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Could mental health awareness be making people psychologically sicker? That’s the thesis of a fascinating paper by psychologists at the University of Toronto Dasha Sandra and Michael Inzlicht. There’s been a massive increase in both the number of people being diagnosed with a mental health condition and the number of people on psychiatric medications, while mental health awareness campaigns and school programs screening students for mental health disorders are ubiquitous. So why does it seem like our problems with mental illness aren’t getting better?

It may sound counterintuitive to suggest that increasing awareness and education about any condition could make that condition worse. After all, screening and awareness about illnesses are designed to help people who either don’t know that they have the illness or are suffering in silence. When it comes to things like high blood pressure or cancer, screening saves lives.

When it comes to mental health, though, more and more evidence is showing that making people aware of the problem makes people worse, not better. Therapists and psychiatrists are seeing patients come to their offices with self-diagnosed conditions that they picked up from TikTok. Parents and teachers report that kids are struggling more and more as they complain that their mental illnesses are impairing their daily lives. What’s happening here?

Sandra and Inzlicht argue that there are four key processes causing well-intentioned mental health awareness efforts to backfire: concept creep, nocebo effects, prevalence inflation, and illness self-labeling. Each one in and of itself nudges people toward developing or worsening mental illness, but all of them work together to decrease the threshold for considering something as a disorder, encourage people to consider normal feelings as pathological, and reinforce negative expectations. Let’s break each one of them down.

1. Concept Creep

Concept creep is when a definition expands over time to include more things or less intense versions of the thing it originally referred to. Trauma is a perfect example; over the past few decades, the official definition of trauma in diagnosing PTSD expanded from events that were well outside the range of normal human experience to anything life-threatening and then further to simply hearing about the traumatic event happening to a loved one. Unofficially, people nowadays have a tendency to use “trauma” to describe just about any bad thing they’ve experienced. When more and more people consider themselves victims of trauma, they’re all the more likely to feel powerless and unable to overcome the bad things they’ve experienced.

2. Nocebo Effects

You’ve heard of the placebo effect; when someone takes a pill, he’s more likely to feel better even if it doesn’t contain an actual drug. The nocebo effect is the opposite: If patients are told that a pill can cause headache and nausea, they’re more likely to experience negative “side effects” even if the pill they took doesn’t contain any active ingredients. If someone watches a reel explaining eight symptoms of depression, someone who has two of those symptoms and thinks “I have depression” is at risk for developing more of those symptoms because she expects her experience to follow what she’s learned from social media.

3. Prevalence Inflation

Prevalence inflation has to do with classifying normal experiences of stress, worry, or sadness as symptoms of a disorder. Everyone has negative feelings from time to time, but people are easily confused by awareness campaigns suggesting that these feelings might be the tip of a psychiatric iceberg. Once someone is convinced that their feelings represent some kind of psychological pathology, it’s a downhill slide to reinterpreting everything in their life through the lens of “I have anxiety” or “I’m depressed.” The more people who consider themselves depressed or anxious, the more common the problem seems and the more people feel the need to describe their feelings in the most severe terms.

4. Illness Self-Labeling

Developing the symptoms of a rare disorder after watching influencers talk about their diagnosis may be an extreme example, but it’s easy for people to get sicker when they label themselves as mentally ill. If someone expects that “being depressed” means feeling powerless and suicidal, they can easily slip into acting as though their powerlessness is the dominant feature of their illness. This, in turn, makes their lives worse because they are less likely to exercise their agency and make good choices for themselves.

This is discouraging, but there are a few things that we can do. First, schools should shut down broad-based mental health screening programs and nonspecific group therapies because these programs have mostly been shown to worsen mental health symptoms. It’s clear that asking students over and over if they are depressed, anxious, or traumatized makes them more likely to feel like the day-to-day ups and downs of life are symptoms of a psychological disorder.

Second, we can educate people about how self-diagnosis and nocebo effects can be harmful to their mental health. Inzlicht and Sandra did another study with some of their colleagues showing that nocebo education was helpful in reducing false diagnoses of ADHD. Strange as it may sound, we need more awareness about the dangers of mental health awareness!

Finally, those of us who want to improve mental health should focus on encouraging behaviors and promoting messages that are good for everyone but especially those who are suffering from psychiatric illnesses. Exercise, adequate sleep, and vigorous in-person social interactions promote emotional well-being at any age or level of illness, and helping people feel as though they are capable of improving their lives is a key factor in improving their mental health.

Psychiatry and therapy can be lifesaving for people who are suffering from mental health disorders, but therapy culture is downright toxic when it’s applied across the board. Despite good intentions, spreading awareness and widespread screening for psychological problems can cause these problems or make them worse. As Inzlicht and Sandra note, with appropriate caution we can help people who are suffering from mental health disorders without accidentally creating more of them.

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Matthew Loftus lives with his family in East Africa, where he teaches and practices family medicine at a mission hospital. His first book, Resisting Therapy Culture, will be published by InterVarsity Press on August 18.

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