The Problem of Online Therapy Culture

The Internet seems like a powerful weapon for distorting mental health wisdom.

Follow a train of thought with me.

1) Many people in the West today, possibly even a majority, suffer from stress, anxiety, and a general mental malaise.

1a) For a minority of these people, their symptoms rise to the broadly accepted clinical definitions of depression, PTSD, etc.

1b) For the rest, the stress, anxiety, and malaise is attributable to various psychological, environmental, and behavioral factors.

2) Because of particular sociological transformations over the past 100 years, a huge number—possibly a majority—of people who suffer from these things have either very few or no meaningful, long-term relationships that offer encouragement, stability, and practical support.

3) In the absence of these sustaining, thick relationships, people who feel besieged by these mental conditions will compensate in other ways.

3a) One of these compensating behaviors is addiction.

3b) For many middle-class people today, a respectable addiction is to the Internet

3c) For some people who are addicted to the Internet as a way of coping with anxiety and mental distress, online therapy culture—memes, influencers, mental health “content,” etc.—feels like the kind of thick community and emotional support system they otherwise lack.

4) Behaviors that are addictive due their value as coping mechanisms are usually quite hard to break. People become defensive over them, often downplaying negative elements as better than the alternative.

5) Thus, for this and other reasons, online therapy culture is almost totally insulated from criticism, and the need its users have for it is often touted as an infallible evidence of its truthfulness and necessity.

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It is pretty much impossible to convince someone over the Internet that something they learned or acquired in a “mental health content” setting may not be true or good for them. Most online communities that I’ve come across that are focused intensely on mental health talk and act like members of a deeply committed religious group. There’s a particular lingo whose definitions are only accessible internally; nobody will explain to you what trauma actually is without giving you concrete examples that are indisputable. There’s a particular epistemological relationship between members of therapy culture and outsiders; anyone who doesn’t show the necessary signs of experience and understanding are not to be trusted, but are most likely trauma-inducers themselves. And there’s an active doctrine of revelation whose canon is opaque but that can be discerned through memes and influencer mantras.

The success of Internet therapy culture is very impressive to me. In just a few short years I’ve watched friends and acquaintances shift their language and categories significantly, and almost none of these friends and acquaintances have any training or education in mental health. When I was in my late teens and early 20s I didn’t know anyone my age who said they were or had been depressed; based on conversations and my social media feeds today, I’d say probably 75% of my friends would say they’ve recently been or are now depressed. I’m positive several of these folks are correct, and that one of the transformations wrought by therapy culture is an increased self-awareness. But I strongly doubt that self-awareness has increased by 75% in everyone.

The reality is that many of us are miserable. But the sources of that misery do not seem to always align with the answers of online therapy culture. One thing that strikes me about online therapy culture—which I’ll abbreviate now as OTC—is how aggressively self-referential it is. People allude to conversations between them and their therapist, but what seems to really be working in the lives of OTC participants is the OTC itself. For example, when I see someone online relaying what their therapist told them, it’s almost always identical to what I’ve seen in a popular meme. I’m not saying I think bunches of people are attributing random memes to their fake therapist, only that I wonder how much of a role OTC is playing in making certain self-help mantras “sticky” and others not so much.

The Internet seems like a powerful weapon for distorting mental health wisdom. For one thing, the Internet sure seems inherently opposed to mental health in a lot of us. For another thing, the power of endless curation and disembodied habitat seem particularly volatile ingredients when we’re talking about something as difficult and explosive as mental health. I worry especially about the dilution of the word “abuse” in OTC, especially since that word has a distinctly separate etymology in the history of the Internet than it does in offline living. On Twitter, you can report someone for abuse for making a death threat against you or for saying you should root for the Yankees instead of the Mets. Somewhere a faceless moderator will determine which of these is actually abuse, but the power that the Internet bestows on each of us over the word “abuse” seems to merit extreme caution and care if online and offline categories are being intermingled freely, as they are in OTC.

Finally, it’s never clear to me just how meaningfully virtue looms in a lot of OTC.

Glennon Doyle @GlennonDoyle

Hi. There is a family next to me at the store. I just heard the dad say to his kid:"Well, it's brave to go on a roller coaster. And it's also brave to say you don't want to go on a roller coaster." Wanted to tell you something good. That is good.

This is the kind of tweet that is clearly an artifact of OTC. The key philosophical insight in this tweet is never spelled out, which means that someone unfamiliar with OTC and who grew up in a somewhat conservative working class environment may scratch their head. But the tweet got 25,000 likes precisely because OTC has conditioned many of us to feel what this tweet implies but doesn’t say: that it’s always right to affirm genuinely held feelings as brave, and it’s always wrong to suggest that genuinely held feelings might not be as brave as a different feeling.

It’s brave to go on a roller coaster, because roller coasters can be pretty scary and most kids have to overcome nerves to ride them. Why is it brave to not go on them? To be sure, it could be wise to not go on them, it could be smart, it could very well be the right thing to do. But why is it brave? How is it that the concept of courage is so elastic that it can apply either direction here?

Let’s change the wording of the tweet to see if something reveals itself. Let’s say instead: It’s brave to get a vaccine, and it’s brave to not get a vaccine. Or perhaps: It’s brave to not vote for Donald Trump, and it’s brave to vote for Donald Trump. One more time: It’s brave to believe that a boy can really be a girl, and it’s brave to believe that a boy really cannot be a girl.

Would any of these three alternative statements be affirmed the way that Doyle’s tweet was? No way. Why not? Because OTC makes virtuous categories elastic in some directions but not all. It’s brave to not go on a roller coaster because really the category “brave” does not exist at all, and what I mean by “brave” is actually living your truth.

I know that many people feel seen and heard by online therapy culture in a way they haven’t felt anywhere else. But like the dream-sharing in Inception, the sensation of a new reality is not a new reality.