the ridiculous way family life is shown in advertisements, those who have studied the effect on children have ignored this aspect of advertising. By their nature, most ads try to associate their products with the wholesome, healthy, happy, active and fun things we would all like to picture ourselves doing or being. If watching advertising is such a powerful negative influence, wouldn't these positive models be just as influential? If TV is such a powerful instigator of negative behavior, couldn't it also engender positive? All those situation comedies where people generally get along, family fights always end with a laugh and positive resolution within 24 minutes. The advertisements of siblings playing together, the family eating together, the teenagers being pals with mom and dad--why aren't these studied? If television is the powerful drug that many believe it to be, and if exposure to negative things shown on TV results in negative behavior (as is the conventional wisdom at the moment), shouldn't the positive stuff depicted result in positive behaviors? Here's a wild thought: if kids are watching as many hours of TV as it would seem, and it's a powerful influence, than just maybe we have better kids, less violence or negative behavior that we otherwise would have without the influence of all those positive models in advertisements and scripted shows where the family always comes together at the end.

And just because it's a drug doesn't mean it isn't therapeutic. Indeed, I have written again and again in these pages that my job is not to minimize the amount of medication a child gets. My job is to make them better. If it takes medication to get there, I'm for it.  It has become part of our modern lexicon to understand that many of us find ways, for better or worse, to self-medicate.  Sometimes this clearly often refers to serious untreated problems.  But it also includes retail therapy and chocolate therapy.  I propose that the giant elephant in the room of self-medication is television therapy.

Dr. Wolffe's Second Television Postulate:
If television is a drug, it could be effective, perhaps essential, for certain diagnoses.
If it is a drug, then it probably has what is generally called a therapeutic window. That's a way of looking at the dose of a drug. Too little, and there's not much chance of harm, but not much good effect, either. Too much, and the harm is more than the benefit. Somewhere in the middle is a dose that maximizes the benefit and minimizes the side effects.

Back in Television 2, I describe some of the children who are watching a lot of television. Whether caused by watching TV or the reason they watch so much TV, they are less active, fatter, and have poorer social skills. I suspect they are self-medicating with the television drug. It's a drug that addresses many different distinct problems. So if you're lonely and don't have a lot of friends, it provides some of the brain signals that you'd get from a non-judgmental friend. If you're depressed and can't stop thinking about how lousy your situation is, it boosts the chemicals in your brain that you might be able to get with a brief, small dose of antidepressant medication.

I wonder if it is actually underused as a drug. Maybe it's even underprescribed as a therapeutic intervention. That's not to say that kids should watch more TV. There are children who, at the end of their exhausting day, are tired and irritable, uncooperative and engaging in behaviors that show poor judgment, impulsivity, and oppositionality. Nearly every day, there's some sort of a blow-up around the same time. Do they have attention deficit disorder? They clearly have a problem with attention, but it seems to affect them only in the 45-60 minutes before dinner. Even if the kid's parent asked me to prescribe a medication for this, there's nothing that works so fast and lasts such a short time. Maybe this child needs 30 minutes of TV once a day before dinner. It starts working immediately. It redirects the child and will help focus attention, at least for 30 minutes or so. Five minutes isn't enough, five hours is too much. If we make this part of an unbending daily routine, and don't miss a dose, the child might look forward to this 30 minutes of television instead of flailing about looking for some undiverted parental attention, which is in short supply in the time just before dinner.
I know a pediatric dentist with small flat-screen televisions on the ceiling above each exam chair. Isn't it obvious why?

Why don't I have a video player the kids can watch—even if only for a couple of minutes prior to and during vaccinations? Wouldn't it keep the kids from ruminating anxiously about their shots? Wouldn't it distract them from the shots themselves? Why isn't there research on this?

Woody Allen, by the way, got to a similar place about 30 years ago. In his movie, Sleeper, he awakens after being cryogenically frozen for 200 years. His doctor offers him a cigarette and tells him that the newest research shows that it's the healthiest thing he can do.

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Please let me know what you think. Do you know a child or situation like this?