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.

Television 2: We have the technology

In Television 1, I pointed out that television is as much a part of our world as refrigerators or kitchen sinks with running water.  There are people who live without these, but they aren’t us.  And our kids probably won’t be them any time soon. Unlike common kitchen appliances, however, television, I believe, is a drug.


Dr. Wolffe's First Television Postulate:
Television is a drug.


Mostly for political and economic reasons, it has taken decades to get tobacco regulated as a drug.  Though used by Native Americans for ritual purposes long before Europeans arrived, it only became clear in the mid 20th century that this was more than a harmless pastime, like quilting or decorative embroidery.  These are gently pleasurable, help some people relax, and don’t hurt anybody else.  It's pretty tough picturing somebody holding up a convenience store in the middle of the night because they they finished their last skein of Pansy Purple #102 and they're feeling so desperate that they are willing to degrade themselves for the next fix.  It will be no surprise what the differences are, and I don't feel it's necessary to cite the references for tobacco use. So as you read the following list, try to think of it referring to someone in your family who:  smokes, gambles, exercises, shops, talks on the telephone, emails, texts, eats, diets, trades stocks, checks stock prices, reads news headlines, or collects something to such an extent that it has a negative impact on their health, appearance, close relationships, job, or life.

It’s addictive.
By addictive I mean that users can't stop whenever they want.  They do it automatically, on a very regular basis.  They feel bad and crave it when they don't use it.  They aren't the only ones who suffer--those close to them can see not-so-subtle changes in their mood, behavior, sleep patterns, and social interactions.  Many adults go to sleep with the TV on.  When it's off, they have a hard time falling asleep.  (It's not because it makes them sleepy--I'll write more of this after the new year in posts about bedtime.)

It can be harmful, even when used as designed.
There is a relationship between the level of harm and the amount you do.  Many people drink alcohol and don't have a problem with it.  Some people do have problems with it.  While there is research on the possible differences in brain chemistry or genetics between alcoholics and non-alcoholics, suffice it to say that some people find it very hard to keep to safe limits.  Ongoing recent research has examined problem gambling using some of the same methods.  There's some reason to suspect that people who can't stop eating the stuff they know is killing them, that exercise or diet or even shop to a level of self-harm have some fundamental neurochemical imbalance that compels them to do what they do.  Though there is much public hand-wringing about the harm caused by television, the research purporting television causing direct harm is deeply flawed.  But the epidemiology appears pretty clear.  Kids who watch more TV have fewer friends.  They do less physical activity.  They are fatter.  They eat more snack food.

Does the TV-watching cause these problems or do kids with these problems choose to watch TV?  I've thought a lot about this question, and I think for some kids it goes one way and for some it goes the other.  So, back to problem drinking:  for some, taking a couple of drinks impairs judgment and interferes with sound decision-making; for others, poor judgment and decision-making skills make them think that they don't have a problem with drinking.  So maybe the kids who have weak social skills or have never had fun by physical activity sit in front of the TV, they find there's something they can do just as well as the popular kids--maybe better.  There's something they can master and be authoritative about when with their peers (maybe Twilight or maybe it was Star Trek for you).  They can be completely open and unreserved with this nonjudgmental entity for which they are just as good a companion as their more successful siblings.  For them, it transports them to a safe and exciting world.  It also interrupts the stream of negative messages about failure, self image, popularity, and status that this child hears from others and from themselves.  It turns this endless loop off.  How, exactly it does this isn't entirely clear.  But the fact that it can suggests the converse question.  If a kid who doesn't have these weaknesses sits in front of the television for the 4 to 6 hours a day many kids watch TV, how might they be affected?  How ever many hours they watch, they aren't riding their bicycles or playing basketball in the driveway while they do it.  They are raiding the kitchen for snacks.  Even if they have a friend sitting next to them, they aren't practicing the subtle skills of social interactivity that make for popular playmates.  It changes what they do and how they act.  So either way, it's a drug.

It affects your body (including your brain).
Why does it calm the angry, tranquilize the oppositional, and make the rest of us into emotionally-blank drones who can't take our eyes away?  How, exactly, is that different from entertainment?  One difference, perhaps for some people (and children) more than others, is that the more you watch, the more you need to watch.  Television becomes part of your life.  When you travel, why do you turn on the television as soon as you go into the hotel room?  Do you let it play all night?  Why do we have to eat while watching (true for movies, too)?  I suspect that the hedonic sensation of eating reinforces the rise in calming and reassuring-type neurotransmitters that accompanies American Idol.  The research really isn't there yet to support fully the way I believe it works, but I think it's just around the corner.  It's very difficult for most people to stop the way they eat and lose the weight they know they need to lose.  No, it's not weak character or lack of 'willpower' (whatever that is).  Eating is so primal that the feedback we get from doing it causes deep and fundamental reactions in the parts of our brain that are invisible and uncontrolled by our intellect.  I think television pushes equally fundamental buttons.  Just like a drug.

Video Violence

In school the day after watching an episode of the popular TV show Kung-Fu, my friends and I would play-fight with all sorts of made-up kicks and chops. None of the kicks ever connected, and nobody ever got hurt. None of us knew any martial arts. It was the early 1970's, and within a few years, Bruce Lee movies and martial arts would become part of our culture. Did our exposure to the TV show increase our violent behavior? In some ways yes, we definitely played in imitation of the fights we saw. But none of us were newly aggressive or violent.

I just finished reading a provocative study in The Journal of Pediatrics. The researchers carefully examined 25 studies published between 1998 and 2008, which looked at the public health effects of exposure to media violence. Most of the studies they looked at (16) were with children, but there were 11 with adult subjects. Most of the studies showed that the more exposure a person had, the more violent behaviors they had.

But they found several interesting things. It turns out that many different measures of violent behavior were used. Some of the measures had never been validated scientifically, and some weren't measures of actual behaviors at all. Some used statistical analysis to see if those with violent behaviors watched more violent video. But did they choose this content because they already had violent tendencies, or did the exposure cause the violent thoughts? And will a child act on aggressive thoughts? Will the exposure to violence cause more violence in our communities?

They wanted to know how many of these studies examined directly-measured real-world violent behavior, such as a crime or hurting another person, and how many used another measure of aggression that would be more difficult to confirm. Some of the studies used ratings from teachers or even peers--these have been shown to have the least credibility in predicting actual violent behavior.

Interestingly, they found that the studies with the poorest measures of violent behavior showed the strongest relationship between violence and media exposure. Those using more certain measures of violence showed a much weaker relationship. Overall, the relationship was very weak.

Another study looked at published studies specifically examining violent behaviors, rather than surveys or questionnaires. They found that there was no general relationship between exposure to media violence and aggressive or criminal behavior.

The American Academy of Pediatrics, and several other official groups, have fully embraced the need to restrict a child's exposure to violent media. In a practical sense, this is increasingly difficult. Because of the internet, a lot of objectionable material is easily available. And because of a child's natural inclinations (see my post on Forbidden Fruit), they will have the innate interest in seeking out some of this content.

But I wonder if it really changes them. The two studies I cite in this post don't support the thinking that seeing violent media will somehow transform our children into violent people. Video games are more popular than ever, and some are shockingly violent. Some are played by children much younger than their rating would imply. But there doesn't seem to be evidence that these kids are more likely to become criminals.

Lack of harm, however, isn't the same as proof of a benefit. Even if I buy the conclusion that violence in the media isn't as harmful as it's currently made out to be, that doesn't mean I think it's a good thing. What would be best, I think, is if the kid would put down the video game and go outside to play some basketball, or ride their bicycle (with a helmet).