By Jessica Jeffrey and Seth Freeman
A “natural experiment” is a real world occurrence which is not designed by researchers, but which contains the basic elements of a controlled study. Among the many curious consequences of the times in which we find ourselves is that we are living in the midst of a significant natural experiment, one that is both important and extremely revealing.
In the ordinary course of things it would be utterly impossible to ask millions of people to transfer the bulk of their professional, educational and social interactions to an online platform like Zoom for several months just so that we could compare their experience of living digitally with human interaction as practiced in more traditional ways. The corona virus pandemic, however, has created this study for us. The early results are in, and they are fascinating.
Some users are ecstatic over this new way of meeting and communicating. Two hour commutes can be cut to zero, saving time for other work and activities. While at your computer you can retrieve relevant materials, look things up during the meeting and quickly share files. You can dress casually. If you need to check on a child, you are right there in the next room. In the delivery of medical care, the ability to have a telemedicine encounter rather than an in-person visit, especially for patients who live far away, can mean the difference between having the encounter or not — sometimes a life-saving difference.
But in addition to these benefits, the Zoom experience has some clear, as well as more subtle, negative consequences. There is, for example, the phenomenon of “Zoom fatigue,” already a well-recognized artifact of life on Zoom and similar platforms, felt by almost every user.
Online psychotherapy is similarly a mixed bag. One advantage is that an online encounter can allow greater insight into a patient’s world, affording a look at where patients live, the pets which share their lives, a sense of their daily environment. Beyond these helpful atmospheric elements, clinicians have observed profound, positive changes in the trajectory of treatment. For example, with a teenage patient struggling to open up in therapy about a sensitive traumatic experience despite having established a solid rapport, the therapist found that as soon as they moved to Telehealth therapy, the patient was able to start expressing her feelings and communicate the difficult experiences she had been unable to talk about during in-person visits.
On the other hand, although there is a great deal of data showing that online therapy and psychiatry is as effective as in-person care, this modality can be particularly tough with children in the current environment. Children are often already online for school during a large chunk of their day, and the last thing they want to do is go online for therapy or a doctor’s appointment. With one young patient, his therapist learned that screens themselves triggered negative responses, a rather significant barrier for on-line treatment. The patient didn’t like seeing himself on the screen and would hide from it during sessions.
For younger children (preschool age), the attention span is about fifteen minutes, but, in fact, for these very young children spending more than fifteen minutes focused on a screen would not be ideal. Their brains need to engage with their 3D worlds.
Schools across the country and around the world at all levels are wrestling with whether to return to traditional in-person learning in the fall, to go completely online or to offer some combination of both options. Online learning is clearly a different experience at each different stage of growth and education, and the effects of missing important aspects of the school experience which Zoom cannot duplicate, like socialization, are widely understood and appreciated. Arguably the easiest transition to online education should be for college students who have internalized the socialization of the earlier grades and are already computer-literate.
John R. Murray, an associate professor at USC, in a recent article in the Los Angeles Times, points out numerous downsides to Zoom versus in-person teaching [https://www.latimes.com/opinion/story/2020-06-03/usc-classes-campus-fall-2020]. “It’s simply harder to engage the class,” he writes. “So much subtle communication occurs in the physical classroom. I can see the student who looks like she has something to say and prod her to speak up, or I can see the student who’s clearly irked by someone else’s comment and ask if he wants to respond.” Ultimately, “The physical classroom provides a humanizing and unifying experience for everyone present.”
Similarly, in professional meetings, the leader can miss telltale signs that more reticent participants have something to add or to object to, and anyone trying to pitch an idea will have a harder time “reading the room.” The intense focus on another person’s face while being unable to process non-verbal cues results in the strain of an increased cognitive load in any Zoom exchange. Many users worry about what they look like on screen or are made uncomfortable by having to see themselves.
The inevitable glitches of using technology add to the stress of life on Zoom. There are interruptions, buffering, drop outs, lag time and bad connections all beyond the user’s control. Having children and pets nearby can be an asset — the family cat jumping on the desk adds levity or can warm up the interaction — but just as often these out-of-context elements can be an unwelcome distraction. Likewise, the ability to look up information online while a meeting progresses can add to the exchange, but the temptation to check email or glance at breaking news, can distract from communicating to others that you are tuned into them, listening carefully, and interested in what they have to say.
Another drawback to Zoom meetings and classes is that we are deprived of the ordinary before and after time. Much creative work, meaningful connection and learning happen in the moments while settling into our seats, chatting before the meeting starts, walking down the halls. Several years ago, the authors of this piece participated in meetings together, but only had the opportunity to become friends in the unstructured time around the meetings. Our subsequent conversations inspired one of us to attend graduate school and earn a master’s degree in Public Health, a fairly significant life change which would never have happened in an entirely Zoom world. The Zoom format doesn’t allow for that informal interpersonal time which is critical in almost every type of human activity.
Before and after time is also important just to use the restroom, get a drink, stretch. In a culture where we schedule on-the-hour appointments and meetings, lasting thirty minutes or an hour, we have to learn to be more mindful in Zoomland of the need for these mental and physical breaks.
An aspect of the Zoom experience which probably goes largely unnoticed by participants is the powerful effect of the visual frame on the human psyche. Filmmakers exploit our unconscious reliance on peripheral vision to heighten the tension in spooky scenes. Normally when we walk through a house, we don’t reflexively feel a sense of impending jeopardy. But when, in a film, the camera frame gives us the point of view of someone moving alone through a building, we are instantly on edge because we can’t check the space around us with our peripheral vision. We have a deep, atavistic need to reassure ourselves that no danger lurks in our surroundings, a protective function of our nervous systems always running in the background during most activities. Being drawn into focusing on a screen — especially the rectangular boxes within the screen — which deprives us of the peripheral surveillance of our environment, unconsciously generates a sense of unease which likely contributes to feeling fatigued earlier in an online encounter than we would experience in person.
Zoom and similar platforms have been an important tool during this difficult period. We would be worse off without these forms of communication, but we can make even better use of them, now and in the future, if we are cognizant of their adverse and undesirable aspects. Meanwhile, the most significant lesson which our natural experiment with Zoom and its cousins has taught us is to value the many wonderful qualities of in-person human engagement.
Let’s use Zoom as much as we need to, but let’s also curb the enZoomiasm. As we emerge from the coronavirus restrictions and incorporate Zoom’s most helpful functions into our lives, let us be sure also to relish the richness and nuance of in-person human interaction which our being forced to use Zoom has revealed.
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Jessica Jeffrey, MD, MPH, MBA is a pediatric psychiatrist and Associate Director, Division of Population Behavioral Health, UCLA Health.
Seth Freeman, MPH, is multiple Emmy-winning writer/producer of television, a journalist and a playwright.