Suzie* was a typical 22-year-old recent college grad from the Midwest who was admitted into my mental health clinic in Austin with a variety of increasingly common psychiatric disorders: depression, self-harm (cutting her arms) and a Borderline Personality Disorder (BPD) diagnosis. BPD is a serious personality disorder that has 50 times the suicide rate of the general population and is typified by black and white thinking, self-harm behavior, emotional volatility, impulsive behavior, shifting self-image and feelings of “emptiness.”
While Susie did initially present with some of the classic BPD symptoms (feeling empty and suicidal), something didn’t add up. Unlike most BPD clients, she didn’t have any of the early red flags; she had good grades and many friends in high school with stable relationships and a stable home environment — and no history of mental illness in her family.
During Suzie’s treatment, we discovered the real culprit: she’d been spending 12-15 hours a day on Instagram, TikTok and YouTube after becoming depressed when her friends went away to university while she stayed home and attended community college. Initially trying to better understand her depression, she started to follow BPD influencers and joined online BPD groups, where she said that she felt a sense of belonging. Slowly and unwittingly, she started emulating what she was learning about BPD online — like cutting her arms after watching videos of influencers declare that cutting helped them feel in control — or at least “feel something.”
Suzie admitted that she never liked cutting herself but did it because she thought that it might eventually offer her relief. And starved for a true identity, she also stated that the cutting and irrational behaviors that the influencers engaged in “made them interesting and authentic,” which she found appealing. By the time she was ready to admit into treatment, she had lost all her friends and spent her days and nights alone and online being shaped by her newly found BPD community.
But something quite amazing happened while she was in treatment; she got better very quickly once all her devices and social media were removed. Within two weeks, she was calmer and less reactive; she made friends in the program; she no longer cut her arms and all thoughts of suicide evaporated. But if she really had BPD, she shouldn’t have been “cured” that quickly; clients with real BPD typically require many months or even years of treatment before seeing improvement. So what was really happening?
We’re living in the Age of Digital Social Contagions. It’s a time where certain illnesses aren’t spread by biological transmission, but by a digital infection that attacks the psychological immune system. Using algorithms that find and exploit our psychological vulnerabilities, we get sicker as Big Tech gets stronger.
And make no mistake: we are getting sicker as a society, with record rates of depression, suicide, loneliness, overdoses, anxiety, addiction, emptiness, gender dysphoria and mass shootings that are disproportionately impacting teens and young adults, all made worse by the isolation and fear during COVID.
Beyond just the depression of living sedentary, isolated lives, we have the congressional testimony of Frances Haugen, The Facebook Whistleblower, who shared internal emails that showed Instagram’s own research indicated that their product increased suicidality in teenage girls and worsened their eating disorders. It seems that being exposed to a constant torrent of toxic content and comparing ourselves to the curated faux-glamor of vapid and shallow influencers isn’t good for the psyche — but it’s even worse than this much-researched and toxic “social comparison effect.”
Followers and views are the coin of the realm in the social-media hierarchy, and extreme content is what attracts that priceless human commodity: our attention. That’s why it’s the most over-the-top content and influencers that attract followers like moths to a lethal digital flame. And it’s also why we’re seeing dramatic spikes in once-rare disorders like Tourette Syndrome, Dissociative Identity Disorder (DID, formerly known as Multiple Personality Disorder) and Borderline Personality Disorder (BPD). These disorders are now being injected into our collective consciousness via popular TikTok and Instagram “influencers” who’ve racked up hundreds of millions of views — and have left a wake of young followers like Suzie who, consciously or unconsciously, are indeed “influenced” as they emulate the psychiatric symptoms of their mentally unwell social media darlings.
This social-contagion group effect shouldn’t come as a shock; for thousands of years we’ve seen it shape human behavior; from donning tribal war paint, to smoking cigarettes, to following your favorite sports team or joining a political movement. We’re social animals hard-wired to mimic and emulate one another. The only difference now that social media has swallowed up our world is that the impact of toxic and digitally spread behaviors are greatly magnified as they go viral.
Although we now know that social media is harmful to our mental health, we can’t seem to stop. Like a cirrhotic alcoholic, the health consequences be damned when you compulsively need another drink — or tweet. And the more of the digital toxin that we consume, the weaker and more compromised our psychological immune system becomes, making us even more vulnerable for further consumption, manipulation and behavior modification.
The Big Tech social media playbook is a simple three step process. Step 1: Create habituation. Use the most sophisticated algorithm-fueled behavior mod techniques to create dependency.
Step 2: Once addicted, the person’s psychological immune system begins to erode. As in any addiction, this is the realm of depression, hopelessness and a sense of emptiness — an emptiness that can only be temporarily filled by more of the toxin.
Step 3: Once weakened and addicted, a person is now susceptible to any number of manipulations; these include further addiction, ideological brainwashing, identity shaping and, sadly, an encroachment into the once hallowed ground of our thoughts. Free no more.
The 1999 Columbine school shooting was the first in the digital age (such events had been almost unheard of before then). Since then, they have become a horrible part of daily life. However, even the FBI acknowledges that these are Internet-fueled copycat events; classic examples of a social contagion — spread and spawned on social media and hate-filled chat rooms that incite the unstable.
This digital social contagion can also lead to ideological extremism. I was an expert witness this year in the capital murder trial of Corey Johnson in Florida, the white suburban teen radicalized by a nonstop stream of ISIS recruitment videos on YouTube. This year, he was sentenced to life in prison for stabbing a 13-year-old boy to death at a 2018 sleepover.
And, of course, we have the logic-defying spike in gender dysphoria; a spike that trans psychologist Erica Anderson, who has helped hundreds of teens transition, says “has gone too far.” According to Anderson, teens — who have always gone through periods of identity confusion and experimentation — are now being exposed to and impacted by social media and trans influencers. Dr. Anderson’s insights were confirmed by Dr. Lisa Littman’s research at Brown, which showed the social media impact on what she termed “late onset gender dysphoria.”
Like BPD, gender dysphoria is a real psychological phenomenon that people genuinely struggle with. However, what we’re seeing now is something different. We’re seeing social media shaping people in ways that seem to mimic some of these disorders yet are not the genuine article. Several colleagues and I have begun to call them cases of pseudo-BPD, pseudo-DID or pseudo-Gender Dysphoria. These are cases where the presenting symptoms dissipate when the person is removed from social media for several weeks, thereby proving that the behaviors presented are not the genuine disorder.
Instead of genuine mental illness, many of our young people are simply attempting to find a tribe or community to belong to via their online explorations and demonstrating what psychologists call “sociogenic” effects; that is, effects caused by social forces — in this case, digital social forces.
What I believe we desperately need is to better understand these powerful shaping effects of social media and to help young people develop a strong psychological immune system and critical thinking skills in order to navigate the rough and turbulent seas of today’s social-media world.
*This patient’s name has been changed.
Dr. Nicholas Kardaras is the Founder and Chief Clinical Officer of Omega Recovery in Austin, Texas and Maui Recovery in Hawaii. A former clinical professor at Stony Brook Medicine, he’s the bestselling author of “Glow Kids” and his latest book “Digital Madness: How Social Media is Driving Our Mental Health Crisis — and How to Restore our Sanity” (St. Martin’s) is out now.
Six Tips for Social Media Immunization
The best way to immunize oneself (or one’s child) from the viral toxic effects of social media have to do with focusing less on the toxin (social media) and more on strengthening one’s psychological immune system. So while it’s always a good idea to both limit and delay a person’s use of social media, it’s critically important to become a modern day Philosopher-Warrior in order to develop the grit and resilience of a Spartan and the critical thinking, curiosity and intellect of an ancient philosopher by adhering to the following tips:
1. BUILD GRIT AND RESILIENCE. According to psychologist Angela Duckworth (the author of “Grit”), we develop grit by leaning in to experiences, and thus allowing ourselves to make mistakes that we can learn from — and we NEVER quit.
2. FIND A PURPOSE THAT RESONATES FOR YOU. As mythologist Joseph Campbell said, “Find your bliss.” With purpose comes passion and a clarity of one’s identity and place in the world — and thus we become less likely to be sucked into influencer nonsense.
3. MAINTAIN A PHYSICAL PRACTICE. Healthy body, healthy mind. Whether you develop a daily walking routine, start practicing yoga or are training for a decathlon, keep yourself moving — it’s the best anti-depressant as exercise raises endorphin levels, creates a healthy sense of accomplishment, and helps the mind stay sharp—thus immunizing it from toxic social media.
4. READ CLASSICAL PHILOSOPHY. From Plato, Socrates, the Stoics and Marcus Aurelius. Ancient wisdom has a time-tested transcendent quality that elevates a person—and doesn’t debase and weaken the reader like superficial tweets or posts aimed at our baser instincts. The ancients also teach us how to cultivate the sanity-sustaining skill of critical thinking.
5. HELP OTHERS. The modern digital world is built to create egocentric narcissism as algorithms curate a me-centric digital world. Break that pattern by focusing on helping others — by volunteering, mentoring or simply being kind to a neighbor. Manifesting the value of altruism is the antidote to the shallow values of prioritizing followers or generating views or likes.
6. BE CREATIVE. BE BORED. Find opportunities to channel your creative self — by writing, painting, drawing—whatever it may be. Creativity is the antidote to the conforming group-think of social media. And when not creating, give yourself permission to be bored and to daydream. After all, boredom is the handmaiden of creativity. When we’re perpetually information over-loaded, there is no space for creative thought or for the mind to roam and wander and be curious—all critical ingredients in feeling self-actualized and not media-dependent.