At bioethics.com, I curate and post articles from the media that deal with bioethics issues. A typical post at bioethics.com is a title, link, and short blurb from an article in the mainstream media, such as The Wall Street Journal, The New York Times, Reuters, or the Associated Press. Over the past year, one bioethics.com post received more views in a single day than any other post, and it won by a large margin: “The Twitching Generation” by Helen Lewis at The Atlantic (See post here).[1] I posted “The Twitching Generation” on Monday February 28, 2022. On Saturday alone it received 2,512 views, and as of April 2022, it had 5,338 views. Those numbers are just for the bioethics.com post which serves as a thorough fare to the actual article. The topic is apparently of interest to our bioethics readers, so let’s look at what we can learn from Helen Lewis’s article about teens and technology.
Lewis’s article analyzes reports from doctors and specialists of the influx of patients, predominantly girls, who have suddenly developed Tourette’s-like tics.[2] These twitches and outbursts match those of popular TikTok users purportedly with Tourette’s syndrome. Lewis is not the only journalist who has drawn attention to this phenomenon. In October 2021, Julie Jargon at The Wall Street Journal reported on TikTok-induced Tourette’s-like tics among young girls around the world.[3] She wrote a follow-up article in March 2022.[4]
Lewis interviewed several experts on Tourette’s, as well as those who deal with contested illnesses and mental health disorders. Tourette’s usually occurs in boys with the characteristic tics beginning around five-to-ten years old.[5] The TikTok-induced tics occur mainly in teenage girls. Doctors started seeing cases before the start of the Covid-19 pandemic, but the numbers increased substantially when teens’ routines and social structures changed due to the pandemic. Sociologist Robert Bartholomew told Lewis that “the pandemic—and the lockdown and homeschooling measures used to contain it—had created a ‘perfect storm’ for an illness spread through social media.”[6]
Bartholomew, who has studied mass psychological illnesses, or what was once called mass hysteria, calls the tics a “social barometer” and a “sign of the times.” He told Lewis that the “tics are allowing teenagers to express something about the unbearable alienation and intimacy of modern life, which is lived so much through screens.”[7]
Bartholomew says an outbreak of mass-psychogenic illness tends to stop when the conditions that caused it are addressed. This means dealing with the underlying cause of anxiety. In past examples of the sudden onset of tics, he says once the media coverage—such as interviews with people who have tics—decreases, the symptoms usually get better. Things are different with the availability of videos on social media.
The Need Behind the Behavior
For those of us that work with teens or have teenagers, we need to keep in mind the question that practitioners of Trust-Based Relational Intervention® ask when working with children with chronic trauma in their past: What is the need behind the behavior?[8]
There is a real phenomenon here that seemed to intensify with the combination of staying at home due to the pandemic and teens spending more time on social media. Many teens who were treated for the tics with cognitive behavior therapy ended up recovering; however, several of them developed eating disorders or non-epileptic seizures, indicating that the underlying problem was still there. As Julie Jargon reported, many of the girls who developed tics had pre-existing mental health issues:
A paper published earlier this month in Australia’s Journal of Paediatrics and Child Health found that underlying undiagnosed or untreated psychiatric disorders, self-harm and school absenteeism are common in adolescents with functional tics. The University of Sydney researchers wrote that the tic-like behavior likely comes from “a mix of cumulative stress, in addition to social-media influence.”[9]
Jargon says that compared to the same timeframe in 2019, in 2020, 2021, and beginning in January 2022 the number of teenage girls that went to the emergency room for an eating disorder doubled and for tics tripled.
The pandemic is not fully to blame says Jean Twenge in an article from Institute for Family Studies, but what it did do was make a bad problem worse.[10] Twenge is the author of the book iGen, in which she says the high levels of teen depression over the last ten years is due to increased social media use and less time with in-person social interactions. This has had a disproportionate effect on teen girls who have a love-hate relationship with social media.[11]
An Anchor in Tumultuous Times
Recent studies have shown that substance abuse,[12] alcohol consumption,[13] and emotional or verbal abuse[14] have increased for all age groups during the pandemic. Additionally, anxiety and depression have increased in all age groups and in all places in the United States.[15] This means teens who were already struggling with anxiety and depression do not necessarily have the support systems that they had before the pandemic. For example, they cannot necessarily rely on the adults in their lives for support because those adults are struggling too and because of the large number of people struggling right now, those adults may be unable to get the help that they need. This is not to blame and shame parents and teachers, but to recognize that in the aftermath of a disaster there will be a large number of people dealing with the effects of trauma in need of care and support.
Being someone with Tourette’s provides an identity and, as some noted, an excuse in case they say something online that is met with antagonism. However, for the teens that doctors are seeing, they cannot control the tics or can only do some for a short time before the pressure is too much to handle, In the Tourette’s community, they refer to tics as unvoluntary.
Curtis Chang and David French, hosts of the Good Faith podcast, mentioned Helen Lewis’s article in their March 5 episode on the spiritual power of leadership.[16]French points out that there is something in our human nature that longs for meaning and identity, which he says many of these teens found in self-identifying with a social media influencer with Tourette’s. And as Curtis Chang noted, we image what we worship.
Lewis said one specialist told her that some of the girls were sad or angry at the thought of stopping their tics. Others were concerned about what their followers would think because they had built an identity around being a Tourette’s influencer. Carl Elliott, in his book Better Than Well, wrote about finding identity in a disability community, even if someone does not actually have the disability, before TikTokor Instagram made these communities accessible.[17] It may be that some teens are searching for a group in which to belong and, with the isolation that happened during Covid-19, they turned to online communities more so than before. However, this does not explain the large number of teens, mostly girls, who have uncontrollable tics that are interfering with their daily living.
I cannot say why so many people checked our bioethics.com post on Helen Lewis’s article. My guess is, now that some of the pressing issues of a pandemic are waning and people are no longer having to balance how to mitigate harms, our bioethics readers are turning their attention to the aftermath of the last two years. Perhaps, in bioethics circles, people are transitioning their mindset from disaster to one of care.
The Church as a Refuge for Care
In a disaster situation, ethical decisions focus on mitigating the harms and stabilizing the situation due to an influx of patients in a short amount of time. The goal is to help as many people as efficiently and effectively as possible. These situations involve difficult decisions of who would benefit most from the limited supply of medical resources and sometimes require a kind of utilitarian calculus of how best to maximize the number of survivors.
Unlike a disaster mindset, the care mindset is relationally focused with the goal of helping an individual patient beyond merely surviving, but toward mental and physical healing. Additionally, while the disaster mindset is centered on scarcity, the care mindset is centered on abundance. This is not necessarily material abundance, though, just as healing is not necessarily physical healing, but out of thankful generosity and compassion.
By way of example, let’s look at the parable of the Good Samaritan in Luke 10, which Jesus uses as an example of how we should treat our neighbor. A man walking from Jerusalem to Jericho was robbed, stripped, beaten, and left for dead. While a priest and a Levite passed by him on the other side of the road, a Samaritan had compassion on the man, and helped him to an inn where he tended the man’s wounds and provided for additional care.
While responding to a disaster requires quick decisions and moving from one injured person to the next as quickly as possible, the Good Samaritan shows us the that care takes time. It is “slow” work. According to the parable, the Samaritan stayed overnight at the inn with the man and the next day said he would pay for the expenses of the man’s care when he returned. The implication is that the man’s care will take time, and that the Samaritan was going to take the time to come back to the inn.
While the “Twitching Generation” is an article about teens, adults too are struggling mentally.[18] Just as pre-flight safety videos on airplanes tell parents to put their mask on first and then fix their child’s mask, the Church can be a place for empathetic care and spiritual consolation for the adults in teens’ lives, who then can give out of their “abundance” of having been cared for. The Church, historically, has been a refuge for those who need care. However, this kind of compassionate care is difficult when a local church becomes a place for political opinions and division over people’s decisions about how best to handle the Covid-19 pandemic.
A mindset of care is one that fosters trust and empathy. One can have empathy without agreeing with the views of the person who is struggling. Jesus was a friend to sinners and the Samaritan helped a Jew. Churches can help families by helping the parents, and parents, in turn, can help their teens to address the underlying stressors and triggers behind rapid onset tics.
References
[1] Helen Lewis, “The Twitching Generation,” The Atlantic, February 27, 2022, https://www.theatlantic.com/ideas/archive/2022/02/social-media-illness-teen-girls/622916/.
[2] Isobel Heyman, Holan Liang, and Tammy Hedderly, “COVID-19 Related Increase in Childhood Tics and Tic-Like Attacks,” Archives of Disease in Childhood 106, no. 5 (2021): 420–21, http://dx.doi.org/10.1136/archdischild-2021-321748.
[3] Julie Jargon, “Teen Girls Are Developing Tics. Doctors Say TikTok Could Be a Factor,” The Wall Street Journal, October 19, 2021, https://www.wsj.com/articles/teen-girls-are-developing-tics-doctors-say-tiktok-could-be-a-factor-11634389201.
[4] Julie Jargon, “Teen Girls Are Still Getting TikTok-Related Tics—and Other Disorders,” The Wall Street Journal, March 26, 2022, https://www.wsj.com/articles/teen-girls-are-still-getting-tiktok-related-ticsand-other-disorders-11648248555.
[5] “Tourette Syndrome,” Mayo Clinic, accessed July 6, 2022, https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465.
[6] Lewis, “The Twitching Generation.”
[7] Lewis, “The Twitching Generation.”
[8] “Trust-Based Relational Intervention®,” Karyn Purvis Institute of Child Development, TCU College of Science & Engineering, accessed July 6, 2022, https://child.tcu.edu/about-us/tbri/.
[9] Jargon, “Teen Girls Are Still Getting TikTok-Related Tics.”
[10] Jean Twenge, “How Much Is Social Media to Blame for Teens’ Declining Mental Health?” Institute for Family Studies, April 11, 2022, https://ifstudies.org/blog/how-much-is-social-media-to-blame-for-teens-declining-mental-health.
[11] See my article “Do You Like Me? The Contradictory Worlds of Today’s Teen Girls,” Salvo 47 (2018), https://salvomag.com/article/salvo47/do-you-like-me.
[12] “Drug Overdose Deaths in the U.S. Top 100,000 Annually,” CDC, November 17, 2021, https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm.
[13] Aaron M. White et al., “Alcohol-Related Deaths during the COVID-19 Pandemic,” JAMA, March 18, 2022, https://doi.org/10.1001/jama.2022.4308.
[14] “Adolescent Behaviors and Experiences Survey (ABES),” CDC, March 31, 2022, https://www.cdc.gov/healthyyouth/data/abes.htm.
[15] “Mental Health and Substance Use State Fact Sheets,” Kaiser Family Foundation, December 13,2021, https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/.
[16] See David French and Curtis Chang, “The Spiritual Power of Leadership,” Good Faith, March 5, 2022, https://goodfaith.thedispatch.com/p/the-spiritual-power-of-leadership?s=r (starts 24:22).
[17] Elliott, Carl Better than Well: American Medicine Meets the American Dream, W. W. Norton & Company, New York, 2003.
[18] Anjel Vahratian, Stephen J. Blumberg, Emily P. Terlizzi, and Jeannine S. Schiller, "Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19Pandemic—United States, August 2020–February 2021," Morbidity and Mortality Weekly Report 70, no. 13 (2021): 490–94, http://dx.doi.org/10.15585/mmwr.mm7013e2external icon.