Social Media Use: A Closer Look at the Real Meaning of Friends

Psychiatric TimesVol 31 No 9
Volume 31
Issue 9

People feel free to post comments on social media sites that they would never dare say to someone’s face. The cure, if only a partial one, is to get out of social media and to start living a real life. What is your opinion on this issue?

In Russian, the word “friend” has a more intimate meaning than other words used for people we know personally. There are acquaintances, there are comrades, and then there are friends. Of the latter it is said, “A friend is someone with whom you have eaten a pound of salt,” meaning that it is a person who has been with you through thick and thin. I often think of this meaning of the word “friend” when someone mentions that so-and-so is his “friend on Facebook.”

The social media phenomenon has become very popular in the past decade, and it has brought about a new way of relating to others. Social media services such as Facebook and Twitter allow simultaneous communication with multiple people, a kind of communication that is rarely possible in physical circumstances-after all, it is not every day one finds himself a speaker in front of a crowd of listeners.

[[{"type":"media","view_mode":"media_crop","fid":"27774","attributes":{"alt":"Friends on social media","class":"media-image","id":"media_crop_6083887428017","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2745","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 200px; height: 203px; float : right","title":" ©JSlavy/Shutterstock","typeof":"foaf:Image"}}]]It has been suggested that psychiatrists should embrace social media as a “new and exponentially growing form of communication.”1 However, rather than encouraging social media use, a closer look at this form of communication suggests that there are many good reasons to stay away from social networking, both personally and professionally.

For most of our history, contact and relationships between human beings have involved physical proximity. Although remote communication such as letter writing has existed for thousands of years, it was understood to have a secondary role to that of communicating in person. Under conditions of physical proximity, communicating with others has necessarily involved the use of special senses: sight, hearing, touch, and smell.

Indeed, the degree of intimacy between people may be said to reflect how many special senses they use when they are together. How close people feel to one another may determine the physical distance between them when they get together, how loudly or softly they speak, whether they make physical contact, etc. In how we consciously or unconsciously manipulate these aspects of communication, we necessarily discriminate between people, establish degrees of specialness, and declare how private or public the relationship is.

Letter writing was traditionally a form of communication that existed in parallel to-but not as a replacement for-a physical relationship. In addition to conveying informa-tion for its own sake, a handwritten letter necessarily bore a unique imprint of the individual writing it. As a physical object with some permanence, it could be made particularly personal or unique in any number of ways. Letters took on scents; bore the stains of tears or spilled ink; and often contained other physical mementos, such as a lock of hair.

In the early 20th century, communication by telephone became possible, and by the middle of the century, most households in developed countries possessed a telephone. Technical matters and cost considerations meant that for at least the first 50 years or so after the invention of the telephone, this device was used to communicate with those who were not a great distance away and for short periods of time.

Even though several households may have shared the same “party line,” telephone conversations were generally understood to take place between two individuals and were, in principle, if not always in practice, a private matter for them. Private telephones were to be found in private spaces, such as homes, whereas public telephones in the community were protected by the confines of a booth that ensured privacy from within and shelter from the noise without.


Individual advice, counseling, or treatment needs to take place in the framework of a face-to-face clinical encounter. In turn, physicians who have a need to make a public statement can do so in any number of ways that do not involve social media.

–Boris Vatel, MD

As telephone communication became less expensive, more accessible, and finally available in the portable form of cellular phones, people started spending more time using it. A curious phenomenon began to take place. Although the two-way nature of conversation continued, the portable nature of cellular telephones has resulted in a merging of a space that was previously considered private with a space that was clearly public.

Where once people separated themselves from others to speak on the telephone, they now began taking phone calls while surrounded by others. The person who chose to use the cell phone in the public space became a de facto public speaker who violated all rules of social conduct in that he addressed himself to no one who was actually present. In fact, an observation has been made that those who have cellular phone conversations in public resemble psychotic individuals responding to auditory hallucinations.

Whereas public cell phone behavior involves talking to one remote person while in the physical proximity of many, social media behavior involves communicating with many remote persons even when one may be physically alone. Both types of behavior occur in apparent ignorance of social rules in the physical world and rely on technology that makes such communication appear normal.

Social media relationships are different

A social media relationship is different from a physical one in several important ways.

The virtual relationship requires that those who participate in it be consumers of a service that makes virtual relationships possible. One is a Facebook subscriber first and a person with “Facebook friends” second. It is those who design and maintain social networking sites who are ultimately in charge of such relationships; they set up parameters in which communication between users takes place and they are the long-term keepers of whatever information users choose to share on their sites. Virtual relationships are literally the property of someone who otherwise would have no part in them if such relationships were to happen in physical space. Moreover, while physical communication has always been a need common to all humans, one can be certain that social networking first and foremost fills the financial needs of its creators.

Because virtual relationships have no physical dimension, they are conditional and dependent on a number of factors that point out their artificial and fragile nature. Try having a Facebook relationship if you have no computer access, if the Internet service is down or unusually slow, if the power goes out, if your backup battery dies, or if one day Facebook is outlawed. The central question here: who is ultimately in control of such a relationship? Does it arise organically between individuals who are free to structure it the way they see fit? Or does it depend on a complex system whose contingencies are ultimately maintained by and for the benefit of others?

Social media relationships take place on display, with the specific purpose of being seen by others. As a result of its intentional transparency, it lacks depth or character. In explaining why he does not use social media, someone recently said, “There is nothing I would want to say to anybody that I would wish to say to everybody.”

Because social media postings are meant for multiple persons, they lose the individual character that face-to-face communication inherently possesses. In real-life situations that are bound by time and space, people cannot help but have unique and unrepeatable encounters with others. In contrast, communication structured along the lines of computer logic is inorganic and infinitely reproducible. This reproducibility applies also to the number of “friends” one may have on Facebook. No wonder a new lingo has to be invented for these things, such as “friending” someone or the awkward “like us.”

Social media relationships foster narcissism in ordinary individuals and encourage narcissistic hypertrophy in those who already possess cluster B traits. What better outlet for people obsessed with themselves than to talk about themselves, often in the most trivial ways imaginable, to as many people as possible? Having many “friends,” being accepted as a “friend” or contact, being mentioned in posts by others-all these appeal to the need to appear important before ourselves and others. Being liked or well regarded is a natural human tendency. However, while in the physical world an exaggeration of this tendency becomes highly visible and irritating to others, thereby providing a limiting influence, in the virtual world, it is encouraged and rewarded.

When people who find it difficult to negotiate human relationships enter a world of pseudo-relationships offered by social networking, they become even more prone to developing grandiosity as well as narcissistic injury. It is not a rarity to see patients whose psychiatric symptoms are exacerbated by reading something negative that someone posted about them on a social media site. How many disagreements, disputes, and misunderstandings have occurred as a result of these completely artificial and superficial communications via a computer monitor? Again, because virtual relationships do not involve physical proximity, people feel free to post comments on social media sites that they would never dare say to someone’s face.

The cure-if only a partial one-is to get out of social media and to start living a real life.

Social media and psychiatry

Social media relationships are intentionally public. It is difficult to see how such communication would be useful in the arena of psychiatric care, where what is communicated within the treatment is meant to be as confidential as possible. We communicate best with our patients on a face-to-face, individual basis. This allows for the appreciation of the patient’s unique circumstances as well as of nuances of communication on both sides of the treatment equation. If telephone interactions are not a substitute for direct communication with our patients, social media interactions are even less appropriate.

In terms of providing public education in very broad strokes, the Internet already contains numerous resources for those suffering from mental illness. Individual advice, counseling, or treatment needs to take place in the framework of a face-to-face clinical encounter. In turn, physicians who have a need to make a public statement can do so in any number of ways that do not involve social media, such as speaking in their local community, writing articles, and participating in educational campaigns.

Social media is not a habit we should encourage in our patients or embrace for ourselves without a good understanding of its many limitations. We could better spend our time developing good face-to-face communication skills, learning how to negotiate private as well as public space, and ultimately having genuine relationships with others. In the real world, we all need friends who are true to the meaning of that word, salt and all.

This article was originally posted on 7/29/2014 and has since been updated.


Dr Vatel is staff psychiatrist, Evansville State Hospital, Evansville, Indiana.


1. Peek H. Social media: an opportunity for psychiatrists. Psychiatric Times. July 9, 2014. Accessed July 28, 2014.

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