Social sickness

Across the oak dinner table, Jane videoed her 16-year-old daughter.

In between bites of Caesar salad and swigs of juice from a lidded cup, Anna shook, pounded the table, and jerked her head of thick blonde hair backward and forward.

She poked others or clamped salad tongs at them while they ate in silence. She clicked her teeth, encased in braces, and coughed out an occasional obscenity or a menacing laugh. And she repeatedly blurted out the word beans.

Four days after this dinner table incident, Anna’s petite legs were shaking so violently that Jane rushed her to the hospital. The night before, her legs stopped working altogether after going limp in what appeared to Jane as symptoms of a seizure. (Since Anna is a minor, WORLD agreed not to use her or Jane’s real names to protect their identities.)

It was March 2021. To Jane, Anna’s uncontrollable tics seemed to come out of nowhere three months prior. She knew her daughter was still angry over her parents’ 2018 divorce. Anna had recently stopped speaking to her dad after he broke up with a live-in girlfriend. Amid COVID-19 lockdowns, Anna grew more depressed and withdrawn. She spent most days holed up in her room, glued to her computer or smartphone.

But as Jane searched for answers, she began to think something else—something more specific—had influenced Anna: TikTok. She learned Anna was binge-watching videos posted on the social media platform by users who said they had Tourette syndrome, a nervous system disorder most common in boys in early childhood. The disorder leads to repetitive, involuntary movements and sounds.

“At one point, [Anna] told me she picked up some of the tics from watching other people do them on TikTok … like the beans one,” Jane said.

Evie Meg Field, a 22-year-old Brit who has 15.5 million followers on TikTok, is said to have popularized the beans tic. Field’s videos document her purported experience with Tourette syndrome and other disorders. They garner millions of views and thousands of likes and comments. TikTok videos filed under the hashtag #tourettes have 7.7 billion views to date.

One day, Anna told her mother she actually had Tourette syndrome. Jane had grown up with a friend who had the disorder, so she didn’t buy it. While Anna was in the hospital, Jane’s aunt sent her a screenshot of the girl’s secret TikTok account. Among other content, Anna had been posting videos of her tics. She also told her followers she had Tourette syndrome.

As strange as it might seem for a previously healthy child to claim she has a life-altering disorder—and even exhibit symptoms that are strikingly similar to those of others her age—lots of girls are doing it. Early in the ­pandemic, neurologists across the globe began documenting a surprising surge of young girls arriving at movement ­disorder clinics with similar Tourette-like tics. Besides their symptoms, they had one thing in common: spending time on TikTok. One study found the number of referrals for rapid-onset tic disorders at some clinics rose from about 5 percent before the pandemic to up to 30 percent by 2021. Some doctors dubbed girls with the beans tic “Evies.” A group of German psychologists called the phenomenon a “mass social media-induced illness outbreak.” Other researchers from the University of Sydney used the words “social media contagion” in a paper published last March.

And the Tourette phenomenon isn’t the only problem. Other psychologists have linked heavy social media use among teen girls to sharp increases in mood disorders and self-harm. Researchers noted the numbers started to climb in the early 2010s, a few years after the iPhone launched and social media gained a solid foothold. Speaking at a Senate Judiciary Committee hearing last May, New York University social psychologist Jonathan Haidt called the spike in teen girls with mood disorders a “specific, gigantic, sudden, and international mental health crisis.”

But in a time when the majority of adolescents have smartphones and interact with their peers almost exclusively over social media, parents struggle to steer their kids away from its harmful effects. Teens themselves wrestle with how to use social media without letting it shape and overtake their sense of identity and self-worth.

Too many are losing that fight. For years, experts have been sounding the social media alarm over adolescents’ increasing isolation and depressive symptoms. But now, coming out of the pandemic, they say social media is ­contributing to a greater range of afflictions and mental ­illnesses—and turning mental and emotional disorders into status symbols, even a way to get more followers. Some experts and lawmakers are trying to hold tech companies accountable. But just like parents, they struggle with how much to intervene to shield kids from the dangers.

JANE BLAMES HERSELF for not paying enough attention to Anna’s activity on social media.

During her lunch break at the hair salon where she works, we meet for Mexican food at a shopping center across the street. Jane wears an Aztec-patterned cardigan with shades of blue matching her eyes, her wispy, lightened hair loosely pulled back. On top of her job at the salon, Jane takes civil engineering classes at a local junior college. She goes swing dancing with her mom on the weekends when her children are with their dad.

After the divorce, Anna and her siblings struggled to adjust to their parents’ separate lives. They also transitioned to public schools when all they had known was homeschooling with Jane. “Within a year, a lot changed for our family, really fast,” Jane tells me over a plate of fish tacos. Anna’s world fell apart, she says, but so did hers. Then the pandemic hit.

During Anna’s hospital stay, doctors put her on medication for anxiety. And they diagnosed her with functional neurological disorder (FND), a group of problems including vocal and physical tics not connected to an underlying disease. While its cause is unknown, doctors say FND is rarely triggered by one thing. Jane joined FND Facebook parent groups. She read all she could get her hands on about the disorder. When she brought Anna’s doctors recent articles and studies about social media use as a factor in functional tics, they appeared surprised.

Meanwhile, Anna was posting TikTok videos from the hospital using the hashtag #FND. That hashtag currently has 898.5 million views on the platform. She also posted videos documenting her treatment. Jane tried to have Anna’s phone taken away, but hospital staff prohibited it. At the very suggestion, Anna flipped out.

PSYCHOLOGISTS JONATHAN HAIDT and Jean Twenge track the correlation between social media use and rising mental illnesses among teens. They found that adolescent mood disorders remained relatively stable until the advent of smartphones and social media. Between 2009 to 2019, rates of mental illnesses shot up between 50 percent and 150 percent, depending on the disorder, gender, and subgroups. Other research shows a sharp and sudden increase in teen girls being admitted to the hospital for self-harm, particularly cutting themselves, beginning in 2010.

Today, 95 percent of U.S. kids ages 13 to 17 have smartphones, according to Pew Research Center. Common Sense Media estimates that nearly 80 percent of teens use social media regularly. The number of 8- to 12-year-olds using social media rose from 31 percent in 2019 to 38 ­percent in 2021, Common Sense Media found.

Two-thirds of U.S. teens Pew surveyed use TikTok. One in 6 said they watch it “almost constantly.”

“TikTok has become the No. 1 source for mental health [information] among kids,” said Sissy Goff, a licensed therapist in Nashville, Tenn., and a Christian author of titles including Brave: A Teen Girl’s Guide To Beating Worry and Anxiety. “I have girls all the time who are regurgitating what they heard some influencer say about any mental health issue.”

Goff says parents feel helpless as they try to teach kids to function socially and use technology responsibly: “I think this causes parents more anxiety than probably ­anything else we’re seeing today.”

Katie Flinn is a licensed therapist in Santa Rosa, Calif., and a forensic interviewer for Sonoma County. She also runs a private practice for children. Parents of kids suffering from mental illnesses, trauma, or other problems often ask her to discuss with their child setting limits on social media or getting rid of it altogether. The conversations never go well. “It’s like I’m asking them to live without a left arm,” she said.

Increasingly, Flinn’s young clients have already self-­diagnosed with a mental illness. But they balk when she suggests they still need a formal diagnosis or when she gently prods at other underlying problems.

Social media “seems to be so a part of them, the addictive nature of it,” she tells me over coffee on a brisk Saturday morning.

One new study from neuroscientists at the University of North Carolina conducted successive brain scans of ­middle schoolers aged 12 to 15. It found that those who habitually checked their social media feeds displayed heightened sensitivity to peer feedback over time.

Flinn says her young clients struggle to separate themselves from what is happening on social media and the approval they find there. “So do we talk about it? Yes. But it’s not even like an individual topic, because it’s part of their existence.”

Eight in 10 teens said social media helps them feel more connected to their friends, according to a recent survey by Pew. Nearly 70 percent said social media helps them feel supported during tough times. But that support is often detached from real relationships, Flinn said. One young ­client referenced a close group of friends for months. “Did you hang out with them this weekend?” Flinn asked during one session. The girl told Flinn she had never met those friends in person and knew them only through social media. Some lived in foreign countries—or said they did.

One recent study revealed that family structure plays a role in how teens use technology. Kids with married ­parents spent two hours a day less using digital media, research from the Institute for Family Studies and the Wheatley Institute found. Children from intact homes were also more likely to report their family had rules around technology, including limiting social media and prohibiting smartphones at dinnertime or in their bedrooms at night.

Flinn and her husband have two young daughters. She is already concerned about how to parent them in the digital age. “What do I do? Because if you don’t let them have social media, they’re unable to connect with their peers in a way that feels relevant to them,” she said. “But you also want to protect them. Where do you strike the balance?”

RHEANNA AMIVISCA, 21, spends her days chasing ­toddlers at a daycare facility. Exhausted, many nights she plops in bed and scrolls TikTok, sometimes for hours. She recently stopped taking junior college classes because her anxiety and depression have worsened. Amivisca was ­diagnosed with those conditions at age 16. Earlier this year, she was diagnosed with bipolar disorder.

I meet Amivisca at a café one morning in November. Her short black hair is slicked back in a ponytail, revealing the word chaos tattooed near her neckline. She hugs me before snapping a quick photo of her iced pumpkin spice latte and avocado toast for her Instagram page.

Amivisca has been snapping and posting pictures since she was 11. The Children’s Online Privacy Protection Act, passed in 1998, sets the minimum age for a social media account at 13. But Amivisca says it was easy enough for her and her friends to lie about their ages and set up numerous accounts on various platforms. With little or no parental oversight, she says, they accessed—and in some cases shared—nude and self-harm photos on social media. Sometimes, they interacted on platforms with users they later learned were grown men.

When I prod at how social media has shaped Amivisca, including her struggles with mental illnesses, she pauses for long seconds before responding. It’s almost as though she is only beginning to understand the harm it caused.

“Instead of TikTok now, where I’m finding people who can support my bipolar and give advice, I was as a teenager finding suicide blogs and self-harm stuff on Tumblr,” she says. “I was feeding into my depression and anxiety … thinking mine had to be worse. I was craving the sadness because online they made it so poetic. It was a bad place for me at the time.”

Today, she believes TikTok is the most addictive social media app. And now more than ever, her feed is filled with videos of users comparing their mental illnesses, she tells me. But she also finds therapeutic content and medical professionals offering free advice. She has saved numerous videos. Some make her laugh hysterically. Others are sad and depressing. Some nights she cannot stop scrolling, even if it takes her down a dark hole.

In recent years, lawmakers on Capitol Hill and in California have debated how to hold tech companies responsible for keeping kids safe online. Last March, President Joe Biden in his State of the Union Address called on Congress to crack down on tech companies for “the national experiment they’re conducting on our children for profit.” But two Senate bills that addressed kids and online safety failed to pass last year. Critics argued those bills encouraged more data collection on kids and prevented them from accessing information on LGBTQ issues.

California Gov. Gavin Newsom, a Democrat, signed a bill in September modeled after a U.K. law that puts legal obligations on tech companies with online products and services likely to be accessed by children. Another state bill failed. It would have permitted parents to sue a social media company when their kids become addicted to its platform.

A 2021 Wall Street Journal investigation last year revealed that Facebook was concealing from the public its own company research showing the ways its photo-sharing app Instagram contributed to worsening body image issues and higher rates of mood disorders among teen girls. The research found that Instagram made body image issues worse for 1 in 3 teen girls.

Francis Haugen, a former Facebook employee and whistleblower, told a Senate subcommittee in 2021 that Facebook harms children in its pursuit of breakneck growth and astronomical profits. Uproar over the issue prompted Facebook to back away from its plans to launch Instagram Kids.

TikTok, owned by the Chinese company ByteDance, claims its community guidelines prohibit content depicting, promoting, or normalizing “activities that could lead to suicide, self-harm, or disordered eating.” In a recent statement on mental health, the company said “de-stigmatizing mental well-being discussions, especially amongst the younger ­generations, is crucial to decreasing … fears about judgment.”

DAVID MURRAY IS PASTOR of First Byron Christian Reformed Church in Byron Center, Mich. He’s also a ­counselor and author of Why Am I Feeling Like This? A Teen’s Guide to Freedom From Anxiety and Depression and a companion guide for parents, among other titles. Murray recalls almost a decade ago buying his two sons in their early teens iPods with internet access. But he grew concerned even then about what they were being exposed to on the internet and smashed the devices with a hammer. His sons, now in their mid-20s, still tease him about it.

The father of five does not mince words about teen social media usage: “It’s a mental health destroyer.” Coming out of the pandemic, Murray worries that not as many ­parents are monitoring their kids’ screen time and social media use. At least, fewer parents are talking about it in his circles, he said.

Some parents weary of monitoring their kids’ exposure are turning to startup companies for help. For up to $14 a month, Bark Technologies monitors kids’ phones and social media use and alerts parents when a child is exposed to online predators or sexual content, or is showing signs of depression, anxiety, suicidal ideation, or self-harm. Since its start in 2016, Bark has detected 1.1 million severe self-harm situations and now monitors 6.5 million kids’ phones.

Matt McKee, the company’s vice president of business development, said TikTok, Snapchat, and Instagram are the three most dangerous social media apps for kids. Those companies err on the side of protecting user privacy and their own profits over keeping kids safe, McKee told me.

While they may be talking about social media less, Murray believes, Christian parents are more aware than they used to be about the realities of mental illnesses. They are more likely to detect warning signs in their kids and seek help, he says. When it comes to social media use, Murray sees an opportunity for the church. He says teens who seek community and significance on social media often are not experiencing those things in real life. “When young people think of church, I’m not sure they always think of joy, purpose, compassion, significance, and people who listen to them,” Murray said. “I’d love to see that change. … Does this not open a huge door for the gospel?”

BACK AT THE MEXICAN RESTAURANT, Jane boxes up her uneaten food. She responds to a text from one of her kids. Guests at the nearest table are loud, but Jane doesn’t seem to notice as she talks about how far Anna has come.

After her hospital stay, Anna spent time in a mental health facility that didn’t allow smartphones. Then, Jane sent her to spend five months with a family friend who lives nearly eight hours away. Jane’s friend and Anna’s therapist supported her decision to replace Anna’s smartphone with a flip phone that blocked all social media. Within a month, Anna regained use of her legs. Her tics disappeared.

Today, Anna suffers from non-epileptic seizures that are lessening. She meets regularly with a therapist. Her legs occasionally still go weak, or she lapses into dark thoughts. But she’s worked some at a local movie theater and has a newfound interest in reading books. She recently went swing dancing with her mom—and wants to go again.

Soon, Anna will turn 18, and Jane seems confident she will use her new adult freedom to get TikTok again. “But I think when she has it again she will have more awareness of how it influences her.”