Mental illness (MI) is characterized by significant disturbances in thoughts and emotions [1]. The World Health Organization (WHO) reports that approximately one billion individuals, equating to over one-eighth of the global population, grapple with mental disorders, with depression impacting 280 million and anxiety affecting 301 million [2, 3]. Despite the prevalence of MI, persistent stigma surrounds it, often driven by historical fears and media portrayals [4]. Corrigan et al. [5] identified two forms of stigma associated with mental illness: internalized stigma, where individuals within the stigmatized group develop negative self-perceptions; and public stigma, encompassing society’s adverse attitudes leading to prejudice and discrimination [5].

The emergence of social media has revolutionized the discourse on mental health, providing a platform for open discussions and education [6, 7]. Social media enables individuals to share their experiences, reducing stigma and initiating conversations [8]. However, social media has also given rise to a concerning trend—the romanticization of mental illness, portraying it as glamorous and desirable [9,10,11]. Some users normalize mental illness by treating it as an accessory and characterizing its challenges as a form of victimization [12]. This phenomenon distorts the true nature of mental illness and may encourage it as an alternative form of self-expression [4]. While prior research has explored romanticization in traditional media [9, 12], a significant gap exists in understanding how social media users perceive and discuss this phenomenon on platforms like Twitter. Existing studies have predominantly examined content analysis and framing in traditional media, overlooking the unique perspectives and language employed by users in the social media context. This study aims to analyze how Twitter users discuss the issue of romanticizing mental health on the platform, addressing the gap in the literature and providing insights into this specific social media context. It seeks to inform policies and interventions addressing the challenges posed by mental health romanticization on Twitter.

Traditional media, including movies, has a history of inaccurately portraying mental illnesses, perpetuating negative stereotypes across various cultural contexts. Wood et al. [13] observed that mental illness has frequently featured in mass media, but these representations have consistently fallen short. They tend to depict mental illnesses as violent, unpredictable, overly simplistic, detached from reality, or innocent [14].

These portrayals often serve as narrative devices, aiding in character development and scene establishment [15]. By presenting mentally ill individuals as behaving and appearing distinct from “normal” individuals, these depictions reinforce an “us vs. them” narrative [16]. Hyler and colleagues identified and examined six recurring movie clichés that further stigmatized individuals with mental illnesses, including the narcissistic parasite, seductress, enlightened member of society, rebellious free spirit, and homicidal lunatic [17]. Numerous studies conducted across diverse cultural contexts have highlighted the prevalence of these inaccurate representations of mental health in traditional media. For example, studies have shown that news coverage in various countries can link mental illness to violence [18]. News stories often attribute gun violence to “dangerous people “rather than “dangerous weapons,” perpetuating stigmatizing narratives [19].

Similarly, Corrigan et al. [5] reported that a substantial portion of newspaper stories in different regions portrayed mental illness as dangerous and violent, with such stories frequently featured prominently. Misrepresentations of mental illness are not limited to newspapers but extend to global literature, including novels. Works like “Liar” (2009) by Justine Larbalestier depict individuals with mental illness as criminal and dehumanized, potentially perpetuating inaccurate perceptions across international audiences [20]. Films like “All the Bright Places” illustrate how the stigma associated with mental illness exacerbates characters’ mental health challenges, impacting individuals from diverse cultural backgrounds within the narrative [21].

Apart from stigmatization, mental illnesses like OCD and ADHD are also frequently trivialized. One aspect of trivialization involves the normalization of symptoms associated with mental illness, which may result in the dismissal of these symptoms as commonplace experiences rather than indicators of significant distress or impairment. For example, behaviors related to obsessive-compulsive disorder (OCD), such as frequent handwashing or checking rituals, may be trivialized as mere quirks or personality traits rather than recognized as symptoms of a debilitating mental health condition. Additionally, trivialization can manifest through societal attitudes and media portrayals that depict mental illness in a lighthearted or humorous manner, thereby minimizing the lived experiences of individuals affected by these conditions. This can contribute to a lack of empathy and understanding toward those struggling with mental health challenges.

Research has shown that trivialization of mental illness can have detrimental effects on help-seeking behaviors and treatment adherence among individuals experiencing psychological distress. When symptoms are trivialized or dismissed, individuals may feel invalidated or reluctant to seek professional help, fearing that their concerns will not be taken seriously [68, 69]. Furthermore, trivialization intersects with other forms of stigma, such as social rejection and discrimination, exacerbating the challenges faced by individuals with mental health conditions in various social and institutional settings.

Several studies have contributed to our understanding of trivialization in relation to mental illness. For example, Clemente and colleagues [68] conducted qualitative research to understand meanings and implications of the stigma related to bipolar disorder and found that trivialization of their symptoms by others contributed to feelings of frustration and alienation, it further contributed to cause of treatment refusal. This demonstrates how trivialization represents a significant barrier to the recognition and support of individuals with mental health conditions in society.

The literature discussed above underscores the historical prevalence of unfavorable portrayals of mental health in traditional media, transcending national borders and encompassing various cultural contexts, including TV, movies, novels, and fictional characters. Providing a brief explanation of how mental health has been depicted on social media would offer valuable insights and enhance the contextual understanding of this study.

In the past decade, social media has undergone a profound transformation, reshaping the way individuals interact, communicate, and address mental health concerns [22]. It has evolved into a dynamic platform for self-expression, enabling people to openly share their thoughts, life experiences, and memories. Moreover, it has become a virtual space where individuals grappling with mental health challenges can connect, find solace, and extend their support to like-minded peers [23]. Research has illuminated the prevalence of constructive and positive discussions surrounding mental health on social media. For instance, it’s worth noting that tweets conveying inspirational messages tend to receive more retweets (an average of 4.17) than stigmatizing content (with an average of 3.66), underscoring the pervasive presence of uplifting messages in the digital sphere [24]. The discourse encompassing mental illnesses like depression and anxiety on social media overwhelmingly leans toward supportiveness and encouragement, creating a sense of solidarity among individuals facing similar struggles [25]. Young people, particularly, utilize platforms such as.

Facebook and Twitter as digital sanctuaries to escape external pressures that can adversely affect their mental well-being [26]. In essence, social media platforms serve as open canvases for unfiltered expressions and candid discussions about mental health, cultivating a sense of online community [27, 28]. Studies reveal that discussions on social media related to depression primarily revolve around offering support and sharing personal experiences, rather than perpetuating stigma or shame [29]. Similarly, research conducted on Sina Weibo, a prominent microblogging platform in China, illustrates that influential users tend to generate more supportive and helpful posts than negative or stigmatizing ones [30].

Information concerning recovery and treatment plays a particularly pivotal role in nurturing a positive discourse on mental health. These findings not only underscore the essential role of social media in dismantling the stigma associated with mental health issues but also emphasize its capacity to foster a compassionate and supportive digital community. In this light, social media emerges as a potent tool for advancing mental health awareness and advocacy [19]. These findings emphasize the profound potential of social media to reshape how we approach mental health, offering not only a space for candid conversations but also a powerful means to combat stigma and promote understanding and support among individuals facing mental health challenges.

The issue of suicide contagion, particularly in contexts where romanticization occurs, has garnered significant attention in academic literature due to its potentially dangerous implications. Gould and Shaffer [70] and subsequent studies have shown that media portrayals of suicide, particularly those glamorizing or sensationalizing the act, can lead to copycat suicides, especially among vulnerable populations like adolescents. Efforts to address this issue include guidelines from the World Health Organization (WHO), Samaritans, the American Foundation for Suicide Prevention, and other mental health and prevention organizations. These guidelines seeks to streamline and deglamorize media reporting of suicide in a responsible manner more specifically news and media information. Among these guidelines is the avoidance of glorification of suicide to help prevent the Werther effect and possible imitation or contagion effects [71, 72]. However, despite these guidelines, research by Stack [74] and others suggests that sensationalized or glamorized media reporting on suicide persists, contributing to increased suicide rates, as evidenced by studies such as Fu and Yip [75] in Asia.

In recent years, attention has turned to the role of social media platforms like Twitter in influencing suicidal behavior. While social media offers real-time engagement and information dissemination, it also presents challenges in monitoring and regulating content related to suicide. Research by Markman [76] and Jashinshy et al. [77] has shown associations between Twitter activity related to suicide and actual suicide rates, prompting platforms like Twitter to update their policies on harmful content [78]. However, the implementation and enforcement of these policies remain a concern, as studies suggest limited uptake of recommendations. Therefore, despite efforts to address suicide contagion through media guidelines and social media policies, further research and action are needed to effectively mitigate the risks associated with romanticized depictions of suicide in digital environments.

While discourses on social media were initially aimed at destigmatizing mental health, there has been a notable shift towards romanticizing mental illness, including the creation of memes and content glamorizing conditions such as anxiety [21]. Users, in their attempt to make conversations about mental illness empathetic, often inadvertently end up romanticizing it, portraying it as an accessory, and those experiencing it as martyrs [31]. This romanticization can manifest in various forms, from seemingly harmless expressions to more troubling instances such as the glorification of suicide [4]. Chen [32] shared her experience of encountering romanticized mental illness content online, highlighting how depression and anxiety were portrayed as fashionable. This phenomenon extends to the proliferation of melancholic content, black-and-white imagery, and narratives of low self-esteem on platforms like Tumblr.

Similar concerns are observed on platforms like Facebook and blogs, where mental health disorders, including anorexia nervosa, self-harm, depression, and anxiety, are increasingly romanticized [1]. For instance, pro-anorexia (pro-ana) websites have gained notoriety for promoting dangerous behaviors linked to anorexia nervosa, such as extreme dieting practices and unhealthy weight loss methods [79]. These platforms often perpetuate unrealistic body ideals and encourage individuals to pursue thinness at any cost, disregarding the severe physical and psychological consequences of eating disorders [80].

Pro-ana websites, for instance, promote dangerous behaviors related to anorexia, perpetuating unrealistic dieting tips and methods [33]. Furthermore, the influence of celebrities like Lana Del Rey, who has incorporated themes of depression into her music and videos, contributes to the normalization of mental health struggles [1]. This trend has serious consequences, including the normalization of suicidal behaviors among young people, a rise in feigned mental illness, and self-diagnosis [9, 31]. It distorts societal perceptions of mental health and hinders genuine expressions of mental health concerns [12].

However, the use of pro-ana communities extends beyond the promotion of harmful behaviors, as they also serve as complex online environments where individuals with eating disorders find social support and understanding. Research suggests that individuals who engage with pro-ana content may do so as a means of coping with the challenges of their disorder, seeking validation from peers who share similar struggles [80, 81,82,83,]. Within these communities, individuals often engage in open and candid discussions about their experiences with disordered eating, sharing personal stories, struggles, and successes. For many, the sense of belonging and camaraderie found in these online spaces provides a form of support that may be lacking in their offline lives [72].

Moreover, some individuals perceive pro-ana websites as empowering spaces where they can exercise agency over their bodies and identities, challenging societal norms and expectations [73]. This perception underscores the complexity of motivations underlying engagement with pro-ana content and highlights the need for a nuanced understanding of these online communities. Despite the potential benefits of social support within pro-ana communities, it is essential to acknowledge the inherent risks associated with these platforms. Exposure to pro-ana content has been linked to increased body dissatisfaction, disordered eating behaviors, and decreased motivation to seek professional help [81, 84]. It is important to acknowledge that pro-ana websites represent multifaceted online environments where individuals with eating disorders navigate between the promotion of harmful behaviors and the search for social support and understanding.

Romanticization of mental illness can be viewed as a contemporary form of stigma, akin to historical media stereotypes [4]. While prior research has explored various aspects of this phenomenon, including its framing and negative effects, these studies have mostly focused on traditional media. There is a noticeable gap in understanding how social media users engage in discussions about and articulate the romanticization of mental health in their own words on the platform. Furthermore, while studies have examined this issue on other social media platforms, Twitter has received limited attention despite its significant role in mental health discourse [34, 35]. Accordingly, there is a critical need to directly explore authentic discourses initiated by Twitter users. Twitter users frequently adopt pseudonyms and tend to interact with strangers, which allows them to communicate anonymously. Analyzing discourse on Twitter could offer a less biased representation of people’s experiences, as it is more naturalistic, includes a diverse population, and is often anonymous, thereby mitigating some of the constraints of conventional data collection approaches [36].