The Paywalls of Mental Health: Why TikTok Became a Diagnosis Tool
A recent study published in Australasian Psychiatry and highlighted by PsyPost examines the accuracy of TikTok videos tagged with #adhdtest, claiming these videos mislead viewers with unvalidated and unreliable methods for identifying ADHD. According to the study, a staggering 92% of these videos failed to meet any evidence-based standard, with techniques like ASMR and “dot tests” dominating the content. PsyPost’s commentary takes a predictable angle, warning readers about the dangers of misinformation and calling for greater reliance on professional diagnostic pathways. The implication is clear: TikTok is positioned as a breeding ground for inaccuracy, its creators irresponsible, and its viewers naive or desperate.
But to frame the issue in this way is to miss the larger picture entirely. The existence of these videos is not a failure of their creators, nor is it evidence of widespread ignorance among their audiences. Instead, these videos are a symptom—a sign of the barriers people face in accessing formal mental health care. Under capitalism, diagnoses are locked behind a paywall, an expensive and protracted process requiring not only money but also time, energy, and resources so many do not have. In such a system, platforms like TikTok emerge as a necessary alternative, filling the gaps left by a system designed to hoard access and create scarcity. The real question isn’t why these videos exist—it’s why so many people are forced to turn to them in the first place.
Diagnoses and Capitalism’s Scarcity Model
In a capitalist society, diagnoses carry immense weight, serving as gatekeeping documents that grant access to accommodations in education, employment, and healthcare. Without the formal recognition of a diagnosis, individuals often find themselves excluded from spaces and opportunities that could allow them to participate fully in life. From extra time on exams to workplace adjustments or access to therapeutic interventions (e.g., medications), these accommodations are rarely offered out of goodwill. Corporations, schools, and employers are not motivated to “do the right thing” when it costs them money—money they would much rather hoard. A diagnosis becomes a necessary key to unlock these accommodations, not because it should be, but because capitalism demands proof of struggle before even the smallest allowances are made.
This system is deeply paradoxical. Capitalism insists on productivity, expecting individuals to conform to rigid norms of efficiency and output. Yet it often withholds the very tools needed for people to meet those demands, providing support only after they can demonstrate significant difficulty. Even then, the system typically does the bare minimum, ensuring compliance with legal requirements while spending as little as possible. This results in a perverse dynamic: people must prove they are struggling just to receive the help that enables them to function, reinforcing the narrative that support is a privilege rather than a right.
At the heart of this issue lies the paywall—a barrier so steep that it restricts access to the formal diagnostic process for many. The costs of obtaining a diagnosis can be astronomical, from specialist consultations and psychological evaluations to follow-up care. For practitioners, the path to becoming one of these gatekeepers is equally expensive, with years of university education, unpaid internships, and the financial burden of setting up and maintaining a practice. These costs drive up the prices of evaluations, making them accessible only to those with significant resources. In countries with privatised healthcare, this dynamic is even more pronounced, as insurance coverage often falls short, leaving individuals to bear enormous out-of-pocket expenses. For those in public healthcare systems, the scarcity of qualified professionals creates another barrier, with waiting lists stretching months or even years. A diagnosis of ADHD or autism, or even access to mental health services, often requires navigating a labyrinth of bureaucracy, expense, and delay that excludes many outright.
These challenges are not incidental—they are a feature of a system designed to maintain scarcity. Capitalism thrives on the commodification of care, transforming diagnoses into yet another product that must be bought. For certain ways of being, like ADHD and autism, where support can be life-changing, the reliance on gatekept evaluations entrenches inequality. In the Global North, these barriers are particularly stark, with diagnostic pathways often inaccessible to those without financial means and/or the privilege of time. The result is a system that not only fails to meet the needs of the many but actively reinforces their marginalisation.
Why TikTok Fills the Void
The paywalls surrounding formal diagnoses have created a vacuum, and platforms like TikTok have stepped in to fill it. For countless individuals, the psychological toll of feeling left out—of not fitting in, of struggling to keep up in a world that demands constant productivity—is compounded by the systemic barriers to accessing care. The cost, both financial and emotional, of pursuing a formal diagnosis is out of reach for many. Whether it’s the thousands of dollars required to see specialists, the months or even years spent languishing on waiting lists, or the sheer scarcity of practitioners, the system leaves people searching for answers on their own. Into this void comes TikTok, a platform that offers something the traditional system does not: immediacy, relatability, and community. For many, it becomes a lifeline.
The TikTok algorithm enhances this experience, tailoring content to the user’s interests with a precision that no traditional system even attempts. If someone searches for ADHD or autism-related content, TikTok quickly picks up on this and feeds them more videos that align with their queries and likes. This creates a highly curated space where users can find relatable stories, hear language that helps them articulate their experiences, and connect with communities they may have never known existed. It is not uncommon for people to stumble across a TikTok that describes their struggles with uncanny accuracy, sparking a journey of self-discovery they hadn’t even known was possible. For many, these experiences provide validation and understanding in ways that traditional healthcare systems fail to deliver.
Critiques of TikTok and self-diagnosis, like the Australasian Psychiatry study and the PsyPost article, ignore this context entirely. These critiques are not neutral observations; they serve to reinforce the monopoly traditional systems have on diagnostic authority. By framing TikTok as dangerous or misleading, such studies dismiss the realities of those who turn to the platform out of necessity, not convenience. They reinforce the idea that only “authorised” gatekeepers—those within the medical-industrial complex—can validate someone’s experiences or struggles. This is a subtle but effective form of gatekeeping, one that delegitimises self-driven exploration and maintains the status quo.
The broader attack on TikTok is not confined to academic papers. Recent efforts by the US Congress to regulate or even ban TikTok are steeped in the same protectionist logic. Many of the politicians leading these efforts are heavily lobbied by TikTok’s competitors: pharmaceutical companies, tech giants, and other gatekeepers within the medical-industrial complex. These entities have a vested interest in maintaining their dominance and eliminating platforms that challenge their control. TikTok, by offering a space where people can share experiences, discuss symptoms, and build communities without paying into the traditional system, poses a threat to their profit-driven model.
Pharmaceutical companies, for example, profit heavily from the current gatekeeping structure. The path from diagnosis to treatment often funnels individuals into systems that generate significant revenue—from diagnostic fees to long-term prescriptions. TikTok disrupts this model by enabling users to share knowledge and insights without an intermediary, empowering individuals to explore possibilities outside the sanctioned pathways. The backlash against TikTok, framed as concern for misinformation, is in reality a thinly veiled attempt to reassert control and preserve profits.
Ultimately, TikTok’s popularity as a platform for mental health exploration is not evidence of its failure but of the failure of traditional systems to meet people’s needs. It thrives because it offers what the formal structures refuse: accessibility, immediacy, and community. Critiques of TikTok, whether through academic studies or congressional scrutiny, are not about protecting users from harm. They are about protecting the dominance of systems that rely on scarcity, control, and gatekeeping to thrive. Instead of asking why people turn to TikTok, perhaps the real question should be why so many feel they have no other choice.
Capitalism’s Broader Paywall Function
Capitalism thrives on creating artificial scarcity, turning basic needs and aspirations into privileges that must be bought. In every sector of society, barriers are erected—not because they are necessary, but because they serve to generate profit and maintain control. Higher education is one of the clearest examples. Degrees have become gatekeepers to employment, their value inflated by the very system that demands them. Federal service positions, for instance, often require a bachelor’s degree for roles that gain little benefit from formal academic training. I once knew an FBI agent whose degree was in art history—a subject he described as “useless” for his career but the “quickest and easiest path” to the qualification he needed to pursue his lifelong dream. His story is emblematic of a broader issue: degrees are not about capability or readiness but about navigating an arbitrary system designed to keep people out unless they can afford to pay their way in.
This trend extends far beyond education. Certification requirements in fields like technology illustrate how the goalposts are constantly shifting, driving up costs and narrowing access. There was a time when I worked as a systems engineer, a role that required no certification at all. Later, the Microsoft Certified Systems Engineer (MCSE) became the standard—a single qualification that most could manage (except me, I was illiterate at the time). Now, the landscape is nearly unrecognisable, with countless certifications required just to stay relevant in the field. Each comes with a hefty price tag, creating yet another barrier that ensures only those with significant financial resources can compete.
Housing, another fundamental need, has been transformed into a speculative market, where the right to shelter is tied to credit scores and income thresholds. The basic human necessity of a home is treated as an asset for the wealthy to trade and hoard. Rental applications demand high credit scores, deposits, and proof of income far exceeding the cost of rent itself, leaving millions locked out of stable housing. It is a stark reminder of how capitalism’s scarcity model prioritises profit over human dignity.
Healthcare operates on the same principles. Life-saving treatments and medications are priced out of reach for those who need them most. The EpiPen, for example, contains roughly $3 worth of medicine, yet its price exceeds $600 due to its proprietary “delivery device.” This is not a reflection of the product’s value or the cost of innovation—it is the result of a system designed to extract as much profit as possible, no matter the human cost.
Mental health diagnoses follow the same pattern. Something that should be accessible to all is instead restricted to those who can pay. The cost of evaluations, treatments, and ongoing care mirrors the same profit-driven scarcity seen in other sectors. Diagnoses become another commodity—something to be earned or bought rather than freely available as a right. This artificial scarcity is not just a flaw in the system; it is the system. Capitalism ensures that even our most basic needs, from shelter to healthcare to self-understanding, are transformed into privileges reserved for those who can afford them. It is this scarcity, not the TikTok creators or their audiences, that we should be questioning. The real issue is not the existence of alternative pathways, but the fact that such pathways are needed at all.
The Real Problem Isn’t TikTok
Critiques of TikTok content creators often miss the point entirely. These platforms, for all their flaws, serve as lifelines in a system that withholds care from those who need it most. They provide access to information, community, and validation for people who would otherwise be left to struggle in isolation. Personally, I don’t use TikTok. Its fast-paced format—flashy visuals paired with predominantly verbal content—is overwhelming for my autistic, Gestalt Language Processing system. I much prefer written forms of media that I can process in my own time and way, aided by my accessibility technology. But just because I don’t use TikTok doesn’t mean it lacks value or shouldn’t exist. Its role in offering support where formal systems fail is undeniable, even for those of us who engage with the world differently, or elsewhere.
Critics frequently point to the existence of bad information on TikTok as evidence of its harm. But this criticism is misleading in and of itself. When traditional systems are inaccessible or indifferent, people are forced to seek answers wherever they can. Of course, there will be inaccuracies; that is inevitable in any decentralised, user-driven space. However, dismissing TikTok outright because of “bad information” ignores a critical nuance: the platform aggregates lived experiences in ways that traditional systems do not.
On TikTok, individuals use their own lives as their “sample size,” sharing their personal stories and insights in a way that traditional medicine would dismiss as anecdotal. Yes, single-sample studies are not the foundation of formal research, but when these anecdotes are shared and amplified by others with similar experiences, they create a collective narrative. In a way, TikTok functions as a form of crowd-sourced action research. Whilst it may lack the controlled environment of clinical studies, it offers something equally valuable: a shared pool of experiences that validate and support people who feel unseen or unheard by traditional systems.
The problem isn’t that these narratives exist—it’s that the formal systems have failed so many people that they have to rely on these spaces to begin with. TikTok thrives not because it is perfect, but because the barriers to formal systems are insurmountable for many. Instead of criticising the platform and its creators, we should be asking why so many people feel they have no choice but to turn to it for help. The existence of these platforms, and the communities they foster, is a direct reflection of the gaps left by traditional healthcare and diagnostic systems. To dismiss them as frivolous or harmful is to ignore the desperation that drives people to seek them out.
Rather than framing TikTok as a problem to be fixed, we need to understand it as a symptom of deeper systemic failures. It thrives because it provides something people are not getting elsewhere: accessibility, immediacy, and a sense of belonging. These platforms should not be dismissed; they should be understood. They offer insight into the unmet needs of countless individuals—needs that traditional systems could meet but choose not to. The conversation should not be about whether TikTok has bad information, but about why people feel compelled to rely on it for answers at all. The real issue is not the platform itself but the society that has made it necessary.
Final thoughts …
TikTok is not the problem. The real issue lies in capitalism’s relentless creation of artificial scarcity, where even the most basic needs—mental healthcare, accommodations, and self-understanding—are placed behind paywalls that few can afford. TikTok exists as a symptom of this systemic failure, stepping in to fill the gaps left by inaccessible, profit-driven systems. Rather than condemning the platform, we should be asking why so many are forced to rely on it in the first place. The answer is simple: because the systems meant to support them do not.
Imagine a world where diagnoses and mental health care were no longer commodities but rights accessible to all. Universal access to mental healthcare would remove the barriers that currently force people to navigate expensive, protracted systems for validation and support. Accommodations could be granted based on need rather than requiring people to prove their struggles through a costly diagnostic process. Resources for self-understanding—whether through therapy, community, or education—could be freely available, empowering individuals without gatekeeping or stigma. To achieve this, we must also ensure universal free access to higher education. Training and educating practitioners shouldn’t come at the astronomical personal cost it currently does, which inevitably drives up the price of care for everyone else.
The argument that this is “too expensive” does not hold water. Each year, the Global North allocates staggering sums to military budgets and other discretionary expenditures—expenses so vast that initiatives like universal healthcare and education would represent a fraction of the cost. If we can afford to fund wars, fleets of fuel-hungry government vehicles, and other non-essential endeavours, we can certainly afford to invest in systems that improve lives, reduce inequality, and strengthen communities. The question is not one of resources, but of priorities.
Platforms like TikTok are a powerful critique of this broken system. They expose the unmet needs and unfulfilled promises of capitalist healthcare structures while simultaneously providing a space for people to seek answers, however imperfectly. TikTok is a signpost, pointing to the gaps we must address. The goal should not be to erase or dismiss it but to create a world where such platforms are no longer a necessity—where care, community, and understanding are available to all, without the barriers of cost or scarcity.