Psychiatric Workforce: There Aren't Enough Psychiatrists

By Herbert S. Sacks, M.D.
APA President

The American family watches television eight hours a day, and by the age of 18, the average teenager will have spent more time watching television than learning in the classroom.

"Watching" by our children and adolescents doesn't engage active ego involvement, with its deployment of self-regulating, organizing, and synthetic functions. "Watching" is more like secondary smoke inhalation. Most of the children I see spend much of their childhood in front of the television set, their fantasies and dreams shaped by the electronic transmissions. What has happened to reading? How do our children and adolescents manage with those portable information storage and retrieval systems called books? In the past, cherished books, with their young readers' scribbled notes and drawings in the page margins, have been read again and again. The creative powers of the authors provoke the recapture of memories and fantasies rooted in the past, now enriched by the vicissitudes of development.

Our older APA members recall with great pleasure their childhood fascination with radio serials: "Jack Armstrong--The All-American Boy," "Helen Trent," and "The Lone Ranger." These serials, like good books, cause the listener and the reader to reach out imaginatively to the author, to become involved in the characterizations of the heroes and villains, rounding them out.

Bringing what is vivid out of books is very different from the viewers' passive submission to what is on the tube, which for many vulnerable children is overwhelming and permits no reworking and integration. TV encourages a Farina-like blandness in the child, blunting the early recognition of subtleties and the beginning ability to enjoy complex arguments. Lurching from blandness to emotional hyperbole and violence is a programming hallmark, except for public television. There is no long-term gift in mindless aggressive and sexual expression, only disintegrative arousal. Burning out the wiring of a child's imagination is more likely when TV is used as a babysitter to dull a rambunctious youngster or to induce a hypnoid state in a fatigued child ready for sleep.

Television's tribalism reinforces what is passive in collective dreaming. Reading, model building, child-generated neighborhood club activities, fishing, touch-tackle, backyard basketball, and the beginning mastery of a musical instrument neutralize television's appeal.

An important network aim is to infect our children with the ethos of global marketing, where billions of dollars ride upon advertising decisions. Every few months a new fantasy figure arises. Follow what has happened to the rise and fall of Teenage Mutant Ninja Turtles and the Mighty Morphin Power Rangers.

The television industry, in complying with the Children's Television Act of 1990, which imposed minimal demands, claimed that "Leave It to Beaver" and "Dragnet" were "educational in nature." Such convoluted claims by business are well known in the universe of psychiatry. We live in an era where profit maximization by business obfuscates reason. So we weren't astonished by the "educational in nature" assertion, which rivaled the famous nutritional discovery of the Reagan Administration that ketchup in school lunches was a vegetable.

In 1961 FCC Commissioner Newton Minow denounced TV as a "vast wasteland." Has it improved for our children over the past 36 years? I think not.

APA has participated in coalition efforts in the past decade advocating for a significant decrease in violent programming on network and cable television. In a position paper approved by the Board of Trustees in December 1993, we stated that "television violence has been shown to be a risk factor to the health and well-being of the developing child and adolescent and to the stability of their families. APA has encouraged voluntary restraint on the part of the TV industry to decrease TV violence." We went further in citing the ineffectiveness of voluntary restraint by the industry and asked for regulatory action.

The lead in developing and implementing strategies to address TV violence has been historically taken by the American Academy of Child and Adolescent Psychiatry (AACAP) allied with our Council on Children, Adolescents, and Their Families. The AACAP over the years has addressed the lack of educational television, inappropriate advertising, the arrival and departure of the "children's television hour," extreme violence during peak watching periods for children, the Children's Television Act of 1990, and now the 1996 Telecommunications Act. Dr. John Livingstone, a Harvard child and adolescent psychiatrist, has been an important scholar and advocate in the AACAP campaign against TV violence.

On July 9 an agreement was reached between the TV industry, 19 child advocacy organizations, and the Congress. The agreement lays out the terms of a voluntary rating system to begin on October 1, 1997, a system that will flash new symbols at the start of programs when appropriate. The symbols will warn of shows that contain violence, sex, and objectionable dialogue. The addition of content information to the previously agreed-upon age ratings is a considerable improvement.

The agreement is actually a proposal to the FCC. In it the signatories request that the FCC accept this proposal in lieu of imposed regulation. Further, it asks Congress to forego new laws in this area for three years, a recommendation that protects the TV industry rather than informing parents and protecting America's children. Newton Minow, now a former FCC commissioner, in an editorial in the Wall Street Journal on July 21, pointed out that few industries have an exclusive license to speak on the public airways, the nation's most valuable property. And few industries are as protective of their constitutional rights as broadcasters. "So it was a delicious irony when broadcasters demanded three years of silence from Congress and children's advocacy groups as the price of their agreement to revise the ratings system," writes Mr. Minow. Any ratings system will be given time to work with the "V chip," which won't be available until next year in almost every new TV set. Using the chip, parents will be able to program their sets and screen out any show rated above a desired level.

Unlike the motion pictures that are rated by an independent board, the agreement will be rated by the folks who produce the TV programs: the same folks who increased the sexual content during the "family hour" fourfold in two decades!

The ratings system is too complicated for most parents to understand and yet vague enough so that reliable ratings from producers who use it are unlikely. To solve this problem, an oversight board might be reasonable. But Jack Valenti, who heads up the Implementation Group of the industry, has rejected an oversight board that is independent, nor will he allow for the development and implementation of independent rating systems. The 23-member oversight board proposed by Mr. Valenti is composed of TV industry executives, the same folks who gave you heightened violence and sex emanating from the box your children view, the same folks who will do the ratings! When the advocacy group asked that five positions be reserved for individuals selected by groups such as the National PTA and the American Academy of Pediatrics, the industry refused. Mr. Valenti will handpick the five nonindustry people on the board; thus, the entire board will be selected by the industry it is supposed to be overseeing.

The V chip technology, developed by a Canadian, will allow only the industry ratings to be used in guiding parents. The industry has flatly rejected "open architecture" V chip technology, which would allow multiple rating systems by a variety of third-party groups, such as the National PTA. Once the industry V chip is in your TV box, it will be there forever, unless a clever inventor can cheaply produce an "open architecture" V chip for parental installation. Fat chance. How many Americans ask their children to operate their VCR's?

As a member of the advocacy group negotiating with the industry and the Congress, APA refused to sign the agreement based upon the oversight board and V chip issues. The AACAP strangely enough, was not invited to be a member of the advocacy group. The AACAP joins us in decrying this agreement. When this agreement comes under review by the FCC, we will testify in dissent. I have reason to believe that the pediatricians will reconsider their approval of the agreement and sign on as well in dissent.

This family matter, affecting worried parents and vulnerable children, is being driven by politics as never before. Four prominent Senators and Representatives from both parties are pushing legislation reflecting much of the advocacy position. But nine Senators, led by Trent Lott (R-Miss.) and John McCain (R-Ariz.), support the agreement based on the industry's promise to adopt stronger voluntary standards. The Vice President, who micromanaged the agreement, announced its triumphant achievement at a White House media event. Four days after the White House fete celebrating the agreement, the New York Times ran a "Political Memo" on page one highlighting Mr. Clinton's remarkable commitment of resources to help Mr. Gore's aspirations in the year 2000 election.

Robert Hughes, the noted Australian art critic and author, reminds us that a warning about TV was issued two thousand years before it was invented, by the Roman poet Ovid. "Video meliora proboque; deteriora sequor": "I see better things and approve them: I go for the worse." Hughes recommends this warning be engraved on every television set in America.

(Psychiatric News, January 3, 1997)