TikTok’s unbalanced mental health content can be helpful or deeply distressing

TikTok’s unbalanced mental health content can be helpful or deeply distressing
TikTok’s mental health content has proven to be both helpful and distressing, according to the author. (Photos: iStock; Pixabay)

There are facts and alternative facts on the app, making it hard to know who to believe. 

“Don’t sleep on castor oil.” Sixteen TikTok rabbit holes later — carefully curated, based on my interaction with content about the oil that had purportedly been fighting for its place on the throne as nature’s best vegetarian balm since the beginning of evolved humans — I was standing in a pharmacy aisle looking like #beetlejuice #justhangingaround.

A manager walked up to me as I was staring at the healthcare shelf and asked if he could help.

“I, err… do you have any castor oil?”

“Ma’am, we’ve been sold out for over two weeks. Sorry.”

I almost didn’t believe it until I walked into a different pharmacy chain in my local neighbourhood only to learn it was sold out there too. “There’s this trend on TikTok…” the staff member said regretfully. “Oh…” I replied.

Instinctive, personalised, triggering

I could’ve bought castor oil from Takealot or a different place outside my immediate residential area, but the power of the platform I’d formerly mistaken for some dancing app hit like a ton of bricks.

I recognise that my sample of two pharmacies is not at all representative and that the one reference to TikTok is neither “rich” in its description nor statistically significant.

Even so, global online publisher Visual Capitalist notes that, by 2023, Tiktok had been downloaded more than 3.5 billion times worldwide since its launch in 2016 — making it the first non-Meta social media app in the world to achieve this. This download figure is not that far from roughly half the global population, currently sitting at eight billion.

Extreme surges in social media use during the start of the pandemic in 2020 earned TikTok a spotlight of its own, when it became the world’s most downloaded app between 2020 and 2021. The app is so popular that other platforms have been trying for the better part of the past five years to tweak and “update” its functionalities, including speedy developments that moved away from the text-and-images format to a decided focus on the quick video setup.

TikTok’s algorithm is eerily instinctive and highly personalised, basing recommendations on anything that offers clues about the kind of content users might prefer. Viewing preferences are curated to within an inch of itself and some scholars contend it is very often based on a user’s current state of mind.

Unlike other social media platforms (none of which I am active on), TikTok’s short-video format is a little like sampling a tasting menu of roughly 10 to 15 courses, wherein one’s interest is piqued at a rather primal level, combining visual novelty with an annoyingly clever interplay of catchy music.

In between all the castor-oil-benefit and RxCKSTxR-pet voiceover videos, I sometimes find myself searching for content in the realm of mental health. When I prompt the app in that direction, the content running along this continuum feels sincere and open-ended.

But, quickly, this little chug can yank a user from viewing safe and interesting content to something I can only describe as downright triggering and disconcertingly performative.

Distressing content

Before diving into any mental health-labelled content, the TikTok app presents the user with a relatively well-composed “mental wellbeing guide”, which includes messaging from expert partners who’ve developed toolkits for everyone to learn more about improving their wellbeing.

The guide takes you through a series of questions, including “testing” whether you’re ready to share your story before recording yourself. It also offers “important signs to pick up on whether someone is struggling” and potential steps one can take in response. Before you click on some #mentalhealth #mentalillness content, TikTok may issue a “viewer’s discretion” warning before allowing you in anyway.

Some of the content behind these hashtags comes close to the opposite of the content on the social media platforms we used to know. What I mean is that instead of viewing a highlights reel, you may find yourself watching a highly distraught person weeping into their phone with sombre background music or a timeline “countdown” (up to the day before) of a person who died by suicide. It’s genuinely distressing.

In April 2023, a study in the US found that TikTok offers many people a sense of “self-discovery”, but it warned that the algorithm also displayed “a worrying tendency to repeatedly expose users to content that could be harmful to their mental health”.

Through interviews with students, researchers at the University of Minnesota commented that participants find mental health information on the app helpful but, because of the way the feed works, it just keeps giving them more of the same: “That’s when it can go from being helpful to being distressing and triggering.”

The ‘therapeutic triad’

Sometimes snap mental health diagnoses are made based on lists (half of which are misleading) about the symptoms of serious mental illnesses, without having set foot in a licensed healthcare worker’s office.

Upon examining the dynamic interplays of capacities and constraints of therapeutic and algorithmic frameworks, another recent study found TikTok “a productive site” to examine mental health subjectivities, including ways in which people come to understand themselves in terms of mental health pathologies.

It is at this juncture that medical professionals — among them a great number of licensed psychiatrists and psychologists — are starting to push back over exactly what constitutes therapy and who can speak authoritatively about mental health matters.

This study, in particular, found that within TikTok exists a therapeutic triad: “therapists as creator-clients” (typically a therapist, social worker, counsellor or psychologist who also shares their mental health journey); the TikTok “algorithm as charismatic diagnostician” (the algorithm as the verifier of what users need); and the user as the affective mediator (the emotionally invested go-between). In a scenario like this, the more you interact with this content, the harder it gets to separate facts from alternative facts.

The therapeutic triad presents a unique framework that allows for unexpected kinds of interaction, care and help. It’s encouraging if you think about the many people who may be benefiting from it.

At the same time, it also permits new forms of exploitation, potentially threatening conventional modes of clinical settings, patient-client confidentiality and crucially, our self-understanding.

To this day, I’m still not sure who to believe in the castor oil debate. Kudos to those who kept emphasising that there’s no scientific evidence to back their content, though. DM

Florence de Vries is a communications specialist and journalist whose primary research interests are in the fields of mental health and the ethics of care.

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R29.


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