“TikTok ≠ therapy”: Mediating mental health and algorithmic mood disorders

Abstract

Popular and professional psychology merge to produce novel forms on TikTok—a platform on which therapeutic content grew enormously during the pandemic, rendering it a productive site to examine mediated mental health subjectivities, including ways people come to understand themselves in terms of mental health pathologies. Examining the dynamic interplay of capacities and constraints of therapeutic and algorithmic frameworks reveals ways in which therapeutic roles and rituals are re-negotiated in this space. Therapists utilize memetic tropes of the platform to position themselves within its affective flows, while leveraging beliefs about the algorithm to connect with users. The affective engagement of users’ works to curate a stream of content against which mental health and therapeutic frameworks are evaluated, ultimately designating a diagnostic gaze to a charismatic algorithm—a potentially emergent social media case of automated forms becoming paradigmatic in the ways we conceive of mental health and therapy.

Keywords

ADHD affect charismatic algorithms influencers mental health mood therapy TikTok

Introduction

The coronavirus disease (COVID)-19 crisis brought with it a reconfiguration of technologically mediated mental health care as it was thrust into a matter of public concern, accelerated clinical necessity, and peaked corporate interest. While remote mental health care—often in automated forms like mood tracking and therapy apps—was on the rise before the pandemic, all forms of remote mental health care were pushed to the forefront during lockdowns (Acumen Research and Consulting, 2021; Camarines and Camarines, 2022). With the increased need for mental health care and diminished access, open conversations about mental health crises and the effects of lockdowns were granted new levels of acceptance on social media. As it did with health care more broadly, the pandemic exposed pre-existing flaws in mental health services, as well as exacerbated them. These include vast mental health and mental health care disparities that could be alternatively mitigated or deepened by the reliance on new technologies (Aguilera, 2022; Campos-Castillo and Laestadius, 2022; Figueroa and Aguilera, 2020).

During this anxious time, professional psychology and popular self-help mingled in a flow of content that has been discussed by some as a new form of remote mental health care. With the waves of new users on TikTok came mental health professionals seeking to connect with their own clients and the public at large. Media attention turned from the deleterious effects of social media on mental health to the potential therapeutic benefits of scrolling TikTok (Blum, 2021; Carbran, 2020). The Washington Post went as far as to describe TikTok as filling a “mental health care gap” (Hunter, 2022). Alongside positive media coverage of mental health content arose growing pushback against non-professional mental health influencers. Subsequent controversies brewed over what constitutes therapy (Dastagir, 2021) and who can speak authoritatively about mental health (see Sung, 2021). TikTok therapists across the board disclaim that “TikTok ≠ Therapy,” but this does not seem to square with discourses of therapy on the platform.

This study asks what is happening in social media spaces that may be experienced as therapy while resolutely declaring themselves not to be. How do therapists and those who engage with them experience and understand mental health and therapy through platformed interactions on TikTok? Are there synergies or tensions with other types of self-help and mental health content on the platform?

Contributions of this study include extending scholarship on health professionals’ utilization of TikTok into the realm of mental health, foregrounding the role of algorithmic imaginaries for both creators and users, as well as the ways elements of therapy TikTok can impact subjectivity or “come to feel truly part of our own ‘authentic’ selves” (Riley et al., 2018).

Here, therapists utilize popular self-help forms and memetic tropes on the platform to position themselves within its affective flows, while leveraging beliefs about the algorithm to connect with users. This serves a legitimating function for users who experience TikTok’s algorithm as a charismatic diagnostician of mental health issues—its perceived otherworldy way of knowing intimate selves working as an authority of pathologized categorizations. Hannah Zeavin’s (2021) notions of mediated therapy provide a framework to think through the ways these enmeshed processes provide the socio-technical substrate of TikTok therapy, where practices and notions of mental health collide with those of algorithmic systems.

This study takes as its starting point Zeavin’s (2021) triadic theory of therapy and mediation—where all forms of therapy consist of therapist, client, and media—and focuses it analytically on the blurry, yet burgeoning arena of social media mental health content. Recognizing the inherent mediation in therapeutic interactions, Zeavin argues, helps us understand in new ways the communication technologies that facilitate contemporary therapeutic relations. Reconceiving therapeutic intimacies in terms of their mediations, including shifting frames and capacities, lends new insights into both therapy and media. This study takes these generative notions as a starting point and analytic for therapeutic TikTok, though it does not map on precisely to each of Zeavin’s deeply nuanced concepts. The triadic theory of therapy and its components help to situate TikTok as an emergent form of therapy within popular media, and thus influential in our cultural conceptions and practices of mental health care. The concept of the algorithmic imaginary illuminates the ways that users experience their interactions with algorithms, and the ways algorithms are likewise shaped by this transactional process (Bucher, 2017).

Enrolling the algorithm in algorithmic research

Mental health content, including therapist videos, livestreams, and user interactions on TikTok round out this study. TikTok received prominent media attention during the pandemic for both its explicitly mental health-related content and the broader therapeutic qualities of this uniquely algorithmically driven social media form. Angèle Christin (2020) suggests “enrolling algorithms” (p. 897) in algorithmic research. This methodological strategy allows, without the need for inaccessible backend information, the examination of TikTok itself as a technology of algorithmic therapy. The digital ethnographic strategy of enrolling the algorithm was utilized in this study to answer research questions regarding the ways that mental health content was experientially encountered in this space. “. . . enrolling algorithms in ethnographic research is a productive way to analyze complex and opaque computational procedures” (Christin, 2020: 898). Christin notes the utility of this method for media and cultural studies. In this case, doing so entailed following therapists and other mental health creators as they were presented by the algorithm on the home feed, called the For You Page (FYP), clicking on relevant hashtags in their videos, reading comments, and watching livestreams. Screenshots and videos were collected and archived with detailed memos to be coded using thematic analysis (Braun and Clarke, 2006).

TikTok as therapeutic mood mediating technology

Through this analysis, it is revealed that the TikTok experience moves from merely therapeutic in a colloquial sense (as in meaningfully helpful or cathartic) closer to therapy proper (involving diagnostics and prescriptive treatment) in part by reconfiguring Zeavin’s “therapeutic triad” in various, deeply intertwined ways. In one formulation that will be elaborated throughout this article, the therapist acts as creator-client, the algorithm as charismatic diagnostician, and the user as affective mediator. Under the legitimizing auspices of professional credentials, therapists utilize trending motifs, and popular discourses about the TikTok algorithm in the relatable disclosure of their own personal mental health struggles. While this factors into the therapeutic experience of TikTok, it is not the as much therapists as the algorithm itself that users imbue with the ability and authority to diagnose them with a mental health disorder. The algorithm is argued as charismatic in the vein of Yates’ (2011) influential charismatic media therapists, and in the way that it is imagined to endow a sort of divine selection in its joining of content and users. Users recognize their engagement with TikTok content as a medium through which networked affect circulates, facilitating this process.

This constitutes what I call a therapeutic mood mediating technology (TMMT) inside of a commercial social media platform, where TMMT enrolls mood and affect as technical and discursive objects to be manipulated toward various ends, conflates modes of care with technological and economic models, and shapes mental health subjectivities. This situates social media in the domain of other mood tracking technologies that are coterminous in targeting mental suffering and optimizing economic productivity. (Cabanas and Illouz, 2019; Davies, 2015; Lupton, 2016). It can also be productively articulated as a social media case of automated models becoming paradigmatic in the ways we think of mental health and therapy (Zeavin, 2021). I argue that TikTok is experienced as an algorithmic therapy and, as such, should be analyzed alongside the more explicitly therapeutic remote forms that Zeavin covers (such as radio, teletherapy, and algorithmic therapies like chatbots).

Therapy culture and media technologies

Mediated therapeutic frames

The Distance Cure (Zeavin, 2021) posits that what is typically conceived as the dyadic nature of therapy, comprised of therapist and client, cannot be understood in the absence of a third party—media. Media here include not only communication technologies, but the frames and rituals within which therapy functions—the meeting spaces and times, pay scales, and even the emotional transferences upon which psychoanalytic therapies were predicated.

These psychic and affective transfers of healing work and meaning-making, as Zeavin understands them, can occur between humans and technology. Zeavin’s discussion of mediation covers interpersonal mediations, internal mediations, and technological mediations. The following passage encapsulates the vexed nature of “distanced intimacy” as it applies to new therapeutic digital technologies:

These intimate configurations—of patients, therapists, and technologies—allow for the regulation of cathexis and unexpected kinds of relation, interaction, care, and help; they also permit new forms of user-exploit while posing threats to traditional modes of clinical labor, security, privacy, confidentiality, and self-understanding. (Zeavin, 2021: 61)

Mediating therapeutic frames structure the relationship via time, space, and financial transaction. Zeavin argues that “both the rigidity of the frame and its capacity for alteration may be part of how new forms of therapy emerge, both in person and over distance,” and that, when they do, “the therapeutic scene takes new, media-specific forms that are in turn invested with meaning on the part of both users and providers” (p. 7).

Therapy cultures

This project follows scholars like Wirth-Cauchon (2000) who view therapeutic encounters as significant spaces where knowledge and power act on the body through mental health-based subjectivities. Along with a site where power and knowledge converge on subjectivity, and an inherently mediated relation, this project considers the “therapeutic” as a broader cultural ethos, where mediated moods become both technological and cultural objects.

Within popular culture, psychology functions as more than discursive, significantly contributing to and “[organizing] a diverse range of technologies of subjectification” (Walkerdine and Blackman, 2017 [2001]: 110). Truth about selves then, according to Rose (1998) becomes technical, as in “effective to the extent that it is embodied in technique” (p. 89). The self-help sphere is a space where these techniques are modes through which “psychology’s truths become the very basis of a person’s self-forming activity” (Walkerdine and Blackman, 2017 [2001]: 104).

Therapy culture as it plays out in media describes the psychologized way of understanding and performing selfhood since older ways of doing so have waned (Lears, 2000; Yates, 2011). The “therapeutic ethos” (Lears, 2000) is a path to a particular instrumentalized notion of well-being which takes place in consumer media as much as it does in actual therapy. What Yates calls charismatic psychotherapy is a convergence of therapy and celebrity culture. Yates’ version of charismatic therapy points to the ways quick-fix economical therapies that are sold as routes to happiness and self-fulfillment play out in the popular sphere, including psychology professionals-turned-media celebrities. In addition, Yates links therapy culture and its connection to emotional experience, via the work of Mark Andrejevic (2004), to the concurrent rise of a media culture where intense emotional experiences are sold, and personal growth becomes a lifetime consumer project.

Beyond helping one through manifestations and expressions of distress, therapy culture becomes a means of self-surveillance and optimization (Lupton, 2016). Neoliberalism extends the economic into the cultural, distilling identities, sociality, emotion, and therapy into market logics (Cabanas and Illouz, 2019; Davies, 2015; Rimke, 2020). Governmental and institutional focus on mental health often foregrounds the economic cost of missed work or lapsed productivity (see World Health Organization, 2013). The “psychological turn” in neoliberalism dictates forms of self-management and optimization that are built around “feeling rules” (Gill and Orgad, 2018). TikTok is a commercial platform with a robust self-help culture, where people access therapy TikTok not only for relief from emotional suffering, but for tips on success and productivity that are often based around the capacities associated with distinct pathologized mental health identities.

Valerie Walkerdine and Lisa Blackman (2017 [2001]) suggest asking how discourses of psychology circulate in media. Rose (1998) asserts that the broader psychology complex works so powerfully by allowing, rather than excluding, others from speaking on its behalf. This mediation and extension of “the psy” can serve to quiet dissonances among wider hegemonic projects. Rose posits that where competing truth claims function alongside broader cultural and political projects, psychology has forged a dominant structure that affords it particular legitimacy among competing narratives, while it can also be harnessed in service of those narratives. This locates psychology in the realm of the political while it enjoys prevalence and influence in the popular sphere. Luke Stark (2020) links mood tracking technologies and emotional computation more broadly to the psy complex in that they both entail a neoliberal therapeutic self-reflection, and are constitutive of “affective publics” (Papacharissi, 2015). Psychology and mood are key aspects of computational politics (Ellis and Tucker, 2020; Hearn, 2010; Stark, 2018, 2020). TikTok (slogan: “a video for every mood”), as an algorithmic media platform, integrates these aspects of therapy culture. Lupton (2017) has called for interrogation of the affective dimensions of health technologies, imploring us to ask, “How does digital health feel” (p. 1)?

TikTok, affective circulations, and the algorithmic imaginary

Scholars have recently theorized TikTok as a primarily affective platform (Hautea et al., 2021), as well as a memetic platform (Zulli and Zulli, 2020). Beyond and beneath imitation and circulation (e.g. the way TikTok can enact a homogeneous dance hall of mirrors), memes can move layered cultural meanings and amass complex political and emotional constructions. Bratich (2014) illustrates via social movements ways through which politicized subjective processes can be animated by memetic forms. The memetic properties of TikTok specifically been explored for the ability to facilitate a particular kind of platformed affect that can shape public understanding of scientific issues (Brown et al., 2022). Scholarship on TikTok has revealed ways in which “the discursive, intertextual, and memetic linkages . . . propagate affective publics” (Hautea et al., 2021: 1). The affective design of TikTok is made up of its memetic qualities, posit Brown et al. (2022), allowing complex expression to circulate through elements such as humor and juxtaposition. The authors describe social media more broadly as embedding strong affective components in both its content and its content’s circulation.

More than any other popular social media platform, TikTok’s circulations are almost entirely algorithmically driven, with users seeing themselves as interacting directly with the algorithm (Bhandari and Bimo, 2022). The experience of TikTok centers on engagement with its FYP, where users are fed a stream of videos through which to scroll (largely from accounts they do not follow and have not interacted with).

Algorithms are “encoded procedures for transforming input data into a desired output, based on specified calculations. The procedures name both a problem and the steps by which it should be solved” (Gillespie, 2014: 167). One fraught question motivating this study is, what has TikTok made a problem? TikTok’s algorithm seeks to provide users with videos that will increase time and retention on the platform (Smith, 2021). These have been theorized as attempts to foster addiction, as well as yielding an uncanny recursive mechanism of “knowing” users (including their interests, illnesses, sexuality, etc.) before or better than they know themselves (Cummins, 2022). Seaver’s (2017) nod to algorithmic charisma references the hype around high-profile tech companies’ algorithms—hype generated not only by the proprietors, but also by critical algorithm researchers, too, questioning whether non-computer science researchers should ground analyses in functional technicalities of algorithms. Ultimately, Seaver argues that algorithms should be analyzed not only in but as culture. Following scholars such as Magalhães (2018) and Savolainen and Ruckenstein (2022), this project is interested not necessarily in algorithms do, but rather what people do with (and to) algorithms, including the taking up and inhabiting of subject positions.

The workings of algorithms structure creator visibility on media platforms (Bishop, 2019; Bucher, 2012; Duffy and Meisner, 2022), and TikTok is also interested in highlighting content with monetization potential (Smith, 2021). For creators, visibility and invisibility can depend on knowing and “gaming” the algorithm (Petre et al., 2019). On the other side, these processes as experienced by users can shape the ways we think about ourselves (Cheney- Lippold, 2011). Beer (2009) marks the importance of affect in the collapse of the ontological and epistemological through algorithmically mediated technologies, noting that we may do better to conceptualize the self as constituted rather than simply mediated by them. On TikTok, this is complicated by users who are particularly conscious of a relationship with the algorithm.

“Hyper-aware” interactions with TikTok’s algorithm are deeply predicated on affects and imaginaries (Bhandari and Bimo, 2022). Algorithmic imaginaries inform practices of social media content creators and users that “in turn [mould] the algorithm itself through their performativity” (Raffa and Pronzato, 2021). Taina Bucher (2017) argues that the ways people think about “often hidden and invisible” algorithms have effects on the ways they experience and use platforms. Notably, Bucher emphasizes the impact of this imaginary on affective encounters and mood, arguing that “examining how algorithms make people feel [is] crucial if we want to understand their social power” (Bucher, 2017: 30).

The uncanny “knowing” of TikTok’s algorithm is not a new phenomenon per se. Algorithms are entrenched in a history of computational forms believed to be able to read users’ emotional and mental states. Natale (2019) explains the ways that the concept of mind-reading has been used simultaneously to explain concrete computational procedures as well as mysterious supernatural phenomena. While these discourses seem paradoxical, they have historically run alongside or even worked along with one another synergistically. This lineage’s new media manifestations can help to inform what we see in therapeutic TikTok.

Social media creators’ beliefs about algorithms have been shown to inform their practices (Bishop, 2019; Glatt, 2022). To attain the visibility necessary for success creators seek to understand what is sometimes conceived as an “omnipotent, mysterious, and unknowable being” (Glatt, 2022: 8). YouTube creators in Glatt’s study sought to please the deified algorithm through common strategies of visibility (like sticking to a niche and participating in trends) while working to not appear contrived. These creators revealed that algorithmic visibility strategies are often in tension with the necessity of relating to the audience through perceived authenticity.

For professionals, performance of expertise complicates feminized relational work (Naudin and Patel, 2019). Studies of TikTok health content creators have shown that professional authenticity and relatability are key dimensions in disseminating health information (Stein et al., 2022). Southerton’s (2021) work on professional health care creators highlights the “collective emotional tone” that runs through TikTok content and the ways content creator strategies tap into it. For professionals, this includes an intimate presentation of the self that is cultivated toward ordinariness and relatability, at times involving vulnerable self-disclosure. “Beyond the intimacy and relatability a creator cultivates, there is a collective intimacy that circulates on TikTok more broadly” (Southerton, 2021: 3259). While the professionals in Southerton’s study utilized microinfluencer strategies to tap into the collective affect of the users, they routinely included references to their own authority and expertise.

Therapists become influencers?

A 2021 New York Times article titled “Therapists Are on TikTok. And How Does That Make You Feel?” (Blum, 2021) showcased TikTok therapists and their rise in popularity during the pandemic. One therapist points to the moment that it struck them that they were no longer merely a therapist making educational content, but an influencer in need of a social media manager. According to BuzzFeed News article titled, “Social Media Therapists Can Resemble Cult Leaders,” “therapists don’t necessarily have to be good at therapy to become influencers—but they do need to be excellent at viral marketing” (Weekman, 2022).

While an ostensible draw of online therapeutic content is that it is free, therapists looking to monetize content engage in many of the same strategies as other influencers to increase visibility, engagement, and to land and maintain sponsorship deals. While much of the criticism around non-professional mental health influences centers around monetization of mental health struggles, therapists have largely avoided this criticism. Still, many social media therapists have sponsorship deals with the same therapy and mental health subscription apps¹ that have been criticized in other mental health creator “drama” (Lorenz, 2018).

Therapists may include social workers, licensed professional counselors, or psychologists—all with different levels of education, theoretical and practical training, and licensure. The majority of TikTok therapists are women in their thirties. Historically, distance therapies like radio shows have leaned on what Zeavin calls a “double bind of feminine expertise”—the professional therapists “hedging both [professional credentials and gender] against and in favor of the claim of expertise on offer, while keeping the mood personal” (p. 206).

TikTok regularly stresses its commitment to mental health, stating that they are helping users feel “empowered to express themselves authentically” about mental health, suggesting the use of hashtags like “LetsTalkMentalHealth” and “Selfcare.” Connecting users with mental health professionals is stated to be a top priority of the platform (TikTok, 2022).

Analysis of TikTok therapy

Therapists as client/content creator

Therapists on TikTok typically open videos with their professional credentials (e.g. “As a licensed therapist with high functioning anxiety . . .”). While establishing themselves as credible among competing information on the platform, they actively position themselves within that competing content. To do this, some TikTok therapists in this study at times invoke an algorithmic imaginary that sees the algorithm as an alchemy of science and spirituality, while tapping into that process by engaging its affective flows.

Intimate performance of self persists as a salient aspect of the charismatic media therapy figure (Yates, 2011). Therapists in this study engaged in strategies to legitimate their expertise while leveraging their openness and relatability, often including disclosure of their own mental health struggles in affective memetic form (picture a therapist group dance where each dancing therapist dons a costume embodying their choice psychopharmaceutical). Users validate these therapists by recognizing both their expertise and openness in their comment sections, crediting the therapists for helping the users to understand and accept their own mental health issues. In videos by non-professional mental health influencers, for example, comments tagging professional therapists often ask them to verify or dispute the mental health information presented.

TikTok therapists experience freedom to relate to their viewers in disclosing their own mental health struggles on the platform. The desire held by those in this profession to help others who are struggling can be at times constrained by the forms and formalities of traditional clinical procedure. Therapists express in their videos and live stream Q&A sessions that they have been encouraged in their training to present themselves to the client as a sort of “blank slate,” refraining from broaching personal issues. Disclosing that they take psychopharmaceutical medications, suffer with anxiety and addiction recovery, and have the same everyday struggles as other TikTok users engenders forms of intimacy often not present in a traditional clinical encounter. More than merely an expression of openness and “realness,” this strategy works as confessional alignment with those they are trying to reach, modeling themselves in the position of someone struggling with and receiving therapy for mental health struggles.

The strategy of adopting the patient-creator role is an unorthodox way for these professionals to, as they say, “meet the patient where they are.” Another means of achieving this is through utilization of trending sounds and motifs on the platform. In the in-person clinical space, as therapists illustrate in video skits and express in comments, understanding these memetic pop culture trends helps foster connection, especially with younger clients. In sharing these pop culture forms, there is a layered social understanding where much is established—or felt—that need not be said. Back on TikTok, the co-created memetic cultural references combine with technical affordances of the platform (Zulli and Zulli, 2020).

Like therapy itself, TikTok involves its own frameworks and rituals. Therapists use TikTok as a way of “meeting the patient not only when and where they are but as their mediated selves” (Zeavin, 2021: 336). TikTok therapists and users alike reflect on this phenomenon as it pertains to the platform. Commenters imagine future formal clinical encounters: “Very soon therapists will stop showing ink blots, but instead they will show you memes and ask you, how attacked do you feel? Or it do or don’t be like that sometimes?” “How about just letting [my therapist] scroll through my FYP?” “This is so relatable—honestly can’t tell you the amount of TikToks I’ve shown my therapist and just said this sound is a whole mood right now” (to which a therapist in the comments responds: “I need all the TikToks!”).

Memetic trends are also used to increase the visibility of therapists’ videos through the algorithm. Therapists explain that they use strategies of algorithmic visibility to extend their educational reach and help more people. Those who become full-time content creators also depend on this visibility for income (Bishop, 2019). Deployment of these strategies additionally works to attune their content with the mood of the users, making their videos not only more likely to be visible but well-received.

Strategies utilized by therapists do not only attune them to the mood of the audience, but work to do the same with other forms of self-help on the platform. These forms can be mutually reinforcing on TikTok, allowing psychology experts to employ (and legitimate) other popular self-help tropes for visibility. For example, videos from “Spiritual Tok” (see Jennings, 2021)—a TikTok-y amalgam of various occult and new age self-help content—often begin with a phrase like, “if you are seeing this video, this message was meant for you,” signaling that there is something beyond just the calculus of the algorithm at work—somewhere between magic and mathematics, the scientific and the spiritual. These seemingly paradoxical forms have a long intertwined history (Mumford, 2010; Rosenberg, 2013), and have melded in cultural imaginaries of both therapy (Carrette and King, 2005; Zeavin, 2021) and media technologies (Natale, 2019; Peters, 1999; Sconce, 2000). Therapists and other mental health content creators have adopted this otherworldly messaging in their own videos: “If you are here, this is your sign to take a mental health day”; “If you are seeing this it was meant for you”; “This mental health message has been trying to find you . . .”

While this messaging may be an avenue of algorithmic alignment with other content and work to increase visibility, it also functions to hold together tensions between spiritual and scientific ways of imagining the TikTok algorithm. User comments like, “I feel like I was summoned to this video” mix with comments about the algorithm holding intimate knowledge about them. At times, crossovers can be seen between the language of Spiritual Tok and diagnostic mental health categories. Again, these might seem like competing forms, as diagnostic mental health is largely (if misleadingly) believed to be entirely scientific,₂ but both can work through media forms to shore up cultural and political notions of individual responsibility for the effects of social problems. Attention deficit/hyperactivity disorder (ADHD)—believed in part to impact the brain’s ability to focus on and productively manage tasks—is prevalently discussed on TikTok, with billions of views on ADHD videos (Williams, 2022). In one comment, a user states, “people with ADHD are basically manifestation generators,” thereby granting them a special power to manipulate their circumstances by mental will.

The charismatic algorithm as diagnostician

The algorithm is similarly seen as an enigmatic processual mix of the material and immaterial. The sensibility that has emerged around the TikTok algorithm is that one can influence it through their concrete actions (e.g. scrolling, liking, commenting) but also through the attitudes, beliefs, and desires that drive those behaviors. As these are not always clear to us or at the forefront of consciousness, it is recognized that platforms attempt to target those subconscious affective forms to intervene on a pre-conscious level (Andrejevic, 2015). On TikTok, the algorithm’s perceived ability to do this has reached cult-like status.

If there is more to the “culty” TikTok therapist vibe flagged by BuzzFeed News, it is telling that the author mentions being fed diagnostic mental health videos by TikTok’s “unsettlingly personalized algorithm” (Weekman, 2022). TikTok therapists stress that they are not diagnosing anyone online, and many claim that they work to avoid attaching symptoms to disorders in their videos—something that they say is far too nuanced for the format. However, many therapists do put out symptomatology videos. Moreover, the broader self-help content that some work to align themselves with regularly attaches broad symptoms to pathologies. It is notable that the term “mental health” on TikTok is increasingly being used synonymously with rather than in opposition to “mental health struggles” or “mental illnesses,” which are ever algorithmically imminent.

While almost all TikTok therapists use the “TikTok ≠ Therapy” disclaimer, ultimately I argue that it is not the therapists but the algorithm that is imbued by users with a diagnostic or clinical gaze (Foucault, 1973). For example, being “diagnosed” with ADHD by TikTok is becoming a meme in itself (Williams, 2022): “Episode 977 of TikTok diagnosing me with ADHD”; “How do I go about bringing this up to my doctor? Because I feel like TikTok says I have ADHD will be laughed at”; “TikTok diagnosed me with ADHD at age 31 and I start my meds journey tomorrow.” Popular writing on the TikTok algorithm often mentions the seemingly ubiquitous experience of feeling both eerily “seen,” and, more specifically, of being diagnosed with ADHD (see Cummins, 2022; Williams, 2022).

The algorithmic imaginary of therapeutic TikTok, I argue, involves imbuing the algorithm itself with the charismatic qualities that Yates describes in media therapy culture. Charisma here is extended from Yates’ conceptualization of the celebrity therapist to signal a collection of attributes, gesturing to the origin of the term—the idea of someone (in this case something) being endowed with “divine favor.” This is not unlike the functional workings of algorithms, which work to favor certain content for visibility. Due to the largely unknown functioning of particular algorithms, this favor is often attributed not only to programming and calculation, but a sort of metaphysical understanding of human affect as it interacts with the platform.

Algorithms have previously been imagined as “mind reading” (Natale, 2019). In the case of therapy TikTok, mood reading may be more apt. This works to create beliefs about algorithms’ access to the unconscious self, which works synergistically with traditional notions of psychodynamic therapies. In addition, the charismatic algorithm designation speaks to influence through affect. In this case, the influence is as diagnostician. Not unlike an experience with the archetypal “charismatic leader” (or Buzzfeed’s “culty” therapist guru), this type of diagnosis through social media engagement can be experienced as moving and revelatory. On mental health videos, comments can be seen such as: “OMG I am literally all these things—could you please tell me how meds help and what to say to my doctor to get them”; “HOW DO YOU KNOW WHO I AM”; “I feel like I was meant to see this”; “It’s scary how well this TikTok algorithm targets me”; “So it’s a specifically for you page today [awe emoji].”

This does not work to obscure as much as reconcile or neutralize preexisting beliefs about material data surveillance, while bolstering beliefs in algorithmic power that add to its diagnostic authority regarding mental health.

Users as affective mediators

Zeavin (2021) introduces the concept of auto-intimacy as “. . . a closed circuit of self-communication, run through a relationship to a media object” (p. 133). This is elaborated in a discussion of journals, where a person “soliloquizes” and then reads back what they wrote, reflecting, as a form of self-therapy. The TikTok FYP—an endless stream of videos presented for users to scroll one at a time—can work similarly. In the case of TikTok, however, it is not one’s verbally expressed narrative that constitutes the soliloquy—rather, it’s the emotional engagement with content on the FYP that is seen as generating new personally tailored content upon which to reflect. Here, the FYP is seen as reflecting back via algorithmic curation what the user has put in through affective engagement and attention. Mental health content is just one piece of this. This is experienced as therapeutic by some users: “Never let anyone say these apps are a waste of time—this video was the therapy I needed and didn’t get”; “I went from laughing to having epiphanies and breakthroughs”; “I joined as a joke, now I’m learning how to heal my inner child.” Here, the affective relationality of TikTok strongly contributes to its therapeutic qualities. This deceptively “closed circuit” of affective engagement with the FYP works to create the auto-intimacy of “. . . a specifically therapeutic relationship to the self that is mediated by [a] program and processes” (Zeavin, 2021: 133).

Zeavin explains that journals are both addressed to the self and to a non-human other. TikTok users communicate to the algorithm through their engagement. Often, users comment that they watch a video multiple times in order in order to increase the likelihood that the algorithm will “bring them back” to see more of the thing in which they have become emotionally invested. At times, they simply register in a comment—as if both programming into the system and projecting out into the world—their “faith” that the algorithm will bring them back at the right time. The right time, according to users, is often when they are feeling down and need a dose of the “feel good” brain chemicals that TikTok videos are often believed among users to produce. Notably, formal diagnostic scales and treatment modalities for depression and other prevalent mental health disorders are often predicated upon forms of mood reading, too.

TikTok users relate on an affective level that often elides the type of linguistic expression that journaling or talk therapy requires. Where TikTok diverges from other types of therapeutic auto-intimacies is that the therapeutic engagement with the self through the platform is additionally mediated by other users and content. A key mode of relationality on TikTok is affective, often expressed as a “mood” or a “vibe” with particular creators or specific videos. Mood and vibe are expressed on TikTok as forms of not simply feeling but relating through the memetic capacities of affect, feelings, and sensibilities. Mood and vibe comments and hashtags can mark where users are working as affective mediators of therapeutic content through the algorithmic platform. The term “mood” often functions on social media as an analog for relatability that suggests a paralinguistic affective dimension. These terms are sometimes used interchangeably or varyingly across platforms and contexts. In one common TikTok usage, mood-as-meme speaks to an affective relationship, for example, “this is a whole mood.” “Vibe” is often used as an aesthetic judgment, expressed through a binary within which videos are declared “a vibe” or “not a vibe,” and “vibe checks” can be passed or failed. Vibe has been discussed as anti-narrative (Chayka, 2021), which speaks to the affective form that therapy assumes on TikTok, with moods and vibes working to position videos in affective alignment or resonance with users or not.

This kind of affective attunement can serve a priming function for diagnostic information about mental health. In other words, many users are ready to more easily accept and incorporate the diagnostic information that they encounter. Much like frames of a therapeutic office setting like low lighting, couch, and so on are sometimes staged to set the mood for the psychodynamic therapeutic process of emotional transference, the TikTok platform and trends may prime users to experience resonance with what is presented as diagnostic criteria (though may not formally be). This phenomenon differs from a Web MD scenario, where people are actively performing Internet searches for specific symptoms and diagnosing themselves. In the case of TikTok, people are encountering and embodying the condition through their mediated selves and daily practices.

For example, on TikTok, ADHD has become a mood disorder,³ and the disorder has become “a whole mood.” ADHD symptomatology videos are rampant on TikTok. Typically directed toward women, the videos depict loose collections of everyday struggles with often gendered⁴ home, work, and relationship tasks, grouping and pathologizing these as ADHD. Ironically (or not), scrolling on TikTok is often presented as a pathological symptom in itself. This kind of “meta” experience forges a deeper entrainment with the content. The videos portraying humorous, relatable struggles to perform “basic life” tasks are experienced with the cathartic relief that there exists an answer via diagnostic category, validating real struggles in a way that counters common criticisms faced by those living with these struggles. Diagnostic categories can then be taken up as mental health identities. These complex assemblages are packaged effectively and affectively in TikTok videos.

Discussion and conclusion

The ways that the TikTok algorithm enlists user affect, along with the ways in which it is imagined as charismatic by users, I argue, situates TikTok alongside other more explicitly therapeutic algorithmic technologies like those that Zeavin analyzes. Users experience TikTok as a therapeutic practice or ritual, and ultimately designate it as therapy through its imagined diagnostic capacities. It is notable that TikTok users often state that they are acutely aware of data surveillance materialities, their commercial functions, and potentialities for control. Professionals’ cooptation of or algorithmic alignment with spiritual trends and tropes do not erase that, nor do they disturb closely held beliefs of the strongly scientific basis of their content. In some ways, however, they do contribute to ways people are able to hold these kinds of tensions together, including seeing algorithms as the straightforward computational procedures they are, yet containing just enough of an enticing element of the mysterious (if not the mystical) to obfuscate if not obscure grim materialities. To be sure, the splitting of these tensions can sometimes lead down “pipelines” through which social media gurus exploit health care anxieties, as was the case with “the holistic psychiatrist,” who began by speaking to concerns about mental health care, and ended up preaching the non-existence of COVID-19 (Di Filippo, 2020). In addition, I find that panics over data privacy as they are popularly framed can actually work to bolster beliefs about algorithms knowing us better than we know ourselves, a key notion in this study’s conception of algorithmic charisma.

The charismatic algorithm is as much process as a conceptualization. Building on Bucher’s model of the algorithmic imaginary, practices of engagement with algorithmic content are transactional, impacting both user and algorithmic behavior. Because of this interactivity, TikTok can be theorized as a therapeutic mood tracking and mediating technology, critically positioning it alongside other commercial mood tracking technologies. The algorithmic imaginary of TikTok is not necessarily at odds with the ways contemporary platforms function. Across digital media, mood data are a hot commodity.⁵ I propose that TikTok contributes to an economy of affective engagement, wherein user affect performs a binding promise to forge connections in market legible and leverage-able ways. Elmer (2019) suggests the attention economy framework foregrounds individual users’ activity on platforms, evading the broader data collection goal of mapping relationships on and off of platforms. On TikTok, for effectiveness, creators need to foster affective attachments between themselves, other content, and users. They need to engage the affective algorithm.

Social media mental health professionals are subject to many of the same issues as non-professional mental health influencers, including monetization of content and strategies of branding and visibility. If the monetary framework is largely fantasized out of the traditional therapeutic interaction (Zeavin, 2021), the monetary frameworks underwriting TikTok therapy may be even more elusive. Indeed, in the wake of state failures, engagement with the TikTok creator-clinician and related content may graft an exhortation to take care of one’s mental health through digital technologies onto already marketized modes of social capital. “Social media therapy” is already inherently paradoxical in that social media use is so often implicated in mental health struggles (Figueroa and Aguilera, 2020).

Within the constraints of TikTok therapy, opportunities do exist for creative ways to engender community and new conversations around mental health. Experiences of mental and emotional struggles find community in therapists’ live chats and humorous sets of common experiences in diagnostic videos. The critique of these therapeutic modalities and mental health models is in no way intended to belie the experiences of those who are helped by them. Opportunities to broaden conversations around mental health beyond what is typically in the clinical therapy room include utilizing affordances of the platform to connect mental health to social issues (like “stitching” or duetting videos and using trending sounds). Some TikTok therapists are tentatively beginning to experiment with these connective forms, but tend to receive a great deal of backlash in doing so. More commonly, user comments reveal that they are making their own connections between mental health and social or political issues when they are algorithmically aligned.

Therapy culture can be seen as “both the symptom and solution” to cultural change and uncertainty (Yates, 2011). Mental health is beginning to be more widely acknowledged as political (Carr, 2022)—not just in the sense of institutionalized mental health services—but the understanding that medicalizing distress can sometimes work to cover over broader systemic issues that are significant contributing factors. That said, mental health care has long been out of reach or of lower quality for those who need it most, with many looking to technologies as a solution. Insufficient as technology may be to solve all mental health care issues, it cannot begin to help without taking into account that the technology itself is designed and implemented in ways that are equitable and accessible (Aguilera, 2022; Campos-Castillo and Laestadius, 2022). TikTok’s memetic hall of mirrors deflects as much as it reflects. Like its most viral dances, its most viral uses of “mood” (Know Your Meme, 2018) are coopted from those then left out of its most visible circulations (see Ile, 2022). Crucially, future research of social media therapy and mental health subjectivities should examine who is left out and unable to access such subjectivities at all.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Holly Avella

Notes

Author biography

Holly Avella is a doctoral candidate in the Rutgers School of Communication and Information PhD program in Communication, Information, and Media, researching mood, media, and mental health technologies.

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