Marybeth McCarter, now a 21-year-old college dropout, struggles to recall a time when she was actually “happy.” She was diagnosed with bipolar disorder earlier this year, but has been misdiagnosed half a dozen times since 2011 with everything from depression to an attitude problem.

“I've never really felt happiness. I can't really explain what it would feel like cause I can only dream about it,” said McCarter during a Skype interview from her mother’s home in the Midwest.

“If I'm like really hypomanic, I get really wound up and energetic and impulsive and depressed and suicidal extremely at the same time,” she said.

Marybeth has struggled with her mental health for as long as she can remember, but in 2013 she found a new coping mechanism for her illness; posting graphic images on Instagram that described her self-hatred or even selfies that outlined her suicidal plots.

“The first time I think I came across some accounts was unintentionally from my own personal account,” explained Marybeth. She was 18 at the time and was going through a severe depressive episode, which for her often involved staying inside, avoiding her “real life” friends and instead opting to do “absolutely nothing” but scroll through her Instagram feed.

For Marybeth, Instagram served as a place for her to freely express herself, a place where she felt that she could be removed from the judgment that she felt from family and friends. As she said it, “[they] didn’t understand what I was going through.”

Her posts on Instagram - though sometimes graphic in what she discussed (Marybeth recalls posting daily posts of the 500 calories she consumed when her depression had taken the form of an eating disorder) - were mainly motivated by her seeking of community.

“When I mentioned [attempting suicide] again on there I got the most support I’ve ever had,” Marybeth said.

The community that Marybeth is referring to is the large number of young people who are using Instagram as a support group for their mental illnesses. The trend of posting online about mental disturbances is not a wholly new one; see MySpace, Live Journal, or Yahoo message boards for earlier permutations.

What is new is the sheer volume and accessibility of these posts to a younger and more vulnerable group of people, more specifically between the ages of 13-18, a group that is legally considered to still be children in the U.S. Additionally, the popularity and potency of photo sharing apps like Facebook and Instagram have been shown to be even more addictive than cigarettes.

Instagram has made strides to try and improve their platform for these mentally unstable teens; most recently by installing a tool that allows users to report people they think might be “going through a difficult time.” This update, while a step in the right direction, seems to still be missing a very important element to actually helping these users: a human connection.

The Discovery

Jess is one such case where there is an obvious lacking of human connection in her online interactions. She is a 13-year-old Instagramer that regularly posts encouraging images about her anorexia; ‘bodychecks’ as they’re known in the community. She explained that she is well aware of the hypocrisy in her belief that social media sites, like Tumblr and Instagram, are contributing to her eating disorder.

“I initially found the anorexia community from a YouTube video criticizing it, that was my first exposure,” she said.

“Some of us don't know we’re killing ourselves,” Jess said. “Some people know and don't care. I'm one of those people.” She has always been insecure her body, she explained to me during a Skype interview: “I was young and I hated my thighs, not because of the media showing skinny women...I’ve just hated myself for ages.”

But these insecurities soon developed into actions, particularly after joining the Tumblr and Instagram ‘thinspo’ communities. This is a place where, using specific hashtags that are unique to the community (e.g. #ana, #mia, #thinspo, #goals), young people can find inspiration or tips on how to lose weight: “[they] have been the outlet of everything that inspires me to starve. Not only do they provide pictures of skinny girls to use as inspiration but there are some good tips on how to starve yourself, safely.”

There’s also a thing called ‘meanspo’. This is where anonymous users post randomly directed pictures like, “you’re a fat pig who has never heard of exercise and will always be that fat friend”, Jess explained. These are some of the more popular forms of inspiration that teens can use.

“All these are what inspires me, and many others, that we will never be good, happy, beautiful until we are thin,” she said. “It changes your perception on things. On what your goals should be.”

Marybeth, who has been an active user of both Instagram and Tumblr to document her own eating disorder and bipolar disorder, says that in her years of being online that she has seen far too many cases similar to Jess’s.

She remembers watching girls who were simply insecure about their bodies go from being what she considered "okay", to being hospitalized two or three times, partially because of the tips and advice they were able to receive from these communities.

"I feel like once you do have a problem you never get away from it. So it's like you don't even know that you're committing to that for life when you're asking for these tips,” she said.

A common experience for these teens creating these online, visual diaries, as that’s how a lot of the girls being interviewed described them as, is the potential for cyberbullying. Though they are keeping their innermost and private thoughts away from the physical public, they are sharing these thoughts with a largely anonymous public. Thus opening themselves up for attack in some of their most vulnerable moments.

Dr. Rosen, a psychologist from California State University, says that anonymity is part of the problem but also part of the reason why teens are so willing to open up to strangers on social media.

“People aren’t culpable for their actions online,” Dr. Rosen said. “There seems to be a lack of accountability between the person posting and the people following them.”

Teens who have already vocalized being in a troubled state of mind, be it through self-harm or depression may become unwilling targets for online ‘trolls’, old or adolescent in age. Marybeth explained how she would commonly receive requests from girls asking to be her pro-ana partner: “misery loves company” said a resigned Marybeth. Another 14-year-old girl with a pro-ana Instagram said in a direct message from her account that she would intentionally follow accounts that would spam yours with meanspo (a term that piggybacks off of the word ‘thinspo’, literally translating to mean meanspiration).

Clare, a 17-year-old who now uses Instagram as a recovery account after seeking treatment for her eating disorder, recounts how even when using Instagram in what she thought was a safe mode (with a private account) she became the victim of unwarranted cyberbullying.

Clare’s recovery account is a private one, whereas her personal account - the one that she uses for her friends and family - is a public one. A private account means that people need to get her approval before following her and viewing the pictures she’s posted. This sense of false privacy led Clare to believe that she could freely post about her eating disorder recovery journey, though it wasn’t long before friends at school found out about her account.

“I experienced being the laughing stock of my friends,” said Clare recounting one of the darker moments from her life on Instagram, “they made their own fake recovery accounts so that I’d accept them on Instagram.”

“They screenshotted my posts and then sent them to a group on Whatsapp and talked about me and laughed about me,” said Clare through a Skype interview.

Marybeth, Jess and Clare have all reported blocking and even reporting certain “trolling” accounts that they’ve found to be harassing, but as Marybeth put it, “no matter how many times you report them they're accounts are still there.” Marybeth explained how, in her experiences (she’s had over half a dozen accounts shut down), Instagram seems more concerned with blocking or shutting down accounts that are legitimately looking for help: “all of the people in a community for depression or eating disorders or self harm they're accounts are constantly the ones being reported,” she said, “but at the same time you have these perverted men like way too old to even be contacting you and their accounts are still allowed to be there. Like I don't get that at all.”

Clare’s story ended with her simply blocking the accounts that she found to be frauds and thanks to the support she had outside her cellphone, she was able to move on. Sadly, stories like Clare’s are more common than a lot of us would assume. What’s worse is that an alarming number of these stories have a much darker ending than Clare’s.

The Human (Mis)Connection

Instagram, led by their owner, Facebook, who bought out Instagram in 2012, began an effort to find a more nuanced approach to dealing with these younger accounts that were posting content that went against their Terms of Use (i.e. cutting selfies, eating disorder tips, suicidal quotes).

Over the past two years, the company has been developing a tool that recruits the online community of Instagram users to become sort of watchers over their fellow man. When they see content that someone has posted that they believe could be showing signs of something more serious, then they can report said account to Instagram who then sends a pop up message to the troubled teen with a list of possible resources. There is a stock message generated, such as the one shown above that was taken by Marybeth when she was awoken one morning to find the alert.

“For someone who doesn't want help it's more frustrating,” said Marybeth, describing the efficacy of the tool in teens. “Whereas for me it's like redundant. It even says in my bio that I'm in treatment, so the fact that it's telling you that you need support or resources I already have is annoying.”

Dr. Reidenberg, the doctor from SAVE who has been working with technology and social media companies on tools like this for the past ten years, believes that the tool is more effective than Marybeth and other teens interviewed for this article would agree. In a phone interview, he explained that the tool allows the distressed users to be easily connected to a chat function or a lifeline.

“It also allows people to be prompted as to what to say, and that’s really important because often times in crisis people don’t know what to say or what to do,” said Reidenberg.

The tool was only released this past fall, so it is too early to test the efficacy of it in the real or virtual world, but something that both the experts and the teens using the app can agree on is that it is far better than just shutting down the accounts entirely.

"You know there's this tendency in coverage of pro-ana and self-harm related content to really kind of almost demonize the posters and the people who are posting this content,” said Clare Mysko, the CEO of NEDA (National Eating Disorder Association), who was also heavily involved in the development of the new tool. She said how most of these kids are struggling with very serious mental health issues, and that by simply shutting down their account - essentially cutting off one of their few sources to human contact (even if it is through an app) - you’re just further marginalizing them.

“You need to remember that these people posting are in need of help and seeking community, that's the reason they’re on there,” she said.

And it’s true that a lot of the teens that are active on Instagram, particularly when they’ve begun seeking professional treatment outside of their virtual reality soon change their social media habits to reflect a healthier support network.

Marybeth says that this trend of switching from a negative account, one that encourages your eating disorder or depression, to one that is a recovery account is something that she has seen quite often.

“Some people will use it more for their struggling and then when they decide to recover they will clear all of their pictures and stuff and end up turning it into a recovery account,” she said. She describes herself as being “nowhere near” being considered a recovery account. Instead, she would characterize her account as a diary, a theme that was reoccurring throughout many other interviews.

“Like in your diary you write things that you don't want anyone to know, and you kind of keep them to yourself and it's your way of getting that out in physical words,” Marybeth said. “But at the same time you're not really getting any support or anyone that can relate. It's all still just you whether you write it out, it's still in your head.”

The issue that a lot of the girls that I spoke with that they kept drawing back to was that they didn’t feel comfortable telling their family or friends about what they were going through, but they still yearned for some kind of support network that could relate to what they were going through.

“When you're in that community sharing with those hashtags it ends up going to the people that are sharing the same related things as you are. You don't have like that shame or guilt that it's even wrong to be going through what you're going through,” said Marybeth.

The gap, clearly evidenced by Marybeth’s repeated “fear” and “shame” of talking about her disorder is one that shouldn’t be too surprising for most, is that a lot of these teens are dealing with disorders that are highly stigmatized in our society. Specifically when it comes to self-harm and eating disorders, two mental conditions that take on very physical forms, there is the common thought that people are just doing this for attention. This perception rings even more true when it comes to teens that are posting about it online. But as Dr. Rosen, the psychologist from California State University explained this form of community building is not new, especially for marginalized teens.

“Community building has been around forever,” said Dr. Rosen. “The issue is, what are you being given?” He went on to explain how if a child is already that far deep in their psychological condition, they’re probably going to require treatment that’s more intensive than just the support of someone ‘liking’ your Instagram post.

“If someone's telling you the right way to cut yourself and hide it, that's probably not a very effective psychological treatment,” he said.

It seems, based on Dr. Rosen’s suggestions and the interviews with dozens of mentally affected teens, that the ‘good’ that seems to be coming from Instagram is not by fault of the company. Instead, it seems to be coming from the community finding creative solutions to combat the negativity that is fostered on the social media app.

Dr. Rosen, when asked about the Instagram tool, agreed that while Instagram’s “motivation is an open question”, it is a good idea to be trying to reach these at risk teens rather than completely shutting down their accounts.

“Because all they're trying to do is make people feel better. Or at the very least feel more normalized that their feeling is not odd,” he said.

What caused Dr. Rosen the most concern with this highly praised update, which Marybeth, Jess and Clare had also already noted, was the lack of human connection.

“Let’s say Joe notices that Suzie's feeling lousy. Joe thinks there's a problem: Suzie may try to kill herself. So Joe notifies Instagram or Facebook, what happens from there?” Dr. Rosen said during a Skype interview from his home in California. “That's my concern, because they're not saying that they're going to employ a stock of psychologists to be available. They're not saying they're going to do anything proactive.”

Though contacted on three separate occasions through email, the Facebook representative who worked with SAVE and NEDA on the Instagram update did not reply before publishing for comment.

Instagram’s attempts to help these vulnerable communities have definitely improved from what they once were, where they’d just shut down accounts without discretion. And both Clare Mysko from NEDA and Dr. Reidenberg from SAVE agree that, while they’re proud of their work so far with Instagram, there is still a lot that needs to be covered.

“I think social media companies have a big role to play in the public health ways,” said Mysko.

Dr. Rosen, however, believes that there is still a central and rather obvious - from a mental health background - element missing from these online tools: a human being.

“In terms of gaining empathy, there is this thing called virtual empathy. It does make you feel more socially supported, the problem with that is that real world empathy is about 5 and a half to 6 times better at making you feel socially supported,” said Dr. Rosen. “The way I always phrase it is it takes about 5 or 6 virtual hugs to equal one real world hug. And I'm not even sure that those virtual hugs are really feeling good, it just makes you feel socially supported. So it's tricky.”