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Christina Animashaun/Vox

How mental health became a social media minefield

Social media is now basically WebMD for mental health.

When I first downloaded TikTok, in the fall of 2018, it only took a few days for my algorithm to figure out that I have ADHD. To be fair, this isn’t all that impressive, as TikTok and the rest of the internet make it extremely difficult to focus on a single thing for more than five seconds — there is simply so much stuff to look at! — and it’s certainly possible to argue that anyone who spends enough time online may experience some of the symptoms that help psychologists diagnose patients.

Videos would show up on my For You page with captions like “Hidden signs you’re ADHD” and “what my ADHD brain feels like,” and I’d roll my eyes because I knew what was coming: They’d reference common attributes of the modern mind — difficulty focusing and difficulty switching tasks, difficulty completing boring tasks and difficulty completing difficult tasks — and finish by saying, “If you relate to this, congrats! You probably have attention-deficit hyperactivity disorder.”

The nebulous definition of ADHD, and Big Pharma’s push to diagnose and treat it, has made the disorder’s very existence the subject of intense cultural debate since before I was born. Were we overdiagnosing neurotypical brain functions? Were we overmedicating children who were simply acting like children? Was it all the health care industry’s fault? This line of questioning is a touchy subject for plenty of people who have found meaning and identity and medical help from their diagnosis. It has also turned discussions around ADHD and psychological conditions with similar symptoms — generalized anxiety disorder, depression, autism spectrum disorder — into land mines, capable of turning a good-faith debate into an endless back-and-forth of ad hominem attacks.

But in the past decade, as social media has forced billions of us to virtually bump into people we never would have otherwise, many of us have also found the need to categorize people into recognizable boxes. One way to do so is by seizing on common human behaviors to name — gaslighting, emotional labor, trauma, parasocial relationships, “empath” as a noun — then disseminating them until they cease to mean much at all. We end up treating mental illness like a subculture, complete with its own vocabulary that only those in the know can use and weaponize.

It often looks like this: On August 26, a woman posted a TikTok suggesting that “excessive reading” in childhood was considered a “dissociative behavior.” In the video, she turns to the camera and shakes her head as if having a sudden, life-altering realization that explains the trajectory of her life; the comments are flooded with people experiencing the same aha moment. “12th grade reading level in 5th grade you say? Damn … #trauma,” wrote one. “At this point all the character traits I have are just my neurodivergence [atypical mental function],” wrote another. (This wasn’t even the first time this discourse happened.)

The responses were not quite as kind once the discussion moved over to Twitter, after writer Jeanna Kadlec tweeted about how she related to the TikTok. Quote tweets ranged from frustrated (“y’all are still absolutely battering any kind of meaning out of the word ‘dissociation’ i see”) to darkly satirical (“oh, you read? that actually means you are mentally ill and abused. i have a huge brain.”) to earnest (“TikTok has pathologized every single behavior and personality trait, which perhaps has done less to destigmatize mental illness and more to dilute it to meaninglessness”).

Consume too much of the mental health internet and it becomes difficult to even understand what anyone is saying. “There is no strict frontier between what is pathological and what is not,” explains Joël Billieux, a professor of clinical psychology and psychopathology at the University of Lausanne in Switzerland. “It’s the way people live them [mental health conditions] and the meaning they give to them, which could result in psychological suffering or difficulties.”

At the risk of, well, over-pathologizing, it basically seems like there are two types of people: those who tend to appreciate and identify with this kind of internet diagnosis — “[X] behavior is actually a trauma response!” does legitimately make sense for some people and helps them live a happier life — and those who find it not just annoying but potentially harmful, stigmatizing, and unscientific. Nowhere on the internet — at least nowhere that I have come across — have those two types of people ever found much common ground, thereby making such discussions highly unpleasant and unproductive. It’s a terrible loop that we seem destined to replay forever. Is it doing us any good?


“It sucks” is the prevailing theory about the internet now, and this is not wrong. There are all kinds of guesses as to why it might be: According to legal scholar and coiner of the phrase “net neutrality” Tim Wu, it’s because of media consolidation and chumboxes; according to author Roxane Gay, it’s because of our tendency to presume the worst in others. Tech journalist Charlie Warzel says it’s because of platform-enabled context collapse, while Atlantic columnist Caitlin Flanagan blames Twitter. Perhaps it’s the never-ending mudslide of algorithmically generated content that leaves individuals stuck under a pile of hatred and extremism, or the ”Like” button, or maybe it’s Congress’s fault.

All of these things are likely true to some extent, but the theory I’ve been thinking about lately is what the writer P.E. Moskowitz calls the “BuzzFeedification of mental health” and which I’d argue can also be widened to the BuzzFeedification of identity (no shade to BuzzFeed or its quizzes, of course, which provide a great service to the procrastinating).

“The internet is basically a categorization machine, so part of me thinks it’s inherent to the internet, or at least inherent to corporate social media, where we all feel so overwhelmed by the vastness of the space and the number of people we interact with that we must whittle ourselves down into categories,” Moskowitz told me over email. “ADHD, bipolar, whatever it may be, become micro communities we can find safety and meaning in.”

Self-selective processes are natural for human beings, and they can obviously be quite useful on the internet, where some amount of gatekeeping is necessary to foster a certain environment. Groups for people whom society often marginalizes — like, say, those with mental illness or who share a common history of trauma — must enforce an element of exclusivity in order to be useful. The trouble starts when, Moskowitz argues, these identity markers are used as a rhetorical tool.

Moskowitz was the subject of this sort of vitriol in early August, when they posted a photo of their Tetris-like parallel parking job. The photo went viral on Twitter, with dozens of people quote-tweeting and replying that Moskowitz was ableist for failing to consider the cars that now might have a difficult time exiting their spot. They were also called a “malignant narcissist” (not an actual term psychologists would use) by someone who explained that they knew a malignant narcissist when they saw one because, they said, they’d been raised by a malignant narcissist.

“I see it most when people want to win arguments — they pathologize themselves to give themselves authority (‘I have XYZ disorder therefore you must listen to me’ or ‘You are being XYZ horrible thing — racist, classist, narcissist, whatever — therefore you’re wrong’),” Moskowitz says. “The categorization allows for a flattening of nuance. You can’t argue with someone calling you a sexist or a sociopath or whatever, and you can’t argue with someone who bases the entirety of their argument in their personal experience.”

This instinct has only intensified over the past 18 months. Amanda Brennan, an internet trend expert at XX Artists, has observed the ways that, after sitting with themselves and reflecting during the isolation of the pandemic, many people have come to monumental realizations about their gender, sexuality, mental health, and identity. “It feels good to say, ‘Here’s a set of predetermined things that I can try on like a hat, and if it fits, it fits,” she says. “It’s like the closet scene in Clueless: You try it on and see how it feels.” (My favorite example of this: a TikTok that reads “when it was supposed to just be 2 weeks on Zoom but now you’re bisexual.”)

One place that Brennan sees it take on some rather unhelpful forms is in fandom discourse — for instance, in May, when Vice journalist Gita Jackson made an offhand tweet about the Harry Potter character Hermione Granger being “annoying” and a “know-it-all” and was then accused of being ableist because some of them felt that Hermione is “coded as autistic.” As the comics news website CBR pointed out, “Jackson is neurodivergent, and the people accusing them of ableism on Twitter seemed to care more about defending a supposedly neurodivergent fictional character than respecting the real neurodivergent person they were talking to.”

Yet it can be an extremely human reaction to defend our own worldviews. “When people are really involved in a fandom, they’re going to see these heavy things from their life in the things that they love because they want to feel more connected to it,” explains Brennan. But sometimes “it starts to become, ‘Well, my headcanon [an individual’s belief about a fictional text that is not canonical to the story] is what matters most, so I’m going to argue that XYZ is X-coded.’ It’s almost like, ‘I want to be seen by this thing that I love, so I’m going to read it this way, and no one else can fight me on it.’”

What we’re talking about here is the problem of being, as it’s often called, “chronically online.” “What’s the most chronically online take you’ve ever seen on the internet?” begins an immensely popular TikTok audio where users can respond and give their own examples. The most common are almost exclusively instances of pathologizing unremarkable behavior: a Reddit comment that suggested a woman was “grooming” her boyfriend because they started dating when she was 19 and he was 18; a video where “cakegender” was given its own pride flag meant to represent “people who feel light and fluffy.”

@cabbagionexus

#stitch with @sorrel.hartley we need to enact grass touching laws. #chronicallyonline #badtake #aita

♬ original sound - Cabbagio Nexus

It’s difficult to talk about this sort of discursive overreach without sounding like a far-right reactionary; indeed, criticisms of over-pathologization have come from conservatives who argue that, to generalize, it’s all just a bunch of self-obsessed liberal snowflake eggheads. “One of the biggest problems is that the far right has correctly identified that this is happening — that the discourse and identity policing has gotten out of control,” Moskowitz tells me, to the point where it becomes hard for others to push back against it without sounding as though you’re siding with an ideology they don’t adhere to. “There needs to be a strong, leftist stance of ‘we’re not going to do this identity-pathology policing thing anymore, but that doesn’t make us reactionaries.’”


Whether doctors over-pathologize certain normal human behaviors has been a subject of great interest in the medical field; when the DSM-V, the standard classification of mental disorders, was published in 2013, many psychiatrists argued that it medicalized typical behavioral patterns and moods, possibly as a result of the pharmaceutical industry’s influence. (One common example here is the potential to misclassify grief over the loss of a loved one as major depressive disorder.)

Billieux has studied gambling and gaming addictions extensively, and warns against the instinct to diagnose every symptom. “The idea of being able to categorize mental illness like you’re categorizing insects, for example, is something that is very complicated and probably is not valid in the context of psychiatric disorders and psychological suffering,” he explains. “These labels are very reductive in terms of defining the psychology of someone, and they tend to ignore individual differences.” He cites studies showing that anywhere between 5 and 30 percent of the general population experience auditory or visual hallucinations — which are stereotypically attributed to mental illness — at some point in their lives without any other issues.

Who’s to say, though, that reflecting on one’s own mental state and seeking help is a bad thing? The American medical system already discourages us from receiving care — it’s unknowably expensive, infuriatingly confusing, and inaccessible to the people who need it most. “There is a treatment gap, which means that there are people suffering who cannot access or don’t want to access psychologists and they should,” Billieux says. “That doesn’t mean that choosing a specific label will help you to overcome this difficulty, or be beneficial at all.”

Take, for instance, generalized anxiety disorder (which I have also been diagnosed with), which hinges on what a patient or doctor decides is an “excessive” amount of a fundamental human emotion. Diagnoses like this are left relatively vague to account for individuals’ ability to function in society and the amount of suffering their anxiety causes, but online, they can sometimes be used as throwaway terms. “For some people, especially when you’re young, there is a bit of a pull to join a group. And the group of people with social anxiety or depression feels like one you can easily join,” Natasha Tracy, author of the book Lost Marbles, on her experience with bipolar disorder, told Mashable.

Many people do benefit from finding the language to describe their psychological experience — it’s the reason group therapy often greatly helps people, explains Inna Kanevsky, a psychology professor at San Diego Community College who uses TikTok to debunk viral myths about mental illness. But she argues that labels aren’t necessarily an instant solution. “Once people start using science-y terms and labeling things, [they believe] they’re contributing to solving the problem, but it doesn’t exactly explain very much. It’s like, what are we going to do?” She uses the example of the online ADHD community to point out that diagnoses can be blurrier than we’d like to think. “Generally, ADHD coping strategies can be helpful for anybody,” she explains. “You don’t need to label yourself to use the advice.”

@dr_inna

Proper differential diagnosis requires a lot of training. I don’t have it, and you likely don’t have it either. But you can start by yourself. #mentalhealth

♬ original sound - Inna Kanevsky, Ph.D. (she/her)

It can feel special, understandably, to adopt a label around which to frame one’s identity, if not outright cool. And the internet rewards it: “Whereas a therapist might question the usefulness of identifying oneself as permanently aligned with whatever struggle one is experiencing, engagement-driven platforms help frame conditions as points of identity, badges of honor,” explains Isabel Munson in a piece on Real Life. People in our own lives may reward it, too: As writer and TikToker Rayne Fisher-Quann pointed out, friends and family tend to be much more forgiving and understanding when you can excuse behavior using a label, as opposed to trying to articulate the complexities of the human mind at any particular moment.

Treating mental illness like subculture, though, can have unintended consequences. Just a few days ago, I was served a TikTok ad for a direct-to-consumer startup centered on delivering cutely branded ADHD medicine to your door. Was this an ad targeted to me based on what TikTok assumes? Or was this sent out to the general public, implying that there are enough people on TikTok who have or think they have ADHD to make the ad a worthwhile investment?

In a story on internet pathologization for i-D, James Greig writes that easily categorizable people are also easy to market to. “While there is genuine support out there and a lot of good intentions, it’s worth bearing in mind that some of the people involved in pushing these diagnoses have a vested interest in doing so,” he writes. (Consider the zillions of products that claim to quell anxiety, a market that’s exploded over the past decade.)

Perhaps the solution to this sort of categorization and grouping is to redefine the terms. “To me, we should start seeing identities more as things you do rather than descriptors of who you are,” says Moskowitz. “I am trans because I care about trans life, because I commune with other trans people, because I donate my money to other trans people. It’s all well and good if you want to claim an identity, but I think every identity comes with responsibility to the communities it represents, to the histories that made those identities possible. If that makes me a gatekeeper, so be it.”

An overreliance on specific labels to characterize oneself as infallible and others as morally suspect only serves to divide us further, making it more difficult for everyone to get proper support. Is it helpful to dismiss someone because you believe they have borderline personality disorder (itself a somewhat controversial diagnosis), or, on the other hand, is it helpful for someone with BPD to excuse the harm they may cause others based on their own diagnosis? Is it helpful to accuse someone of being ableist for, say, being attracted to “himbos,” or are we expending our anger, our frustration, our cynicism at the state of things on whoever happens to tweet something we didn’t like that day?

Diagnosing issues in each other may feel like progress; it may feel like identifying problems that are solvable. Perhaps we feel that as long as there are enough commenters telling someone their video failed to incorporate every single human experience that things could change for the better. But the main change it’s made so far is creating a cycle of bad-faith name-calling (“You’re being classist!” followed by “Go touch grass!”) and mutual resentment.

I hate internet pathologization for the same reason I hate the concept of generations or niche left-wing political posturing: They needlessly divide people who desperately need each other to further their goals. To use a very banal example, memes like “ok boomer” are funny, but divorced from context they ignore the conditions of low-income older adults who’ve been screwed over by the same forces as young folks. Internet pathologizing is an individualist exercise, basically. As a technically “neurodivergent” person (another term that often feels unproductive to me), I’d much rather connect with other people over the aspects of modern life that everyone, neurodivergent or not, can benefit from: access to medical care, therapy, and child care; higher-paying and flexible work opportunities; community support; and a stronger social safety net.

That stuff is hard, though. It’s a lot easier to scroll TikTok and Twitter, whiplashing between outrage over a hastily written tweet and electrifying realizations that perhaps every aspect of your identity could be explained by a single diagnosis. Either way, we’re sitting around, thinking about ourselves. And that, ultimately, is what it is to be a person — not someone with narcissistic personality disorder.

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