Why Do We Love Diagnosing Strangers’ Mental Health Online?

Emma Chamberlain, the 20-year-old YouTuber and Instagram personality, is no stranger to talking about her mental health. In recent years she has spoken about depression and anxiety in several of her vlogs, and talked about her history with disordered eating in an interview with Cosmopolitan in 2020. This openness and perceived realness has only endeared her more to the millions of followers who adore her, regularly calling her “my best friend who doesn’t know I exist” and celebrating how ‘normal’ she is, despite her unfathomable wealth.

Recently, though, her behaviour and presentation in her vlogs has spawned concern among her followers. Her weight, shape and eating habits are being scrutinised by fans for signs of disordered eating; threads in the Emma Chamberlain subreddit talk about how her isolation (in a pandemic year) and subdued energy is a sign of her being "depressed and miserable" and TikToks are posted in which creators say that they are "genuinely worried" about her because they think she is not okay.

This all culminated in Emma herself talking about the matter on her podcast, saying that the speculation she was having a severe depressive episode actually triggered her to have one, leading her to delete TikTok and Twitter. "At the time that I saw these TikToks I was in a great place," she says. "[But] when I saw [them], something inside me cracked."

Emma Chamberlain is far from the first public figure to have her mental health scrutinised and diagnosed by strangers, nor will she be the last. But the way the cards fell in this instance brings focus to how we (think we) understand and analyse other people’s mental health online. The increased (and often false) intimacy of social media, a wide dissemination of mental health jargon, a legitimate desire to destigmatise mental health conditions and a need to make sense of the way others behave have coalesced into us feeling like we can and should diagnose others with mental health problems. Despite being deeply unqualified to do so.

In 1978 the American Psychiatric Association (APA) added Section 7 to its Principles of Medical Ethics, which states that “it is unethical for a psychiatrist to offer a professional opinion [of an individual in the public eye] unless he or she has conducted an examination and has been granted proper authorisation for such a statement.” This section is informally known as the Goldwater Rule after a 1964 article published in Fact magazine which polled psychiatrists about whether then US Senator Barry Goldwater was fit to be president. Goldwater successfully sued the magazine for damages and the APA took an official stance against diagnoses of public figures without due process. While the Goldwater Rule has no official law in Australia, there is a code of ethics which provides guidance to Australian psychiatrists about their media conduct.

Keeping to this rule is one thing when you are a professional bound to a code of ethics and living in the world of 50 years ago, when our exposure to and interaction with public figures (and people in general) was far more limited. But enacting the logic of this rule is more complicated in a world of social media saturation. We have more clues, it seems, to piece the puzzle of personhood together and anyone with a free social media account has access to them. Unlike the days of press statements and carefully choreographed appearances, we have direct access to public figures. And they, in turn, can share with us what looks like their stream of consciousness: their ‘unfiltered’ thoughts and whims, likes and dislikes.

But as the director of the Media Psychology Research Center, Dr Pamela Rutledge, points out to R29, this all means that those left to offer opinions or even diagnoses are not qualified to do so. And even if they were, the information available cannot be considered useful, no matter how voluminous it is. “Most public figures do not present their authentic self,” she says, “but rather a cultivated persona, which means that these diagnoses aren’t even reflecting the real individual.” Nonetheless, we feel like we know them and can recognise their behaviours.

The way that social media encourages and thrives on users developing parasocial relationships with public figures only compounds this sense of intimate knowledge. And for online creators like Chamberlain, who are famous for ‘being themselves’ and make their living through familiarity and relatability, the sense of closeness that a fan develops is an explicit part of their appeal and business model. And with that comes an expectation of transparency. 

Beyond the relationship curated between audience and public figures, Dr Rutledge also points to the prevalence of psychological and psychiatric terminology as a potential contributing factor. “People are a lot more knowledgeable about mental health labels even if they have no idea about the actual diagnostic criteria. You see this all the time when people talk about social media ‘addiction’.”

This terminology, Dr Rutledge says, can then be used to add validity to what are really just opinions. “Mental health conditions sound more ‘grown-up’ or official than just calling someone a bad name — but it is ultimately just name-calling in a fancy wrapper.” In doing so, it can help us as individuals explain or bring some certainty to people’s actions. 

“Diagnoses attribute causality to an individual’s behaviours,” she adds. “People do not like uncertainty — it increases anxiety and fear. Labelling someone with a mental illness puts that person into a category and provides an explanation to make what they do make sense by some criteria.”

This can be seen in the particular nature of what happened with Emma Chamberlain. Kate Lindsay is an internet reporter and cofounder of Embedded, an internet culture newsletter, who regularly reports on the world of online creators. She points out that the expectation of transparency only works up to a point when the individual’s behaviour ‘makes sense’ in the eyes of the audience. “Emma’s brand is relatable,” she tells R29, “because even though she's become extremely wealthy, she films herself sitting around at home and making snacks and playing video games like a normal teenager. But then her fans started to flip it — if she's so wealthy and privileged, why is she spending so much time at home? Is she depressed? Does she have an eating disorder?” Despite Chamberlain’s openness in other instances, fans were more drawn to the conspiracy that there must be something more, something even worse, that she's not sharing.

For people well-versed in mental health language and intent on destigmatising conditions, there is an understanding of how diagnoses could be used to insult or dismiss public figures you don’t like. This only adds to stigma and shame for those with actual diagnoses.

But it gets more complicated when this diagnosis and analysis comes from a place not of loathing but of care and concern. When a parasocial relationship makes you feel as though you know someone and you truly care for their wellbeing, it can be hard to recognise what is otherwise apparent: that we do not know everything about that person, and we never can.

There is an argument that in diagnosing the mental health of strangers or asking them to speak publicly about their conditions, you can destigmatise conditions and ensure that certain behaviours are not idolised and emulated. Given that we live in a time when many people are comfortable with talking openly about their mental health in their own terms, openness has certainly lessened the shame around deeply stigmatised conditions. But this presumes that people are always comfortable at all times, and that we as an audience are always owed that honesty. This assumption, Lindsay thinks, “is why it doesn't seem invasive to people for them to speculate”.

When we follow or are fans of public figures, particularly online ones, we fit them — unwittingly or not — into narratives that work for us. And when that person is seen to change or to deviate or just exhibits behaviours we’ve never seen before, the impulse is to pathologise them: in the framework of a mental health diagnosis we can understand why they do x and y, and even sympathise and relate to them. But unless the diagnosis comes from a professional in the proper setting or from the mouth of the person in question, interrogating and categorising people is not going to destigmatise mental illness or help the individual.

As individuals we don’t have the Goldwater Rule to hold us to account, and limp attempts to get people to ‘think before you post’ don’t seem to have made a dent in people speculating in comments and on subreddit threads. Maybe the only solution is to step back and recognise two things at once: that the person you think you know is a morphing work of fiction but the real person behind it is affected by the speculation.