You’re Never Truly Yours: How Love and Ownership Are Synonymous

by Marcela Muricy, May 30, 2021

“There is beauty in the idea of freedom, but it is an illusion. Every human heart is chained by love.”

Cassandra Clare

When we are born, we are all empty rooms — white, blank, utterly devoid of all life and personality. Our parents, then, are the only ones who may enter freely: they paint the walls, play their favorite hits on a record player, and maybe hang a cross over the door. They make a storage space of us, piling cardboard boxes in the corner and labeling each as “mannerisms,” “habits,” “beliefs,” or “obsession with the JFK assassination.” From the very beginning of our lives, we belong to them, absorbing their traits and letting them shape and define us. They are the primary decorators of our “room” until we inevitably age, maturing and reclaiming agency of ourselves and our identity, refurbishing this space to our own liking. Yet, as we rearrange it with age, do we truly have as much autonomy in the matter as we would like to believe?

When we are born, our rooms are quite put together, with most interests hand-picked and presented as essential, our parents projecting onto us what they’d always dreamed for themselves. Ballet classes at age 2, ice skating at 4, Catholic school at 5 — all the beauties of the New World, supposedly. When we grow, however, things begin to change. We wear mismatched outfits to school because I like it, even if Mom says we’ll get bullied. We rearrange and redecorate our “room” as we reach the age of puberty and change our sense of self. Our perception of the world becomes completely transformed, that “room” finally opens for us to edit — the space seemingly infinite. 

We can change our clothes, betray our schedules, or shed a religion that once meant everything. We can adopt new hobbies and become part of fictional worlds we wished were within reach, allowing the smell of the worn pages to sink into our memory forever. We can find our true passion, begin reciting knowledge of biology like a prayer, and become intrinsically entangled with the beauty and complexity of it all. We can begin to reconcile with the fact that our parents are flawed humans woven from the same cloth, struggling to grapple with lifelong dilemmas. We can shift our mentalities from theirs, tune our radios to a different station, and make that same inherited room completely unrecognizable.

Yet, while some things we may edit, others are inherently permanent, at least in part. As we age and mature, we can modify the way our parents have previously made us think or act, but some things will always remain regardless of our efforts. We can detach the cross from the wall, yet the mark it made would still remain. We can consciously coat the walls in a new shade, but the other will still shine brightly underneath. If we listen closely, our ears pressed gently against the walls, we will still hear the echo of our parents in the things we say. We will still listen to music that we’re well aware is a result of our dads’ incessant playing of the ’70s hits. We will think with realism and logic, yet still find hints of our mother’s act like a lady perspective in our mind. We still belong to our parents in these small, significant ways because of the remnant traits and interests they’ve left in us. Now, though, we’re also made up of everything else, all the other experiences we’ve had up until this point, and all the people and interests that have affected us during this time — everything else we belong to.

So, then, as we age, do we truly begin to experience sole belonging? In a world of supposed free will, we could say we belong to ourselves, but this declared autonomy doesn’t negate the reality in which we act based on others. These may no longer be our parents, but we mold our lives around new ideas, interests, significant others, friends, etc. — anything and everything we love. This raises the question of whether we truly gain ownership of ourselves, or if we simply pass it onto the hands of someone — or something — else. When we’re younger, our parents hold the master key to our “rooms,” and later on, we simply make copies and hand them out to everything we hold dear. Our friends can tiptoe inside and slip an idea or two while we barely bat an eye. Our occupations can be even more invasive, expanding in the space and barricading the door so that they have unilateral control. Our significant others can have the same effect, moving and rearranging furniture of their own accord, creating a more comfortable space or punching a hole through the wall. We grant ownership to those we love because we want them in our lives, and so we allow them to influence us in this way. Because of our parents, we can be raised as God’s, our school’s, our responsibilities’ — until we become more our music’s, our friends’, books’, intellectual interests’, hobbies’, and everything else we spend our time and thoughts on. Ultimately, we all decide what is best to give pieces of ourselves to, and — as this list inevitably grows over time — the key is to embrace it and balance the effect we let it have on us. The room is ours, after all; it is ours to care for, or be careless with. We must recognize the lack of choice in love, however, and only hope to love what’s best for us — and that the key to it not fall prey to vicious hands.


Works Cited

Clare, Cassandra. Lady Midnight. Simon & Schuster, 2016.

Adolescent Peer Relationships and Mental Health during the COVID-19 Pandemic

by Sophia Garbarino, Clare Beatty & Brady Nelson, May 25, 2021

See Sophia’s poster for the URECA 2021 Symposium here.

Abstract

In adolescence, females are more likely than males to experience an episode of depression (Hyde et al., 2008). Having a strong social network has been shown to protect against the development of depression and anxiety symptoms (Santini et al., 2015). In the U.S., adolescent social circles were largely disrupted during the initial phases of the COVID-19 pandemic. Although it has been suggested that higher perceived social support protects against poorer mental health (Magson et al., 2021), few studies have examined the potential association between relationship quality and mental health during the COVID-19 pandemic. In a sample of 104 12 to 18 year-old girls, the present study examined peer relationship quality prior to the COVID-19 pandemic and changes in depression and anxiety symptoms during March to April 2020. Relationship quality was measured with the self-report Network of Relationships Inventory – Relationship Qualities Version (NRI-RQV). Depression was measured with the Child’s Depression Inventory (CDI), and anxiety was measured with the Screener for Child Anxiety Related Disorders (SCARED). Across the entire sample, there was an increase in both depression (t = -4.88, p < 0.001) and anxiety (t = -3.07, p = 0.003) symptoms during the COVID-19 pandemic. In addition, pre-COVID-19 perceived closeness of friendships predicted changes in depression and anxiety symptoms during the COVID-19 pandemic. Specifically, greater same-sex (r = -0.29, p = 0.003) and opposite-sex (r = -0.21, p = 0.04) friendship closeness were inversely correlated with generalized anxiety symptoms. Opposite-sex friendship closeness was inversely correlated with depression symptoms (r = -0.26, p = 0.008). Parent-child relationships were also examined but were not associated with changes in mental health. Findings suggest that healthier peer friendships may serve as protective factors against depression and anxiety in adolescents. As vaccine distribution increases and social distancing policies become more relaxed, adolescents may be able to strengthen relationships that were impacted by the COVID-19 pandemic, contributing to improved mental health.

Keywords: COVID-19, adolescents, relationships, friendships, depression, anxiety


Introduction

Background

Adolescence is a critical developmental period for the emergence of sex differences in depression. By ages 13 to 15 girls are approximately twice as likely as boys to experience an episode of depression (Hyde et al., 2008). Prior research has taken a particular interest in the psychological mechanisms responsible for this shift, focusing specifically on girls.

For both sexes, strong social support networks have been shown to protect against the development of depressive and anxiety symptoms (Santini et al., 2015). In early 2020, when the initial phases of the COVID-19 pandemic began, these social networks were largely disrupted, especially for children and teenagers. The daily routine of interacting with classmates and peers at school was abruptly interrupted due to the shift to remote learning. During this time, research suggests that females in particular experienced a notable increase in depressive and anxiety symptoms (Hawes et al., 2021).

While some studies suggest that higher perceived social support protects against poorer mental health (Magson et al., 2021), few studies have examined the potential association between relationship quality and mental health during COVID-19. The present study examined pre-pandemic peer relationship quality and its potential for predicting depressive and anxiety symptoms during the early COVID-19 pandemic.

Hypotheses

The present study tested two hypotheses: 1) Individuals would display an increase in depressive and anxiety symptoms during the initial stages of the COVID-19 pandemic as compared to pre-pandemic symptoms, and 2) Both parent and peer relationships would inversely correlate with depressive and anxiety symptoms during the COVID-19 pandemic. In other words, healthier and closer relationships would be associated with fewer depressive and anxiety symptoms during COVID-19.

Methods

Participants

The sample consisted of 104 girls from an ongoing longitudinal study at Stony Brook University, the Impact of Puberty on Affect and Neural Development across Adolescence (iPANDA) project. This project is currently investigating the relationship between neural reward sensitivity and the development of depression. Eligibility included being assigned female at birth, aged 8 to 14, being literate in English, having no known medical or developmental disabilities, and living within 30 miles of Stony Brook University in Long Island, NY. One of the child’s biological parents also had to be willing to participate. The baseline sample consisted of 317 girls along with one of their biological parents. Baseline data collection was followed by two additional waves, each spaced approximately two years apart. The third wave was still in progress when the COVID-19 pandemic began in late March 2020, therefore not all of the participants had completed the data collection.

Measures

The iPANDA participants (N = 104) were included in the present study if they completed the included measures within the appropriate timeframes. One measure was completed prior to the pandemic (before March 18, 2020), and two measures were completed before and during (March 18, 2020 and after) the pandemic. The average time between the pre-COVID and during-COVID assessments was 55 weeks.

Network of Relationships Inventory – Relationship Quality Version (NRI-RQV)

The NRI-RQV questionnaire is a self-report measure that assesses participants’ relationships with their 1) mother or mother figure, 2) father or father figure, 3) boyfriend or girlfriend, 4) sibling, 5) best same-sex friend, and 6) best opposite-sex friend. The questions had Likert-style responses (1 to 6: 1 = low occurrence, 5 = high occurrence, 6 = not applicable) and were presented in matrix format with each relationship type. Questions were classified into one of ten scales; the five positive scales measured companionship, intimate disclosure, emotional support, approval, and satisfaction, while the five negative scales measured conflict, criticism, pressure, dominance, and exclusion. Each scale contained three items and was scored by averaging the item responses (Furman & Buhrmester, 2010). The present study focused on the Closeness score, which is the mean of the five positive scale scores, for the mother, father, best same-sex friend, and best opposite-sex friend relationships. Participants completed the NRI-RQV assessment pre-COVID.

Children’s Depression Inventory (CDI)

The CDI questionnaire is a self-report measure that assesses participants’ depressive symptoms (Kovacs, 1992). Scores were calculated by summing the item responses, which were Likert style (not often/doesn’t apply to me, sometimes/somewhat applies to me, very often/strongly applies to me). Participants completed the CDI assessment pre-COVID and during COVID.

Screen for Child Related Anxiety Disorders (SCARED)

The SCARED questionnaire is a self-report measure that assesses participants’ anxiety symptoms. Each item had Likert-style responses (0 to 2: 0 = not true, 2 = very true) and was categorized into one of five subscales: panic disorder or significant somatic symptoms, generalized anxiety disorder (GAD), separation anxiety disorder, social anxiety disorder, and significant school avoidance. A total sum score of 25 or above (out of 82) indicated the possible presence of an anxiety disorder (Birmaher et al., 1997). The present study focused only on the GAD subscale, where a sum score over 9 indicated the possible presence of GAD. Participants completed the SCARED assessment pre-COVID and during COVID.

Data Analysis

Using IBM®️ SPSS®️ Statistics (v.27) software, we conducted two paired samples t-tests to examine whether depressive and anxiety symptoms increased during the pandemic as compared to pre-pandemic. Further, we conducted follow-up partial correlations (controlling for pre-pandemic symptoms) to investigate the relationship between relationship quality and depressive/anxiety symptoms during the pandemic.

Results & Discussion

Figure 1. Pre-COVID-19 vs. COVID-19 SCARED GAD Subscale t-test

t = -4.88, p < .001

Figure 2. Pre-COVID-19 vs. COVID-19 CDI Total t-test

t = -3.07, p < .01

Table 1. Correlations between SCARED GAD (COVID-19), CDI (COVID-19), and peer relationships

COVID-19 SCARED GAD SubscaleCOVID-19 CDI Total
NRI-RQV Best Same-Sex Friend Closeness (pre-COVID)-0.287**-0.080
NRI-RQV Best Opposite-Sex Friend Closeness (pre-COVID)-0.205*-0.259**
Controls: pre-COVID SCARED or pre-COVID CDI
p < .05*   p < .01**  p < .001***

Table 2. Friendship closeness vs. COVID-19 symptoms regressions

COVID-19 SCARED GAD Subscale (β)COVID-19 CDI Total (β)
NRI-RQV Best Same-Sex Friend Closeness (pre-COVID)-.168**.074
NRI-RQV Best Opposite-Sex Friend Closeness (pre-COVID)-.018-.124****
Controls: pre-COVID-19 SCARED and CDI; COVID-19 SCARED or CDI
p < .05*   p < .01**  p < .001*** trending****

Results indicated support for the first hypothesis. Across the sample, participants had greater depressive (t = -4.88, p <.001) and anxiety (t = -3.07, p < .01)symptoms during the COVID-19 pandemic, as compared to pre-pandemic. However, results indicated only partial support for the second hypothesis. Pre-pandemic friendship closeness was associated with changes in anxiety and depressive symptoms; specifically, stronger pre-COVID same-sex friendship closeness uniquely correlated with smaller increases in anxiety symptoms during COVID (r = -.29, p < .01), while stronger pre-COVID opposite-sex friendship closeness uniquely correlated with smaller increases in depressive symptoms during COVID (r = -.26, p < .01). When controlling for pre-pandemic symptoms, pre-COVID same-sex friendship closeness still predicted changes in COVID anxiety symptoms (r = -.17, p < .01). Mother and father relationships were not found to be significantly predictive of changes in mental health during COVID.

Conclusion

Interpretations

It is possible that participants were more comfortable expressing worry to same-sex friends (girls), buffering against increased anxiety symptoms. Perhaps they shared feelings about missing friends or romantic interests at school. Findings also suggest that opposite-sex friends (boys) may have helped improve participants’ moods, buffering against increased depressive symptoms. The girls may have had a crush or two and were happier interacting with them, even if only virtually, while following stay-at-home orders.

Limitations

The sample was predominantly Caucasian and middle class, and from the Long Island, New York area. As such, the sample is certainly not representative of the entire United States, as the U.S. is much more racially and socioeconomically diverse. It is unclear whether or not these results would be similar for individuals of different backgrounds, since a variety of factors, including race, ethnicity, sex, and economic class, impact the degree to which people have been affected, either positively or negatively, by the pandemic (Center for Disease Control and Prevention). For example, Black and Indigenous Americans had the highest COVID-related death rates, while Asians and Whites had much lower rates (APM Research Lab Staff). According to the Pew Research Center, lower-income individuals were also more likely to report lost income and jobs due to the pandemic (Parker et al., 2020). As such, the present study’s sample may not have been affected by COVID-19 as much as other groups.

Further, all measures were self-reported, so participants may have been reluctant to share the full extent of their relationships and COVID-19 experiences. Another important consideration is that there was over a year, on average, between the pre-COVID and during-COVID assessments, meaning we could not account for potential significant life changes, such the death of a parent, losing touch with a friend, moving to a new place, and changes in relationship nature itself. Therefore, the present study’s results regarding pre-pandemic relationship quality may not be fully applicable to pandemic-era relationship health.

Future Directions

Overall, the results were largely what we hypothesized. Increased anxiety and depressive symptoms during the COVID-19 pandemic were evident across the sample and peer relationships predicted changes in mental health. Future studies should investigate these findings further and consider potential gender, race, and socioeconomic class differences that were not found in the present sample. Social factors like gender norms, double sex standards, race/ethnicity, and wealth may further influence the nature of adolescents’ social support networks and how they experienced the COVID-19 pandemic.


References

APM Research Lab Staff. (2021, March 5). The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S. APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race

Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., & Kaufman, J. (1997, April). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36: 545–553. https://doi.org/10.1097/00004583-199704000-00018

Center for Disease Control and Prevention. (2021, April 19). Health equity considerations and racial and ethnic minority groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

Furman, W., & Buhrmester, D. (2010). Network of relationships questionnaire manual. Unpublished manuscript, University of Denver, Denver, CO, and the University of Texas at Dallas.

Hawes, M.T., Szenczy, A.K., Klein, D.N., Hajcak, G., & Nelson, B.D. (2021, January 13). Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychological Medicine, 1–9. https://doi.org/10.1017/s0033291720005358

Hyde, J.H., Mezuklis, A.H., & Abramson, L.Y. (2008). The ABCs of depression: Integrating affective, biological and cognitive models to explain the emergence of the gender difference in depression. Psychological Review, 115, 291-313. https://doi.org/10.1037/0033-295x.115.2.291

Magson, N.R., Freeman, J.Y., Rapee, R.M, Richardson, C.E., Oar, E.L., & Fardouly, J. (2021). Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. Journal of Youth and Adolescence, 50, 44-57. https://doi.org/10.1007/s10964-020-01332-9

Kovacs, M. (1992). Children’s depression inventory. Multi-Health Systems, Inc.

Parker, K., Horowitz, J.M., & Brown, A. (2020, April 21). About half of lower-income Americans report household job or wage loss due to COVID-19. Pew Research Center. https://www.pewresearch.org/social-trends/2020/04/21/about-half-of-lower-income-americans-report-household-job-or-wage-loss-due-to-covid-19/

Santini, Z.I., Koyanagi, A., Tyrovolas, S., Mason, C., & Haro, J.M. (2015, April 1). The association between social relationships and depression: A systematic review. Journal of Affective Disorders, 175, 53–65. https://doi.org/10.1016/j.jad.2014.12.049

Following Our Digital Footsteps

by Ean Tam, May 19, 2021

On January 21st, 2020, the United States reported its first case of COVID-19 in Washington state. Over the course of a year, offices emptied, schools closed, and normal life disappeared. By April 2021, over 553,000 Americans had passed away due to the pandemic. Now, as vaccine shots continue to make their way into people’s arms, the hope of defeating the pandemic appears more attainable. The vaccine is our shot back to the workplace, the classroom, and, some would say, back to normal life.

While suppressing this respiratory disease itself may be possible, many people struggle to take a deep breath and relax. For more than a year, across the country Americans have been sheltering in their homes, taking in the world through screens and behind masks. They have been waiting to return to work, hoping to regain jobs they lost at no fault of their own. It will take time for people to regain a sense of control over their lives and examine the mental health effects of the pandemic.

Perhaps we can comprehend how the pandemic played into the worst sides of ourselves. How did transitioning to a life online affect us? What will be our ‘new normal’ post-pandemic? How do we want to discuss mental health? To answer these questions, we should examine the research into our social and online behavior, including new techniques in studying social media activity.

A Life Online

When isolation orders began, we observed the panic: not as frenzy crowds going berserk in the streets, but in the simplest of manners: lining up at the supermarket. Under the threat of prolonged lockdown, citizens translated their insecurities through their wallet. In the United States, where consumerism is a part of our culture, our spending behavior can exemplify our human instincts: “Cash, and the fantastic appeal of what money can buy… provide a way for humans to distance themselves from the disturbing realization that they are animals destined to die” (Arndt et al., 2004). Certainly, not everyone assumed COVID-19 was going to be the ultimate scourge of the human race, but the mindset was there. As a reflection of that mindset—that we as humans can have some control over our lives—we decided to wipe out the supermarket shelves before COVID could wipe us out.

Of course, the online world to which we were regulated put us face-to-face with another nuisance we had already been trying to grapple with: misinformation. Unfortunately for us, online misinformation has only become worse. In beginning of the pandemic, so little was known about SARS-CoV-2, the virus that causes COVID-19. Once a rumor, half-truth, or plain lie made its way online, there was no way of knowing how far it could travel. But it is clear that unreliable sources induce panic and anxiety, stoking our fears of the current situation, encouraging us to prepare more (Usher et al., 2020; Johal, 2009).

When ventures outside of our homes are limited to stocking up on groceries, the possibilities for personal connections are lost. Small talk is hard to come by, especially when you are six feet apart, wearing a mask, and staring through the glare of plexiglass. Physical interaction has become impersonal. Even the relationships established before the pandemic have been hurt. The online connection has been unable to keep up with the loneliness. While we can turn on our cameras to see each other’s faces on screen, the interaction is not a proper substitute for in-person contact (Lippke et al., 2021). In a study of 212 Swiss undergraduate students, researchers found that the students, because of the pandemic, were increasingly working alone and not engaging in networking with their peers. Students’ depressive and anxiety symptoms also increased. The concerns about the students’ minds ranged from the “fears of missing out on social life to worries about health, family, friends, and their future” (Elmer et al., 2020). For mourners who require “restorative activities (e.g., travel, spending social time with friends),” those options vanished (Lee and Neimeyer, 2020). The emotional connections that would have helped no longer do, and the strength of the friendship has diminished. This faltering sense of belonging and attachments to others can manifest itself in our physical and mental health (Baumeister and Leary, 1995).

It is no secret that internet use and mental health are intertwined. More time spent on the internet affects our social interactions and increases the chances of cyberbullying. It appears the relationship between internet use and social interactions can go either way: problematic internet use (PIU) can be both the cause and the result of diminished social interactions. When internet use is the cause, social interactions suffer because of depression, neglect of offline obligations, and obsessive behaviors, all of which are linked to PIU. When PIU is the result of diminished social interactions, the internet is seen as a coping mechanism—a world to which people can escape (El Asam et al., 2019).

However, the world people enter is not always so agreeable. Excessive internet use has a profound impact on adolescents because they are not only victims of cyberbully, but also encouraged to take part in it. Online communities offer opportunities for validation. At times, participating in cyberbullying is a way for some adolescents to ‘fit in’ with their online counterparts. Moreover, an adolescent who engages in such internet behavior can be expected to develop PIU (Chao et al., 2020). It appears that most of the time, victims of cyberbully do not allow the abuse to end with them. They will have “a desire to respond, which may encourage others to join the fray leading to a potentially long and drawn-out series of increasingly abusive and antagonistic communications” (Chao et al., 2020).

Before lockdown, excessive users of the internet had the ability to separate themselves from their devices. However, once life went online, that opportunity disappeared. We all, in a way, became problematic internet users. A life online, while necessary for the past year, has shown to be harmful to our mental well-being.

Back to Normal?

When we eventually emerge from this pandemic, the cloud of lockdown will still hang over us. One of the lingering concerns will be the home as the petri dish. Throughout this pandemic, citizens have created their own fortresses, hoping to keep the COVID invader at bay. Every trip outside of the home was a potential for letting an intruder in. That is why we wiped down all our groceries and bathed ourselves in hand sanitizer after every door handle. The pressure to keep the home decontaminated has been especially hard on those living with vulnerable groups like the elderly.

Retreating to our homes for the past year has proven to us that some things are simply no longer worth going out: movies, restaurants, shopping. However, “even people who do not become housebound may become fastidious germaphobes, striving to avoid touching ‘contaminated’ surfaces or hugging people or shaking hands” (Taylor and Asmundson, 2020). Pandemic sanitation standards will persist, similar to how some American families maintained their parsimonious, self-sufficient lifestyles after the Great Depression (Taylor and Asmundson, 2020).

The stress of yourself being a carrier and potential hazard to those around you can be exacerbated when living conditions are tight. When living conditions are limited, tensions can flare. Unfortunately, some people find themselves trapped at home with COVID outside and an abuser inside, making their situation a possible source of post-traumatic stress disorder (PTSD) (Taylor and Asmundson, 2020).

For those who have contracted COVID-19, some have had to deal with guilt for possibly infecting others, embarrassment for having contracted the disease while others did not, and shame for not protecting oneself enough. Not even our healthcare workers have been exempted. In Italy, Daniela Trezzi, a 34-year-old nurse, took her own life in March of 2020 after she had tested positive for COVID-19. Trezzi’s colleagues reported that her suicide may have been the result of her concerns of having infected other people (Giuffrida and Tondo, 2020). As COVID-19 surged in New York City last April, Dr. Lorna Breen, an ER doctor at New York-Presbyterian Allen Hospital, committed suicide. The virus had taken the lives of many of Dr. Breen’s patients. Despite the overachieving and dedicated passion to her job, Dr. Breen’s family believed she “was devastated by the notion that her professional history was permanently marred and mortified to have cried for help” (Knoll et al., 2020).

Plenty of people will be able to return to normal life post-pandemic, to go back on the street as if nothing has changed. But for many members of the Asian-American and Pacific Islander (AAPI) community, this is an impossibility. A wildfire of misinformation spreads (and continues to spread) across the internet, pinning a substantial number of American citizens as walking embodiments of SARS-CoV-2. Therefore, for AAPIs, returning to a normal life post-pandemic does not mean traveling down the street as if nothing has changed. As the United States begins to open, we are already seeing increases in racist attacks against AAPIs. We have seen this before. In 2014, Ebola was blamed on Africans because it was deemed an “African problem” (Usher et al., 2020). The ease of scapegoating specific demographics is an example of maladaptive coping “where coping is emotion-focused rather than problem-focused” (Cho et al., 2021).

We would like to think there is a chance for a return to normal. However, for many people, this is an unlikely future. Quarantine and the pandemic experience have affected the mental health of citizens across the globe. The pandemic has left us lonely, guilty, and fearful. It has forced some people to channel their insecurities into counterproductive behaviors. Behaviors that prevent us from regaining a sense of camaraderie and interconnectedness—some things we all lost this past year in quarantine.

Putting Our Online Activity to Good Use

Although living our lives on the internet has strained everyone, there may be something to gain from our past year online. In recent years, mental health researchers have turned their eyes to social media. With every post, like, or share, there may be a hidden meaning waiting to be deciphered. A variety of social media websites have been utilized for possible insights into specific mental health issues. Twitter is a popular site for study. It has been used for learning about detecting signs of depression and suicide (De Choudhury et al., 2013; Tsugawa et al., 2015; Coppersmith et al., 2016). Instagram, Reddit, and Tumblr have been used to study depression, suicide, and anorexia, respectfully (Reece and Danforth, 2017; Shing et al., 2018; Chancellor et al., 2016).

Taking advantage of machine-learning to comb over patients’ extensive social media activity, researchers have found indicators of mental health illnesses. For example, researchers classified tweets of suicidal individuals by their expressed emotions, emoji usage, and frequency of tweets. They found that tweets usually expressed sadness then anger after a suicide attempt, and that frequency of emotional tweets increases while emoji prevalence decreases (Coppersmith et al., 2016). The machine-learning systems allow for detecting these indicators with accuracy as high as 80 to 90 percent. This technique of combining computing power with psychiatric evaluation has led to the term “digital psychiatry” (Chancellor and De Choudhury, 2020). The focus on social media is particularly helpful in studying younger generations. Regardless of race or medical history, a younger age has been “the only significant predictor of blogging and social networking site participation” (Chou et al., 2009).

Northwell Health, New York state’s largest healthcare provider, has realized the importance of using social media for the purpose of engaging with patients as soon as possible. Since 2013, Northwell’s Early Treatment Program (ETP) has specialized in treating adolescents and young adults suffering from psychotic symptoms. Dr. Michael Birnbaum, Director and founding member of the ETP, studies the application of social media as an indicator for psychosis. I spoke with Dr. Birnbaum to learn more about his research with social media and its implications.

“This line of research was happening in the world of computer science, but not so much in psychiatry,” Dr. Birnbaum explained. “The idea sort of organically arose through reading the exciting literature on machine-learning and social media. Thinking about some of the major challenges and obstacles to delivering effective care, we came up with this solution.”

To perform his studies, Dr. Birnbaum and his colleagues retrieved social media archives donated by participants. These databases were downloaded straight from social media websites and then inputted into machine-learning systems provided by computer scientists from institutions like IBM, Cornell Tech, and Georgia Tech. The magnitude of data for these studies were immense. For instance, in one study, from just 223 research participants, Dr. Birnbaum and his team had collected 3,404,959 Facebook messages and 142,390 images. With this Facebook data alone, they found that the machine-learning system could identify research participants who had schizophrenia spectrum disorders (SSD) and mood disorders (MD). In terms of posts and messages, those with SSD were more likely to use words of sensory perception, those with MD were more likely to make references to the body, and SSD and MD groups were both more likely to use curse words. When it came to Facebook photos—a more abstract source of analysis—Dr. Birnbaum and his research team found that those with SSD and MD were more likely to post smaller photos by dimension, and the hues of photos from MD participants were more blue and less yellow (Birnbaum et al., 2020).

Now, while the volume of information is essential to the experiment, the social media archives are not limited to just the research participants. Within these archives, you can find private messages sent by the research participant and messages sent from second parties whom the participant was communicating with.

“One of the other ethical issues is the fact that there are a ton of secondary subjects: all of the friends and connections to other users who don’t necessarily agree to have their data donated and analyzed, and so that’s something that, as a team, will need to sort of grapple with,” Dr. Birnbaum explained. To handle this ethical issue, Dr. Birnbaum’s studies had to eliminate the data from these secondary parties. So, while these secondary subjects may not have their private messages inputted into a machine-learning system, there is no denying that those messages are being stored somewhere at some point. It will be up to the patient to inform his or her friends that their conversations may eventually find their way into a stored database. Consent, conservation, and confidentiality of social media information are only some of the big hurdles of digital psychiatry (Wongkoblap et al., 2017). However, Dr. Birnbaum believes that with the correct system in place and an understanding from the public, the application of machine-learning can find success in psychiatry.

“This shouldn’t be about surveillance or taking the power away from the patient. It’s just the opposite. In my mind it’s creating a way for the patient to be able to learn more about themselves and also share it with their clinician. Just like when you go to see your doctor who orders a blood test or an X-ray, you donate your blood to inform because it’s going to improve your care. Though most people don’t like taking their blood, similarly, I imagine a situation where the benefits would be clear and patients would be willing and interested in donating their digital data to inform their care in a meaningful way.”

Furthermore, Dr. Birnbaum highlighted a key issue in psychiatry: the reliance on self-reported information. It has been shown that self-reported data can be unreliable and underestimate health issues (Wallihan et al., 1999; Newell et al., 1999). Dr. Birnbaum elaborated, “We just are notoriously bad at this—all of us—at describing our own behaviors. Most of us can’t remember what we ate for dinner a few days ago, and so I think that these things can be immortalized in digital data, and so we can accept it more readily and use it.”

And in terms of the depth and perception from which we can learn, social media information may be the closest thing psychiatrists can have to 24/7 observation of their patients. Retrospective analysis of a patient after they have been admitted into the hospital is not the best solution. Social media information may hold the key.

“A patient sees the doctor periodically, and they meet for a certain amount of time and then that’s it,” Dr. Birnbaum said. “You don’t really know what’s happening in between meetings beyond patient self-report. The [social media information] provides information about what was going on between sessions. So, you can learn a lot more about, or rather from a different source and a more objective source, about what people are doing, thinking, and feeling.”
Of course, social media information is no substitute for in-person meetings. For Dr. Birnbaum, “I imagine a situation where someone donates their digital data a day or two before they come to meet me in my office, and then we can discuss the findings and determine whether or not we need to change the treatment plan.”

Although Dr. Birnbaum explained earlier that routine treatment involves monthly meetings with patients, the timing of when a patient should donate their social media archives is not exactly clear: “That is something that has yet to be empirically explored. Maybe it’s once a month when they come see me, maybe not. I could imagine a situation where it is done at the beginning of care and maybe perhaps periodically after that. I think it depends on what information we’re after, what we’re looking for, and how each individual uses social media.”

In the end, social media activity would just be one component of digital psychiatry. The way Dr. Birnbaum sees it, “Social media is a piece of the puzzle. They’re also people looking at speech, facial movements, wearables, cell phone data. All of this stuff paints a picture. A more comprehensive picture.”

What’s the Point?

On April 9th, The Wall Street Journal published an article titled, “Loneliness, Anxiety and Loss: the Covid Pandemic’s Terrible Toll on Kids.” In it, the author, Andrea Peterson, details the faltering grades, confidence, and motivation of young students. One 13-year-old stated, “[I]t’s been a lot harder to make friends and talk to new people… I feel like a lot of us drifted apart… It has set in that I’m alone” (Peterson, 2021).

With vaccines getting administered around the world, our public health appears to be on the right track. For many of the students who spoke with Peterson, transitioning back to in-person social activities will be difficult, but nonetheless, they will finally be in-person. Hopefully, for all of us, returning to in-person work or school will be the remedy we need. But the final obstacle we will face is the way we confront mental health as a society.

When The Wall Street Journal shared Peterson’s article on its Twitter profile, many of the comments were supportive—a lot of teachers and students voicing their approval with the awareness raised by the article. Then, of course, there were comments like these:

It would be quick and easy to say kids these days are just soft. It would be quick and easy to say there are more pressing matters than this. But the people who choose these quick and easy solutions seem to forget that we are all wired differently. We process things differently. Just as physical abilities differ from person to person, our ways of handling strains of our mental health differs. And to those who say the deaths from COVID-19 are more important: yes, preventing deaths is the number one priority, but the pandemic will be over. Can we talk about mental health effects then? Or would we have forgotten about it already?

It is unfortunate to think that these attitudes can exist within families, preventing people from getting the help they need. Whether it be depression or psychotic disorders, stigma exists everywhere. The family unit is not always equipped to understand the needs of someone suffering from a mental illness.

“For the most part, it’s impossible to tease apart providing good care to a patient without involving their family,” Dr. Birnbaum told me while explaining the role of family at the ETP. “So, it’s critical that the family understands what’s happening and has a connection to the treatment team, is involved in the treatment decisions in some capacity, and knows how to be most helpful and supportive for their child.”

It is no secret that there is a clash of how we discuss mental illness. Some people, due to culture or age, like to keep it under the rug, while younger generations tend to be more open about mental health. Those who like to keep a tight lip about it find themselves being blamed for being a part of the problem. Well, to put it simply, they are. I would hope people do not see that as a political opinion. It is informed medical advice.

When asked about breaking the stigma surrounding mental health and culture, Dr. Birnbaum explained, “I think that’s part of the work and that’s part of the advocacy. And part of the excitement of early intervention is sort of getting the message out that there are resources and tools and help available. The more we talk about it, the better.” He added, “Hopefully that’s something that we can do by changing society.”

Changing society will be no easy task. It will take time, just like waiting for this pandemic to be finally over. The ‘new normal’ waiting for us will ultimately be defined by us. If we decide to keep things the status quo, then that is what we should expect. As difficult as the past year has been, we ought to make the most of it. With the new advancements in machine-learning, we can learn from the online activity we amassed in quarantine. Work like Dr. Birnbaum’s shows that studying our online presence can improve the way we comprehend mental health. We can learn more about ourselves, mental health, and possibilities for early treatment for young people. When it comes to pandemic, the light at the end of the tunnel seems to be getting brighter. While we cannot say the same for mental health, our digital footprints can help lead the way.


Work Cited

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You Can Sit With Us, But You Shouldn’t Have To: The Hidden Benefits of Social Cliques

by Vineeta Abraham, May 9, 2021

Many adults with yearbooks filled with high school “horror stories” will claim they  originated from the rigid, harsh social structure they had to adhere to, complete with bullies,  queen bees, and their select array of victims. This myth is the reason behind many administrative efforts to integrate students in middle schools and high schools across the country as an attempt to attack the issue of social circles or “cliques” from multiple angles. When doing this, they often think that tackling the main problem involves eliminating the social hierarchies that exist in the halls of almost every high school. While this seems to be in the students’ best interests, it may be doing more harm than help. What teachers and administrators often fail to recognize is that when students are socially structured, they are able to create identities for themselves and thrive in the niches that the school environment creates for them. While most people assume this means that a sense of privilege will linger among several of these social standings, it should be noted that allowing students to stay comfortably within their social groups might be a better alternative than forcing them to intermingle. Although people have misconceptions about the nature of so-called “cliques,” and are therefore enforcing programs to dismember them, allowing these social circles to thrive, while taking care to encourage healthy cooperation between them, can help students develop psychologically in group settings and avoid the negative effects of not having a social group to call their own.

Much of the skepticism surrounding the existence of social circles in schools comes from  stereotypical assumptions about them. These are often fueled and exaggerated by the media,  through means such as books, television series, and teen-drama movies. The entirety of the  infamous 2004 comedy Mean Girls revolves around a typical new girl trying to outmaneuver the  social ladder that exists at her new school, including the “A-list girl clique” described in the  summary provided on the internet movie database, IMDb. In this movie, many types of cliques  and social circles are represented, as well as a clearly defined ladder that is topped by the so called “mean girls.” The movie highlights the entitled, harmful personalities of those who top these social hierarchies and proposes that cliques tend to remain vicious towards each other and cannot coexist peacefully (IMDb). Media such as this promote a general sense of wariness in the minds of their audiences, which include families, educators, and administrators, through their use of pure exaggeration. One may argue that some schools do in fact have a strong presence of social hierarchies and social ladders, but it must also be noted that this is not very different from how society is structured in a world outside of the school building. Status is not a foreign concept for our communities, and treating it as such in school doesn’t prepare students for what they will face long after graduating from their microcosms of the real world. However, it is possible to attract attention towards eliminating the toxic potentials of social hierarchies while still encouraging the social groups. 

Social circles have existed in schools for generations, and although the way they’re structured has varied through generations, their general formulas remain fairly consistent. Cliques are nothing new, as shown by Jerry Adler, a former senior editor of Newsweek who has written for magazines such as The New Yorker, The Smithsonian, and Scientific American. In a 1999 Newsweek article, he explains that these groups include “athletes and preppies and wanna-be gangsters; pot-smoking skaters and sullen punks; gays and nerds and, yes, morbid, chalk-faced Goths,” and remain “surprisingly similar from coast to coast” (Adler). This consistency further supports the idea that these social structures are not only normal, but even instinctive, especially for adolescents. Shayla Ahamed, a blogger from Penn State University, writes that most people are simply “inclined to become friends with people that are similar to them and share their interests,” claiming that while negative side effects seem to be the focus in the media, forming groups are for the students’ own benefit (Ahamed). Additionally, Daniel A. McFarland, a sociology professor at Stanford University, uses his 2014 study for the American Sociological Review to discuss details of social structures, calling them “supportive and protective” and claiming that this is what leads students to tend to create them more often than not (McFarland). Perhaps the universality in these adolescents’ instincts to self-segregate is an important reason why we should nurture, rather than destroy, this phenomenon that we term “cliques.”  

Although Adler describes that in some places, these hierarchies demand a certain  evaluation of “status” be added to the existing situations, this is not always the case (Adler).  McFarland discusses how “adolescent societies” form when students begin to create groups “with individuals who share similar attributes, behaviors, or attitudes,” continuously  emphasizing the term “homophily” to describe how students constantly look for a sense of  “familiarity” (McFarland). As students begin the extremely trying time in their lives  corresponding to their high school years, their need for connecting to others like them increases immensely, highlighting the importance of having a strong social system to guide them  (McFarland). Although one may believe that social divisions can lead to insensitivity or other  undesirable side effects like bullying, the truth is that proper lessons in respect can, together with  these groups, be advantageous to the student body.  

These avoidable consequences of cliques encourage educators and administrators to overcompensate and actually cause more harm. This anti-clique mentality is inspiration for programs such as “Mix It Up at Lunch,” a social campaign started by the Southern Poverty Law Center’s Learning for Justice project. The “Mix It Up” program aims to encourage students to spend time at lunch with people who are not in their primary friend groups by eating with people outside of those social circles. Learning for Justice has also created multiple other activities to promote integration, including “Mix it Up Dialogue Groups” (“Mix it Up”). Another such example of programs created in an attempt to dismantle these social structures is Abigail N. Kirk’s teacher inquiry for Penn State University called “Kick the Cliques,” in which she promotes classroom activities to encourage girls to cooperate with each other while avoiding the creation of self-made groups (Kirk). These and other similar programs aim to teach students to adapt to other personalities and promote large group settings by straying away from creating smaller groups or self-segregating. While their intentions are pure, programs like these are usually a mix of ineffective and awkward for the students being forced into them, typically without having the choice to opt out. While one may argue that current discomfort will pay off later on, the chances of making most long-lasting friendships from continuously forced collaborations are slim. Furthermore, continuous efforts by the administration to intervene in students’ social decisions can be more harmful than beneficial. 

Rather than trying to eliminate these cliques, schools should embrace the idea of  encouraging kids to thrive within their own social circles. Physician Susan Biali Haas, M.D. argues in her 2013 Psychology Today article, “Stop Trying to Fit In, Aim to Belong Instead,” that people should stop “trying to be something [they’re] not in order to gain acceptance,” which is what integration promotes (Haas). This viewpoint emphasizes the idea that people should embrace their own characteristics and look for those with similarities in order to find their social circles rather than drastically changing their personalities to match those of a preexisting group. The alternative to having to change oneself for the benefit of fitting in would be to allow students to create groups that are naturally suited for their personality types and interests — in other words, allowing them to focus on belonging (Haas). The concept of belonging encourages self-acceptance and self-esteem, thereby providing students with more helpful guidelines for life and helping redirect the goals of administrators. For example, rather than focusing on rearranging students’ social groups, administrative intervention can include teaching students to avoid mean or hateful actions towards those who don’t necessarily fit into their own cliques. Furthermore, author Mark Rowh writes in an article for Current Health 2 that many students claim cliques can be “useful anchors in their social lives,” showing the true benefits they can have on the socioemotional health of students (Rowh). 

Being in small group settings can be psychologically beneficial, and studies of “social  psychology, for example, examine how emotion, cognition, and action are shaped by the social  environment” (McFarland). In an interview with psychologist Dr. Stacey Scott from Stony Brook  University, whose research specializes in emotions and stress in development throughout the lifespan, she described the importance of having “social support” throughout one’s life and  claims that adolescents require that strong support just like adults do (Scott). She explains further by saying that the social segregation that occurs during high school or one’s adolescence is representative of how “adults function in society,” even claiming that “adults aren’t necessarily  friends with everyone, so adolescents shouldn’t be expected to be either” (Scott). She also  suggested that other research has been conducted in the past to explain the normalcy of students  to “view their peers as being nominated under certain groups” and that this is not something we necessarily need to eliminate (Scott). It also encourages students to join small yet fundamental clubs and sports. These clubs and sports follow the same general guidelines that most cliques do — the only difference between most of these clubs and allowing students to create their own social circles is the absence of administrative involvement.  Furthermore, cliques and social groups help students develop and thrive within a self-made “niche in some section of [their] society,” as examined by psychologist Jeffrey Jensen Arnett from the University of Maryland College Park in a 2000 article for the American Psychologist (Arnett). 

The fate is much worse for students who don’t belong to a clique at all. While students  may think that most of the so-called “shunning” comes from social classes of higher status  towards those of lower status, the ones who don’t belong to a specific group often get the worst  of the blow. Chris MacLeod, a registered social worker who founded the website Succeed Socially, claims that failing to socially integrate can lead to “slip[ping] through the cracks” of the community (MacLeod). This feeling of not being “right” for a certain group can lead to feelings of loneliness and exclusion. Although it’s true that those who don’t necessarily conform to a certain group may choose to be that way, either because they  “don’t have enough” of whatever that particular group demands of them or simply because they believe those groups are either “on a pedestal” or “below them,” MacLeod suggests that eliminating these mindsets and embracing the idea of joining a group would prove to be beneficial to one’s social state (MacLeod). MacLeod supports the idea that joining such groups even when apprehensive could help improve one’s social skills such as “making conversation, feeling more comfortable around others, [and] being able to open up to people” (MacLeod). Daniel A. McFarland further discusses the importance of this “peer network” in his research by stating that “cliquing increases” during adolescence because of the “attachment shift from parents and family to peers” (McFarland). Allowing these close-knit relationships to form between students would be a better alternative for educators instead of trying to break these social structures down. This, in turn, will eliminate many of the problems associated with adolescent loneliness, as described by researcher Ahmet Gurses in his 2011 article for Procedia Social and Behavioral Sciences as he attempts to connect the problems of loneliness in high school to “academic  unsuccessfulness” (Gurses). Students without groups at all can find themselves falling into a spiral of adolescent loneliness and social awkwardness, as described by MacLeod. The simple alternative is to embrace the benefits cliques can have on the student population (MacLeod).  

Although the use of the words “clique” and “social circle” have negative connotations, it  should be noted that the majority of these assumptions about the implications of creating social  structures come from personal experience. Most phenomena in society have the potential for negative side effects, but it is wiser to eliminate the side effects rather than their causes. Allowing social structures to flourish in a high school setting can actually be beneficial to the students both socially and psychologically. Rather than implementing programs to negate and eliminate the instinct of high schoolers to self-segregate, schools and educators should work to promote healthy segregation. This would encourage students to embrace their differences and connect with others by developing their similarities. Therefore, programs originally intended to eliminate the prospect of social groups should be redirected in order to fuel the creation of healthy divisions among students while promoting sympathy and amiability between these divided groups. The main focus of administrators and  educators should be shifted from reworking preexisting divisions that students make instinctively to teaching students how these divisions can help them flourish as they enter adulthood and the outside society.


Works Cited

Adler, Jerry. “The Truth about High School.” Newsweek, 10 May 1999, www.newsweek.com/truth-about-high-school-166686. 

Ahamed, Shayla. “The Science of Cliques.” SiOWfa15: Science in Our World: Certainty and  Controversy, Penn State University , 8 Sept. 2015, sites.psu.edu/siowfa15/2015/09/08/the-science-of-cliques/. 

Arnett, Jeffrey Jensen. “Emerging Adulthood: a Theory of Development from the Late Teens  through the Twenties.” American Psychologist, vol. 55, no. 5, 2000, pp. 469–480. 

Gurses, Ahmet. “Psychology of Loneliness of High School Students.” Procedia Social and  Behavioral Sciences, vol. 15, 2011, pp. 2578–2581. 

Haas, Susan Biali. “Stop Trying to Fit In, Aim to Belong Instead.” Psychology Today, 17 Oct. 2013, http://www.psychologytoday.com/us/blog/prescriptions-life/201310/stop-trying-fit in-aim-belong-instead.

Kirk, Abigail N. “Kick the Cliques: Activities to Promote Positive Relationships among Girls in the Classroom.” Penn State U, 26 Apr. 2006. Penn State University, www.yumpu.com/en/document/read/51491966/kick-the-cliques-activities-to-promote-positive-relationships-among-. Manuscript. 

MacLeod, Chris. “When You Feel like You Don’t Fully Fit into Any Social Group.” Succeed  Socially, http://www.succeedsocially.com/dontfitintoanygroup. Accessed 20 November 2019.

McFarland, Daniel A. “Network Ecology and Adolescent Social Structure.” American  Sociological Review, vol. 79, no. 6, 2014, pp. 1088–1121. 

“Mean Girls.” IMDb, http://www.imdb.com/title/tt0377092/. Accessed 20 November 2019. 

“Mix it Up.” Learning for Justice, http://www.learningforjustice.org/mix-it-up. Accessed 5 May 2021. 

Rowh, Mark. “The In-Crowd: the Not so Shocking Truth about Cliques.” Current Health 2, a Weekly Reader Publication, vol. 34, no. 2, pp. 11+.

Scott, Stacey B. Personal interview. Oct. 2019.