Cyberbullying: Notes from the Field

Ellen Selkie, MD, MPH
Adolescent Medicine Fellow, University of Washington/Seattle Children’s

As an adolescent medicine provider, I’m constantly working to keep up with media trends—a great conversation with my patients is often started when I ask what websites they use, or their favorite platform for staying connected with friends.   However, I’ve also seen peer relationships turn sour through media—particularly when it comes to cyberbullying.  

The CDC defines bullying as “unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated.” Notably, bullying falls on the spectrums of aggression and violence, but not all violent or aggressive behaviors are necessarily bullying.  

How does this definition fit cyberbullying?  Well, we certainly see unwanted aggressive behaviors online—name calling and rumor spreading can be easily done by commenting or posting on social media, and text messaging is a quick way to threaten someone else.  The “power imbalance” may not be a physical one, but having secrets about a peer can be very powerful…especially if you decide to talk about them online without permission. For some teens, it may be “easier” to bully others online because of the anonymity that the Internet can offer as well as the potential for a large audience to see nasty messages quickly.  

It’s important to note that most kids who experience cyberbullying are also being bullied in person (“traditional” bullying).  They usually have some idea of who is cyberbullying them, though not always a specific person.  In fact, many studies show that cyberbullying is less common in prevalence than traditional bullying.  But whereas bullying that happens in person is usually limited by the timing and place of the school environment, cyberbullying can happen anywhere, at any time.  I’ve had multiple patients tell me that they check their Instagram at 2 or 3 in the morning “just in case” someone has posted a mean comment, so that they can delete it before too many people see it.

 The potential permanency of messages on the Internet calls into question whether a single post, while not “repeated multiple times,” would still constitute bullying behavior.  I think this is where we get into the topic of why we care about bullying in general.  We know that bullying, both as a bully and a victim, is associated with poor mental health, suicidality, school failure, and other negative health outcomes.  Cyberbullying has also been associated with these negative outcomes, and in some studies is more strongly associated with suicidality than traditional bullying alone.  It’s unclear why this might be, and further research is needed in this area.  But if a single mean post on Facebook is hurtful enough, and a teen can look at it over and over, might that not lead to distress, poor sleep, depression, or other negative consequences?

Regardless, I’m making sure to ask my patients about both in-person bullying AND cyberbullying, and most importantly, how they are coping if they are experiencing bullying.   While some teens view these aggressive behaviors as “drama” that is easily ignored, others take their peers’ online comments to heart.  Knowing each individual teen and their support system is key to identifying those most at risk.  

For more resources on these topics, visit StopBullying.gov and the Cyberbullying Research Center for further information.

Why I chose to be a real doctor with a fake name

ALAN SMITHEE, MD

My interest in studying medicine began in high school. I’d always loved science, and as I considered what I wanted from a career, being a physician seemed to make the most sense. I imagine my reasons for wanting to do so are relatively generic among members of our profession.

But the thing that really filled me with joy was writing for the school newspaper. I had a column on the opinion page, and every time a new issue was published I’d wait with eager expectation for the reactions of my classmates. Had they liked it? Did they think the jokes were funny? While it hardly catapulted me to prom king status, it at least gave me the chance to participate in the life of the school that suited me.

However, as I focused my studies on medicine, writing fell away entirely. The only writing I did was for classes, and nothing for my own enjoyment or a wider audience.

When the opportunity to write for a moderately successful politics/general interest blog came up a few years ago, I was delighted. It was an outlet I’d enjoyed, and I’d contributed a guest post or two. When they invited me to contribute regularly, I jumped.

As it happened, I was at a small turning point in my career. I was leaving a job that I’d come to consider a poor fit, and was taking a new one. Since I had no idea if my new employers would look kindly on my spouting my opinions on the Internet, I opted to use a pen name. It seemed a good way to keep my medical self and this nascent writer self separate.

Several months ago, I managed to get something published in one of the bigger online magazines, an outlet I’ll call The Behemoth. Many of the blog’s other writers had gone on to paying gigs, and with their help I pitched a piece to a couple of places. The Behemoth ran it.

It ended up being more successful than I’d ever dreamed it would be, and went “kablooey” on social media. I’d taken a relatively controversial stance on a very fraught issue that pediatricians continue to face, and clearly touched a nerve. While many, many people expressed support and agreement with what I’d written, I got plenty of blowback. Including from fellow pediatricians.

Given the success of that first piece, I was offered a regular contributor spot, and have been churning out content on a weekly basis or so since. Writing for a general audience site like The Behemoth is not without its headaches and issues, which I think are normative for the industry as a whole. (I’ve had a few articles run at a place I’ll call Parlor, and my experiences there are about the same.) Perhaps I’ll talk about those issues in a later post.

As I’ve adjusted to the (still surprising) phenomenon of being paid to write things, I’ve toyed with the notion of dispensing with the pseudonym. In comments on some of my more controversial pieces (which I know I shouldn’t read anyway), sometimes in between accusations of being a shill for Big Pharma someone will question my integrity since I’m hiding being a fake name. It’s a criticism I can’t entirely dismiss.

Thus far, I’ve opted to keep the pen name. I doubt I’d be able to speak as freely or as honestly if I had to worry about being as nice as I strive to be when wearing my pediatrician hat. (Editorial decisions about how to frame my writing sometimes come off as less nice than even I would have chosen. See above: re headaches.) I think we pediatricians work very hard to be perceived as kind and sensitive, and I suspect sometimes that impulse could get in the way of expressing my thoughts quite as clearly as I’d like.

There are many pediatrician-writers out there who use their real names. I follow the work of many of them, and admire much of it immensely. (One whose work I particularly like disagreed quite pointedly with what I’d written in that first Behemoth piece in a segment for Headline News, which I found about as enjoyable as you’d expect.) Sometimes I wonder if I made a mistake when I chose to write with an assumed name rather than the one on the sign out front. Lots of others have made it work after deciding differently.

For now, the fake name stays. My partners in the practice all know I write and are fine with my dropping it, but the freedom it affords still offers a little bit of comfort. I don’t work super hard to maintain it, and perhaps one day I’ll offend some particularly enterprising individual with enough time and motivation to unravel it. In the meantime, the opinions I express come out just a little more easily, which my writer self finds reason enough to keep the separation in place.