Memo to the Surgeon General: Right Diagnosis, Wrong Treatment

Four months ago, a teenage boy committed suicide with the family shotgun. His parents knew he was in distress. They had taken his smartphone away from him because they realized that the phone was a major factor in their son’s unhappiness. What the parents didn’t know was that the boy had obtained a burner phone, a phone the parents didn’t know about, and the misery was continuing to the point that he took his own life. 

The leadership at this boy’s school invited me to meet with students, lead a workshop for teachers, and speak to parents. We talked about all the bad things that can come over a smartphone, and the need for limits. 

We are not the only ones talking about the dangers of smartphones and the need for limits. Last week, Vivek Murthy MD, Surgeon General of the United States, issued a special advisory warning of the dangers of social media, which teenagers overwhelmingly access via a smartphone. The advisory warned that social media pose “a profound risk of harm to the mental health and well-being of children and adolescents.” It notes that the average 8th and 10th grader now spends more than three hours a day on social media; 1 in 4 spend more than five hours a day. Those hours often come at the expense of sleep: the advisory finds “a consistent relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth.” Nearly 1 in 3 adolescents report using screens until midnight or later. The advisory further notes that social media-induced “fear of missing out,” FOMO, has been associated with anxiety and depression. It also recognizes that social media pushes kids to compare themselves with others, often unfavorably; motivates kids to present an artificial and Photoshopped version of themselves online; and exposes them to harmful content glamorizing body dysmorphia and self-harm. 

OK, but what are parents supposed to do about it? That’s where I think the Surgeon General’s advisory falls short. He advises parents to “Discuss with children the benefits and risks of social media as well as the importance of respecting privacy and protecting personal information in age-appropriate ways,” to report cyberbullying and exploitation, and to encourage in-person friendships. And he advises parents to: “Consider restricting the use of phones…through the night” (emphasis added). 

But let’s be real. Too many parents are uncomfortable asserting any authority over their kid’s mobile phone. I wish the Surgeon General had empowered parents to take the phone. What is your 15-old daughter supposed to say when her friend asks her “Hey, I texted you last night at midnight. How come you didn’t answer?” Is your daughter supposed to say “Well, the Surgeon General has warned that sleep deprivation among teens is a major risk factor for anxiety and depression, and for that reason I give my phone to my parents every night at 9 PM”? It’s not reasonable, it’s not age-appropriate, to expect an adolescent to talk like that. You have to allow your daughter to say “Hey! My evil parents take my phone every night at 9 PM, they turn it off and stick it in the charger, which they keep in their bedroom, and they don’t let me have it back till the next morning!” 

I recommended to one mother that she take her 13-year-old daughter’s phone from her at 9 PM so that her daughter could get a good night’s sleep. She responded, “Oh, no, I couldn’t do that, my daughter would totally freak out if I took her phone.” Mom is letting her 13-year-old make the decision that the parents should be making. And the result is a chronically sleep-deprived 13-year-old who is anxious and depressed. 

My advice to parents: don’t wait for state or federal legislation. You could be waiting a long time. Parents need to act now.

This is a confusing time. We are all beginning to realize that the advent of smartphones has upended life as we know it. It’s a big deal. The lived experience of adolescence is now profoundly different compared with the adolescent experience just 20 years earlier. Teens today are spending less time hanging out with friends, and more time looking at screens. Two weeks before the Surgeon General’s advisory, the American Psychological Association (APA) issued their first-ever advisory regarding social media use by teenagers. But the APA’s guidance was no better than the Surgeon General’s, recommending, for example, that “The use of social media should be limited so as to not interfere with adolescents’ sleep” but with nary a word about who should be doing the limiting—parents or adolescents?—or how, exactly, the limitations should be enforced. 

As a family doctor, I pay attention to these nuts and bolts. I advise parents to install parental monitoring software on any device with Internet access, to enforce limits on social media use. Common Sense Media recommends Net Nanny and Qustodio, as well as Bark or Circle, among other parental monitoring apps. 

Explain to your teen that the use of a smartphone is a privilege, not a right. Inappropriate use of the smartphone will result in forfeiture of that privilege. What constitutes inappropriate use? Downloading or sharing obscene photos is inappropriate use. Cyberbullying is inappropriate use. Posting nasty comments anonymously is inappropriate use. A parental monitoring app will let you know whether any of this is happening, and it’s the job of parents to know. 

Some lawmakers are trying to make a difference. Senator Josh Hawley (R-MO) introduced a bill earlier this year that would make it unlawful for kids under 16 to be on social media, and would enforce the age restrictions with teeth. Right now, kids under 13 aren’t supposed to be on social media such as TikTok, but a recent survey found that 38% of 8-to-12-year-olds are on social media anyhow (As I noted on this blog last year, TikTok is uniquely harmful to kids). Any 11-year-old can go on TikTok, lie about their age, and get an account. Montana’s governor has signed a bill banning TikTok from all operations in the state of Montana, effective January 1, 2024. TikTok has, of course, filed a lawsuit to prevent the law from taking effect, and the law is open to serious constitutional objections. Earlier this year, the governor of Utah signed a new law that prohibits anyone under 18 from having a social media account with the explicit consent of a parent or guardian. That law takes effect March 1, 2024. Texas lawmakers are also considering a bill to ban social media altogether for kids under 18.

My advice to parents: don’t wait for state or federal legislation. You could be waiting a long time. Parents need to act now. The Pew Research Center finds that 95% of teens are on at least one social media app, and more than one-third say they use social media “almost constantly.” We need to limit, govern, and guide how our kids are using their devices. And if you suspect that your kid has purchased a burner phone—a phone that you don’t know about—then you need to take measures to find the phone and explain to your teen, again, the dangers of these new technologies. Amazon even offers a variety of reasonably-priced gizmos to detect and locate a burner phone. 

Imagine that civilization somehow advanced into the modern era without anyone ever figuring out how to make alcoholic beverages. Then imagine that in 2004, the same year that Mark Zuckerberg launched Facebook, somebody figured out how to make beer. Then in 2005 we got red wine, then white wine in 2006 and all the different varieties of wine over the next five years. Then whiskey, liquors, and mixed drinks. How long would it take for parents to figure out that maybe teenagers shouldn’t be consuming alcoholic beverages? I don’t think it would be immediately obvious. On the contrary, I can imagine parents in my own practice saying “Well, alcoholic beverages are now part of the adult world, and kids should be prepared for the adult world. I don’t want my kid to be embarrassed because he doesn’t know the difference between a Merlot and a Pinot Noir.” 

I hear a similar argument from parents about smartphones and social media. What’s missing is an awareness of risks. I think the analogy between social media and alcoholic beverages is instructive. Social media can be addictive, just as alcohol can be addictive. Social media often leads to bad outcomes, just as alcohol can lead to bad outcomes. In fact, social media may lead to anxiety and depression more often than alcohol leads to liver failure and cardiomyopathy. In 1984, the National Minimum Drinking Age Act required all states to ban sales of alcohol to anyone under 21 years of age. Maybe it’s time for a bill banning social media for anyone under 18 years of age. 

Maybe. In the meantime, it’s our job as parents to safeguard our children against the harms of social media. 

Leonard Sax MD PhD is a practicing family physician and the author of four books for parents, including The Collapse of Parenting, which was a New York Times bestseller. More information is online at www.leonardsax.com. 

Editor's Note: The opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.