Within minutes of his first live-streamed conversation with Byron Bernstein on Twitch, Alok Kanojia He issued his warnings. This was not a therapy session; this was just a conversation. His colleagues had warned him, he explained, that blurring the line could lead to a lawsuit.
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“I am a psychiatrist, but I cannot treat your depression via the Internet,” he said.
“Yes, I understand,” Bernstein said.
Kanojia’s fleece jacket bore the logo of Harvard Medical School, where he had done his residency. But he had also been a video gamer who had followed the record-breaking trajectory of Bernstein, known in the gaming world as Reckful. Kanojia smiled at the younger man in open admiration.
“Tell me, what are we talking about today, friend?” he said.
The next hour and 53 minutes were intense. As reactions poured in from viewers, Bernstein spoke about his older brother’s death by suicide. He spoke of his own suicide attempt, of his ordeal with lithium, of the nights when he fell asleep hoping not to wake up. The two men clearly liked each other and Bernstein said he was getting better. They had six conversations, with live audiences numbering in the hundreds of thousands. Then, a few months later, the dialogue ceased, tragically, with Bernstein’s death by suicide at age 31 in 2020.
Kanojia, now 41, has said he never entered into a doctor-patient relationship with Bernstein, and that heoff-line encouraged him to seek medical attention. His critics say he violated professional ethics by exploiting a vulnerable man and allowing him to believe he was undergoing treatment when he was not.
Two years ago, one such complaint reached the Massachusetts medical registration board, where Kanojia is licensed to practice.
Ethical dilemmas like this arise more frequently as mental health care expands beyond the traditional one-on-one private session.
It is now common for licensed physicians to interact with members of the public on live streams, video calls or social media.
Meanwhile, Americans are hungry to hear about other people’s mental health issues and are willing to share their own. Therapy sessions are the basis of a popular podcast and a hit streaming series.
Kanojia, known on Twitch as Dr. K, He declined to comment for this article, citing “a long-standing policy of not discussing private relationships in public settings” and referring questions to his wife, Kruti, co-founder and CEO of Healthy Gamerher coaching and mental health business.
Kanojia began streaming interviews with prominent gamers in 2019, breaking down their mental health struggles in conversations that sometimes lasted hours, while viewers showed their approval with donations and subscriptions to Healthy Gamer.
In Bernstein’s conversations with Kanojia, the popular player almost immediately began recounting his lowest moments, sometimes in tears. The videos drew some criticism, mostly from other mental health professionals in the gaming world.
Rachel Kowert, a research psychologist and founder of Psychgeist, a studio that produces content about video games and science, said conversations andran indistinguishable from therapy, with Kanojia commenting at one point on Bernstein’s psychiatric diagnosis, pointing out that “what you are describing is not clinical depression,” but rather “that his life is empty.”
“He’s giving specific advice for specific people, rather than general advice, which is therapy,” Kowert said.
Kanojia portrayed himself as an innovator, fighting against a medical system that was unable to meet the needs of young people. But he was also aware of professional barriers.
“Hopefully I don’t get sued because I’m not actually providing medical care,” he said during his first conversation with Bernstein. “You know, what if someone goes online and then commits suicide or something?”
“I’ll try not to kill myself anytime soon for you,” Bernstein replied with an easy smile.
“Yes, thank you,” Kanojia replied with a serious expression. “I really appreciate it.”
“Yes, no problem,” Bernstein said.
Offline, Kanojia was taking other steps, Kruti Kanojia said. Although their first conversation was spontaneous, Kanojia asked Bernstein to sign a disclaimer acknowledging that she understood he was not receiving treatment, she said.
For a while, the conversations seemed to benefit everyone. Many viewers said they had been inspired to seek mental health treatment themselves, Kruti Kanojia said.
“It was far more powerful than anything I’ve seen in a public health setting,” he added.
In their sixth interview, Bernstein was optimistic, saying that “everything in my life started working out as soon as we started talking.” The two agreed to continue their conversations offline.
That was in February 2020, just before Covid lockdowns pushed many people into deep social isolation. Bernstein’s condition deteriorated and one of his friends became concerned that he might hurt himself.
On June 30, 2020, the friend contacted Kanojia, who “followed standard guidelines for referring someone, including for outpatient care, higher levels of care, and the use of emergency services,” the Massachusetts Board of Medical Registration concluded.
Bernstein committed suicide on July 2, 2020.
“We went through the standard guidelines and referred him — I wish they had been done sooner,” Kruti Kanojia said. Many things kept Bernstein from doing so, she said: He had been involuntarily committed in the past, and his older brother had committed suicide after starting antidepressants.
“Yes, we live in a broken system,” Kutri Kanojia said. “Why would this person want to participate?”
In a video posted two days after Bernstein’s death, a sobbing Kanojia pleaded with his viewers to live.
“I tried with Reckful, I really tried,” he said. “But I can’t do this alone. Because at the end of the day, I’m not superhuman. I’m just me.”
Two years later, Max Karson — a newcomer to the streaming world — decided to file a complaint against Kanojia.
Karson had never met Bernstein or Kanojia. But he studied psychology at university and his father and grandfather are psychologists. He has a strict view of the boundaries of psychotherapy.
He said he was shocked the interviews, which he said “blatantly” violated ethical guidelines and benefited Kanojia by attracting viewership and donations.
“Reckful didn’t know if Dr. K was his doctor or his friend,” Karson said in an interview. “And a blurry, boundaryless pseudotherapeutic relationship is inherently harmful to the patient. That’s why it’s against the rules.”
Karson is a content creator and acknowledges that this was part of his motivation: criticism of Kanojia was “entertaining for my audience,” he said.
Before Karson filed the complaint, Healthy Gamer had begun introducing “self-corrective actions to address the most problematic aspects of guest interviews,” the company said in a statement in July. The changes included a “call to set boundaries” so guests could identify topics that were off-limits; the option to delete the interview if guests were uncomfortable with the outcome; and a referral packet for mental health services, Kutri Kanojia said. The videos open with a written disclaimer warning that the content “is not a substitute for professional medical care,” she added.
In June, after a two-year investigation, the Massachusetts licensing board reprimanded Kanojia, alleging that he had “engaged in conduct that undermines public confidence in the integrity of the medical profession.”
A reprimand is a “severe censure,” a spokeswoman for the licensing board said. But it has few practical consequences. The board chose not to revoke Kanojia’s license, fine him or limit his medical practice.
In a recently posted video, Kanojia expressed relief at the outcome. He framed the reprimand as a kind of vindication, as the board did not find him negligent or responsible for Bernstein’s death or conclude that he was providing internet therapy.
“That’s the most important thing, that we don’t need to change a single thing in our process,” he said.
In the years since Bernstein’s death, Healthy Gamer has grown into a thriving for-profit company, employing 200 coaches and staff members and providing coaching certification. Kanojia’s profile is rising: He published his first book, and this summer, the Kanojias were invited to the White House to attend a roundtable for influential YouTubers.
Karson, who filed the complaint, described the reprimand as “better than nothing.” But he doubted it would have much effect because Kanojia’s followers would not view it as a serious punitive action.
Gary Bernstein, Bernstein’s surviving brother, said his family had nothing to do with the complaint.
Kanojia “seems like a very nice, friendly guy,” she said, adding, “On the other hand, he did some kind of dangerous things,” delving into deep emotional territory that had brought her brother to tears.
“He was doing that on the broadcast, right?” she said. “Maybe he would think that that could have negative repercussions. But that didn’t seem to stop him.”
‘Yes, we live in a broken system.’
Kruti KANOJIA
CEO of Healthy Gamer, with her husband, Alok Kanojia
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