https://www.npr.org/2021/01/13/956315576/psychiatrist-criticized-for-addressing-mental-health-issues-on-twitch

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Twitch Streamers Go To Dr. K For Help With Mental Health Issues Dr.
Alok Kanojia, known as Dr. K, is a Harvard-trained psychiatrist
specializing in addiction. He addresses mental health issues within
the Twitch audience, which is largely made up of gamers.

Mental Health

To Help Gamers on Twitch, Dr. K Balances Mental Health Advice With
Medical Ethics

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January 13, 20215:08 AM ET
Heard on Morning Edition

Andrew Limbong

To Help Gamers on Twitch, Dr. K Balances Mental Health Advice With
Medical Ethics

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  * Transcript

[healthy-ga]
Enlarge this image

Dr. K, or Dr. Alok Kanojia, on the livestreaming platform Twitch,
talking to his audience about mental health, as commenters react in
real time. HealthyGamer_GG/ Screenshot by NPR hide caption

toggle caption
HealthyGamer_GG/ Screenshot by NPR

Dr. K, or Dr. Alok Kanojia, on the livestreaming platform Twitch,
talking to his audience about mental health, as commenters react in
real time.

HealthyGamer_GG/ Screenshot by NPR

On one side of the screen is Dr. Alok Kanojia. He's in his home
office in a plain white t-shirt, fiddling with a pen, listening
through his big headphones. He's talking to someone who goes by Mini,
who's got on similarly big headphones (hers have cat ears on them).
Mini's talking to Kanojia -- Dr. K, as he's known to his fans -- about
how she's suffered depression, low self-esteem, and panic attacks all
her life. The thousands of people watching this on the live streaming
platform Twitch offer a steady flow of heart emojis and condolences
in the chat box. Mini reveals that she's talked with six therapists,
but none have given her satisfying answers. "What do you want to
hear?" asks Dr. K. She pauses and fidgets and then answers, "what's
wrong with me?" The heart emojis come even faster now.

This type of exchange is common on HealthyGamer_GG Twitch channel,
where Kanojia will talk to people about their mental health issues,
lead group discussions and guide viewers through various meditation
techniques. The channel's rising popularity coincides with the growth
of Twitch as a platform, the pandemic forcing us all inside and
growth in mental health issues.

Kanojia, 38, is a Harvard-trained practicing psychiatrist currently
based in Houston, TX. He says even before COVID-19, the mental health
care system was ill equipped to handle new "assaults on our
cognition," as he calls them: apps designed to keep you scrolling,
video platforms designed to keep you watching, games designed to keep
you playing.

"Because psychiatry isn't enough," said Kanojia in a recent interview
over Zoom. He suggests we need a more holistic approach, like we take
towards physical health. "We need to stop thinking about just
medicine. If we said you had a physical problem, imagine we had no
gyms, no nutritionists -- it just doesn't make sense."

YouTube

Kanojia co-founded the company Healthy Gamer with his wife, Kruti
Kanojia, years before he started streaming. He'd gone through his
undergraduate years spending too much time playing video games like
StarCraft, and Diablo 2, as a way of coping with his feelings.

"The more overwhelmed I'd feel the more I'd play video games. And the
more I'd play video games the more overwhelmed I'd feel. And it
turned into a vicious cycle," he said. He only figured a way out
after visiting India and studying meditation and yoga.

As he was going through training to become a psychiatrist, he asked
his teachers and mentors about video game addiction. After coming up
short on answers, he turned to his gaming peers and asked questions
about their mental health and reliance on video games. He found
common threads between them -- challenges around social anxiety,
confidence, lacking purpose or meaning.

So he started holding informal group discussions both online and in
person about gaming and mental health, teaching participants about
meditation and allowing space for people to open up. By fall of 2019
the Kanojias thought that other people could benefit from these
conversations, so they started the Twitch channel.

The HealthyGamer_GG Twitch channel is part of a long lineage of
people broadcasting advice in pop culture. There was the psychologist
Joyce Brothers on TV starting in the 1950s. Sex therapist Dr. Ruth
became a household name in the 1980s. Dr. Phil's TV show is still
going strong today. But just as they became famous personalities,
Kanojia is wary about being too much of a celebrity. His fans make
Dr. K memes and make ironic jokes about how Dr. K is the only one who
can save them. But his hope is that those people will tune in long
enough to actually listen.

Reach Out: How To Help Someone At Risk Of Suicide

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Act Now To Get Ahead Of A Mental Health Crisis, Specialists Advise
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Games Are Taking A Back Seat To Players On Video Game Streaming Sites

"When they actually learn the stuff that we teach, what they realize
is that they don't need me," said Kanojia.

Addie Nicole Amick sings in the band Halocene, which has itself been
streaming on Twitch for over three years. She struggled with mental
health issues including depression and bipolar disorder. Watching the
HealthyGamer_GG stream demystified therapy for her.

"I think therapy is this scary unknown world that everybody's a
little afraid of," she said.

The HealthyGamer_GG stream convinced Amick to find a therapist, but
she couldn't find one who clicked with her. So she gladly agreed when
Twitch asked her as a partnered streamer if she wanted to participate
in a pilot program they set up with Healthy Gamer to provide mental
health peer-counseling for streamers.

It takes a toll having to be "on'' all the time in front of an
audience, even when you might not feel 100 percent. "There's over a
thousand people watching me," says Amick. "I'm sure there are some
people that are like, 'what's going on with this girl? I don't want
to watch this' and then tune out. And then you see the numbers drop
and then that gets inside your head."

Kanojia is careful to say that what he's doing on Twitch isn't
therapy -- he makes sure to say so at the top of every stream, there's
a statement at the beginning when streams get reposted on to YouTube
and every guest signs a consent form. But critics say it can look and
sound a lot like therapy, which raises some ethical quandaries. The
American Psychiatric Association Principles of Medical Ethics says
that when psychiatrists are asked to give an opinion about people in
a public situation, they can give general advice, "however, it is
unethical for a psychiatrist to offer a professional opinion unless
he or she has conducted an examination and has been granted proper
authorization for such a statement." The question here is what's
general advice and what's a professional opinion.

YouTube

"You can say 'I'm not doing therapy,' but everything that you witness
in the show is clearly therapy," says Rachel Kowert. She's a research
psychologist and the research director for Take This, a mental health
non profit that also serves the gaming population, and she is
concerned about the safety of the people on stream. Kowert also
streams about mental health topics on the Twitch channel Psychgeist --
but it's less personal, more focused on topics than people. She says
there's nothing inherently wrong with conversations being public, but
there is a clear line between a mental health advocate and mental
health professionals.

"The line is that mental health advocates do not generally provide
direct recommendations or opinions about individual cases, whereas
mental health professionals do."

Kowert points to a specific conversation Kanojia had with the popular
streamer and eSports player Byron Daniel Bernstein, better known as
Reckful, in late 2019. Bernstein begins the conversation talking
about being diagnosed with type-2 bipolar disorder, and as he
continues talking about his limited time feeling happy, Kanojia
interjects with "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."

The exchange continues:

    Bernstein: So you're saying you think I was diagnosed incorrectly
    when they said I have bipolar type-2?

    Kanojia: You may have depression on top of that, but what I want
    you to understand is that, like, there are different flavors of
    depression.

The exchange between Dr. K and Reckful got a lot of attention after
Bernstein, sadly, took his own life last summer. It affected Kanojia,
who looked up to Bernstein as a gamer for years. Shortly after
Bernstein's death, Kanojia took to his stream and talked about
depression and suicide among gamers, and he tearfully asked his
audience for help -- by helping each other.

"You be vulnerable, you share, don't worry alone," he said. "Remember
that your struggles are a multiplayer game, too. If you want to help
someone, start by asking for help."

If you or someone you know is having suicidal thoughts, reach out for
help. The National Suicide Prevention Lifeline is open 24 hours a day
at 800-273-8255.

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