“You can do as many brain scans as you want, but you’ll never be able to distinguish an impulse that wasn’t resisted from one that’s irresistible.” — Sally Satel on why social media addiction can’t be proven in court

When Meta and YouTube lost the so-called landmark social media addiction trial back in March, there was jubilation inside and outside the courtroom. Finally, Big Tech seemed a bit less big. Justice, it seemed, had finally been done.

Or maybe not. (Full disclosure: my wife is head of litigation at Google, so I might be a bit biased). But today’s guest, the psychiatrist Sally Satel, doesn’t have a dog (or husband) in the fight, and she’s a skeptic of the trial’s outcome. A senior fellow at the American Enterprise Institute and the medical director of a Washington methadone clinic, Satel argues that the concept of addiction — her clinical specialty — was distorted in the trial to serve a $1.4 trillion litigation pipeline. The plaintiffs’ theory reifies addiction as behavior beyond control. If that were true, Satel argues, none of her patients would ever get better.

Satel comes at this as a doctor rather than a moralist. Clinically, she acknowledges, social media addiction exists — excessive use, loss of control, continued harm — and the treatments are the same behavioral strategies she uses at her clinic. But legally, where causation is everything, the plaintiff argument collapses. No brain scan can ever distinguish an impulse that wasn’t resisted from one that’s irresistible. The mechanism of harm is unprovable — a ludicrously brittle foundation, Satel argues, for a trillion dollars of lawsuits against social media companies.

So when is “addiction” really addiction? Satel’s upcoming book Not a Disease: Rethinking Addiction in the Heart of America’s Overdose Crisis, which will be out in early 2027, addresses this awkward truth. And we’ll certainly have her back on the show to discuss.

Five Takeaways

• The $1.4 Trillion Distortion. The Kaley verdict was $6 million; the pipeline behind it is $1.4 trillion. The suits reify addiction as behavior beyond control — and if that were true, Satel's methadone patients would never get better.

• Clinically Real, Legally Incoherent. In a clinic, social media addiction is recognizable and treatable. In court, it collapses: no brain scan can distinguish an impulse that wasn't resisted from one that's irresistible. The mechanism of harm is unprovable.

• Demoralization Is Not Depression. Nine in ten patients arrive reciting diagnoses they don't have. Kids diagnose themselves by internet because a diagnosis is now valorized.

• Woke Therapy. Counselor training now teaches that the therapist knows what's wrong before the patient speaks. Satel's emblem: a young man fired by his therapist over a remark about his rabbi's sermon.

• The Good News About Fentanyl. Deaths are falling: Narcan nailed to telephone poles, tightened supply, and a generation opting out.

About Keen On America

Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen.

Website: https://keenon.tv/ Substack: https://keenon.substack.com/ YouTube: https://youtube.com/@KeenOnShow

Pre-order Not a Disease: penguinrandomhouse.com/books/839111/not-a-disease-by-sally-satel

Chapters:

00:00:31 Introduction: the March social media addiction trial
00:02:17 The $1.4 trillion pipeline: four states sue Meta
00:04:27 Kaley's case: a $6 million bellwether
00:05:01 Fragilities that predate the platforms
00:07:33 An age of diagnosis — or an age of anxiety?
00:08:26 Depression or demoralization? Histories at the methadone clinic
00:10:53 Diagnosing by internet: the valorized diagnosis
00:12:17 One Nation Under Therapy: is there credible therapy?
00:14:26 Trained eclectic: neuroscience and Freud
00:15:40 Over-medication and the fifteen-minute diagnosis
00:17:40 David Rieff, Philip Rieff, and the triumph of the therapeutic
00:19:42 Medicalizing sadness: where daylight becomes night
00:21:30 Has therapy been politicized?
00:22:14 A raging moderate on woke therapy
00:26:57 The rabbi, the therapist, and the fired patient
00:29:21 Can we really be addicted to social media?
00:29:41 What addiction actually is: the DSM's criteria
00:30:41 Chalk dust and cocaine: people, places, and things
00:33:39 Self-binding: grayscale phones and confiscation
00:35:48 Public enemy number one: what should we do?
00:36:39 Haidt, phone bans, and the collective action problem
00:38:27 The unprovable: irresistible, or just unresisted?
00:40:23 Good news: why fentanyl deaths are falling
00:43:43 Not a Disease: Satel returns in 2027