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SIDNEY FUSSELL

COMM 5183

SCHULTE

SOCIAL MEDIA AS MENTAL MEDICINE

The internet is a lot of things. Primarily, it functions as the ultimate vendor – cars,

clothing, education, and both private and public information are accessible via an increasingly

plethoric number of devices: laptops, desktops, iPads, cellphones, etc. Even devices with

different primary functions have been recalibrated to allow for internet access, including gaming

devices and as of 2010, refrigerators. As this shows, the internet is a sinuous medium, molded to

fit into every aspect of users’ personal lives. The 380,0001 students enrolled in the online college

University of Phoenix utilize the internet as educator, the 90,0002 paying members of eHarmony

utilize the internet as matchmaker, more than 500,000,0003 people worldwide have found a

friend on Facebook and, considering the $121 dollars4 in revenue online health information

database, WebMD, saw in 2009, the internet also functions as doctor.

It seems puzzling, at first, to rely on the technical, computerized abstract of the internet

for assistance when grappling with the meaty, primal stuff of our minds and bodies. But

1 Apollo group, inc. reports fiscal 2011 fourth quarter and year end results. (2011, October 19). Retrieved from http://phx.corporate-ir.net/phoenix.zhtml?c=79624&p=irol-newsArticle&ID=1618736&highlight=

2 eharmony information, statistics, facts and history. (2012, February 8). Retrieved from http://www.datingsitesreviews.com/staticpages/index.php?page=eHarmony-Statistics-Facts-History

3 [Facebook Statistics, Stats]. (2011, January 18). Retrieved from http://www.digitalbuzzblog.com/facebook-statistics-stats-facts-2011/

4 Webmd health corp.10-k 2010. (2010, February 25). Retrieved from http://www.wikinvest.com/stock/WebMD_Health_(WBMD)/Filing/10-K/2010/F47084885

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conceptualizing a meat/machine binary is misleading. In order to understand why people entrust

their bodies to the internet, it is imperative to concentrate on the different features of the internet

itself and how they fit into the contours of our lives. To this end, no technology is as integral to

the dissolution of this binary as “web 2.0” and the advent of social media. While social media

itself has limited (though notable) potentiality to aid in the struggle for good mental health

and pro-social behavior, it may, more importantly serve as a space for recalibrating public

opinion of mental illness, dispelling the misperceptions that contribute to the fear of self-

identifying as “ill.” The technologies that have dissolved the binary predicated on distinct

virtual/reality oppositions have allowed for a level of comfort and fidelity for the internet and the

interpersonal connections it produces that legitimizes the web as an avenue for de-stigmatizing

mental illness as an identity. To evince this claim, a definition of both “web 2.0” and “social

media” is necessary. Paul Anderson, Technical Director of Intelligent Content Ltd. published the

aptly titled “What is Web 2.0?”5 in 2007, hoping to “separate the sense from the sensational” in

the discourse of what exactly web 2.0 is. 6

While Anderson acknowledges the popular perception of Web 2.0 as a “more socially

connected Web in which people can contribute as much as they can consume,” he ultimately

concludes that this is a misleading moniker.7 Web 2.0 is simply the evolution of long-term goals

set for the internet since its inception. Quoting “inventor of the web” Sir Tim Berners-Lee: “Web

1.0 was all about connecting people. It was an interactive space, and I think Web 2.0 is of course

a piece of jargon, nobody even knows what it means. If Web 2.0 for you is blogs and wikis, then

5 Anderson, P. JISC Technology and Standards Watch, UK Higher and Further Education sector. (2007). What is web 2.0? ideas, technologies and implications for education

6 Anderson, 53.

7 Anderson, 4.

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that is people to people. But that was what the Web was supposed to be all along.”8 Although

new technologies are allowing for more visible interconnectivity between users, its been a

function of the internet all along. The specific technologies driving this increased visibility

(blogs, forums, mobile internet access) however, represent new steps forward in this process of

actualizing the internet’s potential for connection. This actualization is foundational in the

construction of webservices that begin to dissolve the meat/machine binary. The internet has

become less of a monologue in front of a machine and more of a computer-mediated dialogue

between humans, punctuated by the specific “web 2.0” technologies.

The evolved facilities available for human connection drives the increasingly ostensible

social tendency to permit web 2.0 into the sphere of private life. This represents a paradigm shift

in cultural knowledge in which “logging in” becomes a mediated form of person to person

connection in and of itself. Nicholas Carr notes this, with some distress, in The Shallows.

Paraphrasing the findings of author Marshall McLuhan, Carr writes “whenever a new medium

comes along, people naturally get caught up in...’the content’…that it carries. The technology of

the medium, however….disappears.”9 This “disappearance” of the medium itself illustrates how

web 2.0 invisibly crossed over into the private sphere. And while Carr derides this as a

deficiency in the public discourse on technology, in the context of material life, it signifies the

universalizing of the medium. Essentially, why the Western world permits social media into

every aspect of personal life.

8 Anderson, 1.

9 Carr, N. G. (2010). The shallows, what the internet is doing to our brains. New York: W. W. Norton & Company.

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The convergence of virtual and reality, guided by users’ desire for human connectedness,

presents the context in which social media may function as medicine. Whatever help social

media may offer would be immaterial without the (at least partial) dissolution of the barrier

between users and the sources of information. Simply put, the human aspect of social media

nurtures fidelity to Web 2.0 as a useful resource because people trust it as a medium. We are no

longer people talking to machines, we are people talking to each other.

As this relates to mental health, several in the field see the accessibility of social media as

beneficial. Richard Zwolinski, author of Therapy Revolution and contributor to the Psychcentral

blog lauds the universality of social media: “social media opens new communication pathways

for those who feel trapped…they can reach out for support [and] learn more about their own

illnesses from professionals and peers …”10 The “communication pathways” Zwolinski

references are the same technologies that signify web 2.0 and actualize the aspirations of

interconnectivity seen in the original web.

This sentiment is echoed by Dr. Susan Giurleo, a clinical psychologist that specializes in

pediatric mental health care: “People can self-identify as someone suffering from a disorder and

talk to others with similar experiences and issues about treatment protocols, coping skills and

feel less alone…this process of sharing online will most likely lead to more people seeking the

help they need.”11 Dr. Giurleo is particularly concerned with the ability of social media to lessen

the stigma of seeking help. By connecting with other people with similar experiences, Giurleo

10 Zwolinski, R. (2011). Mental Health and Social Media. Psych Central. Retrieved on April 12, 2012, from http://blogs.psychcentral.com/therapy-soup/2011/07/mental-health-and-social-media/

11 Giurleo, S. (2010). Retrieved from http://socialmediafortherapists.com/social-media-will-change-mental-health-car

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reasons, the shame of seeking treatment will lessen. If this is true, the rapidity with which online

connections are formed may collectively lessen the stigma of mental illness.

As Dr. Zwolinski says in his writings, “stigma is the biggest obstacle to helping the

mentally ill… seek help and improve.”12 Unfortunately, the stigma of mental illness proves

deleterious to good mental health on multiple levels. Patrick Corrigan of the University of

Chicago details the detrimental effect of social stigma on the individual level:

Living in a culture steeped in stigmatizing images, persons with mental illness may

accept these notions and suffer diminished self-esteem, self-efficacy and confidence in

one’s future. Research shows that people with mental illness often internalize

stigmatizing ideas that are widely endorsed within society and believes that they are

valued less because of their psychiatric disorder. Obviously, this kind of self-prejudice

and self-discrimination significantly interferes with a person’s life goals and quality of

life. 13

Corrigan here is discussing two interrelated factors: self-stigma and social stigma. As he

defines: “public stigma [is] what a naïve public does to the stigmatized group when they endorse

the prejudice about the group [and] self-stigma [is] what members of a stigmatized group may do

to themselves if they internalize the public stigma.”14 As he writes, social stigma of mental illness

functions at a structural level (media representation, creation and maintenance of stereotypes) but

its repercussions are also felt on the individual level, i.e., avoidance of seeking help. 12 Zwolinski, R. (2011). Mental Health and Social Media. Psych Central. Retrieved on April 12, 2012, from http://blogs.psychcentral.com/therapy-soup/2011/07/mental-health-and-social-media/

13 Corrigan, P. (2004). How stigma interferes with mental health care. American Psychological Association , 59(7), 614-625.

14 Corrigan, 620.

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So how could Web 2.0 reduce stigma? In addition to its universality and accessibility,

Web 2.0 creates a space for another potential resource in combating mental illness: creativity.

The Organization for Economic Co-operation and Development (OECD) commissioned a

report15 in 2007 to explore the participatory nature of Web 2.0: “The concept of the participative

web is based on an Internet increasingly influenced by intelligent web services that empower the

user to contribute to developing…internet content …. As the Internet is more embedded in

people’s lives, users draw on new Internet applications to express themselves through user-

created content (UCC).”16 While Web 2.0 allowed for hyper-connectivity between people, it

allowed for individual users to create and share their own content, forming spaces for discourse

based on shared interests. Users can blog on any variety of subjects across various platforms,

creating content in the form of text, video, music, etc. and publishing it for instantaneous access

for other users. The OECD report also discusses the effect participatory culture has on its users:

The rise of UCC has altered the nature and the economics of information production as

the entry barriers for content creation have significantly declined … and led to the

democratization of media production … These changes imply a shift away from simple

passive consumption of broadcasting … to more active choosing, interacting and actually

creating of content and a shift to a participatory culture….the changed structure of

communication and resulting active relationships built around exchange are argued to

have a vital and important impact on how citizens and users communicate and express,

and possible positive impacts on social ties.17

15 Vickery, G., & Wunsch-Vincent, S. Committee for Information, Computer and Communications Policy, Organisation for Economic Co-operation and Development. (2007). Participative web: user-created content

16 OECD, 35.

17 OECD, 35

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As the report concludes, web 2.0 augments the creative capacity of users.

Widespread accessibility allows for huge user bases and instant sharing of user created

content, arising along intersections of common tastes and interests found through the

sharing of experiences. More people talking means more people creating. Anderson’s

report termed this the “network effect.” Using the metaphor of telephone users,

Anderson writes: “When a new telephone user joins the network, not only do they as an

individual benefit, but the existing users also benefit indirectly since they can now ring a

new number and speak to someone they couldn’t speak to before.”18 Web 2.0 allows for

interconnected users creating and sharing personal content. This creates a unique

opportunity for people who’ve never had publishing access to create and participate in a

mediated discourse.

This is especially opportune for those who suffer from the social and self-stigma

of mental illness because it allows them to claim and discuss their identity in a space

moderated by other people like them, as opposed to the public discourse where their

minority status makes them vulnerable to prejudiced behavior. The creative capacity of

UCC allows them to form their own sites of discussion and identity management where

the source of their stigma becomes a commonality, forming the “communication

pathways” that create the “active relationships” that are difficult to form in the “real

world” of stigmatized messages about mental health and the mentally ill.

Three websites in particular are attempting to harness the inventiveness of web

2.0 to aid those suffering from mental illness. WEGO health.com, patientslikeme.com

18 OECD, 20.

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and Webtribes.com utilize social networking formats to facilitate network building

between users. Registered users can post open messages on the forum, track each

other’s progress via blogs and send messages. WEGO health and Webtribes.com both

group users by their particular illness and offer information from health professionals,

including recommendations for finding local therapists in the users’ area.

Webtribes describes itself as a support community that “[offers] a safe place for

individuals with similar challenges to connect [and share] their experiences with other

like-minded members from all over the world.” Website resources include blogs, forums,

polls, instant messaging services and a mobile gallery. Patientslikeme and WEGO health

both feature similar goals. All three websites are ultimately attempting to offer a space

where “mental illness” is reconstituted as an identifier that can connect people, not

ostracize them as a mark of shame. On a very small scale, this reconstitution is a part of

the work of undoing self-stigma and may help in the fight for better mental health.

However, while web 2.0 may foster connections and support between people with

similar ailments, the medium itself is no cure. In terms of material, discernible changes to

an individual’s mental health, research has found online support groups are “not

necessarily effective in terms of producing therapeutic change” and “do not substitute for

professional treatment.” 19 Instead, web support had limited empowering effects that “lead

to more general personal feelings” and not the “tangible emotional, cognitive, behavioral

changes” of direct professional intervention. Researchers suggest a “hybrid approach”

that aspires for “nonspecific empowerment and well-being improvement.”

19 Barak, A., Boniel-Nissim, M., & Suler, J. (2008). Fostering empowerment in online groups. Computers in Human Behavior, 24, 1867-1883.

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Additionally, while the mediated interpersonal connections of web 2.0 have utility

as a de-stigmatizing agent, this is not innately pro-social. Just as users may connect in

ways that reduce the stigma of mental health, they can also create discourses that

encourage self-destructive and dangerous behavior. The popular microblogging platform

Tumblr recently updated its Terms and Services agreement and Content Policy to prohibit

content that the site finds “just wrong.” In a statement on its Staff Page, the new policy

reads:

Don’t post content that actively promotes or glorifies self-injury or self-harm.

This includes content that urges or encourages readers to cut or mutilate

themselves; embrace anorexia, bulimia, or other eating disorders; or commit

suicide rather than, e.g., seek counseling or treatment for depression or other

disorders. Online dialogue about these acts and conditions is incredibly important;

this prohibition is intended only to reach those blogs that cross the line into active

promotion or glorification. 20

This update was met with some agreement and some dissension from users. One user

felt “this could just take away another safe space for ED people on the internet.” While another

felt “considering how many pro self-harm blogs/posts I have seen on Tumblr and how much they

actually influence some people, I think the Tumblr staff is making a smart decision.” One user

was frustrated at where “the line” was, commenting “there are no clear cut specifics as to what

20 [A New Policy.] (2012, February 23). Retrieved from http://staff.tumblr.com/post/18132624829/self-harm-blogs

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you will and will not be able to post, so how are we as the users of this website supposed to

follow this new policy…” 21

As a platform, Tumblr finds itself alternating between alienating users who find the site

as a safe place to discuss the difficulties of living with mental illnesses and actively policing its

users by restricting objectionable content that may promote dangerous, anti-social behavior. This

is a serious limitation of Web 2.0 as a tool for greater mental health. Save for the regulatory

power of the platforms themselves, Web 2.0 lacks any innate filter to preclude potentially

deleterious messages from reaching those seeking aid. And, as the users wrote, this can appear as

either restrictive and totalitarian or ambiguous and unnecessary.

In fact, either extreme is counter to the overall goal of cultivating online spaces beneficial

to mental health. Highly policed regulation of UCC stifles creativity and delegitimizes the

connections made between users, reducing the positive effects of social ties. Meanwhile,

unchecked proliferation of messages without any regulatory filtering may lead to the

“promotion” of unhealthy behavior as Tumblr describes, normalizing and encouraging acts such

as self-harming. As this evinces, UCC is a two-way street. Even the most flagrant violators of

this policy who cross “the line” did so by traveling along the same “communicative pathways”

intended to connect people in positive ways. To work effectively as a medium that promotes

healthy behavior, regulation is necessary to structure UCC in a way that is consistently pro-

social.

While the mechanics of Web 2.0 have been rendered invisible in a way that promotes a

level of comfort with the medium, it still requires extensive refining to function as a medium that 21 Fox, Z. (2012, February 23). Tumblr takes a stand against ‘self-harm’ blogs. Retrieved from http://mashable.com/2012/02/23/tumblr-self-harm-policy/

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can alleviate mental illness, its symptoms and attached social stigmas. Tumblr, was correct to say

“online dialogue about these acts and conditions is incredibly important” but that users “should

seek counseling or treatment for depression or other disorders.” As Web 2.0 becomes

increasingly ubiquitous it is important that it not be regarded as the “final stop” on the journey to

better mental health or that its ability to help be oversold. It is no panacea. Instead, its utilities

should be harnessed to reorient people, armed with awareness and a de-stigmatized, pro-social

identity into professional care and conversations with real world healthcare professionals.

So what specifically can Web 2.0 do? Again, it is not, and should never be the goal of

any web service to present itself as the ultimate mental health medicine. This misidentification

works in a detrimental fashion analogous to offline stigma. Just as identifying as “mentally ill”

presents a stigma, via prejudiced status, that prevents seeking treatment, the fiction of wholly

destigmatized, utopic online spaces where mental illness is immaterial or easily cured can do the

same. A plausible, more effective goal of a mental health oriented web 2.0 should be the

following: First, it should establish people with mental illnesses as a diverse class – not a

monolith of homogenous social outcasts. The proclivity of social media to encourage creating

identities helps to facilitate this greatly. Second, it should allow for the creation and maintenance

of regulated spaces where those within this class can self-identify and exchange stories and

establish networks of support. This bid for collectivism encourages expression and creativity,

and an important articulation of the difficulties of overcoming mental illness that contradicts the

prejudices of offline spaces. This is where the precarious nature of regulation vs. free expression

becomes central, as it is important that these connections be consistently pro-social. With these

benefits in place, the third goal of web 2.0 should be to direct people to therapeutic intervention

in their personal lives, supported by online connections. This return to reality is crucial in

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dispelling the desire to herald web 2.0 itself as medicine. Web 2.0 is not the medicine, it is the

means to empower yourself to the point where one can go get the medicine.

This is by no means an all-inclusive plan. For example, it assumes a single narrative of

mental illness and how it’s treated. Cyclothymia for example, is a mild mood disorder whose

sufferers have very high functionality. It would be erroneous to draw a clear parallel in terms of

need and treatment with someone who suffers from schizophrenia, which often necessitates long

term psychiatric care. Additionally, this narrative risks assuming that sufferers are responsive to

the medium at all. A teenager experiencing depression and anxiety after being harassed online

via forums, chatrooms, etc. would be extremely reluctant to this suggested model.

That said the model is intended to showcase the potentiality of Web 2.0 as a site of

negotiation where discourses of mental health, stigma and general wellness can be redefined in a

way that lessens the prejudices these people face as a minority class. The crucial first step,

seeking help, is the genesis for this process. This is essential to the formation of the social ties

and class consciousness that necessitate the changes requisite for rethinking mental health as a

difficult, but surmountable obstacle that does not have to be faced alone and does not have to be

a mark of shame or deficiency, but can be a commonality that can lead to connecting with others

who can aid users on the path to good mental health.