Today, Explained - Tiktalk therapy

Episode Date: June 10, 2024

Some therapists are turning to TikTok as a way to make more money and avoid burnout, but is a nightly scroll through therapy content enough to help solve our mental health crisis? This episode was produced by Denise Guerra, edited by Amina Al-Sadi, fact-checked by Laura Bullard, engineered by Patrick Boyd and Andrea Kristinsdottir, and hosted by Jonquilyn Hill. Transcript at vox.com/today-explained-podcast Support Today, Explained by becoming a Vox Member today: http://www.vox.com/members Learn more about your ad choices. Visit podcastchoices.com/adchoices

Therapist self-disclosure. What is it? Should we do it? How much do you care to know about it? I use the word emotional peanuts because I think about unpacking. We could talk about the emotions wheel. We could talk about emotional literacy. Have you noticed more therapists on your nightly TikTok scroll? We're therapists, and of course we're curious about how does that make you feel? If it feels like more mental health professionals are turning to the social media platform, you aren't imagining things. It's not a coincidence that so many people are dropping out of these professions and finding more freedom and money and fulfillment

doing the influencer thing or the entrepreneurial thing. But does more access to information about mental health mean more to information about mental health mean more people are getting mental health treatment? That's ahead on Today Explained. Okay, these are things that hot therapists are obsessed with. Obviously, I'm a hot therapist. I have a lot of hot therapist friends. BetMGM, authorized gaming partner of the NBA,

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BetMGM operates pursuant to an operating agreement with iGaming Ontario. You're listening to Today Explained. I'm Jonquan Hill, filling in today as host. My colleague Rebecca Jennings is a senior correspondent at Vox covering internet culture. And she explained what therapy talk actually looks like. When people talk about therapy talk, they're talking about the mental health experts and therapists who are sort of using the posting norms that are rewarded by TikTok's algorithm to build followings. And a lot of the time that means they'll use a strong visual hook. There are some that will like, you know, set up toys to use as a metaphor for, you know, your mental state or something. In therapy, I like to call it the domino mindset.

Let me explain. Now, every day you stack up lots of these small actions. For example, you meet that deadline and you remember your friend's birthday, but then one small thing goes wrong. And in your mind, this happens. And then they'll hop on to trending memes or audios. So, you know, when that meme was going around where it's like, we're X, of course we're Y. I'm a black therapist, so of course I'm gonna confront my patients in therapy with phrases like, so you're just not gonna do what we talked about doing?

We're therapists, and of course we're curious about how did that make you feel? We're therapists, we're gonna- Oh my god, are you okay? No, I'm not. Are you hurt? Emotionally, mentally. I feel like I got the weight of the world on me. A lot of therapy talk will stress a lot of identity markers.

Sort of like, you know, are you a woman who was diagnosed late in life ADHD? Or do you have high-functioning depression and, you know, something like a highly sensitive person? These are terms that have gone really viral on TikTok and the rest of the internet, I think in part because there's a lot of young people and they're finding themselves, or there's a lot of people that haven't been exposed to therapy speak and are now kind of trying to work on themselves or figure out how to make positive changes. Let's talk about why ADHDers suck at taking criticism. ADHDers experience this thing called RSD or rejection-sensitive dysphoria.

What a sexy name. RSD is the term for- So can you tell us a little bit more about who is posting? You know, are these actual credential therapists? Are these like, you know, randoms posing as mental health professionals? It's all the above. So you have psychologists, you have psychiatrists, you have licensed therapists, but then you have a lot of people who are life coaches or authors. And these are obviously credentials, but they are credentials that effectively anyone can kind of call themselves.

You can call yourself a life coach. You don't have to pass a test. It's just a word that you can use. Or you can call yourself a mental health expert and no one's there going to be like, well, no, you did not get your expert certification. Those don't exist. And you can call yourself an author if you like self-published a PDF of something. On the Internet, it's like what matters is how many people follow you. Yeah.

How popular are these videos? Like how many people are watching them? A ton. So a lot of these therapists have, you know, more than a million followers. One of the bigger ones has like 5 million. Another one has 3 million. There's Dr. Julie. I'm a psychologist and here's three things you need to know about anxiety.

Number one. Who is a a psychologist and here's three things you need to know about anxiety. Number one, who is a British psychologist, an author. She is big on the visual hooks. She will like flip over an hourglass or she'll dump out a bowl of candy and use the candy as a metaphor for like things that you care about or something. Sugar or caffeine? Which one disturbs your sleep the most? Then there's therapy. Jeff. Three tips on how to make an anxious avoidant relationship work. One, predict your partner's needs. He is pretty inescapable on TikTok. He has three million followers. He does a lot of the sort of dating advice, which is also a huge part of TikTok. He'll do a lot of like validating

stuff about. It is not your fault that you have an anxious attachment style. It's the fault of the environment that you grew up in. It's because you had parents or caregivers that were inconsistent with their love and attention. Or, you know, if you're in whatever single phase you're in, here are ways that you can, you know, still honor your goals and get out and meet people. And here's how to like know what like what red flags are in dating and things like that. And those are really, really popular. So are these therapists monetizing their content? How much are they making if they're doing that? Here's the thing. Therapists and psychologists have always been influencers to

some degree. You know, they'll, you know, do speaking gigs and write books and be important like public intellectuals. Whereas on TikTok, I think a lot of these messages and a lot of this like personal branding can travel much, much wider than, you know, a typical self-help book written by a therapist. I've got some stuff to give away. I'm still getting my head around this, but my book was the UK's top selling nonfiction book of 2022. They're going on TikTok because that's where the people are to build this audience and then getting these great book deals to sell to that audience and oftentimes doing a lot of brand deals, which is, you know, typical influencer labor, which is making an ad for a company and posting it on your TikTok, basically. Some of them have merch. One of them

has a t-shirt store that has, like, favorite client on it. And then some of them will, you know, have side businesses. Like, one of them has, like, a coaching business that's specifically for influencers. Yeah, like the idea of buying like merch from my therapist is very, I don't know why, but that feels weird and stressful to me. And, you know, I just wonder, I realize we are in like a side hustle era. Everyone has a side hustle. Everyone is trying to like monetize what they do even more. But is, you know, that traditional in-person sitting on the couch or even, you know, on Zoom therapy just not enough to make a living anymore? Because I'm sure there are people listening where it's like every time I come up off that copay or that out-of-pocket payment, it feels like it should be enough,

you know, to get by on where you don't have to do a side hustle coaching influencers. Right. One would think. So one of the therapists I talked to kind of explained this to me. And therapists typically get paid because insurance companies set their rates. Like they don't really get a huge say in how much they're making. There are some adjustments based on where you live. Obviously, like a therapist in San Francisco or New York is going to be paid more than someone in Texas. And so in the case of one therapist I talked to, Therapy Jeff, he told me that he can make like eight or nine times the amount that he could make from just seeing clients alone in a year on brand deals and merch and being an influencer. And so he's making a ton of money.

But ironically, he also told me that, you know, he doesn't want to do TikTok forever because it's kind of messing with his mental health. Like, he has to worry about the algorithm and how it will, like, reflect on the day's post. And it's just, like, this constant grind, which I, you know, I hear from every single TikToker I've ever talked to.

They're like, this is a huge grind. And, you know, I hear from every single TikToker I've ever talked to. They're like, this is a huge grind and, you know, not as like diminishing rewards, basically. But if you succeed like him, you can make, you know, almost a million dollars, which is wild. Yeah, I think it's interesting that he spoke to you and mentioned like, oh, this is taking a toll on my mental health. Because, you know, everyone has their stuff. I don't know, you tend to think of your therapist or like your mental health professional as kind of like enclosed in this glass case. They have it together.

And I think part of the beauty of that relationship is you don't really know a lot of their business. But these therapists are really open. And I just wonder, you know, what that does for the dynamic. Or maybe it's different online than it is IRL. Yeah, I think one thing that I've really found striking about therapists on TikTok is how often they'll talk about their own mental health or their own, like, sort of family situation. It's exhausting. And sometimes it's tiring and sometimes I will withdraw and I just do my own thing until I feel better. And for a really, really long time

in the mental health field, that was sort of like blasphemous to do. Like you do not, like you are basically supposed to be a brick wall. But I think in sort of the era of social media and the era of influencerdom in general, I think we see this in journalism as well. It's like you're seeing, you're hearing a more subjective voice. You're getting more of an insight into who the person is behind the screen or behind the voice or whatever. And so I think this is a trend that's bigger than just therapy, but professionals are now feeling a lot more comfortable. And what they're saying is that clients appreciate it. They feel like they can relate to a therapist that they know a little bit more about. And so I think it sort of fits in with this sort of mold of

having a personal brand and putting it online. And I think it works out really well for them. Rebecca Jennings covers internet culture for Vox. Coming up, just because we're seeing more talk about mental health doesn't mean people are getting better. In fact, the numbers suggest it might be getting worse. Support for Today Explained comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained, ramp.com slash explained, r-a-m-p.com slash explained.

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With your help, they can stop the extreme Project 2025 agenda. Join the ACLU at aclu.org today. You're listening to Today Explained. I'm George McCary. I am the director of the DeWitt Wallace Institute of Psychiatry and a professor of psychiatry at Weill Cornell Medical College. Okay, so earlier in the episode, we talked with one of my colleagues about TikTok therapists, which, you know, kind of feels like the latest in pop psychology. But mental health is so much more than, you know, attachment styles or trying to find out the reasoning behind your ex's behavior. What populations are getting left behind when it comes to treatment and awareness when it comes to mental health?

You know, one of the problems with thinking about mental health is it's really a pretty vast domain. And it ranges from, as you say, something like, you know, what's going on with my boyfriend to, you know, really severe illnesses that are probably in some very significant portion genetic, viral illnesses, hormonal illnesses. It's very hard to talk about it without distinguishing what we're talking about. I mean, in terms of the TikTok stuff, I'm all for education and helping people understand what's going on in their lives and when they need to get help is a good thing. But, you know, treating them as a different thing. There's a lot, a lot of work to be done that can't be done by education. So we hear all of this talk about how mental health has gotten worse, but how have the numbers shifted over the past few years?

Well, it's been a pretty dramatic shift ever since COVID. Spikes in anxiety or depression correlated to the weekly number of reported COVID. As the coronavirus was surging in 2020, fewer pediatric patients went to the emergency room, likely because people were trying to avoid hospitals. But despite the overall drop in visits, a new study shows there was an increase in the number of teenagers who went to the ER for suicide attempts, suicidal thoughts, and self-harm. We have clear indications that the number of suicides, ER visits, addictions, anxiety and depressive disorders, all the numbers are up. This was a Gallup poll. They found that in someone's lifetime, they had 29% adults likelihood of being diagnosed with depression. That's one in three of us.

Highest rates were in people 18 to 44. And there was a difference men versus women. Women, 37% diagnosed with depression in their lifetime versus men, 20%. For some of those, you could say it might be that we're more aware. And so people that weren't getting diagnoses got diagnoses anew. But you know, a bunch of these are empirical events, like an ER visit's an ER visit. It's not a label. A suicide attempt or a new addiction is an empirical event. So that's just clearly increased incidence of illness. I feel like I'm constantly surrounded by talk of mental health, you know, but it seems like there's a real

disconnect between talking about it and having language for it and actually getting treatment and help. Yeah, I think that there is, you know, on the one hand, we've done a very good job destigmatizing mental illness. So I want to say in terms of the positive of everyone talking about it, I think that's a really good thing. But the negatives you see when you go to Cook County Jail or you go to Rikers Island, where there are people who are obviously severely mentally ill, and we're treating them in a jail, in a prison. And so under treating communities, especially people who are impoverished, different immigrant communities, different communities really, you know, are not getting the care that they need. And now this has hit a full blown crisis. When you add to that, too, that mental health services aren't always accessible, They're not always covered by insurance. And, you know, it's still true that we have whole areas of the country that are

pretty much deserts for mental health care. Like you just it's if they're very, very few psychiatrists and psychologists. We have about 50,000 psychiatrists for a country of 300 million people. So that's really insufficient. And then if they cluster in urban areas and on the coasts, you can imagine what happens in the middle of the country. How did we end up with the current system for mental health care that we have now? Why do we treat it in the ways that we do now? I went out to find what exactly the mental health system was, and I was

immediately informed that we had no system. If you think of a system as coordinated parts that are there for the major things, which is to care for folks, to get diagnosis and treatment, and to do research to help to develop the field since it's such a complicated field. In fact, we have a very fragmented system where different parts of the puzzle don't really communicate well with others, and so lots of people fall through the cracks. We have this problem that's kind of three-tiered. One is, how does the community care for people, house them, feed them? You know, we have these homeless encampments

that are, you know, the shame of our nation. We have jails filled with the mentally ill. McDonald is the watch commander at the Twin Towers Jail, and he walks me into a ward called Intake. They were just arrested, and they were just taken off the streets. I see newly arrested inmates tethered to tables by chains to keep them from attacking others. I would say most of these inmates in this module were homeless. That problem that we have on the streets directly relates to what we have going on in the county jail. So that's like one part of the problem. The second

part of the problem is we have better treatments than we've had ever, but we don't get them out to folks. So there are lots of underserved communities. There are lots of, you know, deserts where it's very hard to get actual treatment. And the treatments are really good in a lot of places, but not in others. We should all be concerned at the low rates at which Americans, particularly Americans of color, are able to access and receive mental health treatment. It is crucial to understand that individuals in need of professional mental health resources are not to blame for their inability to get treatment.

So we really need the scientists to step up and to try to help our patients. Really, the institution that's supposed to be leading our national mental health effort, which is the National Institute of Mental Health, has gotten very much obsessed, I would say, with this dream of finding like a single gene or a single neural pathway for what turns out to be very complex, multi-determinant illnesses. So we have billions of American taxpayer dollars going to research, which I support. I support good research, but at the expense of clinical work that might really push the ball forward for patients and for care.

You know, we get whacked by a virus, which causes massive mental health consequences. And there's no gene for a viral attack that disrupts homes and societies and fearful reactions and trauma. There's no gene for that. So you are a psychiatrist yourself. And I just wonder if you could, you know, like, wave a magic policy wand and, you know, all of the recommendations that you have to improve America's mental health come true, what would they be? Like, where would you start? I would start by saying we need more of a unified system. We right now have a research arm of the government, NIMH, which has completely dissociated

itself from the delivery of services and for a center and leadership that takes into account these very complicated problems. We need leadership that says, of course, we're going to do more genetic research, but we are going to really shift our portfolio to a much more balanced approach. And then we have a lot of work to do on delivery. You know, just the antidepressants we have now, if we can get them out to all the depressed people out there, we would be doing a lot of good. So how do we do that? There's got to be ways using, you know, maybe digital apps or something like that to help with the delivery of services. I don't think that, you know, TikTok is going to be the treatment, but maybe it can get people to get treatment. How about that? There are a lot of players here that aren't just like you and

your clinician. Like, there's lots of societal stuff of players here that aren't just like you and your clinician. Like, there's lots of societal stuff going on here that's impacting mental health. You know, things like discrimination that especially are deeply entrenched, poverty that is deeply entrenched. We know that these things are massive stressors on individuals. And so to, you know, simply say, well, that's a social problem, not a medical problem, is to be naive. These are things that alter people's worlds, their sense of hope, their sense of despair, the risk factors of addiction and of depression, et cetera, et cetera. We know that. So you might say, well, it's overwhelming to do something about that.

But okay, let's start by acknowledging that it's a very big problem. So we have to really move towards a more balanced biopsychosocial set of causes, acknowledge that it's very hard for us to make huge generalizations and think in a more nimble way about how we can affect people's health. George Makary, thank you so much for joining us. It was delightful to be with you. Thank you. George Makary is the director of the DeWitt Wallace Institute of Psychiatry and a professor of psychiatry at Weill Cornell Medical College. Later this week, we're going to be talking about credit card debt,

and we wanted to know, are you in a lot of it? Are you having to rely on your credit card for everyday expenses or emergencies? Are you having trouble paying on your credit card for everyday expenses or emergencies? Are you having trouble paying it off every month? Tell us your story by calling 844-453-4448 or recording a voice memo on your phone and sending it to todayexplained at vox.com. Today's show was produced by Denise Guerra. It was edited by Amina Alsadi, fact-checked by Laura Bullard, and engineered by Patrick Boyd and Andrea Christian's daughter.

I'm John Glenhill. This is Today Explained. Thank you. you