99 Pubs and Zero Followers? Psychiatric Leadership in the Age of Influencers

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COMMENTARY

“I just want to give everyone what they want, and I’m in a family full of narcissists,” says Lochy, a teenage character from a privileged family, in the most recent season finale of the popular television show White Lotus.¹ Terms like “narcissist,” “borderline,” “sociopath,” “psycho,” and “psychotic” have entered the vernacular and become part of everyday conversations amongst people who do not hold degrees in mental health. Lay people are increasingly using terms like these to describe themselves, people they know, and public figures. This phenomenon has been attributed in large part to celebrities and influencers discussing their own mental health issues and mental health issues in general on social media.^2-6

I have spent the past 3 years since I finished training working on one of the inpatient forensic psychiatry units at Bellevue Hospital treating patients admitted from Rikers Island for acute stabilization. I have the ability to impact the patients I directly treat, but like many early career psychiatrists, I am “100% clinical.” While influencers and celebrities talk about their own experiences with mental health issues and drive conversations about mental health on social media, I spend most of my time on an inpatient forensic unit separated from the rest of the world and from my iPhone by metal detectors, gates, and correctional officers. It is primarily nonmental health professionals who are shaping the mental health discourse via social media platforms.⁷

This phenomenon of individuals disseminating information on social media platforms about a field they lack formal expertise in is not unique to psychiatry; however, there are several factors that seem to contribute to this phenomenon being more pronounced in psychiatry specifically. One factor is that psychiatry is distinctive among medical specialties in that there are no explicit physical exam findings or lab values to match a presentation to a diagnosis and treatment. Different providers may diagnose the same patient with different disorders. Even the same provider may change their diagnosis over time.

Psychiatry is also unique as a medical specialty in that it is focused on the human condition, which is something lay people can relate to, are typically interested in, and may feel they can offer expertise in even though they lack formal mental health training. Social media posts about mental health issues seem more likely to attract viewers than, for example, posts about pulmonary or urological conditions. A larger audience can potentially relate to and benefit from information about mental health.

Additionally, the mental health field is unique in that it is not comprised solely of psychiatrists, psychologists, NPs, and PAs; we also have licensed therapists, licensed counselors, social workers, and peer specialists. While there is a dearth of studies examining the general public’s understanding of these roles and the differences between them, the limited literature suggests lay people have misperceptions and uncertainty regarding the credentials and levels of training these roles entail.^8-10

There are certainly some potential benefits to this phenomenon of nonmental health professionals bringing attention to mental health issues using social media. For example, lay people can share their personal struggles with mental health that others may relate to, empathize with, and find helpful in understand and coping with their own experiences and illnesses. Someone does not necessarily have to be an expert to be helpful. Social media is an inclusive space lacking the traditional barriers of peer review which can bring unique and diverse perspectives to the mental health discourse. Involving nontraditional voices could theoretically improve cultural competency in the field and also help to address mental health inequities.

However, there are also significant potential dangers associated with lay people posting about mental health. Many individuals giving advice about mental health issues online are not mental health professionals and can spread misinformation. One study found that only 3% of the most popular mental health videos on TikTok were created by credentialed mental health clinicians.^{11, 7} A study conducted by a group called PlushCare, a company that offers virtual mental health and primary care appointments, examined TikTok videos on mental health and had their medical professionals give their opinions on whether information in the videos was inaccurate or constituted potentially damaging advice. The study found that 84% of videos offered inaccurate information or damaging advice. ^11,12

Self-diagnosis is another potential negative consequence of content generated by nonmental health professionals. Celebrities and lay people post about their own mental health issues which viewers may relate to; this can lead viewers to self-diagnose with the same disorder as the content creator based solely on identification with the content creator’s individual experience. Lay people posting about mental health can also oversimplify complex psychiatric disorders that mental health professionals obtain years of training to learn to diagnose and treat.^13-15 In addition to self-diagnosing, it has also become more ubiquitous for lay people to use diagnostic terms to refer to acquaintances and public figures. The Goldwater Rule is encapsulated within the American Psychiatric Association’s (APA) The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry and is also a standard part of psychiatry residency curricula.¹⁶ Additionally, many of us have seen how stigmatizing diagnoses, even if only mentioned as a possibility one time in a patient’s electronic medical record, can affect the quality of care a patient receives in the future or the outcome of their criminal case. We also may be more likely to question the usefulness of labeling individuals with psychiatric pathologies. We also know that there is a tendency for certain conditions to be overdiagnosed or underdiagnosed among patients of certain races and genders.

The rise of mental health influencers raises the question of what we should do as mental health professionals and aspiring leaders in mental health. Should we start posting mental health content on social media to correct misinformation and educate the public about mental health? Or should we continue to focus our efforts on peer-reviewed journals and other scholarly mediums? Do we need to reclaim our roles as leaders in the field by entering the social media world?¹⁵

In terms of arguments for entering the social media arena, some mental health professionals cite a need to correct misinformation about mental health online by disseminating our own evidence-based content. Judith Joseph, MD, a child psychiatrist at NYU with a prominent social media following, argues that doctors should be on social media because they can provide reliable and evidence based information. She expresses concerns about misinformation and the mental health discourse being dominated by less reputable individuals if doctors do not take active roles. She also discusses opportunities she has gained access to as a result of her substantial social media following.¹⁸ Other mental health professionals discuss the role psychiatric leaders can play as catalysts for societal transformation—that their role transcends the clinical and compels them to “actively shape policies that address the root causes of mental health disparities.”¹⁹ Some argue that providers can “position themselves at the forefront of their field” by “showcasing and discussing novel treatments and technologies that improve safety and enhance patient experience.”²²

One factor that may deter mental health professionals from disseminating information on social media is a concern about being labeled as influencers rather than as scholars or clinicians. Proponents of mental health professionals creating social media content counter this argument by highlighting the need to deviate from the “typical influencer model.”¹⁷ They discuss focusing on “authentic communication,” which they describe as “sharing meaningful insights, engaging in public health discussions, and demystifying medical processes and advancements.”¹⁹

Another concern with entering the social media arena is avoiding entering into a doctor-patient relationship with followers. Some mental health influencers include disclaimers as part of their content to help address this issue, but even this practice is not common.²⁰ Another potential barrier to having a strong professional social media presence is the time commitment involved: influencers with the most followers post at least daily. The time it takes to create that much content would be difficult to balance with a full-time mental health job. Monitoring others’ posts, reviewing comments from followers, and dealing with “trolling” also add to the time burden. Another concern, especially for forensic psychiatrists, is the importance of neutrality and objectivity; even if writing in a neutral manner or tone, the topics of posts or any content posted could be scrutinized on the stand.

Another consideration is the damage that social media can do to mental health. Should we even endorse these platforms that can cause so much psychological harm? Several studies have found correlations between social media use and mental health issues including addiction, anxiety, depression, bullying, and distorted body image.^14,21,22 However, evidence also suggests social media can be beneficial. Being aware of its possible harm would likely aid providers in maximizing benefits and avoiding negative consequences.¹⁸ 

To revisit the crucial questions: Are influencers who are not mental health professionals supplanting us as leaders in our field, which is by its nature particularly vulnerable to incursions from non-professionals? Or should we think of influencers as distinct entities? Does being a leader in mental health in the “Age of Influencers” necessitate that we contribute to content on social media? There are no straightforward answers, and there are pros and cons to both abstaining from posting professional content and to contributing. Social media platforms do facilitate discourse and create a vast space for mental health professionals to lead and share their expertise with the general public in an evidence-based and informed way. Some mental health professionals who developed robust social media presences also report that doing so opened up opportunities for leadership that they would not have otherwise had. It is also problematic that mental health content is largely disseminated by non-mental health professionals, arguably giving these creators pseudo-leadership roles in the mental health world. Mental health professionals could theoretically combat misinformation on social media by joining the discourse and thereby simultaneously reinforce their roles as leaders in the field. However, there are several potential risks, harms, and costs associated with creating content which deter mental health professionals from pursuing professional social media roles. For mental health professionals who decide to create mental health content, being aware of the potential pitfalls and challenges while proceeding cautiously will be crucial.

Dr Aggarwal is a clinical assistant professor in the Department of Psychiatry at New York University Grossman School of Medicine. She is also an attending forensic psychiatrist at Bellevue Hospital Center.

References

1. White M. Amor Fati. “The White Lotus.” Season 3, episode 8. HBO; April 6, 2025.

2. Haupt A. Gaslighting, narcissist, and more psychology terms you're misusing. Time. March 15, 2023. Accessed April 10, 2025. https://time.com/6262891/psychology-terms-misused-gaslighting-toxic-narcissist/

3. Hale M. When therapy goes wrong: the problem of underqualified psychotherapists. The Guardian. October 19, 2024. Accessed July 8, 2025. https://www.theguardian.com/society/2024/oct/19/when-therapy-goes-wrong-the-problem-of-underqualified-psychotherapists

4. Shane Dawson’s YouTube series on Jake Paul faces backlash over use of the term “sociopath.” Teen Vogue. October 4, 2018. Accessed July 8, 2025. https://www.teenvogue.com/story/shane-dawsons-youtube-series-jake-paul-sociopath

5. Dodgson L, Colombo C. Influencers are using psychological terms like ‘narcissist’ and ‘gaslighting’ to fuel drama and bring in clicks. Business Insider Netherland. August 14, 2021. Accessed July 8, 2025. https://www.businessinsider.nl/influencers-are-using-psychological-terms-like-narcissist-and-gaslighting-to-fuel-drama-and-bring-in-clicks

6. Asif S.“Manic,” “narcissist,” “sociopath”: how social media uses psychiatry terms. Op-Med. September 3, 2024. Accessed July 8, 2025. https://opmed.doximity.com/articles/manic-narcissist-sociopath-how-social-media-uses-psychiatry-terms

7. Miodus S, Jimenez A. TikTok therapy: an exploratory study on popular TikTok mental health content. In: Technology, Mind & Society 2021 Conference Proceedings. American Psychological Association; 2021.

8. Domingo-Espiñeira J, Varaona A, Montero M, et al. Public perception of psychiatry, psychology and mental health professionals: a 15-year analysis. Front Psychiatry. 2024;15:1369579.

9. New study offers insight into public perception of counseling profession. Inside UNC Charlotte. October 11, 2016. Accessed July 8, 2025. https://inside.charlotte.edu/news-features/2016-10-11/new-study-offers-insight-public-perception-counseling-profession

10. Hall R. When therapy goes wrong: the problem of underqualified psychotherapists. The Guardian. October 19, 2024. Accessed July 8, 2025. https://www.theguardian.com/society/2024/oct/19/when-therapy-goes-wrong-the-problem-of-underqualified-psychotherapists

11. Sood A. Psychiatry on TikTok: providing education to teens in an ethical manner. Psychiatric Times. June 27, 2023. https://www.psychiatrictimes.com/view/psychiatry-on-tiktok-providing-education-to-teens-in-an-ethical-manner

12. PlushCare Content Team. How accurate is mental health advice on TikTok? PlushCare. August 1, 2022. Accessed July 8, 2025. https://plushcare.com/blog/tiktok-mental-health

13. Weigle P. Psychoeducation or psychiatric contagion? Social media and self-diagnosis. Psychiatric Times. May 8, 2023. https://www.psychiatrictimes.com/view/psychoeducation-or-psychiatric-contagion-social-media-and-self-diagnosis

14. Khan Z. The dangers of excessive social media usage. Psychiatric Times. October 13, 2022. https://www.psychiatrictimes.com/view/the-dangers-of-excessive-social-media-usage

15. Rossiaky D. Experts express concern over mental health advice on social media. Medical News Today. October 24, 2023. Accessed July 8, 2025. https://www.medicalnewstoday.com/articles/experts-express-concern-over-mental-health-advice-posted-on-social-media-platforms

16. The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. 2013 Edition. American Psychiatric Association; 2013.

17. Joseph J, Duerr HA. A psychiatrist’s journey in social media advocacy and clinical research. Psychiatric Times. June 25, 2024. https://www.psychiatrictimes.com/view/journey-in-social-media-advocacy-and-clinical-research

18. Alag P, Wakefield SM. Psychiatric leadership in the 21st century: navigating transformative roles in global mental health. Psychiatric Times. January 10, 2025. https://www.psychiatrictimes.com/view/psychiatric-leadership-in-the-21st-century-navigating-transformative-roles-in-global-mental-health

19. Kolovich G. Robust online presence needed to meet expectations of today’s patients. Medical Economics. March 18, 2024. Accessed July 8, 2025. https://www.medicaleconomics.com/view/doctors-must-have-robust-online-presence-to-meet-today-s-patients-expectations

20. Pretorius C, McCashin D, Coyle D. Mental health professionals as influencers on TikTok and Instagram: what role do they play in mental health literacy and help-seeking? Internet Interv. 2022;30:100591.

21. Farnsworth J, Di Nicola V. Extending the terms of the social: digital worlds and the fluid social. Psychiatric Times. July 10, 2024. https://www.psychiatrictimes.com/view/extending-the-terms-of-the-social-digital-worlds-and-the-fluid-social

22. Mohan A. The double-edged sword of social media. Psychiatric Times. April 5, 2023. https://www.psychiatrictimes.com/view/the-double-edged-sword-of-social-media