Why do we love to pathologise normal behaviour online?

By reducing nuances of mental health to sweeping statements, social media might actually be leading to over-diagnosis.

by James Greig
22 April 2021, 7:00am

Did you enjoy reading as a child? I'm sorry to be the one to tell you this, but the cherished hours you spent reading Harry Potter books were actually just your body’s way of dissociating in an uncomfortable environment (also RIP to your idea of JK Rowling as a decent person). Do you sometimes forget to text your friends back? It’s probably, definitely, because of a past trauma, and certainly not the natural result of a culture in which we are expected to be socially available at all times. Better get a therapist on the line! Do you struggle to concentrate at your office job, where you spend eight hours a day performing boring tasks in front of a screen? I hate to be the one to tell you this, but there’s probably something immutably wrong with the chemicals in your brain.

As far as the internet is concerned, just about everything you do might be evidence of a troubling pathology. Social media can undeniably be a great resource for people experiencing mental illness, alongside people who have ADHD, and people who fall somewhere along the autism spectrum. A condition like ADHD, for example, is still said to be underdiagnosed (particularly among women) and raising awareness about this might bring people to a diagnosis they sorely need. But as with many things online, there is a downside to a free, entirely unregulated flow of information.

Across Instagram, TikTok and Twitter, the phenomenon of people ascribing diagnoses to everyday behaviour is rife.It doesn't matter how innocuous the trait in question is, someone, somewhere on the internet, is eager to tell you that possessing it is evidence of a medical condition or life-long disorder. “Sometimes doctors get criticised for medicalizing things, but the public can do that as well,” Dr Jon Van Niekerk, from the general adult faculty at the Royal College of Psychiatrists, tells i-D.

“The problem with diagnosing [online], and people presenting as mental health experts when they’re not, is that you can actually create more anxiety: if you get it wrong, you're going to over-diagnose, and then something which is normal gets pathologised.” But on the other hand, “you could be giving someone reassurance, when really that's not what they need. A lot of the time when people come and see their GPs or mental health professionals, we'll do physical examinations to make sure that [the symptoms aren’t part of] an underlying physical health problem, so you have to be careful you’re not missing that.”

The idea that people with ADHD are “relatable” has become something of a meme in particular. It’s very, very easy to look at a symptom and think “that’s me”, particularly when it’s presented without context. Everyone struggles to concentrate sometimes; most people have lost a set of keys or turned up late to an appointment. But having a few symptoms of a syndrome does not necessarily mean you have a disorder -- something which can get lost in the “if you do (x), then you’re (x)” genre of post.

“There is a spectrum,” says Dr Van Niekerk. Take the example of BPD (Borderline Personality Disorder): “Being impulsive, or sometimes having mood swings, especially if you're a teenager, is part of just normal maturing, it doesn't mean you've got borderline personality or you're narcissistic. There’s a lot of misunderstanding of these terms.”

Social media incentivises reductive or sweeping statements, meaning that these kinds of distinctions often get flattened by the way we talk about mental health and neurodivergence online. Given that its platforms are mostly limited to 60 second videos, 10-slide infographics, or 280 character microblogs, it rarely provides the space necessary to tackle these topics with detail or nuance. According to Dr  Natalie Hendry, from the Digital Ethnography Research Centre at RMIT University, Melbourne, and co-author of a new book about Tumblr, this effect is motivated by a number of factors.

The main culprit is, of course, our good friend late capitalism. “Whenever you create a space on social media for people to talk about these things, there's also a new market that pops up,” she says. “On TikTok, people are obsessed with passive income. The pandemic and people losing jobs and money means that people are finding other ways to build an income.” This could be creating and monetising Canva worksheets to help plan your day while you're dealing with ADHD, or marketing journals with cool little graphics in them to help you process your trauma. “There’s this market that sits alongside people sharing tricks and tips.” This market -- and the financial imperatives that come with it -- sits alongside the culture of diagnosing strangers with mental illnesses and disabilities. In a sense, it depends on it. 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.

Clout and money might help to explain the motivations of the influencers and content producers, but why are users en masse so keen to participate? It seems as though there is a real, widespread eagerness to interpret our own behaviour through a medical lens. According to P.E Moskowitz, author of the lucid psychological newsletter MentalHellth, this phenomena is less about individual brain chemistry and more about the society we live in.

“I think people feel overwhelmed by the Internet, and overwhelmed by society at large in the sense of how confusing and isolating it is. If you're 18 or 19 and you grew up in the suburbs, you don't have access to much real community -- most of your community is online. And online is a very confusing space,” she says. “I feel like this kind of categorization of mental illness into these very specific things allows you to find communities.” Which isn’t entirely a bad thing, right? It’s all very well urging young people to seek “real” offline help, but the truth is that these “more legitimate” methods are often inaccessible. Dr Van Niekerk acknowledges that, in order for people to get the right care, “We need the government to give us enough resources.” Perhaps the reality we need to face is that these nebulous social communities are the best care people can get right now, and at least something’s better than nothing.

“I think it's great to be able to relate to people and find a community based on your traumas and how fucked up and maldapted you feel to society,” says P.E. The issue is, however, that these overly-pathologised views of mental health and neurodivergence usually invite us to situate the root of the problem firmly within ourselves, and as fixed parts of our identity. “If more and more of us all feel so maladaptive to the point that we require medication, then perhaps we can all collectively realise that something larger is going on that does not have to do with the chemical composition of our brains. I think we need to realise that it's something larger than that.”

In the past, criticisms of over-pathologising have often come from the conservative right. According to Dr Hendry, these conversations aren’t new. “There’s a book from 1966 that conservatives love, called The Triumph of the Therapeutic by Philip Rieff,” she tells me. “It argues that, as psychology became more dominant in the Western world, people became more and more obsessed with making sense of themselves through their emotional worlds, using psychological language and ideas.”

“The Triumph of the Therapeutic has since been republished by the conservative press ISI books, as its narrative in terms of what the right currently refers to “snowflakes”, “vulnerability”, and “being triggered”, feels sadly quite contemporary.” It’s clear that these ideas are still prevalent on the right today, where there is a widespread mockery of safe spaces, content notes, and all manner of conditions, based on the assumption that people are exaggerating their distress for attention.

But there are ways of critiquing these online cultures without being an alt-right troll. Whatever you think of pathologising normal behaviour online, we should always believe people when they tell us they’re suffering -- particularly in 2021, when your safest assumption is that practically everyone around you is existing in a state of spiritual agony.

“We're all living these lives of fucking brutal despair right now, because capitalism is just getting worse and worse,” says P.E. “We all feel isolated. But for some reason, people can't connect these things. The reason that people are basically killing themselves through opioid use, to me, is the same reason that you feel so completely unable to function on a daily basis that you need seven different mental health meds. Our brains are not meant to live in this society.”

It seems reasonable to suggest that when someone thinks they have ADHD, BPD, PTSD, or whatever, this doesn’t necessarily mean that they do. It’s possible to be mistaken, particularly given the wealth of misinformation out there. But even having the suspicion that you have a disorder suggests that something isn’t right, and we should take that seriously. Why else would you be driven to categorise your behaviour if you didn’t have the nagging feeling that something was lacking, or that it might be possible to live your life in a way which wasn’t so difficult?

This isn’t to say that medication isn’t often necessary and helpful, but that the answers may lie outside of the current medical model. What’s interesting about the culture of online pathologising -- which its adherents often claim exists in opposition to this framework -- is that it still upholds its exact value system.

The existence of this online culture is an indictment of both the lack of support available, and the wider climate which makes people miserable in the first place. It can also stand in the way of us recognising these external factors. Where it exists, our unhappiness, our inability to function, should stand as a rebuke. “Viewing [my ADHD symptoms] as a symptom of something larger in our society that is preventing me from being able to function in the ways that I want to, versus it being some inherent brain thing, is very important to me,” says P.E. “Because it makes me feel like the world is changeable; that we can build a better society where these things are not as big of a problem, as opposed to thinking that I am irreparably broken.”

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