Arachnophobia

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Social media is much maligned, so much so that the US surgeon general called for a warning label on social media, blaming it for adolescents’ declining mental health.¹ Australian lawmakers already approved social media bans for children under 16.²

Given the uproar over social media, one might think that nothing good could come from these popular online platforms. Yet a psychiatry resident reports that she was relieved of her long standing spider fears (arachnophobia) via self-directed exposure therapy on an arachnophile subreddit, where spider aficionados post photos of their pet spiders. The affordability, availability, and accessibility of her innovative deconditioning exercises impressed me, especially when compared with more expensive virtual reality approaches discussed at the American Psychiatric Association’s digital psychiatry tutorial.

The resident’s technique, with its ease of use, and its $0.00 price tag, might be extra valuable when mental health professionals are in short supply but mental health needs skyrocketed. Admittedly, there is only so much we can generalize from an N=1, especially since that N is a nonrepresentative sample of 1 highly motivated and highly educated psychiatrist-in-training. We need larger and more diverse samples, studied over longer intervals, before generalizing about the projected success of this approach, its utility with a broader population pool, or potential drawbacks in varied settings. Given that our society currently issues trigger warnings about emotionally evocative stimuli, and that we are constantly concerned with medico-legal liability, it seems wise to recommend that this interesting antiphobia antidote be used in supervised appointment settings only.

As for the self-experimentation described, I should stress that her choice of this treatment was initially inadvertent. On the upside, this self-help strategy circumvented cumbersome Institutional Review Board approvals, which are admittedly in place for a purpose, but which can discourage even the most resolute resident-researcher. Still, self-experimentation in medicine has a long tradition, even if it is typically viewed askance.

Robert K. Altman, MD, a renowned physician-journalist who authored an entire book on this understudied topic (Who Goes First? The Story of Self-Experimentation in Medicine),concluded that self-experimentation is more common than we might expect. It is sometimes surprisingly successful.³ Not every experiment turns a benevolent Dr Jekyll into a destructive Mr Hyde, as detailed in Robert Louis Stevenson’s famed 1886 novella.⁴

Many transformative medical discoveries included self-experimentation. As a case in point, which is especially relevant to psychiatry, Dr Joseph Goldberger started with observational studies of the epidemiology of pellagra. To prove that this devastating and often deadly disease—which contributed to a significant percentage of psychiatric admissions in our Southern states—had a nutritional, rather than an infectious, etiology, he hosted filth parties where he and his staff ingested pellagra scabs, without developing any of the characteristic 4D’s (dermatitis, dementia, diarrhea, death)of pellagra.⁵

Thanks to Dr Goldberger’s persistence, and his willingness to engage in unorthodox techniques that challenged the prevailing scientific wisdom, the US was eventually freed of this disorder and many individuals who had been hospitalized in psychiatric sanitaria recuperated and returned home.^6,7 Compared with these filth parties, scrolling through social media posts and eyeballing arachnoids to relieve phobia symptoms seems tame.

This piece was published in conjunction with An Unexpected Psychiatric Benefit of Social Media: Exposure Therapy.

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.

References

1. Murthy V. Surgeon General: why I’m calling for a warning label on social media platforms. New York Times. June 17, 2024. Accessed February 19, 2025. https://www.nytimes.com/2024/06/17/opinion/social-media-health-warning.html

2. Kim V. Australia has barred everyone under 16 from social media. Will it work? New York Times. November 28, 2024. Accessed February 19, 2025. https://www.nytimes.com/2024/11/28/world/asia/australia-social-media-ban-law.html

3. Altman RK. Who Goes First? The Story of Self-Experimentation in Medicine. University of California Press; 1998.

4. Stevenson RL. The Strange Case of Dr Jekyll and Mr Hyde. Longmans, Green & Co; 1886.

5. Bungum T. The contributions of two public health pioneers: John Snow and Joseph Goldberger. Nevada Journal of Public Health. 2005;2(1):14-19.

6. Morabia A. Joseph Goldberger's research on the prevention of pellagra. J R Soc Med. 2008;101(11):566-568.

7. Ozarin L.The case of the vanishing diagnosis. Psychiatric News. January 21, 2005. Accessed February 19, 2025. https://psychiatryonline.org/doi/full/10.1176/pn.40.2.00400028