The way we commonly discuss mental-health issues, especially on the internet, isn’t helping us.
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Anxiety has become its own genre of popular content. Social-media feeds are crowded with therapy influencers who tell us to be more aware of our anxiety, our trauma, our distress. Instagram is full of anxious confessions and therapy-speak. The TikTok hashtag #Trauma has more than 6 billion views. According to Listen Notes, a podcast search engine, more than 5,500 podcasts have the word trauma in their title. Celebrity media are awash with mental-health testimonials, and summaries of those testimonials, including “39 Celebrities Who Have Opened Up About Mental Health,” “What 22 Celebrities Have Said About Having Depression,” and “12 Times Famous Men Got Real About Mental Health.”
As anxiety has become content, it’s also become a part of more daily conversations. I’ve spoken with many parents about my work on America’s mental-health crisis in the past few years, and several have noted that their kids share their symptoms and diagnoses in group chats, rattling off the acronyms OCD, GAD, and PTSD with a casualness once reserved for high-school gossip.
What’s wrong with this? One might think that nothing at all is. Surely the rising volume of anxiety content partly reflects the rising volume of actual anxiety; the share of teens today who say that they are persistently sad has never been higher. What’s more, the destigmatization of distress can clearly be beneficial. We are finally talking openly about emotional crises that, in the past, were buried in silence and substance abuse.
But in the past few years, I’ve become more convinced that the way we commonly discuss mental-health issues, especially on the internet, isn’t helping us. Watching and listening to so much anxiety content, which transforms a medical diagnosis into a kind of popular media category, might be contributing to our national anxiety crisis.
The way we talk about the world shapes our experience of the world. In 2022, the researchers Lucy Foulkes and Jack L. Andrews coined the term prevalence inflation to describe the way that some people, especially young people, consume so much information about anxiety disorders that they begin to process normal problems of living as signs of a decline in mental health. “If people are repeatedly told that mental health problems are common and that they might experience them … they might start to interpret any negative thoughts and feelings through this lens,” Foulkes and Andrews write. This can trigger a self-fulfilling spiral: Some individuals who become hyperaware of the prevalence of anxiety disorders may start to process low levels of anxiety as signs of their own disorder, which leads them to recoil from social activities and practice other forms of behavioral avoidance, which exacerbates their anxiety.
Prevalence inflation might explain why some policy makers and schools have struggled to reduce anxiety with behavioral interventions. As The Atlantic’s Olga Khazan has reported, studies have found that several mental-health programs for young people actually made many of their mental-health problems worse. One study of a U.K. mindfulness program that included more than 8,000 British teenagers found that the intervention increased anxiety. Perhaps the programs were half-hearted; maybe the teens weren’t fully engaged, or parents weren’t folded into the program. But it’s also conceivable that the programs haphazardly increased the salience of anxiety, depression, and distress for students without giving them the proper tools to dispel those negative feelings.
Darby Saxbe, a clinical psychologist at the University of Southern California and a mother to a high schooler, told me she has come to think that, for many young people, claiming an anxiety crisis or post-traumatic stress disorder has become like a status symbol. “I worry that for some people, it’s become an identity marker that makes people feel special and unique,” Saxbe said. “That’s a big problem because this modern idea that anxiety is an identity gives people a fixed mindset, telling them this is who they are and will be in the future.” On the contrary, she said, therapy works best when patients come into sessions believing that they can get better. That means believing that anxiety is treatable, modifiable, and malleable—all the things a fixed identity is not.
This is just one way in which our society popularizes the language of therapy while eviscerating the substance of it. Another is through the arousing negativity contained in much viral media: indignation, anger, shame, “I’m literally shaking.” Something about the five-alarm fire of moral outrage burns efficiently across the prairie of the social web. But cognitive behavioral therapy, for example, encourages patients to avoid catastrophic thinking, to cool the fire of anger, to reconstruct their feelings and thoughts to be more patient with themselves and with others. The share of adults receiving mental-health treatment is surging, but we have built an online ecosystem that thrives on the very principles that counselors implore us to reject.
When I asked Saxbe whether internet conversations about anxiety might be partly driving the anxiety crisis, she readily agreed. Marshall McLuhan’s observation that “the medium is the message” has been on her mind as she notes the way that social media takes people out of the physical world. “We all, and young people in particular, too often use our phones to withdraw and avoid,” she said. “So even if we’re getting insightful therapeutic content, we’re often getting it while we’re in bed and on our phones.” Of course, she acknowledged, some online conversations can feel cathartic and even help people put into words their inchoate feelings. But alone on couches and in beds, thin lines separate active reflection (which can be healthy), rumination (less healthy), and outright wallowing (not healthy). “It’s not so different from listening to sad songs when you’re sad,” she said. “Of course, I would tell a patient that it can be cathartic. But if it’s all you do to cope? That’s bad.”
More deeply, she added, the algorithmic architecture of social media isn’t doing us any favors. The “If you liked that, you might like this” organization of information on social media means that our engagement with certain kinds of content—politics, lifestyle, or mental health—can burrow us deeper into that genre. Rather than allow us to work through our negative feelings and move on, it can trap us in algorithmic whirlpools of outrage, doubt, and anger. (Anybody who has doomscrolled through a particularly gruesome news cycle can surely empathize.)
There is an enormous difference between destigmatizing therapy—an expert-led, one-on-one conversation about mental health, for the benefit of oneself—and celebrating Therapy Media—nonexpert, one-to-1-million broadcasts about mental health, for the benefit of an audience of strangers.
There is also an enormous difference between critiquing therapy itself and critiquing the poppy online version. “I teach clinical psychology, I am a therapist, and I’m very pro-therapy,” Saxbe said. But we may have overcorrected from an era when mental health was shameful to talk about to an era when some vulnerable people surround themselves with conversations and media about anxiety and depression, which makes them more vigilant about symptoms and problems, which makes them more likely to problematize normal daily stress, which makes them move toward a deficit model of psychopathology where they think there is always something wrong with them that needs their attention, which causes them to pull back from social engagement, which causes even more distress and anxiety.
The solution begins with the principle of opposite action. Saxbe said the best thing we can do for ourselves when we’re anxious or depressed is to fight our instinct to avoid and ruminate, rather than get sucked into algorithmic wormholes of avoidance and rumination. The best thing one can do when they’re depressed is to reject the instinct to stay in bed basking in the glow of a phone, and to instead step outside, engage with a friend, or do something else that provides more opportunities for validation and reward. “I would tell people to do what’s uncomfortable, to run toward danger,” Saxbe said. “You are not your anxiety. You’re so much more.”
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