The Fashion of the Mind

America’s mind has fallen deeply ill. We’re addicted to psychiatric drugs. Social media influencers show off their constellation of mental health diagnoses for a fawning audience. Chopping off or sewing on body parts is a socially accepted medical treatment. Something’s not right here.

The intersection of Big Pharma and radical progressivism explain the supply side of the equation. More than wanting to correct neuroses and imbalances, the demand side is rooted in a desire to alter consciousness as if we were plug-and-play machines just waiting to be modified. This fashion of the mind enables us to indulge in fantasies of being, of taking on culturally sanctioned beliefs and mental health labels as an alternative to genuine character development.

On one level, it seems unthinkable to consider that many Americans might be faking it — even to the point of taking pharmaceuticals. After all, mental illness cannot be written off wholesale, as the Red Pill right (eg: Andrew Tate on depression) sometimes likes to claim, eager to throw the baby out with the bathwater of the genuinely progressive gains of taking mental health seriously. There are genuine and debilitating conditions that are beyond the help of conventional psychotherapy to the point of necessitating pharmaceutical intervention.

But, if discourse around mental illness was once taboo, this stigma is well on its way toward overcorrection. In fact, it’s now trendy to be mentally ill. One only need casually browse Twitter or TikTok to find influencers sharing their latest diagnoses and what roster of medications they’re taking.

Today, any utterance of a negative disposition is quickly affirmed and validated. Keeping to the American way, mental illness is commodified, packaged, and sold alongside ready-made subcultures and seemingly innumerable chemical cocktails just for you — but also for millions of others like you.

Sidestepping legitimate uses, we know many medications will not cure mental ailments, only treat them — and poorly, in many cases; it’s not exactly a secret that SSRIs designed to treat depression can amplify suicidal thoughts, for instance. So, why do we still take them? For at least some, it isn’t to cure or treat anything. A diagnosis edifies their emaciated sense of self, crying out for substance, starved by a vapid postmodern culture.

How Mental Illness Became Trendy

There is a longstanding mystique with melancholy that has infatuated Americans for the better part of the past few decades. Personality traits don’t exist anymore, merely an endless permutation of symptoms cobbled together as a self-diagnosis for more likes, shares, and follows. But, seeing melancholy through rose-colored glasses is not a new product of the social media era. Its allure is well-documented in the cultural canon. Romeo and Juliet, Faust, and even Titanic, engender the bittersweet pleasure of the tragic aesthetic.

If music was representative of our cultural milieu, the psychedelic charms of the 60s and 70s were counterbalanced by grunge in the 80s. Dingy, greasy, and downtempo, grunge made depression cool. The anti-establishment aesthetic manifested as ripped jeans, plaid, and long hair for millions of Gen Xers.

In something of a parallel, the modern wave American exceptionalism of the 1990s gave way to a tone shift in the following decade. From a sunny, if not naive, cultural disposition was born emo culture, embraced by Millenials — a sort of sadder and more passive goth whose teenage angst was channeled into a fledgling digital world. Where grunge was still mediated by mass media like MTV — and fizzled out as is typical in the lifecycle of a fad — emo culture found a ready home in the burgeoning online world: Xanga, MySpace, and tumblr. Arguably, emo never died like grunge. It transmogrified into the beginnings of the present-day cauldron of affirmation, spawning ever more speciated branches of identities.

“The internet was the Millennial version of television, which achieved much of the same effects [David Foster Wallace] noticed about TV and amplified them,” writes Emmet Penney in a piece on Default Wisdom. He continues:

The major throughlines from the early 2000s of Millennial culture experience and today is mental health, which on the internet involves self-diagnosis, social triangulation, and boundary policing. It’s a consensual panopticon of mutual psychologism, moral invective, and scapegoating tinged with the typical American self-helpism and self-serving concern. 

Today, we see this peaking in Gen Z aesthetics. There is a deliberate crafting of one’s public persona to emphasize affectations that typify being quirky and unique. One zoomer thinks picking up rocks instead of admiring her surroundings means she’s autistic. Influencer (and OnlyFans model) Corinna Kopf sells merchandise with the tagline “my anxieties have anxieties,” ostensibly made altruistic because she’s donating a portion of profits to the Anxiety & Depression Association of America. Terminally online e-girls (or e-boys or e-they’s) cobble together graphics that enshrine “anxiety queens” and self-harm as aesthetic ideals.

Tumblr’s position as a hub of depressive artfulness has been so intertwined with actual suicidality and self-harm that searching for terms like “depression,” “crying, and “scars” on tumblr will bring up the following prompt:

Textual Intercourse

But the internet “isn’t real life,” some may say. Go “touch grass.” This misses the mark. Culture has unfurled via deeper and deeper layers of abstraction from technological advancement. It’s been happening since the advent of the printing press.

As Professor Jaishree Odin writes:

“Marshall McLuhan rightly notes that the shift from predominantly oral culture to print culture also affected the nature of human consciousness in that print represented an abstraction of thought which gave precedence to linearity, sequentiality and homogeneity.”

The shift from oral to written culture initiated a fundamental change in how we communicate and saw the world around us, and maybe more importantly, how we defined ourselves. Beyond Gutenberg, the post-industrial age, and telecom, we’ve gone further away from words as symbols to words as being. Symbolism, as employed for most of human history, has largely been… well, symbolic. But in postmodernity, the symbolized is now less important than the symbol itself.

Take the ubiquitous “save” button. Anyone born in or adjacent to the era of floppy disks understands what the little pictogram refers to. For Gen Z and younger, it’s purely representational. We can transpose this example back one generation with the “voicemail” icon, which is a small cassette tape. That the physical media these symbols call upon are no longer in use demonstrates our crossing the threshold from real to hyper-real.

This same abstraction happened to our conception of self. We’ve retreated from a life of doing that characterized the Postwar Era to favoring the mimicry of the mannerisms and styles of those we wish to emulate, with no small contribution from the dawn of Hollywood as the American cultural engine. Our drive to seem rather than to actually be has been ingrained into us for at least half a century.

This brings us back to the fashion of the mind. There is a natural limit to what we can signal with clothes, accessories, and personality affectations alone. But in our neuroticism, a switch flipped in the 21st century. Fashion of the garment was not enough.

We have arrived at a place where everyday people are compelled to adorn themselves with neo-pronouns, emojis of allegiance to Black Lives Matter or Ukraine, and in something of an inverted magnum opus, the unquestionable adoption of mental illness labels — and their complementary psychiatric medications and even surgery — to add a veneer of authenticity to the quaking mass that is the postmodern ego.

Psychic Charms of the TikTokers

As expected, it is difficult to quantify to what extent mental illness and psychiatric meds are being used to prop up the papier-mâché psyches of the otherwise uninteresting and spiritually deprived. This is made more difficult when it is taboo to even suggest that at least some of the prolific mental health diagnoses and their respective treatment protocols might not all be legitimate. Exhibit A is seen in the vitriolic response to those who question transgender orthodoxy.

One amusing but disappointing TikTok hints at what is happening — a sibling catches their sister and friend watching a TV show while both are pretending to manifest the tics of Tourette’s syndrome.

In a 2021 study published in the Movement Disorders medical journal, researchers examined the explosion of TikTok users allegedly presenting with Tourette’s. Their analysis found that TikTok tics were different from those of typical Tourette’s patients. The scientists concluded these are manifestations of “sociogenic illness.”

Harvard Health Publishing denies that just because these presentations are sociogenic, it might mean that these people are attention-seeking or doing it on purpose. But a passage from the aforementioned study highlights the potential for absurdity:

Despite our study cohort spanning different countries, 67.9% of the cohort mentioned their TikTok tics were from other content creators, and the majority had the same vocal tic of the word ‘beans.’

Unless there is something objective about “beans” that unifies Tourette’s patients across the globe, it’s safe to call BS. It’s not rocket science. The sociogenic component at least partly stems from the classic adolescent desire to pile on weird but (hopefully) endearing mannerisms. But where these were once bullied out of circulation in the Before Times, they are now million-liked fixtures on our scroll walls.

It gets even worse when we look at Dissociative Identity Disorder (DID) — formerly called multiple personality disorder — and the influencers who claim to have it. Clinically, DID is when the psyche splits off into fragments of personalities, usually because of trauma. It is very rare, occurring in about 1.5 percent of the global population, according to the National Institute of Health.

But, there are scores of social media denizens who have crafted personas based on their purported illness. These influencers refer to their alternate personalities as “alters,” which conveniently seem to manifest at will for the selfie camera. One TikToker, The Sprite Company (unrelated to the Coca-Cola brand), shows how they switch alters based on “triggers” like certain songs, going from “Jonas” to “Jillian” in one clip.

Together, so goes the narrative, the alters together operate as a “system,” with one personality usually as the “host,” or dominant personality. It’s hard to gauge just how popular all this is, but the hashtag #DIDsystem has 1 billion views on TikTok. The Sprite Company has nearly 300,000 followers and 9.6 million likes.

The challenging part about critiquing this — and the inauthentic adoption of other conditions — is that DID is a valid clinical diagnosis, and there are certainly those who are legitimately impacted by the illness. For example, it’s not uncommon for those who experience sexual abuse to be afflicted by a powerful impulse to “split off” and dissociate from their trauma. But, like the social contagion theory behind transgenderism, there is little doubt there is a diffusive component to these fashions, mindlessly boosted by millions of scrolling teens eager to affirm and validate their contrived personalities.

When we think of mental illnesses that might not be all that genuine, attention deficit hyperactivity disorder (ADHD) is typically among the top candidates. From 1997 to 2016, ADHD diagnosis shot up from 6.1 percent to 10.2 percent in kids and teens aged 4 to 17. Unsurprisingly, it’s correlated with frequent digital media use.

ADHD as we know it today was formally introduced into psychology in 1986 in the DSM-III-R. Before that it was known as just ADD, and before that, as “Hyperkinetic Reaction of Childhood.” Its validity as a diagnosis has come under continuous scrutiny — especially because of how it overlaps with typical behaviors inherent to childhood and adolescence. It’s more demonstrable that it is at least likely overdiagnosed.

In response to claims that the pattern of increased diagnosis of ADHD is in part due to it being trendy, the usual response seems to be that “increased awareness” is responsible for the uptick. While that may be a factor, it appears there’s more to it.

One 2010 study showed that ADHD diagnoses are “driven largely” by “subjective comparisons” of kids in the same grade in school; teachers were more likely to assess younger kids as showing ADHD symptoms. As a result, the youngest children in the classroom were almost twice as likely to be prescribed stimulants to treat their condition (which seems to be youth itself).

A 2022 study further tested this phenomenon (which is so well-known it’s called the “relative age effect” or RAE) against another other possibility: that the age differential was from the “double burden,” of both being younger and also exhibiting genuine ADHD symptoms. Looking at an aggregation of 1,294 and 130 teachers across 17 elementary schools, researchers found this alternate explanation was not supported. Their conclusion?

Our multilevel analyses put forward the first hypothesis only, supporting the medicalization of immaturity. RAE in ADHD seems mostly initiated by teachers' pre-diagnostic actions toward younger children.

ADHD also ties into autism and the concept of “neurodivergence” and “neurotypes.” If you have inclinations like balancing on narrow curbs or spinning your keys, you’re “stimming,” repetitive activities that serve as coping mechanisms. And of course, you’re showing them off in montage on Twitter. ADHD and autism can now overlap and can be called AuDHD.

Drinking more than one beverage at a time means you have ADHD, while commenters chirp, “OMG, me too,” keeping the affirmation back-patting going strong. ADHD causes hyperfixation on turkey and leads one to being called “turkey girl,” by grocery employees. Every possible human ailment and trait can be apparently explained through the ADHD prism, even alcoholism.

The ridiculous permutations of how ADHD can allegedly manifest are humorous. But of all the mental fashions, ADHD may be the most destructive. Its symptoms are diverse enough to be a catch-all for the varying expressions of childhood and adolescence (which apparently now continue well into our 30s and 40s). It's trendy and easy to adopt, compared with higher investment labels like bipolar disorder and PTSD.

And, conveniently, the first course of treatment for ADHD is often powerful and highly addictive stimulant drugs.

Fast Pharma

It would be easier to give benefit of the doubt to how quickly these conditions and diagnoses have proliferated and how zealously their affirmation is demanded if there weren’t a 13-figure global industry around them.

The top psychiatric medications of 2020 included:

• Sertraline (Zoloft) to treat depression at 38.22 million prescriptions, totaling $523 million spent;
• Amphetamine/dextroamphetamine (Adderall) to treat ADHD with 26.24 million prescriptions, totalling a whopping $2.35 billion spent;
• Fluoxetine (Prozac) to treat panic disorder and depression with 23.4 million prescriptions, with $654 million spent);
• Alprazolam (Xanax) for anxiety and panic disorder with 16.78 million prescriptions totalling $197 million;
• And Lamotrigine (Lamictal) to treat bipolar disorder with $744 million in purchases.

We need to ask ourselves, out of the 252 million psychiatric prescriptions issued to Americans in 2020, what amount of this is actually necessary for patients’ well-being? What portion of these medications are taken not to improve quality of life, but to appease what seems like an unquenchable desire to be different, to pharmacologically fulfill the promise of being a beautifully damaged, indie-movie quirky, and/or chaotically entertaining individual?

It’s easy to dismantle the more extreme examples of DID or the obviously ludicrous “beans”-uttering Tourette’s influencers. It’s harder to differentiate when it comes to more standard diagnoses like depression, anxiety, and PTSD.

The pretense around actually helping people erodes even more when we look at the recent advent of how the emerging telehealth industry is cutting out the middlemen, aka those pesky doctors, to create an almost direct pipeline between Big Pharma and patients.

Online mental health startup Cerebral launched in 2020 to apparently treat depression and anxiety and charge a fee that would allow patients to virtually meet with a nurse practitioner to receive prescriptions for antidepressants. As reported by the Wall Street Journal, in 2021, a company presentation showed how they could stretch their advertising dollars twice as far by targeting ADHD as opposed to depression/anxiety because of greater conversion rates.

After securing more than $400 million in financing, the company aggressively pushed forward with social media advertising and enlisted a small army of contractors to prescribe medication after brief virtual appointments. They 10x’ed their sales and ostensibly struck gold with a $4.8 billion valuation. Not long after, they came under federal investigation for allegedly reckless prescription practices.

In the UK, a similar application called Kooth is taking up the fast-pharma scheme in the realm of transgenderism. The country’s National Health Service (NHS) is unable to keep up with the demand for psychotherapy, so mental health apps like Kooth are filling in the gap. Kooth funnels young people into gender ideology through a biased library of articles; online forums where young people reinforce each other’s gender affirmation; and live chat with “online emotional wellbeing practitioners” who don’t need legitimate counseling credentials, as reported in Unherd by writer Mary Harrington, who underwent psychotherapist training in the NHS system. She writes:

There’s something nightmarish about this scenario. Epidemic levels of (predominantly female) youth psychic distress are being funnelled through a kind of online sausage machine of the soul, in the name of “access”... Starved of in-person presence and empathy, nothing prevents the loneliness and misery of young girls being colonised by the disembodied and dissociative one-size-fits-all ideology of gender.

I’m Not Late, I Have Time Blindness

The biggest counterargument to skepticism of the growing cornucopia of mental health labels is how discussion around legitimate mental illness was taboo in recent generations past. But there are two major downsides to the blind acceptance of loosely diagnosed mental illness.

The first is that it muddies the waters of genuine suffering in a couple of ways. Those suffering can easily fall prey to the templated lifestyle of pharmaceuticals and mindless encouragement that fulfills an aesthetic, more than a therapeutic, end — and the cycle of victimhood and social reward continues. Meanwhile, those with actual mental health issues are taken less seriously.

Arguably, the greater problem is that it chokes the impulse toward progress in the individual.

Instead of the possibility of having issues with punctuality, we have to have “time blindness.” Instead of attempting to hone a naturally energetic and curious mind, we must have ADHD and amphetamines are the answer. Instead of accepting one’s biological sex and potential deviation from traditional gender roles, we are unequivocally born in the wrong body and the only cure is going under the knife.

It also facilitates the micronizing of the civic and cultural soul. We’re not just “more polarized than ever” as any contemporary critic can point out. The frenetic blooming of subculture within subcultures — and therefore, identity labels — traps the individual in a labyrinth of abstraction.

In a race to the bottom, our incessant over-labeling divides us further and further from our peers. In the pursuit of social currency and shortcuts to mature self-development. We adopt corporate-sponsored labels to prop up egos that have been built up by a shoddy scaffolding of trite slogans, celebrity worship, and otherwise undifferentiated and chaotic social white noise.

The ultimate irony of all this is that fashion of mind itself seems to be a legitimate mental illness. But it’s not one we’ll find in the DSM. It’s borne of a pathogen in the collective mind. Throughout time, our theologians and philosophers have been its diagnosticians. In our historically recent secularization of society, the task of diagnosis has fallen into the hands of the academic and bureaucratic class, whose self-selected neuroses and inclinations for passive-aggressive control shine through.