Twitch Therapy: The Controversial Rise of Online Mental Health Interventions
Twitch Therapy: The Controversial Rise of Online Mental Health Interventions
The case of a psychiatrist's Twitch streams highlights the evolving landscape of mental health care delivery and the complexities of maintaining ethical standards in the digital age.
TLDR:
The rise of online platforms like Twitch has transformed the mental health care landscape, with both opportunities and concerns.
Mental health advocates and therapists are using Twitch to reach new audiences, but the platform lacks the regulations and boundaries of traditional clinical settings.
The case of Dr. Kanojia's Twitch streams, which involved therapy-like sessions with vulnerable individuals, has sparked intense scrutiny and ethical debates.
The Massachusetts licensing board issued a reprimand to Dr. Kanojia, recognizing the blurring of boundaries between clinical care and other online formats.
The general ethical guidelines for mental health professionals leave a gray area for how to operate ethically on streaming platforms, as technology continues to outpace the evolution of these guidelines.
The proliferation of mental health content on platforms like Twitch and TikTok, often delivered by individuals without proper credentials or oversight, poses a significant risk to vulnerable individuals seeking help.
The mental health care system in the United States is already woefully inadequate, and the introduction of these unregulated, potentially harmful alternatives threatens to further undermine the efforts of legitimate professionals to provide effective and ethical care.
There is a need for widespread mental health reform to ensure mental health care is truly accessible and delivered in a responsible, ethical manner, especially in the digital age.
The Facts:
The world of mental health care has undergone a significant transformation, with the rise of online platforms like Twitch becoming a new frontier for mental health discussions and interventions. As Dr. Yvonne Wohn, professor and director of the New Jersey Institute of Technology's Social Interaction Lab, notes, "There's much more awareness [regarding mental health], but it is still a stigmatized topic." Twitch has evolved beyond video game streaming, with people creating art, making music, and chatting with friends. Mental health advocates and therapists are using Twitch to reach people and talk about therapy. Some mental health streamers talk about their experiences with mental illness, while others are licensed therapists or psychologists providing lectures and discussions.
Mental health streaming on Twitch is similar to the short-form mental health content on TikTok and Twitter, but there are concerns about misinformation and the lack of personalized care. The state of mental health care in the U.S. is dire, and Twitch continues to be used as a way to reach new people, despite the uncertainties and ethical concerns. There is a need for widespread mental health reform to ensure mental health care is truly accessible.
As the traditional one-on-one therapy model has expanded to include remote counseling, some mental health professionals have taken their practices to the streaming platform, engaging with viewers in ways that blur the lines between therapy and casual conversation. Twitch is not a clinical space, and there are no rules for what constitutes a mental health stream. Anyone can use the "Mental Health" tag.
As Dr. Lynn Bufka, senior director of practice transformation and quality at APA, explains, "A lot of professionals and professional organizations are really grappling in some new ways with some ethical questions that, because of changes of technology, are somewhat newer."
Dr. Alok Kanojia, known on Twitch as "Dr. K," has been at the forefront of this shift. Dr. Kanojia is a psychiatrist who did his medical residency at Harvard Medical School. He has been conducting in-depth, therapy-like sessions with prominent gamers and influencers on Twitch, discussing their mental health struggles.
One such session was with the late Byron "Reckful" Bernstein, a popular gamer who struggled with mental health issues. Reckful opened up to Dr. Kanojia about his depression, suicide attempt, and other personal matters. In the session, Dr. Kanojia directly commented on Reckful's mental health, stating, "You may have clinical depression, but I think what you're describing is not clinical depression. I think your problem is that your life is empty. That's different." Reckful died by suicide in 2020, two years after his last conversation with Dr. Kanojia. This exchange has been the subject of intense scrutiny, with critics arguing that Dr. Kanojia violated professional ethics by providing such specific medical advice to a non-patient.
A newcomer to the streaming world, Max Karson, filed a complaint against Dr. Kanojia with the Massachusetts licensing board, arguing the interviews violated ethical guidelines. As Max Karson stated, "Reckful did not know if Dr. K was his doctor or his friend. And a blurry, unboundaried, pseudotherapeutic relationship is inherently harmful to the patient. That's why it's against the rules."
Dr. Kanojia has maintained that his Twitch streams are not intended to be a substitute for professional medical care, and that he has taken measures to ensure viewers understand the limitations of their relationship, including having Reckful sign a waiver. However, the ambiguity of their interactions led to the complaint and a subsequent investigation.
After a two-year investigation, the Massachusetts licensing board issued Dr. Kanojia a reprimand, stating that he "had engaged in conduct that undermines the public confidence in the integrity of the medical profession." While this is one of the lesser punishments available to the board, it underscores the ethical quandaries that have arisen as mental health care expands beyond the traditional one-on-one private session. However, the board did not revoke Dr. Kanojia's license or impose harsher punishments.
The tragedy has further fueled the debate surrounding the boundaries and responsibilities of mental health professionals in the digital age. Since then, Dr. Kanojia's company Healthy Gamer has continued to grow, and he has gained a higher profile, hosting the U.S. Surgeon General on his stream and publishing a book.
The View:
Dr. Kanojia's Twitch streams represent a troubling departure from the well-established ethical guidelines that govern the medical profession. By engaging in therapy-like sessions with vulnerable individuals, he has brazenly flouted the rules designed to protect patients and maintain the integrity of the profession. The fact that the Massachusetts licensing board saw fit to issue him a reprimand, even if it is one of the milder punishments available, is a clear indictment of his conduct.
The traditional mental health community has historically lagged behind the desire of more modern practitioners to circulate mental health education via online platforms, although the pandemic has decreased this gap. Twitch has seen some actual mental health professionals who stream, taking different approaches, but they must be mindful of ethical guidelines around providing personalized advice or diagnosis.
The complaint against Dr. Kanojia is "one of the first times" the line between clinical care and other formats like streaming and coaching has been explored by an official body. This suggests that the Massachusetts licensing board recognized the pioneering and evolving nature of this type of mental health care delivery. The blurring of boundaries between therapy and "not really delivering medical care" that Dr. Kanojia claims to uphold is a mere facade, one that is easily shattered by the reality of his interactions.
The general ethical guidelines for mental health professionals leave a major gray area for how to operate ethically on streaming platforms, as technology continues to outpace the evolution of these guidelines. Mental health streamers and professionals on Twitch are attempting to lessen the gap in accessible mental health care by meeting people where they are. The line between a telehealth session with a therapist and a therapist-led advice show is clear, but the line between other online mental health spaces is less so, leading to concerns about misinformation and ineffective/harmful advice.
A doctor-patient relationship starts when a clinician begins to provide medical advice using their training and expertise, regardless of whether they call the individual a "patient." The argument that Dr. Kanojia's streams are not intended to be a substitute for professional medical care rings hollow in the face of the evidence. His specific comments on Bernstein's mental health status, including the assertion that his "problem is that [his] life is empty," demonstrate a level of clinical analysis that goes far beyond mere casual conversation.
Moreover, the notion that Dr. Kanojia has taken measures to ensure viewers understand the limitations of their relationship is undermined by the fact that Bernstein himself seemed to be confused about the nature of their interactions. Regulations barring psychiatrists from commenting publicly on individuals who are not patients are in place to ensure that providers are always guided by the best interests of the patient, not the personal or financial interests of the provider.
By allowing his Twitch streams to become a platform for self-promotion and revenue generation, Dr. Kanojia has betrayed the trust that the public places in medical professionals and has compromised the sacred bond between doctor and patient. The implications of Dr. Kanojia's actions extend far beyond his own conduct. The proliferation of mental health content on platforms like Twitch and TikTok, often delivered by individuals without proper credentials or oversight, poses a significant risk to vulnerable individuals seeking help.
There is a space for mental health on Twitch, but professionals continue to grapple with uncertainties in this new corner of the industry, highlighting the need for widespread mental health reform and ensuring mental health care is truly accessible. The mental health care system in the United States is already woefully inadequate, and the introduction of these unregulated, potentially harmful alternatives threatens to further undermine the efforts of legitimate professionals to provide effective and ethical care.
Know More:
Dr. K: Reckless (Dr. K, Reckful, Therapy Ethics Documentary)
Insights From:
A Psychiatrist’s Livestreams With a Twitch Streamer Raises Ethical Questions - The New York Times
Why some licensed therapists are streaming on Twitch - Polygon