Sociogenic Illness

Notes on a newly-published paper on social media and social contagion

It’s now been over a year since I stopped reading the algorithmic feeds of Twitter and Facebook. The effect of their absence from the halls of my mind has been quite profound: it’s easier to think, and much easier to be optimistic of the world.

Being a teenager was really damn hard when I was one. You’re awkward, hormones are raging through a body you don’t really know well yet, and you feel generally alienated. On top of all this, there’s all the pressure from other teenagers experiencing the very same thing, trying out explanations for why the world is the way it is and affecting actions and trying on identities that they’ll later discard for others.

I didn’t have the crushing and inexplicable weight of social media narratives and comparisons to complicate my own development: I’m sure it’s even harder now. One of my nephews is just entering puberty, and I can already see some of the deleterious effects of social media on his mental development. In conversations, he tries to express his thoughts in meme form, and becomes very frustrated when the adults around him don’t immediately get the underlying joke that he himself doesn’t fully get, either.

Another person I know, just out of his teenage years, has trouble engaging in conversations without referencing social media. He often acts listless and lost in group conversations until someone shows him an image on a smartphone screen. When that happens, however, he’s suddenly quite animate and alive. It’s like he cannot be himself until there’s an illuminated screen visible.

I’m sure you have your own stories and observations about such things, too.

For years, there’s been quickly-suppressed suggestions that social media use is leading to particular self-destructive behaviors in teenagers, especially adolescent women. Writers have linked the increased prevalence of Non-Suicidal Self Injury (NSSI) behaviors such as cutting to the popularity of posts about it on Tumblr and TikTok, along with surges of self-diagnosed syndromes such as Tourette’s and Multiple-Personality Disorder (also called Dissociative Identity Disorder, or DID).

The problem has been that these essays and studies have all relied primarily on anecdotal evidence. Everyone seems to feel something’s been happening, but because there have been very few scientific studies published regarding it, it’s not entered into the realm of approved knowledge. We feel it happening, but because the “science” doesn’t say it is happening, it isn’t.

Fortunately we may soon “allowed” to think about this as truth, thanks to an article in the February, 2023 issue of Comprehensive Psychology. It’s timidly entitled “Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion?”

The paper first compiles a list of mental-health and other disorders which seem to be on the rise among teenagers, and then explains how they seem to:

have emerged within the context of a broader fusion and coalescence of individual self-diagnosis, including anxiety, depression, eating disorders, autism, and gender identity-related conditions on social media platforms, perhaps most notably on the social media site Tumblr during the first decade of the 2000s, but also Instagram and most recently on TikTok as well .

The continued evolution of this trend underscores an urgent need for increased understanding of the influence of social media on mental health, including its phenotypic clinical presentations and the possibility that increasingly algorithmic social media platforms may serve as a vehicle of transmission for social contagion of self-diagnosed mental illness conditions.

The two sections that I’ve bolded are particularly worth your attention. The second of these two is what many critics of social media’s role in identity-formation have been asserting for years: “social contagion” seems be playing a role in a lot of self-diagnosis. That leads to the former emphasized text, which includes “gender identity-related conditions” as one of the increasing categories of self-diagnoses.

In 2018, a controversial paper was published proposing the term Rapid Onset Gender Dysphoria (ROGD) to explain startling and unexpected increases in self-diagnosis of gender dysphoria. The author was excoriated, but the underlying phenemonon is the one that medical advisory boards in Finland, Sweden, the Netherlands, and the United Kingdom have become alarmed by: there have been massive surges in teenage girls seeking gender treatment, far outstripping teenage boys seeking the same.

ROGD was proposed not to explain why this was happening, but rather to point out that there was something new happening. Most people with gender dysphoria previous to these increases had shown signs of it throughout their youth. What appeared to be happening now was that adolescents who had never shown signs of it previously—and who themselves reported never experiencing it previously—were suddenly experiencing it. Often, this was occurring in “clusters,” where groups of teenagers connected either online or in school all reported gender dysphoria within a short period of time.

In other words, “social contagion.”

The paper primarily focuses on Tourette’s Syndrome and what are called “Functional tic-like behaviors” (FTLB), rather than on gender-identity related conditions. The FTLB matter is particularly fascinating: youth watching TikTok videos with millions of views in which the creator demonstrates their “condition” suddenly find themselves having the same “condition.” And again, it’s primarily affecting teenage females:

A large majority of those demonstrating FTLBs are adolescent females, which also forms a core user group of TikTok. Patients with FTLBs are also more commonly diagnosed with anxiety and depression, than those with TS which frequently co-occurs with neuropsychiatric conditions such as Attention-Deficit/Hyperactivity disorder (ADHD) and Obsessive-Compulsive Disorder (OCD). FTLBs are in keeping with a Functional Neurological Disorder in the context of anxiety and depressive symptoms and diagnoses, and more broadly with affective dysregulation. Many presenting to psychiatric clinics have also noted they have seen popular videos on Tourette's syndrome and have since started sharing the same tics.

Another condition which has seen increased popularity is that of Dissociative Identity Disorders (or multiple personality disorders).

Hashtags such as #DID, as well as #borderlinepersonalitydisorder and #bipolardisorderhave received millions of views, and popular content creators post videos capturing them ‘switching alters’ (i.e., plurals). Impressions from both the lay public and clinical professionals have converged in the observation that a salient feature of this emerging DID and self-diagnosed mental illness social media posting and discourse is that it has a distinct appearance of being romanticized, glamourized, and sexualized (or possibly malingered).

Someone shared a series of these videos with me last year and I didn’t know what to make of them. In the videos, primarily young women act out multiple personalities (of multiple genders) which have conversations with each other and with the audience. Through video editing, the person appears to switch almost seamlessly between them.

The authors’ analysis that they are being “romanticized, glamourized, and sexualized” is most definitely how I would put it, but having been a social worker for mentally-ill homeless people with DID, I can assure you that real-life cases are hardly sexy, romantic, or glamorous. They’re terrifying, not just for those witnessing the condition but especially for the person suffering from it.

As I mentioned, the paper is entitled quite timidly and the conclusions the authors reach are somewhat ambiguous. I suspect this is at least partially related to the general outrage that results whenever scientists try to suggest there’s something deleterious in social media use, especially in the counter-examples often provided that “most people” viewing such things don’t develop these conditions.

Such counter-examples are a lot like saying “most people drive drunk and don’t crash,’’ or “I did heroin once and didn’t get addicted.” In such arguments, there is an incorrect assumption that the linkage between a cause and an outcome must be universal for it to be true. If even one instance of it not being universal exists, then the critic believes himself or herself to have disproved the mechanism entirely.

Likely aware of such facile dismissals, the authors propose a framework for understanding why social contagion occurs in certain people but not others by using the “diathesis-stress model.” Some people are more vulnerable to it through environmental or biological factors which Marxists would recognise as alienation:

The diathesis-stress model of individual differences to environmental context provides an organizing heuristic to begin to develop such an explanatory framework. Classic diathesis-stress or vulnerability-stress models postulate that poor developmental experiences (e.g., stressful or resource-poor environments) are most likely to impact the development of individuals who carry vulnerability factors, which are latent diatheses that result in increased risk for psychopathology when “triggered” by exposure to negative or otherwise stressful developmental experiences. Latent diatheses reflect biological or social-cognitive predispositions to react and behave in specific ways; psychopathology reflects signs, symptoms, and behaviors associated with mental illness or inconsistent with mental health in the normative range.

That is, in certain conditions and mental states, some people are vulnerable to this kind of transmission. This isn’t a strange idea: sales and advertising work on these principles. A person feeling unhappy, unwell, uncomfortable with their body or their life is more easily persuaded to buy something. The most perniciously effective advertizing helps get the person to that vulnerable state in order to sell them a product which seems to them like the key to a new life or the solution to their alienation.

Again, we feel this to happen, by which I mean we have a knowledge about this mechanism that isn’t yet part of the scientific canon of approved knowledge. Because it hasn’t yet received the official status of “things we know,” we have trouble articulating it without feeling a bit crazy ourselves or being accused of conspiracy-thinking.

So this paper will help, I hope. Escaping the algorithmic Feed has helped me become more optimistic about the world, but I’m regardless still pessimistic about how long it will take for us to let ourselves acknowledge how bad this has all gotten. The paper itself is a call for more papers, more research, rather than a conclusive end to a matter. Its most scientifically-obtuse language is at the end, a habit I’ve noticed academic writers employ to dull the potential for controversy:

Recognizing and responding to this possibility by researchers and mental health practitioners is an urgent public health priority in our view, given extant evidence suggesting that the social media environment is a mental health risk factor for adolescents and youth struggling with elevated personality psychopathology and inchoate personal identities during the transition to young adulthood. In addition, whether and how social media technology is a contributing force in both potentially inducing sociogenic illness while simultaneously influencing how professional mental health organizations evolve with respect to understanding and defining mental illness—thus potentially immunizing current sociogenic illness from classical diagnoses of mental illness—is crucial to take stock of in order to rigorously inform public health discourse and policy.

Perhaps in the next few years we’ll see more research on this. In the meantime, any attempt to understand what is happening will continue to have an appearance of conspiracy-thinking or esotericism. Especially for those who’ve politicized their self-diagnoses or for those who immediately see critiques of these mechanisms as inherently hateful, reactionary, or worse, suggestions something else is happening will be aggressively dismissed.

That’s unfortunate, of course, but that’s the ontological mess we’re stuck in within modernity right now.

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A brief update

My writing has been a bit scant here as of late on account of the holidays, some travel, and especially the end stage work of two large editing projects (my own Here Be Monsters and Melinda Reidinger’s The White Deer). I’ll have some more time coming very soon, and have several reviews (including of Dougald Hine’s upcoming book) and a new episode of The Re/al/ign (with Dougald Hine) bientôt.

Thanks for your patience and your deep support.