Rule 34 states that ‘if you can imagine it, it exists as internet porn’.
Similarly, in this digital age, ‘if you can imagine it, influencers exist related to it.’
Whether it’s makeup or live action roleplay, social media is full of people who share their hobbies, and who we in turn let shape our habits and purchases.
As trends move on for us, so they move on for influencers. And one of the talking points of the last few years has been mental health.
You’ll find two types of ‘mental health influencer’ on Instagram and beyond: The first may feature posts regularly or semi-regularly focusing on mental wellbeing; the second is someone who is part of an online niche of speaking primarily about mental illness, often focusing on their own experiences and diagnoses.
Followings range from large to small, and the messages can range in helpfulness from a blanket #bekind to touching stories of recovery or signposting towards free helplines people can call in crisis.
As a whole, mental health activism has been well-received, with many of the soundbites (it’s okay not to be okay, your feelings are valid, normalise speaking up) appearing on our stories and feeds.
Where things become complicated, however, is when influencers are relied upon to support their followers, and when they’re not equipped to deal with becoming ‘famous’ for being mentally ill.
Dr Paul Marsden PhD CPsychol FRSA, Consultant Consumer Psychologist and Lecturer in Psychology at University of the Arts London spoke to Metro.co.uk about the idea of the Dunning-Kruger effect, ‘a cognitive bias whereby people with limited knowledge or competence in a given intellectual or social domain greatly overestimate their own knowledge or competence in that domain.’
Essentially, sometimes the loudest people in the room are the ones who know the least, or as Charles Darwin put it, ‘ignorance more frequently begets confidence than it does knowledge.’
This is absolutely not to say that anybody trying to raise awareness about a topic through social media is uninformed (or worse, purposefully ignorant) but that it’s not always the most knowledgeable and careful people who cut through the noise.
‘A little knowledge can be a dangerous thing,’ says Dr Marsden.
‘It’s more complicated than you’d think and advice in mental health needs to be personalised.’
He also says there may be ‘ethical concerns’ over monetising content around trauma.
‘The whole influencer economy is about monetising,’ he says.
‘It’s driven by money, and so [mental health influencing] is not the same as having a sponsored post by by a fashion brand – you’re basically monetising people’s problems.’
Intention is an important thing to consider when it comes to any sort of activism or social influencing. Not all influencers are simply in it to make money or to find fame. For example, destigmatising mental illness is often cited as a big push for those in the public eye.
30-year-old Cara Lisette has just under 25,000 followers on Twitter, where she shares her eating disorder recovery journey and advocates for treatment for those with mental illnesses.
She initially started a blog using a pseudonym as she was so frightened of people knowing she was ill, but tells Metro.co.uk: ‘As I joined Twitter and started to become more active I found a group of people using it to raise awareness and it felt like an amazing movement to be part of.
‘I then started my own blog and a dedicated mental health instagram account and over time it has led to me becoming a more vocal and prominent campaigner, including starting a couple of viral hashtag movements.’
Although Cara says she tries to keep her persona ‘kind’ and ‘friendly’, she’s aware of the responsibility she has (even if that wasn’t the intention when she starting blogging).
‘I try to help as much as I can,’ she says. ‘I also do my best to avoid posting too much content that could be considered triggering.
‘For example, when sharing about my eating disorder I never share my weight, specific calorie intake, or BMI.’
Mental illnesses are – for the most part – messy, complicated, and difficult to live with. Suicide is a topic that is often discussed too late, with certain demographics (such as young Black men) experiencing high suicide rates partly due to stigma.
Destigmatisation for groups where mental illness is maligned is invaluable. But what does wider stigma against the mentally unwell look like in 2021?
A survey by the American Psychiatric association found that 54% of people felt mental health stigma had reduced in the last ten years, but just 14% used social media to improve their mental health.
A study looking at the Mental Health Awareness campaign Time to Change also found that people’s willingness to have contact with someone with a mental health problem has improved by 11% since 2009, while attitudes towards those of us with mental health problems have also improved by 9.6% in the same period.
In young people, it’s thought that watching videos or reading blogs on others’ medical issues ‘may improve young people’s health literacy, prompt individuals to access relevant health services and enable individuals to better explain their own health circumstances or make better health choices’.
Yet, on the opposing side, this same report states: ‘Measures to ensure information is credible and can be trusted by young people would need to be in place before social media is used as a means to spread official health information – although the potential is there for it to be a useful tool.’
‘Speaking up’ about mental illness is potentially less needed than it was before, given how commonly it is spoken about (by major figures such as Prince Harry and Meghan Markle, for example). What needs to happen next is action.
This point in the ‘awareness’ journey around mental illness is a watershed moment in that, as a society, we know what needs to happen. But at present there isn’t the funding or governmental impetus to ensure that everybody has access to what they need to get better.
It’s very hard also to separate your identity from your mental illnesses when they take up so much of your life and are what people associate with you.
According to the Centre For Mental Health, mental health problems account for 28% of the burden of disease on the NHS, but only 13% of spending.
In 2016 the NHS released a ‘Five Year Forward View for Mental Health’, with targets such as ‘expanding the Increasing Access to Psychological Therapies (IAPT) programme so that 25% of people with a common mental health problem have access’.
This target was reached last year, but some may argue that it wasn’t remotely ambitious enough to provide effective parity of esteem (where mental health is valued equally to physical health).
It’s all very well to see an Insta-friendly ‘don’t feel guilty for doing what’s best for you’, but what next? All the self-care in the world (commercialised or not) would still be an inadequate remedy.
People gravitate towards online communities if they feel underserved by traditional mental health care, providing a vital source of support that often isn’t there for those who can’t afford private therapy or are denied a diagnosis due to bias.
Dr Marsden believes that this ‘peer to peer support’ is necessary for those suffering with depression and anxiety in particular, but that influencers need to consider the quality of their message and ensure they’re signposting to official support channels rather than simply offering their own advice.
He says: ‘When it’s done right, mental health advocates have a critical pathfinder role – so they’ll actually point you to qualified expert information sources from qualified medical professionals – basically connecting people who need mental health care with people who deliver health care, and they are the go-between.’
Those in power would benefit from seeing a growing social media niche like this as a symptom of a societal problem, much like how we see the rising use of food banks as a signifier of poverty in the UK.
If mental health issues were treated earlier (through counselling in schools, for example, as well as addressing issues like poverty or bullying as part of a holistic approach), would people need to rely on parasocial relationships to feel ‘seen’ and to get advice on how to actually recover?
Mental health influencers who speak on their own experiences have a positive effect on society’s opinions – depending on the quality of their sentiment and how well they signpost – but labelling and pathologising ‘normal’ behaviours can be dangerous.
A search on TikTok for #mentalhealth shows that videos under that hashtag have been watched 9 billion times, with some picks near the top including one that calls ‘causal sex’ [sic] self-harm, and another that says worrying about losing your phone means you have social anxiety.
Users have no warnings or verifiable research to point them in the direction of useful content. Then, the more they interact with these pop-psychology videos, the more they’re shown them due to the algorithm.
It’s unfortunately up to consumers to cut through the noise of those aiming to go viral using scientifically spurious claims, and find support or content from trained professionals.
ADHD is a particular disorder that’s been spoken about a lot on social media recently, with some influencers in the mental health sphere creating ‘relatable’ content that’s designed to help people self-diagnose.
Dr Khaled Helmy welcomes the wave of social media inspired mental health awakenings. He says that lockdown and the explosion of TikTok in this time have both pushed people to seek treatment.
‘People are at home, they become bored and can take stock of problems. And then they have time to look at TikToks regarding that, like certain people raising awareness,’ he explains.
‘Then they read about the symptoms and say “oh, it’s me”. Many people come for treatment because they’re more aware of ADHD.’
He says that, typically, people don’t normally realise they have ADHD, seeing their issues as a set of separate problems and consequences (impulsivity, job losses, relationship problems, financial issues, drug or alcohol dependency).
Being prompted by influencers and advocates helps people see that some of the things they’re experiencing could be a mental health matter, and Dr Helmy says that this ‘increases the likelihood of these people to come for treatment.’
However, the influx of people assigning illnesses to ‘normal’ behaviours could delay finding the root cause of any actual issues.
‘One of the videos I saw was saying, “if you’re trying to fix things, it’s a trauma response to having your feelings invalidated”,’ says Dr Marsden.
‘I think it’s a real hazard in that it contributes to this kind of pathologisation of life, where we want to give things a label, and the normal stresses and strains of life we want to turn into a pathology by giving it a label.
‘People might see themselves as victims and start behaving as a victim to create this kind of victim and blame culture, which destroys your own sense of self esteem.
‘You get a sense of what psychologists call learned helplessness, with people feeling like “it’s not my fault, I was made this way and there’s nothing I can do about it”, which is not good for flourishing and positive mental health.’
It’s tough for even the most seasoned medical professionals to deal with this, given the extent of the mental health problem in the country. How do they ensure they’re not minimising people’s struggles while stressing that certain behaviours don’t meet diagnostic criteria?
For influencers, another doubled-edged sword exists. Speaking up during the bad times gets you noticed and supported, but when you’re known for your illness it means recovery is potentially tied to a loss of digital identity.
Cara says that she struggles with the positive comments she receives when sharing her story.
‘I have actually gained a lot of followers on my most recent recovery attempt which has been lovely and I’ve felt very supported,’ she says.
‘I do worry at times that as I progress further in that process that I will become somehow less “interesting” to people.
‘It’s very hard also to separate your identity from your mental illnesses when they take up so much of your life and are what people associate with you.’
There are numerous recommendations that could be made on the part of social media site owners and the NHS. It needs to be recognised that ‘fake news’ is not just a politics problem, and healthcare providers can no longer rely on waiting until someone makes it to the GP’s office.
All health information should be regulated. There need to be protections in place for influencers themselves to report distressing things they see and to access support themselves.
But, most importantly, official and professional mental healthcare has to cater to more people – including those who have grown up online.
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