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Media Column | September 01, 2002

The Media: Relationships to Psychiatry and Children: A Seminar

Kristopher Kaliebe, M.D.; Adrian Sondheimer, M.D.

Academic Psychiatry 2002;26:205-215. 10.1176/appi.ap.26.3.205

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MediaChild and Adolescent Psychiatry Training

Dr. Kaliebe is a first-year resident in child and adolescent psychiatry at Louisiana State University School of Medicine, New Orleans, LA. Dr. Sondheimer is Associate Professor of Psychiatry and Training Director of Child and Adolescent Psychiatry, and Dr. Kaliebe was previously a third-year general psychiatry resident, at the University of Medicine and Dentistry of New Jersey—New Jersey Medical School. Address correspondence to Dr. Kaliebe, Division of Infant, Child and Adolescent Psychiatry, 1542 Tulane Avenue, New Orleans, LA 70112.

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Abstract

Media technologies and content exert powerful effects on individuals and society. The authors describe a multilecture seminar, intended for general and child and adolescent psychiatry residents, that focuses on media impacts on society. The presentations are intended to prompt critical thinking regarding the opportunities and risks that media forms and content present for children and adolescents. The potential uses of media in psychiatric education and clinical work are discussed in this context.

Figures in this Article

The recent explosion of novel communication methods demonstrates an imperative to use new technologies to connect, educate, and entertain. Communication has always been essential to human survival. Since the development of speech and human gestures, but particularly in the recent decades since McLuhan announced "The Medium is the Massage" (1), technological advances have been feverishly directed at augmenting our abilities to communicate. All would agree that the media have powerful effects on both individuals and cultures, but much disagreement exists about the manifestations of the media's impacts and how medical professionals should examine and respond to the issues they raise.

Concerns relating to media exposure are most sensitive when children are involved. Young children lack the physical abilities, intellectual development, and financial independence necessary to determine their environments. Thus children are to a great degree prisoners of the active or passive choices adults make on their behalf. As children grow, develop their preferences, and indulge their capacities to make independent choices, their less than mature abilities to evaluate the risks and benefits of varieties of media exposure may leave them vulnerable to the impact of poor media choices. Moreover, because of children's developmental sensitivities, their exposures may have longer-lasting effects than would be expected with adults. Effects might include the development of tastes fostered by media, for better or for worse, with subsequent effects on social skills, academic achievement, and physical, emotional, and spiritual health.

COURSE DESCRIPTION

Given these concerns, the first author devised a multilecture seminar course to address these issues as part of the Culture and Psychiatry seminar series, offered within the general psychiatry residency training program at the UMDNJ—New Jersey Medical School. The course is designed to engender critical thinking about media and their effects on patients, mental health professionals, and children.

The course comprises four 90-minute seminar meetings organized by topic: an introduction and overview, a description of different forms of media, a discussion of the relationships between psychiatry and the media, and, finally, predictions concerning the future and a debate. Throughout the course, the impact of media on child development remains a central focus and concern. The material covered in the syllabus and a reference list of readings relevant to each seminar are made available to the residents prior to the meetings. The course material, outlined in Table 1, is described below.

MEETING I: INTRODUCTION AND OVERVIEW

In the first meeting the presenter introduces reasons for addressing the subject of media in the context of general and child and adolescent psychiatry education, outlines the subject matter, and distributes the syllabus and a list of relevant readings.

Definition of Media

The dictionary defines "media" as "a means of mass communication" (2). The expression "the media," however, is often employed colloquially to refer not to the technological means used but to the content and/or the individuals who produce the content. Thus it is important to distinguish between these two uses when engaged in discussion of "the media."

Mass media began with the printing press, and early interactive technologies included the telegraph and telephone. The most available current formats for dissemination of information are the packaged and released data contained in written text, radio, television, and movies. Recently, however, the use of the Internet and wireless technologies such as cellular phones and Web-enabled personal digital assistants has become widespread. It is an underlying thesis of the course that the expansion and implementation of different types of media-derived information transmission have driven far-reaching changes for both individuals and society, with particular implications for children and adolescents.

Media and Social Behavior

Media analysts have outlined profound effects of new means of communication on individual and group identities. This section explores a dialogue of relevant ideas. Examples of current thoughts regarding the media can easily be drawn from many of the "public intellectuals," so called by Posner (3), who have weighed in heavily on the alarmist side in America's culture wars. For example, Meyrowitz (4) contends that continued expansion of easily accessible information will provide common knowledge bases and expand social linkages, causing shifts in existing social structures. Posited consequences would include the empowerment of individuals to gain access to information independently, thus reducing the strengths of existing hierarchies that are predicated on exclusive access to information. Concerns are expressed that interpersonal disconnectedness may develop as a result of this newfound independence and reliance on technology, at the expense of live human contact.

Other predictions that have been offered include the following. A dominating media culture will cause the family to become a more porous barrier between its children and the surrounding society. Diminished adherence to traditional customs will occur, and increased efforts will be needed to maintain distinct group identities and prevent cultural homogenization. Children will be exposed to more general or adult content, blurring the lines separating developmental stages. Meyrowitz describes a developing "pop culture" based on media images largely free of specific ethnic, religious, or social contexts. He further posits that these cultural changes are driven by developing technologies, and that these purported major evolutions in society and culture will emerge independent of the media's content.

Few observers would debate the powerful impact of advances in media technology. Many would argue that these changes are in fact useful and valuable to society because they encourage the recognition of similarities, in contrast to an emphasis on differences. The major questions thus center on the relative risks and benefits of exposure to the new media and, very importantly, how the media can best be used to foster children's development in positive ways.

Media and Children

Media modes today include both mature technologies that have melded into the everyday routines of most Americans, such as radio and television, and new and possibly better ways to connect and interact, such as pagers, cell phones, and the Internet. Because the human developmental process is greatly affected by interactions with the environment, children's habits, tastes, and knowledge are shaped in part through exposure to these devices. Technologies are implemented with the expectation that they will benefit the user, yet concerns are raised about children's potential misuse of the media (5), the media's possible effects on individual children, and the imputed impact of mass media on communities and families (6).

Pediatricians and child and adolescent psychiatrists are the medical professionals who have expressed their concerns most forcefully. Strasburger and Donnerstein (7), in a comprehensive review article focusing on children and the media, write that "television and other media represent one of the most important and underrecognized influences on children and adolescents' health and behavior." The Committee on Public Education of the American Academy of Pediatrics (8) has warned that media exposure may pose "a significant risk to the health of children and adolescents." In a 10-year update for the American Academy of Child and Adolescent Psychiatry, Villani (9) asserts the imperative need for clinicians to assess the role of media exposure when diagnosing and treating children's behavioral problems. Evidence is cited that correlates media exposure, when unregulated by adults, with multiple physical and emotional problems in children, including violence and aggression, risky sexual behaviors, alcohol and drug use, and reduced academic achievement (7—9).

Research concerning the television programs most watched by children indicates that parents frequently are unable or unwilling to limit their children to small amounts of recommended high-quality programming (7). The failure of "expert" warnings to resonate with the public, the overwhelming and pervasive impact of the media, and parental lack of time or energy to monitor their children's programming may account for these findings.

It is important to note that many parents, researchers, and mental health professionals disagree with the claims of negative impacts of media exposure on children. In addition, significant concerns are often voiced about First Amendment rights and the specter of potential censorship. Many people are opposed to restrictions on access to the media on principle (10), and others see no evidence that proposed restrictions would have a positive impact on the problems that media exposure allegedly engenders (11).

These issues are further complicated by rapid changes in technology and content, along with frequent societal changes that render suspect both general and definitive statements. Furthermore, findings derived from correlative research studies such as those cited above require interpretation. For example, does the dramatic rise in media exposure correlate with an increase in violence and/or with other factors that may better explain the aggressive behaviors? Does watching television cause depression, or do depressed children watch more television? How should the comparison of the United States to a society such as Japan's, which televises relatively violent media content but sustains low crime rates, be judged? A consensus suggests that further research is needed, emphasizing an attempt to determine which youths might be most at risk for the negative consequences of media exposure (11).

A Socially Toxic Environment?

Numerous writers have criticized the media for its purported negative impact on children. As professionals and advocates for children, psychiatrists must examine these ideas, appreciating those that are worthy while maintaining skeptical and scientific perspectives.

Garbarino (12), one such exponent, describes point-and-shoot video games and video portrayals of violent acts as "social poisons" to which parents are advised to limit their children's exposure. Others of like mind believe that media content undermines the national character and promotes sloth, hedonism, sexual misconduct, and commercialism (13).

Social conservatives such as Bork (14) take such views several steps further by favoring formal restrictions on media availability (that is, censorship), especially for children, which they contrast to prevention of political discourse or dissent. Bork justifies the former with the contention that "lowbrow media content" contributes to the development of a populace with "blunted mental faculties and coarse emotions" that could lead to a disorderly, hedonistic, and dangerous society.

Out of related concerns, the National Organization for Women created a "Love Your Body Day" in an attempt to counter media images perceived as "offensive, disrespectful, unhealthy, and dangerous" (15). Pipher (16) contends that the media have "sexualized and objectified women," thus eroding their self-esteem and contributing to gender stereotyping, sexism, and violence against women.

Kirkpatrick (17) contends that American society's cultural values have been altered by television content. He asserts that children's values are distorted by a media culture that rarely mentions religion, devalues family bonds, and does not reinforce the values of justice, compassion, and community. Political leaders, jumping on the bandwagon, have attempted to use these arguments to change the media environment and its content (18).

Paglia (19), by contrast, celebrates current culture, including rock music and modern cinema, as an eruption of latent paganism which formerly "lay repressed by the rigid, narrow, and puritanical WASP hegemony of the 1950s." She is a spokesperson for those who embrace the move from a typographic to a video-centered culture, and she argues forcefully that media selection is a citizen's free choice in a representative democracy.

The struggle to maintain such freedom of expression, fight censorship, and preserve individual rights is fought daily by organizations such as the American Civil Liberties Union. General and child and adolescent psychiatrists are not immune to society's political and philosophical pressures, and they need to pay attention to these competing perspectives as they maintain their roles as child advocates.

MEETING II: FORMS OF MEDIA

Numerous media forms are available to today's consumers, some representing older and others more recent technologies. Meeting II focuses on the most commonly available media forms, outlines the ways they are used, and emphasizes their interface with children.

Print

The creation of the printing press sparked revolutionary change six centuries ago by setting the stage for the spread of literacy to include ever-increasing numbers of people. Subsequent printed matter has included newspapers, popular and technical books, political tracts, advertisements, cartoons, and comics. The relatively recent emergence of competing forms of information transmission, however, may diminish the power of the written word and consequently affect societal behavior.

Putnam (6) contends that newspaper readers vote, volunteer, visit friends, and participate in civic organizations more often than nonreaders. Postman (20) believes that, in a culture dominated by print, public discourse tends to be characterized by a coherent and orderly arrangement of facts and ideas. Mental health professionals have suggested that learning to read and the exercise of the "literary mind" enhance self-discipline by repeated exercise of these skills (21). Similarly, educators are concerned that in the face of newer media forms, a reduced emphasis on understanding the written word in favor of video images could negatively affect academic achievement and intellectual development (22). On the other hand, literacy is not a prerequisite to the visual incorporation of information, and wider exposure to television and films increases the spread of knowledge to progressively larger populations. Although reduced literacy among today's children has not been found, concerns remain that children's progressively greater involvement with video transmission of information may negatively affect reading behaviors.

By contrast, advances in word processing have made inexpensive, high-quality publishing tools available to today's children. Computing and printing technologies encourage children's creative expression and improve the quality of their output. Projects ranging from individual reports to school newspapers are now easily laid out on computers with myriad editing features. As never before, children's creative expressions are facilitated by these new technologies.

Radio

Though an older technology, radio remains a widely used media format. Because radio is portable and can be listened to while performing other tasks, children and adolescents have significant exposure to radio broadcasts. Station programming typically includes recorded music, news, and advertisements. Extended "talk" programming offers differing perspectives and opinions in a format that frequently allows for a healthy discussion of issues. All-news and all-sports stations provide rapidly updated and expanded coverage of these topics. Children and adolescents listen to these stations, although they tune in predominantly to popular music programming. Children are also exposed to advertising and its influence in all of these formats, although the use of recently implemented satellite radio, which allows for an array of commercial-free programming, may diminish this exposure (23).

Television and Movies

Popular films emerged in 1896, the "talkies" in 1927, and television in 1946. Ninety-nine percent of U.S. households have at least one television (24). The earlier Golden Age of Television, having been shaped, in part, by inhibiting governmental pressures, yielded in the late 1960s to the portrayals and programming current now.

Perhaps more important than government influence have been corporate and business trends, which have always powerfully affected programming. Three major networks controlled television content in the United States until the emergence of cable television in the 1980s, after which the networks' "least objectionable material" standard became no longer economically feasible. Currently a majority of Americans have cable or satellite TV, which has brought both a much greater quantity of television programming and the targeting of more specialized demographic units. These changes have resulted in increased airing of educational and cultural programming, as for example on the History and Discovery channels, some of which is geared toward children and adolescents.

The programs most watched by children, however, typically stress entertainment over education. The average American child watches 21 hours of television weekly (24). Many of the shows marketed for children, or made for adults and watched by children, raise additional concerns. Technologies such as the V-chip are available to block channels, but it is unclear how often or how effectively they are used by guardians.

Concerns have been expressed about the sexual content of television programs and movies, including those targeting adolescents. Rarely are negative consequences shown, such as sexually transmitted diseases, fatherless families, and single mothers living in poverty (25). How viewing these images may affect children's developing views of sex and sexuality, gender roles, partners, families, and relationships are among the questions raised.

The potential negative effects of viewing violence and aggression on TV is another serious concern (26). The American Academy of Pediatrics review on media violence (8) characterizes the evidence as strongly associating media violence with increased aggression, through the learning of aggressive behaviors and attitudes, desensitization, and fears of victimization. Critiques of content include reference to the frequent display of graphic violence with only rarer glimpses of consequences such as incarceration, chronic injuries, or the impact on victims' families. The National Television Violence Study (27) estimates that young people view 10,000 violent acts per year. Although case studies describe individual children negatively affected by television content (28), it is noteworthy that most children process these images without developing problem behaviors related to violence or aggression. Ideally, research would focus on determining which children might be at higher risk for negative impacts.

Possibly less examined is the effect of television advertising on children. Substantial research has investigated the influence of tobacco and alcohol advertising on children, despite their purported direction at adults (29). Children may feel pressured to define themselves, in part, with the use of these products. Moreover, to augment traditional commercials, advertisers have moved toward "stealth" advertising, a paid arrangement of product placement in television programming and movie stories without explicit depiction of the corporate relationships. It is unlikely that the developmentally immature viewer can discern that these are placements of corporate messages unrelated to the televised story.

Fictional stories provide children with information about the world, but children also view television news reporting of current events and commentary about them. News programming is typically geared toward adults, but child viewers may be more susceptible than their elders to the effects of repeated viewing of frightening images, such as those seen on September 11th (30,31). The phenomenon of replicating acts seen on the news is an additional concern. Psychiatrists therefore have developed guidelines for the responsible reporting of suicides, with the goal of limiting contagion effects (32).

Because both children and adults receive a substantial amount of information through television news, psychiatrists have suggested that the profession take a more proactive stance by participating in media coverage of issues that have an impact on mental health. Formal training in interactions with the media has been implemented as part of some training programs (33).

Music

Music, a powerful personal and societal force, can provide emotional and physical outlets, can play a part in religious, ritual, and cultural expression, and can be used to express emotions. Examples include church spirituals, battle hymns, and love songs. Given technological advances, live performance is no longer the primary means to experience music. Rather, electronic storage and dissemination allows music to be delivered to pedestrians, in cars, on home systems, and in public spaces. The average teenager is estimated to listen to 10,500 hours of rock music between the 7th and 12th grades (34).

Musical preferences are opportunities for children and adolescents to express their identities via identification with artists, congregation with peers at concerts, festivals, or parties, and support of the styles, attitudes, and themes reflected by their music of choice. These choices and the volume at which the music is played frequently conflict with adult preferences and styles. Adults therefore have been expressing their doubts about younger people's music for a very long time.

Plato, for example, believed that the individual raised on noble and graceful music might more easily develop "a harmonious soul" (35). He favored outlawing subversive music in his ideal world. Today, Bloom (36) suggests that rock music undermines discipline, moderation, and other civic virtues. Researchers during the past decade have attempted to show correlations between music choice and risk-taking behaviors (37) and between music choice and suicide (38). These findings have led to recommendations that child psychiatrists and pediatricians incorporate the taking of "media histories" in the course of routine pediatric evaluations (39).

This debate over musical preferences clearly illustrates the perennial tensions between adult inclinations and the behaviors, attitudes, and tastes of the young. More than two millennia ago, Socrates commented: "Our adolescents … love luxury … have bad manners and contempt for authority … show disrespect for adults … contradict their parents … [and] tyrannize their teachers" (40). Indications are that these adult complaints and worries have never changed, yet society's standards constantly do. Elvis Presley's music, a case in point, caused outrage for the culture mavens of fifty years ago, but today his performances would compare with the mildest of popular artists. It is true that children often choose music clearly at odds with adult society and its values. But while lyrics may make references to drug use, violence, and sex, interpretations of these phenomena should include the view that this music asserts a healthy independence and search for identity, even while others view it as a corrupting influence that may galvanize and harm disaffected youth (41).

Video Games

Hand-held, table, computer, or television-monitor video games represent a seven billion dollar industry (7). They have largely replaced the board games and marbles of prior generations. These games provide benefits in that they promote manual dexterity and facility with electronic equipment. Although a minority of games do have educational and thought-stimulating features, video games overall are considered by some to be shallow diversions with no prosocial teaching messages that reduce time for exposure to nature, exercise, education, and human interaction (42). Alarming to many are graphic and realistic games such as Doom, Mortal Kombat, and Quake, which show blood and body parts flying in profusion, and Grand Theft Auto III, in which participants carry out missions for organized crime, kill police, engage in sex for hire, and beat pedestrians with baseball bats (43).

The exposure of children to such graphic videos, as was true of the Columbine killers who imitated their favorite violent video games (44), could lead to desensitization to the importance of human life and the consequences of aggressive behaviors. Similar desensitization is exploited, for example, in the instruction of older adolescents who, as military trainees, must learn to kill. During training, their schooling is accomplished by shooting at human figures, not bull's-eyes. Playing violent video games at young ages could engender similar indifference because immature children may not be as sensitive to these ultimate implications and effects as mature adults.

Internet

The Internet is a massive interconnection that enables electronic devices, wherever connected, to send and retrieve information. It is also a huge information-retrieval resource, akin to an encyclopedia but vastly multiplied. School children will often use the World Wide Web, for example, to research material for their studies (45). The Internet also allows for transmission of e-mail, the newest form of text communication, to people anywhere on earth who possess the necessary technology to receive it. Related portable connected devices such as personal digital assistants and cell phones with Internet access, as well as streaming broadband (video and audio), can also be implemented as communication vehicles between families, schools, and businesses. Contradictory predictions about the societal impact of these new communication modes include both improved maintenance of established social bonds and less successful creation of significant new ones (6).

What are the implications for children? Clearly, youngsters are fully engaged in the electronic revolution. They enter online chat rooms that allow for anonymous exchanges of ideas and feelings. They also review and download information important to their schooling and access other websites for pleasure. In addition to their peers, however, others with less friendly motives have also adapted to the medium. Psychiatrists have raised concerns regarding children who might possibly be damaged by exposure to inappropriate material or, less often, lured and potentially abused by sexual predators (46). Children and adolescents, in the process of maturation and naïve to adult experience, are legally protected against entering into contracts. However, they need to be warned about divulging personal information to strangers and following up anonymous exchanges with face-to-face meetings, and possibly cautioned about accessing material unsuitable for their age.

MEETING III: MEDIA AND PSYCHIATRY

The media and psychiatrists interface in several ways. The first is that psychiatrists, as members of the body politic, are as much subject to the influences of the media as the general public. Another is that psychiatrists are often depicted as characters in TV and film productions. A third connection is that psychiatric educators need to understand how to use media as aids to education. And still another is that new information technologies and communication tools can assist both the therapeutic process and interprofessional exchange. Meeting III reviews all of these elements.

Media Portrayals of Psychiatryand Mental Health

Many positive and negative portrayals of psychiatrists, psychiatric practice, and mental illness in commercial films have been described (47—49). Examples of current popular representations include the TV shows Frasier and The Sopranos and the recently released films A Beautiful Mind, Analyze This, and Girl, Interrupted. While many of the representations and story situations are distorted, exaggerated, or farfetched, other productions deal sensitively with psychiatric practice and mental health issues. Unfortunately for a profession that desires to combat "stigma," productions of the latter type are in the minority (50). More typically, children and adults engage in many hours of TV viewing with little exposure to characters with mental illness, and characters that do appear are often portrayed as frightening or dangerous to others. The resulting implicit message might be that the mentally ill are either dangerous or nonexistent. When mental illness is reflected in popular programming, however, it can have a liberating effect. For example, the accurate portrayal of an autistic character in the Brazilian soap opera Pedra Sobre Pedra led to greater societal acceptance and knowledge of that disorder in Brazilian society (C. Gauderer, personal communication, 2002).

Uses of Media in Psychiatry Training

Training programs can use media to teach psychological theory (51), psychopathology (52,53), psychotherapy techniques (54), psychosocial formulations (55), and discussions of personal and character development (56). Commercial film portrayals that illustrate these factors in children and families have received specific attention (57). The advantages of video include the use of brief clips to highlight teaching points that can later be addressed in greater depth. Superior examples of therapeutic techniques, model interviews, and depictions of clinical dilemmas can be saved and used repeatedly (58). Information derived from the Internet can add interactive and portable components to teaching presentations. One can imagine that the lecture series of the future might consist primarily of downloaded material (59).

Standardized assessments using videotapes of patient interviews remove the element of chance differences among patients, contributing to more uniform evaluations of residents (60). Furthermore, computerized testing can provide immediate feedback and analysis regarding a resident's strengths and weaknesses.

Therapeutic Uses of Media

New technologies hold promise for improved patient care. Technologies such as streaming video and e-mail allow doctors to communicate more easily with patients and their families. Educational materials can now be downloaded from the Internet or delivered on CD-ROM, thus providing simultaneous text and video in an interactive format more digestible than pamphlets or videotapes (61). Videoconferenced consultations and psychotherapy can be provided successfully via linkages of psychiatrists to schools and other practitioner locations (62). Consequently, some psychiatry residency training programs have incorporated seminars concerning telepsychiatry into their curricula (63).

Although some adults are uncomfortable with the adoption of new technologies, children, growing up in an e-world, are more likely to embrace these changes. Therefore, the future is likely to see more communications between children, parents, and their psychiatrists via websites and e-mail messaging, with links to teachers and schools. Furthermore, Internet augmentation of psychotherapies, currently explored with adults, may also work for children and adolescents (64). In addition, these new technologies have helped seriously ill children cope with hospitalization by creating virtual therapeutic communities that permit children to interact through text, voice, and video conferencing (65).

Exposure therapies have also taken a leap forward with the use of virtual reality machines. Phobias and impairing anxieties may be addressed relatively safely and easily because the experience of flying, giving speeches, attending school, or performing in a public setting can be addressed in a more real-seeming environment than the traditional psychiatric office setting (66). Virtual reality research affecting children has been published concerning treatments for attention-deficit/hyperactivity disorder (67), autism (68), and anorexia (69).

New Technologies and Information Retrieval

Computerized medical charts are legible, clear, well organized, and potentially available at the touch of a button. Their use enhances continuity of care, organization of information, and speed of access (70). Psychiatrists caring for children might eventually be able to access school, agency, and court data quickly and easily in order to facilitate treatment. Personal digital assistants (PDAs) enable portable recordkeeping, and improved wireless technology may soon be available to allow PDAs entry to huge databases of clinically related information (71). Researchers are attempting to evaluate both the validity of data gathered via the Internet (as in a recent study of Web-gathered data on adolescent self-reports of risky behaviors [72]) and the methodology's cost-effectiveness (73). Already, psychiatric research efforts focused on disease expression and treatment approaches have been greatly enhanced by the combination of computerized charting, accessible spread sheets, and the ability to compile data in different combinations and from different geographic locations. Caveats have been expressed, however, that Internet data-gathering may lead to less rigorous inclusion and exclusion standards, and that information retrieved from the Internet may tend toward the most easily available rather than that derived from the highest-quality sources (74).

MEETING IV: THE FUTURE?/?DEBATE

Having reviewed media and their effects on the human environment as well as the common forms of media and various relationships between media and psychiatry, the last seminar meeting focuses on speculations about even newer technologies and their potential interface with psychiatric practice. In addition, the residents, now having the necessary knowledge on which to base opinions, are urged to enter debate over the difficult issues of children's exposure to media forms and their content, and the adult concerns they stimulate.

Future Technologies

It is useful to consider what may lie ahead for electronic media. Current trends indicate not only ever-increasing adoption of Internet technologies, but also of more powerful broadband connections. As capacity increases, larger quantities of data will be quickly sent and received. As these modes of content distribution expand, small groups and individuals will be further empowered to make their materials available to potentially larger numbers of consumers.

New communication technologies will similarly change the way individuals connect and interact. Industry leaders speculate that memory capacities and portability will vastly increase and new technologies will better complement our senses, examples being voice recognition and optical scanning (75). These new technologies will merge into daily routines and lifestyles, and interactive technologies might also enable children to more easily learn desirable behaviors and skills. Furthermore, existing technologies such as pagers, PDAs, and cell phones will continue to gain in ease of use, spurring constantly increasing adoption by progressively greater numbers of younger people.

Resident Debate

As new media technologies emerge, so do the possibilities, the questions, and the problems. Given novel media forms, the thrust of free markets, and desires for freedom of expression, the media choices available to children are likely to increase over time. Thus it will remain to parents and caregivers to undertake the protection of children from the effects of poor media choices. How to do so, while attempting simultaneously to avoid overprotection and censorship, is a complicated dilemma. During this meeting residents are expected to use the knowledge derived earlier to engage each other in discussion as they strive to develop their positions on this issue.

CONCLUSION

Child advocacy goals regarding the media could focus on the integration of media education into children's traditional education programs, augmented by public health initiatives regarding media choices. Psychiatrists, following similar efforts by the American Academy of Pediatrics (39), should contribute by educating parents and children about healthy uses of the media. Political advocacy could focus on the attempt to engage media industries in the development of sensible ratings and assessments of the benefits and risks of developing technologies.

Innovative technologies and evolving patterns of utilization will continue to spur changes for both society and individuals. Change, however, is often met with resistance due to fears of the unknown and the potential disruptions posed to established patterns of thoughts and behaviors. Some of the essayists cited earlier (10,14,16,19), who either strongly protest against or warmly embrace these changes, usefully serve society as lightning rods. However, they stake out provocative positions that produce acclaim from their supporters and opprobrium from their antagonists, with little room for modulated responses. By contrast, it is incumbent on us as general and child and adolescent psychiatrists who act as advocates for youth, and as individuals with knowledge of patterns of media use, content, and relevant research data, to adopt a professional stance that balances children's needs for protection against the push for heavy-handed paternalism that violates children's autonomous rights.

Given that societal change occurs rapidly, it is wise to remain open-minded about the purported negative and positive effects of media on society and individuals. However, these changes do have a significant impact on children and adolescents, and they therefore demand ongoing and thorough examination.

TABLE 1. The Media: Relationships to Psychiatry and Children

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