等着我

TikTok Shouldn’t Be TikDoc_我的网站

人民的名义

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As government scrutiny and even some statewide TikTok bans trickle in, concerns about the app’s impact on youth mental health are often repeated. Among the concerned are the bereft parents of a teen who killed himself last year, reportedly after seeing self-harm content on TikTok.

While states and some organizations decide whether TikTok poses enough danger to warrant a ban, I want to sound the alarm about an online mental health risk that’s even more chronic and not limited to TikTok: an epidemic of self-diagnosis, fueled by social media, that’s leading to improper treatment, missed treatment and the trivialization of serious mental health conditions.

If there’s a silver lining to the COVID-era mental health crisis, it’s that people seem more willing than ever to talk about mental health struggles with friends, with colleagues and sometimes to the whole world online. Even better, they’re willing to get help. The percentage of adults aged 18 to 44 seeking mental health treatment rose significantly during the first years of the pandemic, according to data from the Centers for Disease Control and Prevention.

If you spend any time online, you can’t miss the new candor about mental health conditions. TikTok and Instagram influencers share their struggles and diagnoses on camera. In recent years, executives on LinkedIn have shared photos of antidepressant medication with the hashtag #PostYourPill. Actor-singer-beauty mogul Selena Gomez launched an entire content platform focused on “mental fitness.” Conditions such as anxiety disorder, ADHD and OCD are not only being de-stigmatized, in some contexts, they’re trending.

Open discussion of mental health is undoubtedly a good thing when it eradicates shame, results in people feeling less alone or motivates somebody to seek needed professional care. But in this new era of openness, we risk oversimplification and even trivialization of complex medical conditions, increasing the risk of overtreatment for some, undertreatment for others and overall mistreatment of people exposed to a cacophony of mental health conversations online but lacking access to balanced, authoritative information and quality clinical care.

Let’s say a young woman perusing TikTok sees an influencer sharing that he has attention-deficit/hyperactivity disorder, then – thanks to social media algorithms – over the next week, more ADHD-related content appears in the young woman’s feed. Some of the symptoms feel relatable, so she does a YouTube search on ADHD. After watching a few of the thousands of videos on the topic, she decides that she herself has ADHD.

This is not unusual. Some therapists at Talkspace, where I serve as the chief medical officer, report they have clients coming to sessions with more complex or specific self-diagnoses. Whereas a client might have said, “I think I’m depressed,” a few years ago, now more are saying, “I think I have borderline personality disorder” or “I think I’m on the autism spectrum.”

Such self-diagnosis can be dangerous. When a social media user becomes convinced that they have a mental health disorder, it can lead them to seek inappropriate treatments. They may announce their self-diagnosis to a primary care provider who doesn’t have sufficient mental health expertise to appropriately evaluate the presenting symptoms. Or the patient may wind up using a telehealth provider to get a prescription medication that’s not helpful or is dangerous. In the case of the hypothetical young woman above, she’d likely be seeing ads for ADHD-focused telehealth prescribers within days, if not minutes, of initially engaging with ADHD influencers.

Diagnosing a mental health disorder isn’t as simple as checking off a list of symptoms. Many healthy people experience symptoms of a mental health condition, but the true measure of whether those symptoms merit a diagnosis and treatment is whether they impair the individual’s ability to function. That determination requires working with a licensed mental health professional to evaluate the frequency, intensity, severity and specificity of those symptoms, and understand them within the broader context of life events, stressors and family history.

A “reel” diagnosis needs a real-life one

To address the “TikTok effect” and stop the dangers of self-diagnosis, mental health professionals must meet people where they are: online and actively searching for answers, inadvertently creating a curated feed.

Social media companies and other platforms with user-generated content have a responsibility to create guardrails that ensure clinically-vetted and accurate information is within reach of anybody seeking content about mental health conditions.

For example, if you enter the search terms “depression” or “suicide” into Instagram, you’re offered a list of mental health resources. However, searches related to specific conditions like OCD, ADHD and Tourette’s link directly to memes and user-generated videos of (to put it generously) mixed quality. Since the start of the pandemic, we’ve seen how quickly social platforms could flag content related to COVID or vaccines and direct people to CDC information on those topics. Therefore, it does not seem unreasonable to expect the same for content around sensitive mental health topics.

When somebody hears about a condition online and believes, correctly or not, that it affects them, they are more likely to feel worried, triggered or even distraught. Thankfully, that same technology can quickly link them with mental health care without stigma or stress and allow them to find real answers under a professional’s guidance – if they land at a responsible, high-quality source of tele-mental health. We recently revamped our own site to provide clinical insights from a dedicated team of licensed, practicing clinicians to add dimension to the spectrum between experiencing symptoms and having a condition.

Unfortunately, some telehealth services are all too quick to prescribe medications, including controlled substances, based solely on answers to online questions. At Talkspace, I am personally committed to our policy of not prescribing controlled substances online. When our board-certified psychiatrists and psychiatric nurse practitioners do prescribe medication, it is only after live video consultations and a comprehensive psychiatric evaluation.

Because mental health conditions are so much more complex than what can be captured by a checklist of symptoms, I’m wary of any company that prescribes without live consultations. When digital health companies feed into the misconception that everyone with depressive symptoms is clinically depressed or anyone who’s easily distracted has ADHD, they risk hurting more people than they help.

At a time when it’s all too easy for both the worried well and people with serious mental health conditions to self-diagnose online, it’s imperative that both social media and digital health companies do everything possible to direct vulnerable audiences to trustworthy information and comprehensive, ethical care.

。现在大家聊起国民党最狂、最自负的王牌将领，张口就是张灵甫。孟良崮一役，死守待援、宁死不退，傲气是出了名的。但很多人不知道，早在1946年东北战场，有一个师长的傲气，比张灵甫还要离谱。同样是黄埔四期出身，同样手握王牌精锐，他被重兵团团包围，上级主动派兵来救，他直接拒绝，非要靠自己一支部队硬闯突围，最后硬生生把一支百战王牌打没了。这个人，就是千里驹师师长李正谊。

B | 他带的第二十五师，隶属五十二军，在国军体系里是实打实的老牌主力。这支部队的名气，不是靠吹捧得来的，完全是抗战一场场硬仗拼出来的。早年长城抗战，军情紧急，没有汽车、没有机械化运输，全师士兵纯靠两条腿，长途急行军奔赴古北口前线。

C | 赶到战场来不及休整，直接顶上去挡日军主力，整场战役打下来伤亡极重，但死死顶住了日军的进攻。后来的台儿庄、武汉各大会战，二十五师从来都是打最苦的仗、顶最前线的位置。十几年抗战打下来，老兵极多，实战经验充足。抗战胜利后接收美式装备，改成半美械编制，火力、单兵素养，在东北国军里面，绝对是第一梯队的水平。

D | 杜聿明对这支部队一直很看重，他早年就在二十五师当过副师长，深知这支部队的底子有多厚，也清楚这支部队能打、敢打。也正因如此，李正谊自打接手这支部队，心气就越来越高。仗打多了，胜仗拿多了，慢慢就飘了，压根瞧不上当时东北民主联军的战力。

E | 1946年下半年，东北南满战场对峙激烈。

F | 国军全线压上，试图压缩我军活动范围、彻底肃清南满主力。当时各部稳步推进、互相掩护，唯独李正谊沉不住气。他一心想抢头功、抢战果，不顾兵团整体作战节奏，带着自己的二十五师拼命往前冲。冲得太快，左右友邻全部跟不上，硬生生把自己打成了一支深入敌后的孤军。东北民主联军四纵的指挥员，打仗极稳，一眼就看出了这个破绽。不硬拼、不硬碰，故意边打边退，步步示弱，一点点引诱李正谊往前追。李正谊越追越顺，越追越轻敌，根本没有勘察地形、没有防备埋伏，带着一万多主力，直接钻进了新开岭的山谷地带。这个地方地形特殊，两边全是高山，中间一条窄路，典型的口袋地形，进得去、出不来。等李正谊反应过来不对劲的时候，已经晚了。四纵八个团迅速合围封死所有山口、退路、制高点，彻彻底底把二十五师困死在了山谷里。消息传回沈阳司令部，杜聿明当场就急了。他太懂战场形势，也太懂二十五师的价值。这支部队要是没了，东北国军的正面战力会直接掉一档。他不敢耽误，连夜安排部署，调动新六军、五十二军的增援部队火速赶去解围，同时直接发电报给李正谊，让他就地坚守，老老实实等着援军到位，千万别擅自突围。正常的将领，到这一步，肯定是抓紧固守、等待救援。被重兵包围，孤军无援，等待增援是唯一的活路。但李正谊不这么想。他觉得自己的二十五师是老牌精锐、半美械配置，打了十几年仗，经验远超对手。他根本看不起包围自己的部队，从心底里不相信自己会被全歼。他直接回电杜聿明，地面援军不用来，他不需要任何人救。

G | 只要求空军过来空投弹药、补给，靠着自己的二十五师，完全能自己打出包围圈，甚至能反打一波，击溃当面的阻击部队。杜聿明拿他没办法，只能依他，安排战机进山空投。可新开岭全是深山峡谷，气流混乱，空投精度极差。大量弹药、物资根本落不到国军阵地，反倒很多落在了四纵的控制区里，等于白白给我方送补给，帮倒忙。

H | 接下来的几天，新开岭的仗打得极其惨烈。李正谊集中全师所有火炮，疯狂轰炸周边高地，组织一波又一波的敢死队冲锋，死死争夺老爷岭等关键制高点。二十五师的老兵确实能打，一度冲上去拿下部分阵地，攻防来回拉锯，双方伤亡都非常大。但仗最怕耗。孤军被围，没有补给、没有休整、没有援兵，打一波少一波。二十五师的弹药越打越少，老兵骨干不断牺牲，士气一天比一天低。反观四纵部队，死死咬住包围圈，顶着伤亡持续压缩阵地，不给对方半点喘息机会。

I | 打到最后，二十五师彻底撑不住了。整师建制完全打散，指挥系统瘫痪，士兵要么战死、要么溃散、要么投降。这支从抗战一路打出来的千里驹王牌师，就这么彻底打没了。大势已去之后，李正谊换上普通士兵的衣服，混在溃兵里想蒙混过关逃跑，最后还是被搜山的战士辨认出来，当场被俘。新开岭这一仗，意义非常特殊。这是东北解放战争早期，我军第一次完整歼灭国军一个整建制主力师，直接打破了当时国军“精锐无敌”的嚣张气焰。