Why TikTok is the Worst Therapist I’ve Never Paid For

Sometimes it feels like social media algorithms know me better than I know myself, and nowhere is this more true than the For You Page on TikTok. Even the most minute changes in my mood, beliefs, or daily habits are picked up by the app. And, as the app learns more about me, I have also learned a lot about myself.

As someone who has spent years improving my mental health through therapy, some of my greatest breakthroughs and moments of self-awareness have come through coming across content that calls me out. Sitting across from a therapist, it is easy to pick and choose what aspects of the self you want to reveal. In contrast, you cannot hide from the algorithm, and everything from likes to comments to watch time can betray the true state of your emotional well-being.

And while I always resonate with the content that comes across my For You Page, like most people, I know that you can’t trust everything (or everyone) that you see online. With the amount of misinformation that circulates within and outside of social media platforms, I have recently begun to side-eye any and all mental healthcare advice that floats across my For You.

Especially in light of the emotional experimentation on users that platforms like Facebook have been heavily critiqued for, there is something incredibly suspicious to me about the spread of mental health or therapy content online. With more and more Big Tech corporations getting into the business of healthcare, perhaps we should all be thinking about how the algorithms underlying these apps are not only capable of manipulating what we see online, but also how we feel, who we talk to, and what we do in response to those feelings.

TikTok as Mental Health Haven

Although social media content is never a replacement for one on one therapy or support groups, I think most can agree that counseling services are expensive and not readily available to everyone everywhere. Therefore, many people either look to those around them or the internet in order to cope with their mental health concerns.

And, even when people do have access to therapeutic services, it is not uncommon for therapy goers to get a second opinion from Dr. Google every now and again. In this sense, the internet is a great starting off point to do research and find helpful strategies or even a community of like minded individuals that can help improve one’s mental health.

Reflecting on our current moment in time, the COVID-19 pandemic will be known as a moment of collective trauma that many people will be recovering from for years to come. Social media platforms like TikTok offer a space for people to come together and add some levity to the difficult experiences that we all have been facing. As it is stated in the article “13 Mental Health Professionals Using TikTok to Help Others”, we can see how the app can actually be used to share information that can assist in getting through tough times.

At the same time, Mental Health TikTok is not all laughing at our collective COVID induced pain and the community is not all mental health care professionals. Much of the video content which falls under the category of #MentalHealth (or any number of related tags) comes from people who have their own struggles with a range of disorders and diagnoses. In sharing their stories, these individuals are doing the important work of removing some of the stigma around struggling with mental health and seeking help.

Creating Community through Content Creation

By creating content from the perspective of the patient and not the therapist, the comments sections for mental healthcare videos become their own internet support groups. Individuals who struggle with the same diagnoses can find comedy and comfort in seeing themselves represented through someone else’s stories. In addition, for those who are struggling with the symptoms of a mental health disorder without the diagnosis, these videos offer the language for what might be wrong and advice for what the viewer can do about it.

This community building, a norm of the internet and social media, is not only one of the best parts of TikTok but also one of the biggest issues with mental healthcare content on the app. As it was stated earlier, most people do not have access to therapeutic services, and when it comes to TikTok, many of the users aren’t old enough to engage in the self-advocacy and self-awareness required to seek help.

Due to the fact that there are multiple layers of privilege underlying one’s ability to receive proper healthcare or official medical diagnoses, there are many individuals who choose to self-diagnose. This is especially common when it comes to disorders that are more difficult to diagnose as you get older, like autism or ADHD. And although it is not my place to pass judgement on the validity of self-diagnosis, I do feel it is my place to pass judgement on the validity of social media algorithms and the logic of recommendation that might lead to the dangers of self-diagnosis.

The Problem with Self-Diagnosis

Unlike working with a therapist one on one, many people on TikTok have chosen to self-diagnose and identify with any number of mental health disorders based on the recurring recommendations of the algorithm. Similar to the hypochondria that comes with diagnosing yourself through Dr. Google or WebMD, the free flow of mental health content on TikTok is also creating its own mental health crisis as users flock to diagnose themselves based on the app’s video recommendations.

However, the algorithm is not a therapist working to better your mental health, but a technology that is engineered to give you what you want. For some users, this can be very helpful, as the recommended videos on their For You Page become a starting off point to their mental health journey and reaching out to a mental healthcare professional. Yet, for others, the validation from users on the app and the algorithm can be a hindrance, because they don’t understand how the content that they are seeing is a reflection of their choices and not their personality.

Known for its AI and the way that the app uses machine learning, the creators behind TikTok have been able to keep users hooked on the site because of how responsive the algorithm is to the user. As users interact with content, the algorithm is learning what they like and what they want to see. If you self-diagnose and begin to self-identity with a particular community or type of content, the algorithm is going to keep feeding you that content so that you keep coming back for more.

In this sense, by aligning oneself with a community of users that identifies with a particular mental health disorder or diagnosis, many users are unknowingly creating a self-fulfilling prophecy for themselves on the app. The more they interact with content which reflects a particular diagnosis, the more of it they will see, giving credence to a diagnosis that may or may not be accurate.

Healthcare Algorithms and Artificial Intelligence

Recent statistics have indicated that we spend hours on our phones everyday, significantly more time than most people would spend talking to a therapist or a loved one about their problems. Therefore, it is easy to conflate what the app knows about us with who we truly are, simply because the algorithm has spent more time with us and therefore collected more data on us than most people have.

And to some extent, this computer generated diagnosis is a prescient example of many concerns around the future of healthcare and data. As healthcare algorithms become a part of diagnostics within hospitals and doctor’s offices we are seeing greater integration of these algorithms into important decision making processes. This integration not only brings up concerns around algorithmic bias and the ethics of letting a computer influence medical opinion, but also concerns around data collection and sharing.

Large technology corporations like Google and Amazon want to get in on these data stores by making deals with key players in the healthcare industry. These deals mean that the companies that have data on our spending habits, on our interests, and even our beliefs will now potentially have access to data on our health and wellness. These deals have started to make me wonder how adding the valence of healthcare data to the large stores of data that tech giants already have will influence us all.

We are now living in an era where advertisers, media makers, and even government officials no longer have to guess at what the public thinks, wants, and needs. They can know about, and predict, every aspect of our lives with great detail and certainty through social media data. Especially knowing that algorithms are already being used to influence small things like consumer spending habits and future trends:

What other ideological shifts are made possible now that we are telling social media algorithms about our mental health concerns?

How will this health and wellness data, whether official or unofficial, be used in the future?

Protecting the Future of Mental Health Data

Especially as COVID-19 has ushered in the expansion of tele-health and seeking healthcare services online, it will be incredibly important to protect the data that is collected on our mental health i.e. who has access to it and what they use it for. Through drafting and instituting legislation and policies which not only put a check on the sharing of health related data by the Tech Giants, we must all also be conscious of the way that we freely share our mental health data and concerns online.

In this case, TikTok users need to become more conscious of how machine learning and the algorithm works, instead of trusting in the algorithm to know more about them than they know themselves. There are also multiple changes that TikTok could, and should, make in order to help users responsibly engage with health related content on the app.

For example, TikTok currently includes a feature that informs users who experience seizures due to lighting changes that certain videos contain a strobing effect. Similar to the warnings seen on TV series which deal with serious topics, warnings could also be placed on content that is speaking to medical diagnoses encouraging users to seek out professional help, support services, or just taking the content with a grain of salt.

Overall, the popularity of this type of content is also a clear example of the importance of mental healthcare at this time. So, in addition to making changes when it comes to the collection and dissemination of healthcare data, there is also a lot of progress that needs to be made towards making therapy, psychiatry, and other mental healthcare services more affordable and accessible to all individuals, whether in person or online.