The Social Construction of Mental Health Facts in Social Media Language

Abstract

Social media has had a significant impact on the increasing visibility of mental health. This article draws on a digital ethnographic approach and discourse analysis of posts to the microblogging site X (formerly Twitter) to examine uses of and metacommunication about the language of mental health. The analysis traces and snapshots how mental health language is being used to construct mental health, mental illness, and related subjects as a meaningful social object by participants on social media. The results focus on a particular practice around contesting the language and meaning of mental health designations, identities and language as a form of communication ritual that produces normative metadiscourse about mental health, what it means, and how we should understand and talk about it.

Social media has had a significant impact on the increasing visibility of mental health (e.g. Kirmayer et al., 2013; Mikhaylova, 2022; Pantic, 2014). This article draws on a digital ethnographic approach and discourse analysis of posts to the microblogging site X (formerly Twitter) to examine uses of and metacommunication about the language of mental health. The analysis traces and snapshots how mental health language is being used to construct mental health, mental illness, and related subjects as meaningful social objects by participants on social media. The results focus on a particular practice around contesting the language and meaning of mental health as a form of communication ritual that produces normative metadiscourse about mental health, what it means, and how we should understand and talk about it. Specifically, contestation discourse around mental health “facts”—including discourses around knowledge, language, and reality—is a ritual for the moral organization of society, with implications for how we understand ourselves and each other.

Social media as metadiscourse

X (formerly Twitter) is treated as a uniquely influential platform in public discourse, often quoted in traditional media and noted for its political influence (Mao et al., 2023). It allows for more exposure to varied content because communities are not closed (Draucker & Collister, 2015) and it has a usage base skewed toward more educated, political posters who develop expertise and share it (see Wojcik & Hughes, 2019). Thus, while X is not the most-used or most-representative social media platform, it serves a unique informative (not just entertainment) purpose for users and nonusers alike, with a unique potential to influence public attitudes (Jungherr, 2016). Common genres of X, including sharing own experiences, providing “hot takes” or “controversial opinions,” and posting explainer threads, constitute X as a space where people expect quasi-educational discourse—whether it is fact-checking, correcting misinformation, providing alternative views, doing science communication, and so on (Tardy, 2023). X is not a neutral space for information exchange however, but like most social media, operates as a site of contestation where ordinary people, inexpert celebrities, influencers and “micro”’-celebrities, and established experts, as well as people of different political orientations, can attempt to persuade others in, within, or beyond their own networks (cf. Avella, 2024).

As such, a large part of X posting involves commentary on its function as a machine for generating and spreading opinions. The recognition of persistence of online communication (e.g. that things can be seen before deleting or even screenshot and shared—a practice common on X) (cf. Torres-Lugo et al., 2022) and awareness of the limitations of X posts (240 characters for most ordinary users as of writing, etc.), for example, lead to follow-up replies that attempt to provide context, comments on the unsuitability of X for certain kinds of communication, jokes and memes about bad-faith readings and misunderstandings, and in general, a lot of what might be called “self-conscious” posting in which participants may anticipate how their contributions will be interpreted as well as taking account of how they, as people, will come across (Ditchfield, 2020). From an interactional perspective, this is called “recipient design,” in that people design what they say by considering how it will be taken by particular people to whom it is addressed (cf. Raclaw et al., 2020). In online contexts, the challenge is that regardless of whoever is addressed, many more unknown (and unanticipated) audiences may come across what was posted. This is further impacted by algorithmic and access components of online interfaces (Avella, 2024), and online participants demonstrate some awareness of this as they use platform affordances to engage creatively to orient their messages either broadly, or to particular audiences or communities (e.g. Lachmar et al., 2017; Zappavigna, 2018).

These considerations offer many rich resources for participants to further comment on the discourse occurring on social media (Biri, 2021). This “metadiscourse” (Craig, 1999, 2016) or “discourse about discourse” is rife on X (see Craig, 2012): as Bakhtin (1981) noted, “in real life, people talk most of all about what others talk about” (p. 338). As such, X can provide snapshots of the communicative construction of ideas in public discourse, allowing us to scrutinize how such ideas are constituted.

Mental health discourse online

“Mental health” is a large subject amid this terrain. As a field of knowledge, psychological health has had a long preoccupation with matters of definition, categorization, and legitimacy. The historical process of developing studies of psychological disorders as an empirical project has tended toward increasing scrutiny and specification (Foucault, 1965, 1976). As a scientific discourse, the professionalization of mental health practice aligned itself closely with the medical sciences (Foucault, 1973) in its emphasis on tracing the etiology, development, and effects of mental illness in an ostensibly objective fashion and from a position of expertise. However, this enterprise is embedded in ethical and cultural assumptions such that the representational work on which these professional practices so rely (e.g. the observation and assessment that leads to the production of a “diagnosis”) can better be understood as formalizations within the structure of their own discourse (rather than, say, an “accurate” objective diagnosis of a person) (Goodwin & Goodwin, 2014).

In this view, we can think of a “discourse of mental illness” or a “discourse of mental health” within which people across society may operate—centrally (as doctors and other professionals, or as patients) or more peripherally (as people with attitudes and assumptions about such matters). Institutions outside the health professions also play a role, as organizations concern themselves with workers’ wellbeing or mass media proliferate their own representations of the topic for further public participation. Alongside other efforts to de-stigmatize identities in offline and online contexts (such as with disability and aging, e.g. Huang et al., 2022; see also Long, 2015 for a historical review), the access and network breadth afforded by the internet, social networking sites, and social media have intertwined the online world with the subject of mental health—sometimes as a corrective to mental health challenges, sometimes as a cause of problems, sometimes as site of conversation about what mental health is and how it should be addressed (Competiello et al., 2023; Sadagheyani & Tatari, 2021; Tucker & Goodings, 2018).

This increasing concern with, public awareness of, and discourse about mental health and mental illness became salient during the COVID-19 pandemic from 2020 (see Pfefferbaum & North, 2020), especially in relation to online information and social media (e.g. Biester et al., 2021). This highlighted key ways in which “mental health” was invoked as a matter for personal, professional and public concern, for example, as a reason to question lockdown and isolation policies, as a risk in relation to “spending one’s life online,” and as a result of the short- and long-term effects of contracting the illness. While the role of the pandemic itself is not a focus of the current project, its occurrence provided an exigency for the topic of mental health and generated more discourse, often in relation to a shared frame of reference and conversations of which much of the global public were aware, and therefore could potentially participate in, be exposed to, and have an opinion about. In doing so, participants are not merely commenting on or representing what mental health is or their beliefs about it, but actively building, scrutinizing, arguing about, and evaluating ideas around mental health (cf. Lindgren & Johansson, 2023).

Mental health: constructed

Mental health and mental illness are constructed through accounts, versions, and understandings produced in discourse, with language as a significant part of this process (Eisenberg, 1988; Foucault, 1965, 1976; Horowitz, 2012; O’Reilly & Lester, 2017). Importantly, these construction practices have a crucial normative dimension: even in professional practice where objectivity is the goal and obvious deployment of values may be suppressed, nonetheless, morality is pervasive (cf. Foucault, 1965, 1973, 1976). This is actually an expected component of how ordinary people discuss mental health in everyday life. Mental health is a politicized topic in public discourse, with implications for wellbeing and survival (e.g. Lachmar et al., 2017; Shakes & Cashin, 2020), about which people are understood to have strong feelings (e.g. Happer & Philo, 2013; Trevisan, 2020), where emotion displays can be signals about one’s commitment to anti-stigma or justice on behalf of others, or can convey authenticity about one’s own experience (e.g. Robles & Castor, 2019; Tracy, 2011).

In what people say about mental health and how they talk about it, they orient to larger normative narratives in society while producing their own judgments and co-constructing with others how such judgments resonate (or not) with their social context. Thus sharing mental health opinions and information online is not merely an act of informing, but a contribution to and (re)constitution of the social-moral order, and reality itself, therefore functioning as a communication ritual (Sen, 2017) that serves a symbolic function beyond its surface discourse at the very heart of how we promote ourselves and others as “good” or attempt to degrade others as “bad” (K. Burke, 1989; Garfinkel, 1956). When people talk about others as members of categories (Sacks, 1992; cf. Housley & Fitzgerald, 2009), they reveal inferences that associate types of people with behaviors, traits, activities and expectations presumed to be inherent to them. Categorisation is a social practice commonly used to praise or blame others, and is a mechanism of social judgment and moral ordering (Jayyusi, 2014).

An examination of posts about mental health online provides a context for examining how mental health is socially constructed through use of online language, including social actions (Housley, 2021) and technical affordances (Gibson, 1977) such as typography, images, and platform constraints. This analysis takes a discursive, constructionist approach (see Potter & Robles, 2022) to understanding how mental health is constituted as a discursive object based on the following questions:

1. How are people using, invoking, and contesting “mental health/illness” (and related terms) as concepts in online spaces?

2. What actions are mental health language being used to accomplish in online spaces?

The results of the analysis describe (1) contesting language and definitions related to mental health as a key practice accomplished through (2) actions such as categorizing, sharing, complaining, correcting, disagreeing, and illustrating. Put together, these produce an ongoing, heterogenous discourse around the fact status of mental health: what it is, what to call it, how to talk about it, and why (or whether) it exists. This discourse is normative and human and therefore moral—it is about people, about who is good or bad and who needs help, who is at fault and what is at stake in society. While the current project focuses analytically on morality as an interactional orientation to situated language and social actions (Bergmann, 1998; Robles, 2017, 2024; Sidnell, 2010; Turowetz & Maynard, 2010), this has implications for how the micro-practices of discourse online contribute to ideologies in a society.

Methods

This analysis focuses on the most common patterns of practices that participants engaged in through one user’s (the author’s) ordinary experience of the microblog platform X, examining how collections of actions, multimodal features, interactional moves and normative dimensions were mobilized to constitute mental health meanings in the online setting.

Data collection

The research was initiated within a digital-ethnography (Smart, 2023) style of participant observation on the X (formerly Twitter) microblogging platform, which includes posts (tweets), threaded replies, and reposts (retweets). Examples were captured by screenshot (to preserve design features and authenticity of initial encounter) and copy-pasted or transcribed as text for analysis. The orientation to the subject of mental health was inductive and iterative. Data were collected as the subject of mental health was raised about what constituted forms of mental health or illness, pleadings for more awareness of mental health, sharing personal experiences with mental health, reflecting on conversations about mental health, and more implicit mentions of mental health in relation to mental disorder diagnoses, social problems, traumatic events, discussions of disability and illness, and issues at the nexus of neurodiversity and identification (such as accommodations for autism).

Mental health content was a significant and noticeable dimension of posts among the approximately 1300 accounts followed or posts those accounts “liked” which then showed up in the feed, despite the fact that none of the original accounts followed were explicitly mental health accounts or framed themselves as providing that kind of content (indeed, this partly inspired the research in the first place). Rather, this seemed to be a product of the intersection between academic accounts with research interests relevant to mental health (or who regularly reflected on mental health in relation to university work), and politically engaged accounts that would routinely link social problems to mental health. While these accounts did not necessarily engage with each other, their paths occasionally crossed, and while they did not necessarily devote their posts primarily to mental health, they engaged in these conversations regularly enough, and with others who were centrally involved in mental health subjects, that it produced many relevant examples.

Data collection over 2022–2023 yielded 338 examples, where “one” example as defined here includes any initial post plus all accompanying comments, responses, threads, replies, or reposts as they were captured at the time of their encounter (where a “single” example may in fact include several, dozens, hundreds of separate, unique addenda). These were examined more closely to be selected for the final analytic collection (197 core example) including those who posted regularly on such subjects, and those who posted occasional one-offs. This focal collection comprised three primary actions through which participants constructed mental health “facts” in online spaces, the focus of which in this article is contesting language and definitions around mental health. Among examples featured in this article, there may be varied types of posts in terms of their content or structure (e.g. as initial posts, reposts, or replies), qualities of the poster (follower counts, celebrity status, etc.), or attention to the post itself (views, number of likes or retweets, etc.). These aspects may be attended to as they are treated as relevant to the analytic point but were not themselves the focus of the analysis, which is described in more detail below.

Data analysis

In examining X posts, attention was paid to various elements of how the posts were presented, framed, and organized, including typography and emojis; images, and visual content; posting, re-posting, and replying; use of embedded links, quotations, and hashtags; formulations and “turn” design; and uptake or how posts were treated in the way that they were responded to (through replies, quotes, or screenshots, for example). Other features were also noted (such as follower counts, views, poster bios) but these were not the focus of the analysis. Rather, the focus of the analysis was on the social action each post was accomplishing; how that post was organized in relation to other posts; and how categories of people may be stated or inferred (Schegloff, 2007; Stokoe, 2012).

The analysis was undertaken primarily through discourse analysis, a constructionist, qualitative method that focuses on the use of language to accomplish social actions in their interactional context (Ehrlich & Romaniuk, 2013). The goal of this approach is not to broadly characterize all ways of talking about mental health in online spaces, or to attribute specific forms or intensities of influence to particular people or styles of post, but to interrogate functions and strategies of such talk and to reflect on their consequences in this particular linguistic and online context. The analysis draws on elements of conversation analysis and membership categorisation analysis, particularly in their online applications (cf. Housley et al., 2018; Meredith, 2019), to attend to the interactional and sequential dimensions of online discourse and how categories are invoked and deployed therein.

The data are presented in a combination of screenshot images and direct quotations, with the latter particularly reserved for purposes of making more anonymous the participants who do not have a recognizable public presence on the platform (though some images have also been anonymised for the same reason). ¹ This analysis describes a predominant practice accompanying use of mental health language on the microblog X: contesting language and definitions related to mental health. Due to space constraints, the analysis presents just a few illustrative examples that highlight the pattern, but will be introduced with some discussion of proportional distribution—not to make any claims about the representativeness of this sample for X or social media generally, but to characterize the sample and the trends of one person’s (the author’s) feed as an example of the sort of thing people encounter when scrolling their social media account.

Contesting the language of mental health

Talk about talk—about the ways we communicate and the language we use (Craig, 2016)—is a pervasive feature of communication. When terms and descriptions are contested, the notion of facts and reality itself is at stake in a deeply moral sense: if we do not share the same basic frame of reference, intelligibility becomes fragile, incommensurability may emerge, and conflict is difficult to avoid (e.g. Edwards et al., 1995; Fitch, 2003; Robles & Castor, 2019). This is certainly the case in online spaces, where disagreement is often a case of people speaking past one another, and formulations (and reformulations) of basic “facts” about reality easily lead to stalemates and polarization (cf. Robles & Xiong, 2024).

The core data sample (n = 197) featured nearly half of initiating posts that were primarily oriented to distinguishing what is and isn’t mental illness, and language and definitions around mental health, including contesting definitions and perspectives, correcting the record, managing identifications, and attributing structural reasons and causes. These kinds of posts comprised a significant portion of mental health posts in the author’s feed (a larger percentage than all other data initially collected), and focused on the terminological, definitional, and causal dimensions of mental health and illness.

What is (or isn’t) it?

For example, the following image created by a mental health organization and shared without accompanying text on X seeks to correct misconceptions for the purposes of destigmatising depression (Figure 1):

Figure 1.

Image created by a mental health organisation and shared without accompanying text.

This and similar posts reflect on mental health issues and mental illness as stigmatized in society, and are often shared by organizations. But individuals also engaged in a similar genre of sharing and awareness-raising, often drawing heavily on personal experience to highlight problems with conceptions of mental health. Most of these comprised complaints or laments about one’s struggles in light of stigma, lack of resources and support, or both. One person decrying the lack of employment opportunities and the effect on their own and “all of our” mental health ends the post with the comment “I’m unraveling.” Another quote-tweets a post to draw on their experience to disagree with it (Figure 2):

Figure 2.

Quote-tweet of a post claiming mental health is widely discussed.

In the original post, a claim is made that mental health “could quite literally not be any less stigmatized than it is currently. It’s all anyone talks ab [about].” This is quote-tweeted with the resisting comment that describes all the mental health talk the original poster (OP) refers to as “shallow references” driven primarily for profit, and rejects this as a sign that mental health is destigmatized. The quote-tweeter then responds to themself with an if-then statement using all caps to emphasize the state under which mental health would be destigmatized: then the poster would not have to “lie” about all the experiences that are due to their mental health struggles, such as why they have gaps in their resume or miss school. This is closed off with the extreme case formulation (Pomerantz, 1986) in all caps of having to lie “all the time” which the poster is “sick of having to do!”

There were also posts about one’s own experience that were more light-hearted or meant to help other people with mental health problems. For example, one poster comments “guys stop knocking the psych ward its barely what you see in movies i be chillin and doin my lil activities.” Though there is a humorous element to the playful tone employed, the post mainly provides an alternative perspective that combats what most people might assume about psychological institutionalization based on popular entertainment media (“what you see in movies”). While it may also not be common or characteristic of all experiences of institutionalization, it is formulated as a personal experience that minimizes the possible negative dimensions of such a situation. Others shared their experience with mental health problems in similar more light-hearted ways, such as one post explaining “I know I’m having a mental health Moment™ when my drag race consumption spikes exponentially”; another described the self-talk she engages in when in a manic episode which she jokes was brought upon by “sunlight.”

In these cases, participants offer a little window into their world by characterizing a moment in their lived experience that presents stories, anecdotes and formulations purporting to display for others what mental health and illness means as an experiential and behavioral phenomenon for them. These types of posts and their engagement produce an epistemically graded discourse about what mental illness is or isn’t “like,” based on some form of expertise or personal experience, combating the potential epistemic injustice (Scrutton, 2017) that can occur when there is a gap between lived experience and public opinion or expertise. A valid way to contribute to this discourse online is through the actions of sharing, describing, or even complaining about this experience, and in particular, making a case for what is right and reasonable with regard to mental health, and what is not—in other words, how we should see it, based on those who know about it.

How should we talk about it?

Many posts focused specifically and explicitly on the terms and definitions associated with mental health, including commenting specifically on the way terms evolve and broaden. This is sometimes remarked on humorously as it applies to the general public or other groups, as in the following example in which a direct quotation is used to show an example of someone using the phrase “mental health” as something people can “have.”

In this example (Figure 3), the use of “mental health” as a phrase and the hypothetical example “he has mental health” is attributed to “me man” (presumably the partner of the poster) and the post closed with five crying emojis suggesting a sense of ironic dismay—perhaps at the use of a term that seems nonsensical or ungrammatical, or in a sense that conveys its opposite (it is not clear exactly what it means here, though the following example suggests that a wider or opposite connotation is the direction in which the phrase is broadening currently). In the reply, the poster confirms that this instance may be part of a larger pattern, referring to “this” (a deictic reference to the example) as something their students do (students often standing in as a symbol for younger people whose language use marks the boundaries of change). The closing “lol” (for “laugh out loud,” often used non-literally) reconfirms the ironic orientation to this practice as something that is unexpected, and perhaps humorous, in addition to possibly being unfortunate. This developing meaning of “mental health” is elaborated in a different post that more explicitly characterizes this as a broader phenomenon in which “mental health” is being used to mean poor mental health, or mental illness.

Figure 3.

A direct quotation is used to show an example of someone using the phrase “mental health”.

Here (Figure 4) the poster shares an image from the results of a study they participated in, commenting on the study’s use of the term “mental health” to mean something broader, even opposed, to its literal and original meaning. Rather than particular ordinary people or groups such as students, this use is attributed to researchers or professionals of some sort. The poster explicitly comments on the strange and oppositional nature of the term which has taken on a “funhouse mirror-meaning” by pointing out that their use of the term “decreased” suggests that “mental health” is actually being used in place of something different such as mental health problems or mental illness.

Figure 4.

The poster shares an image from the results of a study they participated in.

These sorts of comments show that people are aware of and sensitized to “mental health” as a recognizable but malleable linguistic object—but they also orient to these changes as not merely about language, as the post below demonstrates.

In this case (Figure 5), the poster self-identifies as mentally healthy (sane) and contrasts this with a neurodiverse diagnosis, “autistic,” before going onto suggest that autistic is a technical term that has been used in a broader and broader sense until it means something like “normal”—presumably, as indicated by the contrast, something that is not consistent with a technical term and the diagnosis it is meant to represent. More similar to the “funhouse mirror” comment previously described, the way this description is formulated suggests there is something potentially problematic about this, as the poster does not merely use the verb “expand” (a relatively neutral way of suggesting broader usage) but follows this with “mutate” which has more negative connotations. While opinions about language change outside of most linguistics-oriented academics are often more conservative and negative, it is probably an even more contested language matter if it relates to topics that have identity and political implications.

Figure 5.

The poster self-identifies as mentally healthy (sane) and contrasts this with a neurodiverse diagnosis.

Thus, there is a deliberate attention among posts to X to the language of mental health and what its effects might be on the basis of that language use, and similar to this example, many of these types of posts also linked mental health to other categories such as mood disorders, neurodiversity, and minority status. For example, in the following (Figure 6), the poster shares information (similar to the previous section of analysis) but the information is not strictly about personal experience—rather, it is an instance of explicitly challenging common perceptions based on mental health language, in this case, to distinguish neurodiversity from mental health.

Figure 6.

The poster shares information challenging common perceptions.

The poster describes the view they are correcting as something that “many people think” and characterizes two examples of neurodiversity (Autism, ADHD = attention deficit hyperactivity disorder) as “neurodevelopmental” conditions rather than “mental health conditions.” Another post comes to a similar place, initiating in a different way by raising it as a personal opinion. The poster starts with a sort of disclaimer (“I’m going to put this out there”) as something tentative that may not be well-received but is something they “really think” about the word “diagnosis.” They attribute this generally (without specifying) but by raising the specific example of Autism, may be referring to neurodiversity generally.

In response (Figure 7), a poster follows up with an information-seeking question that offers the OP the opportunity for expansion, and the OP replies with an “I dunno”-prefaced list of candidate examples (Jefferson, 1990) followed by a formulation of what the problem is with the word “diagnosis”: that it makes neurodiversity “likened to illness/disease.”

Figure 7.

The poster gives an opinion about the word “diagnosis” in relation to autism, and receives replies.

These and other examples illustrate that how mental health is used as a term—as well as how certain diagnoses associated with mental health and neurological differences are defined—are consequential matters. This concern over language and terminology is a common type of discourse that emerges in response to social justice issues, for example, the evolving language associated with medical conditions and race as well as issues of reclamation (as with “queer”) (Brontsema, 2004). Arguing about language is a way of arguing about the substantive matters of phenomena. While this and the previous section illustrate discourse that generally takes the existence of mental health for granted, the following section describes posts that challenge or support the fundamental reality of mental illness.

Does it exist?

Another type of posts focused on the relationship between causes and definitions of mental health and illness, particularly in relation to structural or capitalistic notions, societal and governmental support, and as measured by the medical or psychiatric establishment. This was often accomplished in relation to the existence of mental illness. The strongest version of this viewpoint is probably best exemplified by the following post:

In this example (Figure 8), the poster quotes a post which is a common type of content/response-generating post asking for some type of “unpopular opinion” (or “hot take”) that might garner a lot of attention by taking a stance that is either uncommon or highly contested. In this case the poster attributes being “mentally ill” to a lack of having “basic needs met,” suggesting that attributions of mental illness are a response to lack of support (and perhaps suggesting more social or governmental assistance would resolve this problem, for example, by providing a basic income or universal housing). The fact that this is indeed a contested perspective is illustrated by another post (Figure 9) that takes issue with a slightly different purported causal basis.

Figure 8.

Quote of post inviting “controversial” opinions suggests a solution to mental illness.

Figure 9.

Quote of a post about mental illness disagrees with the idea that there is an illusion of a mental health epidemic.

The poster quotes a post that describes an “illusion of a vast mental health epidemic” that has been “created” by “confusing normal responses to life with mental disorder.” This attributes the source of mental illness or mental health problems not to a lack of needs being met, but to “life”—which may mean roughly the same thing (if “life” includes such states as a matter of fact), or may in some other sense suggest that life is full of situations that “ordinarily” engender some response that is being mistakenly categorized as mental illness. The quoter responds to this by collapsing a distinction in the course of reformulating, and contesting, what has been said. This distinction compares so-called somatic (physical) illnesses and mental illness, suggesting that just because a problem develops as a “normal” response to something in the environment does not mean it shouldn’t be treated (due to the distress, disability, adverse health, and poor quality of life that may result). Thus the physical problem is equated with the mental health problem, undermining the extent to which a mental health epidemic can be legitimately redescribed as an “illusion” (as the OP does).

In the following example (Figure 10), a similar stance is taken in the midst of a thread about the antipsychiatry movement.

Figure 10.

Posts appearing within a long thread about the antipsychiatry movement.

Building on the same sort of argument, the poster expands on their own threaded posts with the same sort of distinction being identified, this time among professionals: a presumption that mental illness is not “real” (with use of quotation marks) illness, but rather a pathologization of unacceptable behavior. While the subsequent post accedes part of the critique (mental illness can be used strategically to marginalize people), it continues the point that ignoring the “real” effects of mental illness will cause harm if people assume that if it is not a recognized disorder then it should not require medication or treatment.

While this comparison of mental illness and “physical” illness was commonly raised (or critiqued), another component of this more-or-less same argument involved comparing mental illness to more temporary or less debilitating characteristics—for example, the difference between an anxiety disorder or experiences of anxiety “understandably” caused by stress in one’s life; or as the next example (Figure 11) highlights, between clinical depression, and sadness, grief, or depressive episodes attributed to personal tragedies that would make such responses intelligible.

Figure 11.

Post reflects on the differences between mood and disorder.

The poster distinguishes between the “sadness and grief of life events” and “bouts of depression”; he bases this distinction in his own “lived experience” (“like me”) and as an experience that has been observed over the course of a long life (“older people”; “50 years or more”). Thus, there is a chorus of posts online that congregate around the seriousness of mental illness and resist the ways physical illness or temporary/non-debilitating mental health challenges are used by some to undermine mental illness as a valid concern or a “real” problem in society. This chorus contributes a discourse about the reality of mental illness, and what it fundamentally means for people and society.

“Realities” of mental illness

In this project’s analysis, descriptions and uses of mental health language were involved in definitional activities in which online participants actively proclaimed, negotiated, and contested the reality of mental health as an experience, as an idea, as a diagnosis, and as a set of terminologies for a widespread concern about health and wellbeing in society. Specifically, online interactants oriented to facts about the “reality” of mental health through working out mental health meanings and as a basis for discussing norms about mental health, including how it should be understood, how it should be treated, why it exists in society, and who gets to decide these matters. Through discourses of knowledge about mental health, the language of mental health, and the reality of mental health, participants contributed to a larger, complex, heterogenous discourse of contestation over the meaning of something that is polysemous and evolving. While the ideologies this discourse may orient to are neither stable nor held in common, they are underpinned by moral concerns over authenticity and legitimacy, communication norms, and reality itself.

The implications of this are not just about the content of posts regarding mental health and what its meaning is, but specifically how mental health is being constructed through the specific language, and technological affordances, provided for in the online platform X (formerly Twitter). This is relevant not just to this particular topic, but to any contested social issue where people’s identities matter, the definitions and categorisations are meaningful, and normative expectations mean people have to explain and defend themselves and their positions. Social media such as X provide a useful entry point into both snapshotting moments of such contestation, and tracking the evolution of arguments about important matters over time, allowing us to more closely examine how the metadiscourse (Craig, 1999, 2016) of mental health and illness is unfolding in these critical public spaces.

These (meta)discourses in motion on X are not necessarily new or unique, but they point to a larger challenge related to the most important concepts in human life and how easily they evade commensurability in fragmented public and political spaces. It seems very likely that mental health (whether that is the right word) is indeed an “essentially contested” (politicized) concept (cf. Boromisza-Habashi, 2010). These ideas are fraught with contestation, and social media is a fertile soil for generating discourses of contestation. In this project, this discourse was characterized by three discourses within it: a discourse of knowledge in which expertise and authenticity legitimized “facts” about mental health and illness; a discourse of language in which terminology was wrestled with and disagreed about; and a discourse about the reality of mental health, and how and whether it exists. These discourses illustrate how “reality” is used rhetorically to ground contestations over mental illness, functioning less as an actual convergence of opinion about facts and more as a ritual for socially constructing the relationship between mental health and the moral order. This ritual, like many in public and on social media, does not actually function in service of establishing facts, but uses facts and arguments about them as a symbolic exorcism of fundamental moral anxieties over how to deal with (mental) difference in everyday life and society.

In line with Lievrouw’s (2012) definition of the “relational internet” in 2012, these data are inevitably shaped and limited by the account of their (white, English-speaking, primarily Western-hemisphered) user in an era in which social media is individually tailored, not just by followers but networks of followers, patterns of likes, and more. The purpose of this research is not to suggest these posts will be common or shared across any user of X or any other social media. Rather, the posts are indicative of a certain state of conversation at play in important and influential parts of the public sphere, particularly where forms of expertise and access to “truth” start bumping into each other. The discussions taking place in these spaces are signs of the sorts of things that matter to people—and how to tell what and who matters, or should matter, in society.

These signs are not trivial. Research on the direct effects of social media on mental health have been mixed, with studies showing that positive messages may have little effect (Beelen & Karsay, 2024) and negative or stigmatizing message effects may be conditioned by other factors (Competiello et al., 2023). However, social media has been shown to have enormous influences on what gets shared and talked about in online spaces, and posts (X in particular) are commonly circulated throughout traditional media as well, increasing reach to quite a wide audience (Mao et al., 2023). Furthermore, in an era increasingly characterized by distrust toward experts (Weingart, 2023), and where self-diagnosis in particular is often seen as permissible for neurodiversity and mental illness where there are not enough resources for formal assessments and perceptions of widespread bias among professionals (Rutter et al., 2023), it has never been more important to understand how people reckon with these issues “on the ground.”

The clinical discourse examined by Foucault (1965, 1973, 1976) enforced a number of constraints on people in the process of the professionalization of psychiatry as a science, and its imitation of the biomedical model too easily replicated a dualistic assumption that simplistically fed into a neoliberal hierarchy between “valid” and “invalid” illnesses (Sunley, 2023). This strategic invocation (and hierarchical privileging) of reality has been an ongoing source of debate highlighted by social constructionism, from its academic emergence to its uptake in a “post-truth” public discourse (e.g. Ejue & Etim, 2024): as Edwards et al (1995) point out, the rhetoric of reality is a common response to examinations of how people construct meaning in their everyday lives—one that attempts to appeal to an unexaminable horizon we dare not breach, especially in politics (S. Burke & Demasi, 2019). The academic debate is somewhat complicated when we look more closely at contemporary ordinary social interaction. As with many other communicative practices (cf. Sacks, 1992), people invoke reality for all sorts of political aims, from the detestable to the sympathetic. Until we devise (and get the public to value) a different basis on which to argue and to distribute resources via political systems, reality will continue to function as a rhetorical sticking point; and it will probably continue to be unhelpful as the shifting sands on which it sits are revealed for the unstable basis they always were.

Conclusion

Contestations about subjects that affect people’s everyday lives are also always contestations about what it means to be human, and such practices do not merely advance arguments or resist opinions, but function to profess one’s devotion, to absolve people of their sins, to exorcize demons, and all manner of moral work. As such, discourse about mental health online is ritualistic beyond the communicative sense of ritual and into the more overtly moral ways in which communication differentiates between matters of right and wrong, and who are good or bad people. A key dimension of normative metadiscourse (Craig, 2016) about mental health in public social media spaces involves the so-called facts about mental illness. Reality continues to be a rhetorically productive explanatory mechanism around mental health and illness, and arguments over mental health a ritual to reassure us that we can easily tell who is good and who is bad. These arguments are far from being resolved and resist simple encouragements toward education or literacy or attempts to recover a shared “truth” basis. We must investigate what people are saying, where they are saying it, how they are saying it, and what is at stake for them when they do so. When language is not taken for granted but instead contested or at the center of public argumentation, it is a sign that something important is being wrestled with at that moment in history.