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Real Conversation – There’s No App For That

Think about the last time you had a really good talk with someone. Maybe it was over lunch, or in the car, or over the phone. Or maybe, ideally, the conversation took place in a living room or other comfortable space, without time pressures or interruptions. If so, you made eye contact, observed facial expressions and body language, and shared personal moments together. This typically creates increased feelings of closeness and strengthens the bonds of friendship or family relationships. Afterward, you likely felt that you knew the other person better and that he or she knew you better in return. Does this kind of conversation happen often? Ever?

Now think of your most recent text or email thread. These, too, are often referred to as conversations. But do they serve the same purposes? Are they of equal value? It doesn’t take much thought to realize that the differences are striking and important. These digital communications inherently lack the level of interpersonal connection and intimacy that the face to face (and, to a lesser extent, phone) conversations provide. Here are several reasons:

  • We often must guess about the intended tone and emotion of texts and emails. Using emojis and other symbols help in this regard, but they can only go so far.
  • Text and email often embolden people to “say” things they would never verbalize face to face. Unfortunately, this is almost always in a negative sense.
  • There’s no rhythm to electronic communications, and sometimes longer or shorter pauses between responses are misinterpreted.
  • It’s difficult to know someone’s true response to our digital communications, because we can’t see facial expressions or body language, and responses can be tempered and thought out before being sent.
  • The overall tone of text messages and emails is cold and unemotional. A smiling emoji doesn’t have the same effect as a smiling human face.
  • The inability to make eye contact when communicating electronically means that it can never be as personal and meaningful as face to face conversation

There are many other items that could be on this list. Some argue that the muted emotions of digital communication can be a positive thing, leading to fewer arguments, or less contentious relationships. Another argument is that the additional time afforded to craft responses and make them “perfect” is a net positive as well.

However, being human is messy, and so are relationships. It’s often in the real-time, back and forth of in-person conversations that closeness is created, despite the stress – or maybe even because of it. If our communications are too clean and sterile, does the human part of the connection we should feel with each other really stand a chance?

The Empathy Crisis

At this point, you may be wondering why I am writing about this particular topic in a pediatric blog post. Rightfully so. But this actually has a lot to do with our children, from the youngest newborns to the current generation of teenagers. Young people today are part of the most “connected” generation there has ever been. But it is clear they are often failing to make the most important connections for long term happiness – emotional connections with each other and those around them. There is mounting evidence that one of the biggest casualties of the digital age is the ability of children to learn and feel empathy. This could have catastrophic consequences in the years and decades to come. But awareness and prevention are keys to averting the potential crisis.

Empathy is defined as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.”¹ The ability to be empathic is an essential component of good mental and emotional health. Indeed, it is one of the key elements of all healthy societies, communities, and families. The lack of empathy results in all kinds of social ills.

Empathy is learned… and taught. Piaget and Freud once proposed that empathy can only be learned after a certain age. For Piaget, that age was 7. He claimed that children are inherently self-centered from 0-7 and unable to understand another’s point of view or feel the emotions of another. This is now known to be false, and even the youngest children can learn and show empathy. Children under 2 years of age can be observed to feel what another is feeling. Toddlers are sensitive to the feelings of their friends and will often mimic their emotions, a necessary precursor to empathy. But empathy needs to be repeatedly modeled and encouraged in toddlers before it becomes a part of their behavior. Three-year-olds can make the connection between emotions and desires, and they can respond to a friend’s distress with simple soothing gestures. Five and six-year-olds are learning how to read others’ feelings through their actions, gestures, and facial expressions — an essential part of empathy and social skill.²

Empathy Across Age Groups

From birth to about the age of 2, eye contact, facial expressions, physical contact, shared noises, soothing, and many other interactions are the mainstays of healthy nurturing. So what happens when new parents, instead of engaging with their infant for hours on end, as should be the case, devote their attention to a screen, small or large? Then, what happens when they put a small screen in the hands of their one-year-old and teach her how to swipe, open apps, and become fully engaged with such an entertaining device? Now all eyes are on screens, rather than on each other. If this pattern is repeated often enough, then a child may spend more time interacting with the virtual world than with their real-world teachers and mentors. How can she be expected to learn empathy, and myriad other essential interpersonal skills, in this world of limited face to face interaction?

In her book “Reclaiming Conversation,” author Sherry Turkle writes the following:

The work of psychiatrist Daniel Siegel has taught us that children need eye contact to develop parts of the brain that are involved with attachment. Without eye contact, there is a persistent sense of disconnection and problems with empathy. Siegel sums up what a moment of eye contact accomplishes: “Repeated tens of thousands of times in a child’s life, these small moments of mutual rapport [serve to] transmit the best part of our humanity – our capacity for love – from one generation to the next.”³

Yet study after study shows that we spend less and less time in personal interactions, physically making eye contact with each other and interacting. This is truer the younger the age of those studied. If parents are eating dinner with their children, that’s a wonderful opportunity to connect and bond. However, if they’re eating dinner with their children and looking at their phones the whole time, the opportunity is wasted, and they may as well be eating at different times and in different places.

Now picture a grade-schooler. At this stage, he craves the attention and affection of his parents and those around him. He requires frequent mentoring, modeling, and physical play. At school, he is learning the basics of acceptable behavior in various social settings and can see his peers’ reactions to him, both positive and negative. But if most of his interactions are digital, then he doesn’t get this feedback. Or worse, in some online and virtual interactions, what would normally be negative and harmful behavior may produce positive feedback and reinforcement (think violent video games, or viral videos of people treating each other badly, etc.).

Again, no viewing experience can replace all of the benefits of personal interaction, especially with parents. So if one of the most often modeled parental behaviors is looking at a phone screen, or a computer screen, or a television screen, what do we expect our grade-schoolers to learn? What do we expect them to view as most important to their parents? And what do we expect to be the result of minimal face to face interaction between parents and children?

When Teens Lack Empathy

Fast forward a few years, and an early teen is surprised to get in trouble over a post on social media. She doesn’t understand why her friend was hurt by it. After all, she was “just having fun” and “it’s not real.” When asked to put herself in her friend’s position, so she can comprehend how her friend felt, it’s as if she doesn’t understand the concept. The idea of apologizing to her friend face to face is out of the question. She does manage to admit that she never would have said the words in her post directly to someone in person but also admits that she is unlikely to change her online behavior.

It turns out that this teen’s limited personal interactions are with a small group of people who are very similar to her. The vast majority of her communications are on social media, generated on her phone, and the only feedback she receives is through likes, retweets, repostings, and comments. She prefers to communicate, even with her friends, by digital means rather than in person. And while she says that she loves to hang out with her friends, she is typically on her phone at those times, while her friends are on theirs. This has been referred to as being “alone together.” She spends far more time on screens than she does in actual conversations with the people around her. Statistics show that this is the case for the vast majority of teens today. The fact that most teens are more connected to electronics than to each other and their families should be unsettling to all of us.

The Cost of Tech Success

Among today’s parents of children and teens, there is a growing feeling that we were blindsided by the onslaught of digital devices over the past several years. With all of the amazing things these devices can do and their many applications, we didn’t think twice about sharing these miracles with our children. Once all of these devices came within reach of the average consumer, and we could buy phones and tablets and computers and gaming devices for ourselves and our children, we never stopped to ask ourselves if we should.

These devices and apps and games were created to be used. Success in the tech world is measured by the amount of time people spend using a product. Make no mistake about it, addiction is the goal. An addicted consumer represents a constant revenue stream. It’s very telling that many of the leaders of the biggest tech companies are notorious for not allowing their own children to use tech. Waldorf School, one of the most reputable schools in Silicon Valley, forbids the use of electronics anywhere on campus. They even discourage screens at home. Tech giants know exactly how dangerous and harmful their own creations can be, and they try to protect their children from it. And they start from the time they’re born. It’s bad enough if teens are dependent on their phones and devices, but how much worse is it when that dependency begins before preschool?

What Can Be Done?

Delay the age at which children are exposed to these devices. This will not be easy, and for some, it is obviously too late. But the American Academy of Pediatrics has long warned about the use of screens too early in life, and the detrimental effects it can have on normal social and intellectual development.4 So while it may be cute that your 2 years old knows how to work your smartphone, it’s difficult to measure the harm that may be done to a whole generation of tech savvy but socially stunted children.

Encourage children to play together without electronics. I believe that what happens on the playground during recess is just as important for long term success as what happens in the classroom. When children play together, without devices, they don’t just play. They talk, they joke, they laugh, they argue, they may even fight on occasion. They learn how to interact with each other, what’s appropriate and what is not. They learn how to be a friend, to think outside of themselves, and how to empathize. If this is only happening at recess, however, and not in the hours after school and on weekends, then children are unlikely to sufficiently learn these invaluable human lessons.

The teenager equivalent to this is hanging out without using electronics. I’m not sure this is even done anymore. What it will take is for some teens to no longer tolerate phone and device use when they are hanging out together. The current state of being “alone together” with everyone looking down at a screen can be replaced by conversation, actually getting to know each other and deepening friendships. It will take a brave few to do this, and then it may spread. We can encourage our teens to be among the trendsetters.

Many are now recommending that no one under the age of 16 should have a smartphone. And those over 16, who have a smartphone, should be closely supervised, with parents checking on their phone and social media accounts regularly. These ideas are often met with derision from teens and parents alike and dismissed as being out of touch with the realities of today. But today’s reality is not a great one. Levels of anxiety, depression, loneliness, feelings of isolation, bullying, and suicidal ideation have all increased in recent years. There is a direct correlation between these problems and the amount of time spent on electronics, particularly smartphones.5 Junior high students appear to be particularly vulnerable to these effects. For those who will not swap out their teen’s smartphone for a flip phone, then you may employ parental controls either on the phone itself or through your wireless carrier. This can be an important step in helping your teen decrease time spent (wasted) on the phone, opening up more of an opportunity for social interaction (actual talking).

Create tech free places or times. While at the dinner table, when the family is at home together, when friends are physically with each other, and while in the car – these are some of the times and places for disconnecting from devices and connecting with people. It will likely take some effort and persistence to change these habits, but creating more opportunities for conversation is a goal worth pursuing.

We must look at ourselves and make the changes we want to see our children make. Think back to the beginning of this article. I asked you to recall a conversation in which you truly connected with someone, and you were both better for it. When was the last time you had a moment like that with your teenagers? For those with younger children, when did you last have floor time with them, play a game together, look in each other’s eyes and really connect? If these experiences are not the norm, then there is work to be done.

Look Up From Your Phone, Shut Down The Display

In his 2014 video, Gary Turk poignantly made the case for consciously limiting our use of electronics in order to connect more often with those around us. Here is the link:

Some of my favorite lines from this video are the following:

“So look up from your phone, shut down the display.

Take in your surroundings, make the most of today.

Just one real connection is all it can take

To show you the difference that being there can make.”

We Simply Must Make Time for Conversation Again

This is true in the workplace, in public spaces, on buses and trains, and most importantly, in our homes. If you don’t feel you’re very good at it, then practice. Look people in the eye, smile, and speak. Express a generous thought. Share an experience. Tell a joke that falls flat, and then laugh because it wasn’t funny. Take time to listen, to learn, to empathize, to care. Create the bonds that can hold a friendship, a family, a company, a community together. This is done through the most human of all the media we have – conversation. We owe it to ourselves to ask the hard questions and make the hard changes. And we owe it to our children.


¹ (online dictionary)

² Ages & Stages: Empathy, by Carla Poole, Susan A. Miller, Ed.D., Ellen Booth Church

³ Reclaiming Conversation – The Power of Talk in a Digital Age, by Sherry Turkle

4 Children and Media Tips from the American Academy of Pediatrics

5Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time

A Better Night’s Sleep

We all know the feeling of hearing the alarm go off after a long night of counting sheep. Getting a good night’s sleep is essential to maintaining health and enjoying life.  There is no magic recipe for getting the perfect night’s sleep, but there are several basic practices that can help increase the chances of getting a long, restful night’s rest.

The amount of sleep needed varies depending on the individual and the age group. Babies generally need 16 hours of sleep each day, teens should get 9 hours and it’s recommended that adults sleep 7-8 hours each night. These numbers may vary and it’s important that you FEEL like you are rested after each night’s sleep. Signs of a good night’s rest may include:

  • Waking up when the alarm sounds
  • Clear thinking
  • More energy
  • Less worry or stress (or maybe better able to handle the challenges of life)

Better sleep does mean a better life! What are some basic things that all of us can do to better our night’s rest? The answer is Sleep Hygiene. Sleep Hygiene is a lot like personal hygiene. It includes the basic things that we should do every day (like brushing our teeth and taking an occasional shower) that will keep us on track to getting a solid night’s sleep every night. I won’t list all the aspects of Sleep Hygiene but a few of my favorites are listed below.

  1. Scheduled Bedtime and Wake time. We all remember getting told to get to bed, but somewhere along the way we forget the wisdom of our mothers and we start thinking other things are more important. Going to bed at the same time every night and waking up the same time every morning might be challenging at first, but once the habit is created, sleep will improve.
  2. No screen time. The blue light that comes from our TVs, phones, tablets, etc. can keep you awake, so do your best to decrease usage and do not use them in the bedroom!
  3. Get up as soon as your alarm goes off.

Getting a good night’s sleep is essential for the enjoyment of life. I believe we are here to enjoy the time we have, and by doing the small things to achieve a better night’s sleep, I have no doubt you will feel better and enjoy life more!


Haley Pledger, PA
Women’s Care
Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
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