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Monday, February 26, 2024

It’s Easy to Blame Mental Health Issues on Tech. But Is It Fair?

Mr. H, the first documented hikikomori in the United States, was 30 years old when he arrived at the psychiatric clinic at the University of California, San Francisco. Slender, with long fingernails, he wore a black leather jacket with metal studs and tied his shoulder-length hair in a neat ponytail.

“His demeanor was surprisingly natural,” said Alan Teo, the psychiatrist who met Mr. H that day. Mr. H was calm. He seemed comfortable. That was notable for anyone who had to trek through the odyssey of social encounters separating the East Bay from the heart of San Francisco. But it was especially impressive for a man who hadn’t left his house in three years.

To be fair, this period was far from the worst of Mr. H’s isolation. “During the first and most severe year,” wrote Teo in a medical journal in 2010, “he remained within a walk-in closet, ate only ready-to-eat food, did not bathe, and urinated and defecated in jars and bottles.” A housemate supplied the food.

The concept of hikikomori, a Japanese word roughly translating to “social withdrawal,” was popularized in the late 1990s to refer to the hermits of the Information Age: the jobless, school-less adults who stayed in their homes for months and often years. Mostly young males living with their parents, hikikomori number in the hundreds of thousands in Japan. Some have spent more than 20 years in isolation.

“We really have no idea about the number of hikikomori in the United States,” said Teo. But enough people reach out to him for help that he knows “there are folks suffering in the shadows.”

Mr. H passed his time in virtual worlds. He watched anime. He played video games. He roved through the depths of the internet voraciously devouring information, including medical articles on hikikomori, which is how he found Teo. His case wasn’t exceptional. When Teo and his colleagues surveyed 487 Japanese students in 2019, they found a strong correlation between excessive internet use and the risk of becoming hikikomori. Researchers working in Poland, Hong Kong, Korea, and Canada have likewise reported a connection between the black-hole allure of techno-realms and crippling social isolation.

The growing awareness of hikikomori echoes a broader popular narrative: Modernity is making us depressed. Consumed by screens more than people, we eat alone, live on our couches, and prefer zombifying entertainment to nighttime conversation. Some writers, like Harvard evolutionary biologist Daniel Lieberman, point to the inactivity brought about by technological innovations. “Are we vulnerable [to anxiety and depression disorders],” he asked in his 2021 book, Exercised, “because we now face environmental factors, requiring less physical activity, that we never evolved to handle?”

For others, the problem is loneliness. For decades, the story goes, new technologies have been supplanting human contact, trading glittery highs for long-term isolation. The internet promised reconnection but, according to some commentators, only made things worse. It offered people “a kind of parody of what they were losing,” wrote New York Times bestselling author Johan Hari in his 2018 book Lost Connections, “Facebook friends in place of neighbors, video games in place of meaningful work, status updates in place of status in the world.”

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Like the internet itself, these stories are attractive. They paint an alarming picture—depression and anxiety are spiking—and blame it on the splashiest changes rippling through society. But as the internet teaches us, what’s attractive is not always true.

In the Bolivian lowlands, where the Andean foothills meet the Amazonian rainforest, a tangle of rivers and logging roads cuts through the tropical forest and savannah. This is Tsimane territory. A land of monstrous fish and anteaters, tapirs and chatty primates, bullet ants and anacondas, these forests have been home to the Tsimane people for as long as anyone can remember. Reaching some Tsimane villages takes at least three days from the regional airport hub, Santa Cruz, comprising a flight to the edge of the Amazon, a truck ride to a river port, and a two-day trek with a dugout canoe.

The Tsimane are tropical gardeners. Numbering some 16,000 people across more than 90 villages, they grow maize, rice, manioc, and plantains, supplementing their diet with fish, game, fruits, nuts, and honey. A small portion of their diet, roughly 10 percent, comes from trade. Ten years ago, no village had power-line electricity, and today only a small minority are connected to the grid. Very few communities have televisions or other electrical appliances, and “even then,” said Jonathan Stieglitz, an anthropologist at the Institute for Advanced Study in Toulouse, “it will be shared by 5 or 10 different houses.” He speculates that fewer than 100 Tsimane (about half of 1 percent) have smartphones.

Despite the remoteness of their territory, the Tsimane are world-famous, at least among scientists. In 2002, anthropologists at the University of New Mexico and the University of California, Santa Barbara started the Tsimane Health and Life History Project, which combines anthropological and biomedical research with medical care and other humanitarian aid. (Stieglitz is a codirector.) Since then, over 140 academic papers using project data have been published, on topics as diverse as personality, spousal abuse, and blood lipid levels. If you ever saw a news story about research on remote Amazonians, you were likely reading about the Tsimane.

The Tsimane attract attention because they teach us about the past. They are not static relics, of course. Like people everywhere, they are adapting to a shifting world, with many embracing shotguns, Spanish, and wage labor. Yet their lives still share many characteristics with those of our pre-modern ancestors. The Tsimane share food. Communities are small. Most interactions are face-to-face, and nearly everyone is surrounded by family. They consume a high-fiber diet, and the average adult walks at least 15,000 steps a day. Because of their traditional lifestyle, the Tsimane help scientists map out how modernity impacts minds and bodies.

The findings so far have been staggering. The Tsimane endure constant assaults from pathogens—the typical person has gastrointestinal parasites and lungs scarred by tuberculosis—but are free from many of the chronic and degenerative diseases that plague rich Westerners. They have the “lowest reported levels of coronary artery disease of any population recorded to date.” (An 80-year-old Tsimane has the heart of an American in their 50s.) Compared to people in industrialized societies, their brains atrophy much less with age. They have hardly any fatty liver disease, and men’s prostrates grow more slowly than in the United States. But despite being both active and hyper-communal, they are just as susceptible to depression as sedentary, isolated Americans.

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The Tsimane clearly suffer from persistent sadness and loss of interest. They have a word for a depression-like state, yoquedye’, which they attribute to “thinking too much” about illness, poverty, or the death of a loved one. Serious bouts of yoquedye’ can end in suicide.

Despite the similar language, comparing depression between the Tsimane and industrialized societies is tricky. The research team drew on scales used widely by Western clinicians, but the differences between the Tsimane and Western societies forced them to tailor the questionnaire to the local context. In a final interview, researchers asked Tsimane participants to report, on a scale of 1 to 4, how often they experienced 18 depressive symptoms, from crying easily to thinking about self-harm. Roughly 10% of the participants reported a mean score of 3 for each symptom, meaning that, on average, they suffered from all of the symptoms “often” or “always.” This is about twice the percentage of Americans who reported regular feelings of depression in 2019.

Why are the Tsimane—so active, communal, and free from technology—depressed? When researchers asked this question, they found that two of the strongest predictors of depressive symptoms were physical injury and social conflict. This makes sense. The Tsimane’s bodies are active but stressed. A physical injury can torpedo a person’s productivity, making them feel useless. Meanwhile, the importance of social bonds means that unresolved conflict can eat away at a person. Quarrel with a friend, and you risk losing a lifeline. Overstep an egalitarian norm, and you invite endless gossip.

The findings overturn the popular narrative. High physical activity and interdependence, the very virtues supposed to ensure positive well-being, make the Tsimane susceptible, not immune, to depression. The mantra that technology worsens depression through sedentism and isolation is only part of the story. New technologies may turn us into homebound loners, but by lessening our reliance on bodies and social bonds, they also help buffer us from nature and social drama—vagaries that have likely caused distress since the origin of our species.

Other research echoes the Tsimane work. In the late 1980s, anthropologists studied subjective well-being among hunter-gatherers and pastoralists living in Botswana. The researchers designed surveys similar to ones conducted in Ireland, Hong Kong, and the United States, and found dramatic differences. The two traditional-living peoples had, respectively, the lowest and third-lowest well-being scores of seven communities surveyed. Roughly 20 percent of hunter-gatherers and pastoralists selected the lowest possible well-being score, compared to 1 percent of Irish people, 0.5 percent of Americans, and 2 percent of Hong Kongers.

As with the Tsimane, a big determinate of a person’s well-being was their physical condition, but health mattered much more for traditional-living peoples than for people in industrialized societies. If a pastoralist went from poor or fair health to excellent health, their well-being rose on average by 68 percent. For Irish people, Americans, and Hong Kongers, in contrast, the boost in health status was associated with a 12 to 18 percent difference in well-being. For people who rely on intense physical activity to meet their needs, illness and injury are psychologically crippling.

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Anthropological research like this challenges simple stories about modern technologies making us anxious and depressed. Yet it can only tell us so much. Lifestyles in industrialized societies are worlds apart from the Tsimane’s. Even if you abandon the fantasy of a pre-technology paradise, you might still insist that smart phones and social media are pulling us to a psychological breaking point. But even that yarn starts to unravel once we tug at it.

It isn’t hard to find high-profile studies linking new technology to mental health issues. A research article published in 2018, for instance, analyzed data covering 500,000 US teens and found an association between digital technology use and depressive symptoms and suicidality. The paper has been downloaded 170,000 times, covered by over 250 news outlets, and cited in more than 900 other research publications. It is one of many.

Amy Orben, a psychologist at the University of Cambridge, saw a concerning pattern in these studies. “The mental health measures used were quite haphazard,” she said. Researchers made a slew of subjective decisions, from the mental health measures they analyzed to whether they included control variables. When, for instance, Orben and her collaborator Andrew Przybylski looked at one popular data set, the Millennium Cohort Study, they discovered over 600 million ways to analyze it, all of which were defensible. The data sets were “too big to fail,” she said: Researchers could design analyses (not necessarily intentionally) to produce any result they wanted.

So, using three large-scale data sets, Orben and Przybylski ran all possible analyses, or at least the 60,000 that aligned most with previous researchers’ approaches. Like researchers before them, they discovered a negative association between digital technology use and well-being. But it was tiny. Specifically, digital technology use explained 0.04% of the variation in adolescent well-being. “We found that wearing glasses has a more negative association with adolescent well-being than digital technology use does,” tweeted Orben.

The correlations reported by Orben and Przybylski hide deeper complexities. For one, everyone responds differently to digital technology. A study that tracked Dutch teenagers’ well-being and social media use found that 44% felt neither better nor worse after passively using social media, 46% felt better, and only 10% felt worse.

Just as important is how we use digital technology. “You can do so many things on social media,” said Philippe Verduyn, a psychologist at Maastricht University in the Netherlands. On average, all those things may have a trivial effect on well-being. “But what is much more interesting is to realize that some of those things might actually have very positive effects,” he said, “and some of those things might have very negative effects.”

Verduyn has devoted years to understanding these variable effects. In 2017, he and a team of psychologists reviewed evidence showing that the important distinction is between passive and active use. Passive use (think: scrolling) breeds envy and social comparison. Active use (think: messaging) establishes social connection. But in the years since, Verduyn has learned that even that distinction is overly simplistic. Just this year, he and his colleagues published an updated model, recognizing that active use can have negative effects (no one responds to your post) and that passive use can feel positive (you see that other people feel insecure, too).

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Alan Teo and his colleagues have seen this variability studying hikikomori. In 2016, the augmented reality mobile game Pokémon GO inspired long-time hermits to leave their homes in search of collectible monsters called Pokémon. Excited by what they were seeing, Teo and other researchers wrote to the journal Psychiatry Research suggesting that PokéStops—physical locations with in-game characters—be set up at hikikomori support centers. The former Japanese prime minister Taro Aso even celebrated the game’s therapeutic effects, proclaiming that “overseas reports show that people whose social withdrawal had been unable to be cured by psychiatrists started to leave the house to play with Pokémon GO.”

Hikikomori hunting for Pokémon, depression among the Tsimane, social media’s medley of effects—these stories all urge a dynamic view of technology—something akin to the Force from Star Wars or the Polynesian concept of mana, a powerful potential that is intrinsically neither good nor bad.

The impulse to blame anxiety and depression on technology isn’t surprising. It taps into familiar fables of an Edenic past. And it blames modern problems on the exciting, eye-catching, sometimes scary innovations that regularly reconfigure society. But if our goal is to create a happier, healthier society, we benefit not from waving the banner of a fetishized past but from embracing technology and harnessing its therapeutic powers.


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