Mental illness doesn’t work like measles
Reports of teens developing tic-like behaviors after watching TikTok videos highlight something most of us don’t consider about mental health: symptoms can be social.
Since March 2020, specialists in the United States, Australia, Canada, and the United Kingdom have seen a dramatic spike in young patients seeking treatment for tics, according to The Wall Street Journal. Doctors say most of the young people watched content from TikTok creators who say they have Tourette syndrome, one type of tic disorder. Top TikTokers film themselves involuntarily cursing, slapping themselves, making clapping sounds, and more. Cumulatively, #tourettes videos have been viewed more than 5 billion times.
Some researchers have claimed the sudden surge in TikTok tics is a “pandemic within a pandemic,” as the teens struggle with schoolwork, feelings of isolation, and even bruises and other physical marks from their tics. But TikTok isn’t creating the distress these teens feel, says pediatric psychologist Allison Libby, an associate clinical professor at the University of California, San Francisco. Instead, the tics are a byproduct of anxiety, depression, and even traumatic stress. Far from dismissing these issues as “all in your head,” acknowledging how symptoms are shaped by a broader social context — and, now, by social media — could help teens find relief for more than just their tics.
“Symptoms are a means of expression,” Rebecca Lester, a professor of sociocultural anthropology at Washington University who studies psychiatry, religion, and gender, told me. “We learn in different cultural settings, even local settings, how to communicate our suffering.” That learning isn’t intentional — or even necessarily conscious. But the consequences can be debilitating.
Mental illness doesn’t work like measles, which manifests the same way wherever it goes. Because emotional experiences can vary dramatically across time and place, so can symptoms.
Take, for example, traumatic stress from war. Psychiatrists tend to treat World War I-era “shell shock” as a precursor to PTSD, a concept that was solidified in the aftermath of the Vietnam War. But the two groups of veterans often exhibited wildly different symptoms. Mutism, seizures, and paralysis were common symptoms of shell shock. PTSD, by contrast, is defined primarily by flashbacks. The further back in history you go, the stranger soldiers’ symptoms seem: in the Civil War, soldiers suffered from “nostalgia,” or homesickness, that made it difficult for them to breathe and unsettled their stomach.
There isn’t a “correct” stress response to war — or any other hardship. In every case, the soldiers’ suffering was very real. But their symptoms changed in part because their culture did. The plight of the TikTok teens suggests we’re in the middle of another revolution in the language of distress today.
Many symptoms have a social component, but tics, in particular, happen to be very suggestible, Libby says. In 2011, for example, as many as 20 teenagers in upstate New York, almost all of them students in the same school, suddenly developed similar tremors. Explanations included environmental pollution and cancer clusters; Erin Brockovich sent a team to test local soil. Ultimately, doctors close to the patients concluded the physical symptoms were the result of psychic distress. Fortunately, by the next spring, many of the afflicted teens were on the road to recovery.
Just 10 years ago, teens were most directly influenced by the handful of kids in their homeroom; today, thanks to platforms like TikTok, the whole world can feel like one big high school. Earlier this year, German psychiatrist Kirsten Müller-Vahl and her colleagues introduced the phrase “mass social media-induced illness” to describe an outbreak of tic-like behaviors among German teens that began in 2019 and is linked to a popular YouTube creator with Tourette syndrome. Add to that the COVID-19 pandemic, which more than 25 percent of American high school students say has worsened their emotional health, and an outbreak of tics seems almost inevitable.
So what happens next? The difference between true tic disorders, which typically emerge in childhood, and tic-like behaviors, which are what these TikTok users seem to be experiencing, doesn’t matter much for treatment, Libby says. Both groups will likely undergo something called comprehensive behavioral intervention for tics, or CBIT, to manage their symptoms. However, if there are other underlying mental health issues, those need to be treated, too. “My guess is that they will absolutely be able to recover,” Libby says, “especially if they are getting treatment for the underlying anxiety or depression.”
When it comes to the current spike in tic-like disorders, “blaming TikTok, it’s a cop-out,” Lester says. For these teens, the distress was probably already there. These symptoms just made it impossible to ignore.