The TikTokification of Mental Health: What Can a Legit Shrink Possibly Add?
Updated: Oct 6, 2023
Social media is the first place where many people get information about mental health. Yet misinformation on platforms like TikTok is rife and the algorithms serving up the content are based on the reach of the influencer rather than the quality of the information being shared. If the signal from qualified professionals is being crowded out by the noise of empty platitudes and misinformation, what can a legitimate shrink possible contribute in a 45 second soundbite and should they even try?
It seems so anachronistic that back in 2013 I wrote an article called "Should Shrinks Tweet" . in which my primary concern was how talking therapists may expose themselves too much and unwittingly diminish the quality of the therapy they provide. This would happen by contaminating the "blank screen" that, among many other important things, gives clients the freedom to speak about themselves without knowing too much about their therapist. How naive of me! How long ago that ship has sailed!
By the time my book The Psychodynamics of Social Networking came out in 2014 I moved onto exploring how Google searches and social media had irrevocably altered relational dynamics not just between shrinks and their clients, but between everybody. It does this by mediating how we present ourselves, how we perceive the presentations of others, and how relationships are mediated online. In short, it's all about how the architecture of social media platforms mediate our unconscious drive to recognise and be recognised by others.
Now the landscape has considerably shifted again. When I was coming up as a new therapist 25 years ago it was considered gauche to market yourself at all (modesty and word of mouth was the way) and it was considered downright bad taste to include a photo of yourself if you did choose a bolder marketing strategy (usually a leaflet or ad in the back of a local magazine or newspaper). Even when therapists, always laggards in the tech game, started having websites, many avoided including their image in them - hence inaugurating the nausea-inducing plethora of stoney creeks and sandy beach landscapes that continue to adorn counselling websites to this very day.
As it happens, humanising shrinks through the vehicle of social media is no bad thing. It demystifies therapy, helps to make mental heath professionals more real, approachable, and more accessible to broader audiences. But there is a downside too. Many therapists attempting to create a "personal brand" on social media do so by denigrating other forms of therapy or therapists; operating in echo-chambers that reinforce narrow points of view; and build followings by reinforcing stereotypical identities around diagnostic categories.
Rather than presenting therapy styles as different forms of treatment, this form of branding is often presented as "right" while constructing other methods as "wrong." Even worse, therapists, particularly on Twitter, frequently engage in public internecine wars which hardly make them look like the paragon of professionals trained in human psychology.
Mental Health TikTok: A choice between platitudes, mis-information, and a 45 second diagnosis:
Can't help yourself from checking your phone when you're supposed to be writing an essay? You probably have ADHD!
Feel nervous when you walk into a party and find it hard to make small talk? You probably have a social anxiety disorder!
"Psychology says expecting nothing from other people is self care."
"Psychology says pretending to be happy when you are in pain is a sign of how strong you are."
Introverts don't like it when people join them in a lift.
Social media is awash with empty platitudes, toxic positivity, statements of the obvious, inspirational quotes, and hopeful maxims. But being cliché doesn't make it wrong, and maxims are maxims because they have a grain of truth; a cascade of platitudes may be irritating, but they are not harmful. But neither are they psychology. If psychology were as simple as a snappy maxim, folks like me would be out of a job. But statements like the "psychology says" memes above are both invalid and harmful. So is ill-informed one-size-fits-all advice, not to mention mental health condition diagnosis via a 75 second video.
The Robert Downy Jr. meme above is a great example of a bad psychology meme for many reasons - but it's particularly illustrative because there is no such thing as an introvert. Introversion is not a diagnosis or personality type, is a preference. Though many of us tend to be more or less introverted or extraverted, we all have qualities of both - which is the point and beauty of the whole theory! What I like about this meme in particular is how it shows up the ridiculousness of an identity-based formulation shared on social media. Very few people welcome other people joining them in a lift - and the relief felt when the door closes is experienced by the vast majority of us, not just "introverts."
On social media we often see universal human traits co-opted under the umbrella of a single condition, diagnosis, or personality type, rather than as a preference for a state, trait, experience, or condition that we all share to some degree. As I have written elsewhere, this creates an atmosphere that focusses on differences rather than commonalities. It also reifies diagnostic categories like ADHD, autism, and anxiety disorders as wholly-contained concrete categories of identity, rather than labels to help us contain and gather a complex collection of symptoms, experiences, and traits. Limiting one's understanding of oneself under one label can limit one's capacity to explore broader versions of themselves beyond that label.
This is neither to dismiss these diagnoses nor those that identify with them, but it is important to bear in mind that we all experience the world differently, and we all have more commonalities than differences, outside of limited circumstances (psychosis, for example) it generally a matter of degree. Finding succour in an identity that connects you to others with shared experiences and traits is indeed a good thing - but holding them too tightly can interfere with the potential to expand beyond them as well as relate to others who experience the world differently.
On social media platforms, especially TikTok, short-form videos excel at taking relatively common traits and experiences and explaining them away as diagnostic criteria for a particular singular condition. The very act of being on a platform like TikTok activates the dopamine system which, in effect, mimics an attention deficit hyperactive response in the brain, so it's no wonder anyone may self-diagnose after watching a number of related videos on this platform.
The trouble is that the vast majority of those videos will have been made by influencers, not professionals. And while these influencers may have good intentions, they will be speaking from their experience and sharing personal opinions. While I whole heartedly support people talking openly about their experiences and that this sharing can be beneficial, there are important further consequences to consider, especially when you consider that according to one study more than half the content about ADHD on TikTok contained misinformation.
We all benefit from patient groups having a forum to speak about their experience - but many influencers on TikTok frame this as expertise. It's less a matter of patient voice than the platform and influence of the platform that is being used. You see, it would be equally irresponsible for a qualified professional to suggest a mental health diagnosis in a short TikTok video or Instagram reel. These short-form platforms are simply not the place for this sort of thing. In short, misinformation is a problem, but so is the misuse of the platform as a quasi therapeutic space - even if the information is correct! Hence we can't just blame unqualified influencers - professional content creators need to think critically about how they are using these platforms too.
The Great Paradox of De-Stigmatising Mental Health
We've come a long way in the past two decades in destigmatising mental health conditions. We now openly talk about things that were only recently hidden by shame, stigma, discrimination, and misunderstanding. Paradoxically, around the same time that we were de-stigmatising mental health conditions, many of us were also hard at work critically evaluating the nature of psychiatric diagnoses, where they came from and what they really meant: a psychiatric diagnosis (nor its treatment) is not as straightforward as diagnosing a viral infection. The publication of the DSM-5 (TR) came under intense scrutiny for expanding normal human experiences (e.g. prolonged grief) and turning them into a pathological diagnoses. Such was the concern about the rapid expansion of diagnoses and the numbers of people falling under them that Dr. Allen Frances, Chairman of the DSM-task force resigned and wrote his excoriation of the DSM-5 in his book Saving Normal.
Those of us who have gone through years of professional training understand that a diagnosis of mental illness is a construct based on a whole variety of factors, and as such they should be held seriously but also lightly. While diagnoses like psychosis and mood disorders are distinguished by the severity of the form they take and consequently the relief they can provide for those who receive a correct diagnosis (often after many misses) that lead to appropriate treatment, other diagnoses like Generalised Anxiety Disorder and ADHD are a more difficult to capture succinctly because their defining elements are shared by everyone in matters of degree. Few people will read the DSM criteria on GAD or ADHD and not identify with much of it - and again - this is not to say that for many the degree of these symptoms are not debilitating.
For many mental health professionals, the aim of deconstructing diagnostic categories like these was not to dismiss them entirely (though there are those in the anti-psychiatry movement who wish to) but to see them as the constructs they are rather than concrete entities.
The aim of destigmatisation wasn't just to be more inclusive and accepting of those with a diagnosed mental health conditions, but to show that we all experience challenges to our mental health to a greater or lesser degree - and that those with a given "condition" aren't something essentially "other."
While social media does a great job in helping to reclaim mental health conditions from being perceived negatively, enabling those with them to better embrace them as part of themselves, it also contributes to the dividing of people into distinct identity categories with shared traits upon which identities are founded: even when many of these traits are universally shared amongst the population. With so many people getting their information about mental health and illness from platforms like TikTok and then going on to self-diagnose and identify with those conditions, you can see why that might be a problem.
So What's a Qualified TikToking Shrink To Do?
This is a tough question to answer - but I've dragged you all this way - so I should probably offer you at least an attempt at answering it! When I wrote my piece about Twitter I covered some ground that is still relevant for professionals who go public on social media.
If you are a mental health professional on social media you should only post what you are comfortable with if every client, past, present, and future, could see what you've written.
This is enough to turn most professionals off. If it's not your style that's absolutely fine. You should really only engage if you want to, and you feel comfortable doing so. And if you choose to do so here is some more suggested guidance:
Never post any material, however anonymised, about what happens in your consulting room. "I had a client who..." should never appear on your timeline.
As a public professional, behave towards others with respect (or don't engage at all) descending into tit-for-tat bickering online doesn't help anybody. Healthy respectful debate is fine.
Communicate in ways that are suited to the platform you are using. For example, the lack of nuance on Twitter invites pushback - save complexity for other spaces (like this).
Know that by being public you will be the object of projection and that this makes you vulnerable. Take feedback online with a few grains of salt.
Ensure you abide by the guidelines of your professional body.
Most importantly, know why you are there, do it if you enjoy it, and do your best to make your contribution a positive one.
This last point is important because it will help you stay in your lane. You may be online to build your practice, promote your book, share your ideas, or just as a form of self-expression. Just be conscious of your aim and use it in a way that brings you a sense of joy and creativity, not an obligation. I do it because I'm committed to making the ideas from Depth Psychology more accessible - but also because I find it interesting in fun. When I don't anymore, I'll stop.
Why I'm There: Psycho-Education, Creativity, and Fun
When I decided to join Twitter it was generally frowned upon in the field. But that was a long time ago and all that's changed now. Still, how I came to that decision is important to share. I felt that though I was a psychotherapist, that didn't make me a monk who had to sequester himself away. I wanted to participate in this new public forum like everyone else, so I decided to do so in a way that I felt was responsible as a clinician.
Back in 2021 when I joined TikTok I did so because I thought it would be fun. In my undergraduate years I studied film-making, and TikTok gave me the opportunity to play around with all that again despite how cringeworthyness of my videos. TikTok gave me the opportunity to develop my creativity in the app and talking about things that I like to talk about (Freud, Psychoanalysis, etc.) to a novel and understandably perplexed audience. My most popular video by far is on the Oedipus Complex with over 400,000 views, mostly from gobsmacked youths who find the whole thing totally weird and incomprehensible (you can't blame them)! I have enjoyed the challenge of distilling complex ideas into minute-long videos, as I have done with my series on ego defense mechanisms. I have also had the great pleasure and privilege of making a series of videos on The Freud Museum London. My aim has been to be informative, fun, and to do my best to avoid platitudes or stating the glaringly obvious (which to be fair is difficult in psychology).
I'm hardly an "influencer" because my following is small - most of my videos get between 200 and 500 views. I have been told by many marketing gurus that my problem is that I do too much "aboutism". I talk about Freud, about Psychoanalysis, about Psychology. I don't tell people what they need to know or do to make their lives better - I'm not being the guru. The reason I have avoided this approach is outlined above. When limiting your content for these ethical reasons, it can be difficult to find what sort of contributions actually add value.
In the world of short form content it's very difficult to avoid empty platitudes, cliché, or simply stating the obvious. Attention spans on these platforms are too brief to go into any level of complexity.
It's more challenging that you'd think to say something that's novel, valid, and useful in a 90 second video (and only a tiny percentage of viewers make it to the end of a video as "long" as 90 seconds). Frequency of posting is also required if the algorithm is going to pick you up and distribute you widely. Because I do it mostly for fun, when I am moved to, and because I find it difficult to make even shorter videos that are the most widely consumed, my influence remains negligible. Mostly, I'm okay with that.
Mostly. While I still believe that the platform isn't ideal for the nuanced psychological insights I prefer to deliver, nor that if I were better able to do so, this input could be the signal that distinguishes itself from the noise of platitude and misinformation - let alone have anyone pay any attention to it - I do strongly believe that qualified professionals with a knack for sharing important and authentic information should be making their presence on these networks to at least make a dent against the tide of bullshit. With more than 80% of mental health material on social media being misleading and almost 15% containing information that can be harmful, qualified professionals have a duty to contribute in some way.
That still one's solve it. Essentially it's down to the platforms themselves to build in functionality where algorithms prefer authenticity over engagement. But we know this is not really in their interest. In my ideal world, rather that creating content that aims to run contrary to the current, I would like to see mental health professionals at the table in the leadership of these organisations. There's no reason why social media cannot deliver a degree of psychological and emotional intelligence within their platforms. However, since neither Instagram nor TikTok have offered me a board position, I'll try some more short form videos instead.
Addressing the Tiktokification of Mental Health:
My 30 Day TikTok Trial:
If you've made it this far, you're a real trooper since long form content like this is going the way of the incandescent lightbulb. But I thank you for your attention. While I will continue to produce long form content (because I prefer the nuance), but additionally, for the next thirty days I'll be releasing a series of short videos on TikTok and Instagram that experiment with my own answer to the question above in relation to the Tiktokification of Mental Health, "What's a Qualified Tiktoking Shrink to Do?"
There will continue to be a fair share of aboutism - but having enlisted the help of a friend and colleague who's better versed in the world of short-form social media than I - it will also be an experiment in different forms, themes, and expressions. I will continue to abide by my own set of guidelines and do my best to remain authentic and novel while attempting to produce shorter form content that doesn't diminish itself to the platitudinal or obvious. Whether I succeed or not (and what success means) we shall have to find out. The adventure starts today, with the ironically titled Why You Shouldn't Listen to Folks Like Me on Tiktok.