Sahar Khodayari, a 29-year-old Iranian woman, died on Sept 9, 2019, after setting herself on fire in protest at the threat of a prison term for attending a football match—an activity prohibited by Iranian authorities. She had disguised herself as a man to enter the Azadi Stadium in Tehran to watch her favourite football team. Security guards arrested her and an Islamic Revolutionary Court subsequently declared that she must face imprisonment. After leaving the court, she poured petrol over her body and set herself alight. She died a week later in the intensive care unit of Tehran's Motahari Hospital. She became known on social media as #BlueGirl, after the colours of her football team, Esteghlal. Zahra Abtahi and colleagues, from Florida International University, Miami, studied the public reaction to Khodayari's suicide as an example of collective or cultural trauma among Farsi-speaking Twitter users. They reviewed a random sample of over 8000 tweets sent in September, 2019, and hundreds of further posts made a year later. They identified three main themes—calls for greater awareness about her death; advocacy for social justice, through protests against the government; and the processing of public experiences and feelings. In the Journal of Traumatic Stress, they write: “In undemocratic countries, like Iran, where there are limited free physical spaces for public gatherings, social media provides a platform for people to come together after tragic events to express emotions and discuss thoughts and actions.” Twitter can be a valuable way to forge human connections when an event provokes the need for a sense of community, reflection, and social action. “The girls of my country are burning every day!”, wrote one Twitter user after Khodayari's self-immolation. The death of 22-year-old Mahsa Amini on Sept 16, 2022, while in the custody of Iran's “morality police”, for allegedly violating the Islamic Republic's strict hijab regulations is one more outrage that has mobilised social media. The rapid spread of public protests—amplified by videos of women removing and burning headscarves, cutting their hair, and defying Iranian police—led government authorities to shut down the internet. “Women, life, freedom” has become the signature call of this growing rebellion.
Few organisations exist today without a social media strategy—an attempt to control the storms of Twitter and related platforms. Medical journals are no exception. Twitter has become a powerful tool for science communication. During the worst moments of the pandemic, Twitter provided an indispensable means to connect with front-line doctors living through the hell of COVID-19-ravaged hospital wards. Some Twitter protagonists have become wise and compelling voices—Christina Pagel and Eric Topol, to name but two. Twitter remains the closest one can get to a global conversation about science and medicine, health equity, and social justice. It connects countries, communities, and generations. But Twitter has also evolved into a playground for acts of strangely performative narcissism. It has swollen the egos of some already privileged individuals who have become infatuated by their own myth-making.
What a waste. Growing numbers of research reports are describing the pathological effects of Twitter. Social media have accelerated the spread of racism. Anti-Asian hate speech was disturbingly common in western countries during the COVID-19 pandemic. This fact should be a serious concern for medicine. Racism is a troublingly neglected determinant of health. Ideologically populist political parties use a more aggressive and polarising vocabulary than moderate parties. Divisive political language is the new norm that fuels the spread of disinformation and hatred. These negative sentiments proliferate further and faster than positive sentiments, leading users to reinforce, perpetuate, and magnify sectarian hostilities. Much has been written about the diffusion of misinformation by social media during the pandemic, but most expressions of concern have amounted to little more than hand-wringing. Perversely, medical and public health communities continue to underestimate the harmful effects of social media on human health and wellbeing. Sometimes, we even contribute to those harmful effects. And as the tragedies of Sahar Khodayari and Mahsa Amini prove, if we continue to pollute Twitter with our small conceits and vanities, we trivialise its most important and urgent attribute—a place where fact can legitimately confront and oppose force.
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Published: 01 October 2022
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