Selected Papers of #AoIR2024: The 25th Annual Conference of the Association of Internet Researchers Sheffield, UK / 30 Oct - 2 Nov 2024 Suggested Citation (APA): Tylstedt, B., Westwood, H. L., Holroyd, D., Stein, K. (2024, October). Social Media as a Key Actor in Redefining Healthcare Industry Dymanics. Panel presented at AoIR2024: The 25th Annual Conference of the Association of Internet Researchers. Sheffield, UK: AoIR. Retrieved from http://spir.aoir.org. SOCIAL MEDIA AS A KEY ACTOR IN REDEFINING HEALTHCARE INDUSTRY DYNAMICS Beatrice Tylstedt Uppsala University Hannah L. Westwood Coventry University Deanna Holroyd The Ohio State University Krysten Stein University of Cincinnati Blue Ash College Introductory Panel Statement In June 2023 singer-actress Lady Gaga provoked debate after posting sponsored content on her Instagram account, partnering with pharmaceutical company Pfizer to advertise Nurtec ODT, a migraine drug (Nugent, 2023). This follows a recent trend of high-profile figures and influencers spreading healthcare information and misinformation on social media. Wellness guru Belle Gibson presents another example, having lied about treating her (non-existent) cancer through a vegan diet, exercise, and alternative medicine, thus inspiring followers to treat their cancer through wellness and opt out of traditional medical cancer treatment (Baker & Rojek, 2019). While social media platforms have evolved into channels for health promotion, health information distribution and patient communities (Chretien et al., 2011; Eghtesadi & Florea., 2020; Hawn, 2009; Gerbaudo, 2022), both these examples highlight how social media has a real impact on how users engage with health-related debates and conversations surrounding health and embodied experience. The link between social media and health is complex, with research typically exploring how social media shapes our understanding of health and impacts how we intervene on the body (Lupton, 2014). Notably, recent research considers the roles of wellness and patient influencers (e.g. Wellman, 2023; Stephanidis, 2023; Sweeney-Romero, 2022; O’Neill, 2020), patient activist communities (e.g. Petersen, et al., 2019), and healthcare influencers and pharmaceutical sponsorships (e.g. Stein, Yao & Aitamurto, 2022; Willis & Delbaere, 2022; Willis et al., 2023) on shaping health discourse. This panel builds on this body of literature, by advocating for an interdisciplinary approach to studying the relationships between social media and health, and emphasising the importance of considering the impact on users and creators when examining the interplay between top-down corporate and bottom-up content creator presences on health-related social media. Employing critical feminist theoretical and methodological approaches, the papers together argue for greater attention to how emerging technologies and platforms are becoming crucial industry actors in shaping knowledge about the body, wellness, and health. This panel begins with a methodological intervention offered by our first panellist, who advocates for a feminist situational analytical approach (Clarke, 2003, 2005) to explore the complex entanglements of bodily health, social media health-related discourses and content, and the broader dynamics of the healthcare industry. In particular, this first paper introduces the role of social media in the FemTech – female technology – industry, showing how social media is a key location for companies to communicate with their current and prospective users. This first paper sets the stage for the rest of the panel, by highlighting the need to attend to the relational dynamics between digital media technologies and elements of the healthcare industry. The following two presentations draw inspiration from this critical, feminist methodological approach, using digital ethnographic and qualitative analytical methods to examine the impact of digital and social media on perceptions, behaviours, and societal norms related to the context of health and the healthcare industries. Both of the following panellists presents a case study informed by critical interdisciplinary theories from the fields of science and technology studies, gender studies, and health/medical humanities, to demonstrate how social and digital media play a pivotal role in shaping understandings of what is deemed normative and healthy in relation to our bodies. The second panellist conducts a close reading of Natural Cycles influencer advertisements to explore how the FemTech industry uses social media as a tool to advertise health and wellness products and reframe narratives about contraceptive health. The final presentation transitions from considering how healthcare practitioners and traditional industry actors engage with social media, to consider how everyday social media users and content creators are emerging as key actors in shaping understandings and definitions of ADHD. These case studies, paired with the methodological offering of the first panellist, shed light on the various ways in which social media platforms have become crucial sites of information about wellness and bodily health for both traditional healthcare industry actors, non-professional users, and content creators. As such, these papers demonstrate the wide-ranging impact that emerging technologies and social media platforms have on the healthcare industry, and on wider conceptions of health. Ultimately, this panel highlights the necessity of adopting critical, feminist methodological approaches that are sensitive to the nuanced and complex entanglements of social media discourses, media technologies, socio-political contexts, broader healthcare industry dynamics, and the body. By drawing together these three research projects that are situated in three different cultural contexts (Sweden, UK, and USA) this panel contributes interdisciplinary, global perspectives to the evolving landscape of digital culture and social media health-related content – highlighting their influences on reproductive health technologies, influencer marketing, mental health, and the healthcare industry at large. References Baker, S. A., & Rojek, C. (2019, May 2019). Wellness influencers like Belle Gibson promote dangerous pseudoscience as a cure for disease. Independent. https://www.independent.co.uk/news/health/belle-gibson-cancer-cure-fraud-wellness- influencer-pseudoscience-health-a8928571.html Chretien, K. C., Azar, J., & Kind, T. (2011). Physicians on Twitter. Journal of the American Medical Association, 305(6), 566–568. https://doi.org/10.1001/jama.2011.68 Clarke, A. E. (2003). Situational Analyses: Grounded Theory Mapping After the Postmodern Turn. Symbolic Interaction, 26(4), 553–576. https://doi.org/10.1525/si.2003.26.4.553 Clarke, A. E. (2005). Situational analysis: Grounded theory after the postmodern turn. Sage Publications. Eghtesadi, M., & Florea, A. (2020). Facebook, Instagram, Reddit and TikTok: A proposal for health authorities to integrate popular social media platforms in contingency planning amid a global pandemic outbreak. Canadian Journal of Public Health, 111(3), 389–391. https://doi.org/10.17269/s41997-020-00343-0 Gerbaudo, P. (2022). ‘From Individual Affectedness to Collective Identity: Personal Testimony Campaigns on Social Media and the Logic of Collection’. New Media & Society, online first. Hawn, C. (2009). Take two Aspirin and tweet me in the morning: How Twitter, Facebook, and other social media are reshaping health care. Health Affairs, 28(2), 361– 368. https://doi.org/10.1377/hlthaff.28.2.361 Lupton, D. (2014). Apps as artefacts: Towards a critical perspective on mobile health and medical apps. Societies, 4(4), 602-622. https://doi.org/10.3390/soc4040606 Nugent, A. (2023, June 15). Lady Gaga raises eyebrows over paid partnership with Pfizer migraine drug. Independent. https://www.independent.co.uk/arts- entertainment/music/news/lady-gaga-pfzier-migrane-drug-ad-b2357922.html O'Neill, Rachel (2020) Pursuing “wellness”: considerations for media studies. Television & New Media, 21(6). 628 - 634. https://doi.org/10.1177/1527476420919703 Petersen, A., Schermuly, A. C., & Anderson, A. (2019). The shifting politics of patient activism: From bio-sociality to bio-digital citizenship. Health (London, England : 1997), 23(4), 478–494. https://doi.org/10.1177/1363459318815944 Stein, K., Yao, Y., Aitamurto, T. (2022). Examining Communicative Forms in #TikTokDocs’ Sexual Health Videos. International Journal of Communication (IJoC). 16(2022), 1309-1331. Stephanidis, C., Antona, M., Ntoa, S., & Salvendy, G. (2023). Representations of Health and Wellness on Instagram: An Analysis of Posting Behavior of Top-Ranked Health Influencers. In HCI International 2023 Posters (Vol. 1835). Springer. Sweeney-Romero, K. M. (2022). Wellness TikTok: Morning routines, eating well, and getting ready to be “that girl”. In T. Boffone (Ed.), TikTok Cultures in the United States (pp. 108-116). Routledge. Wellman, M. L. (2023). “A friend who knows what they’re talking about”: Extending source credibility theory to analyze the wellness influencer industry on Instagram. New Media & Society, 146144482311620-. https://doi.org/10.1177/14614448231162064 Willis, E., & Delbaere, M. (2022). Patient influencers: The next frontier in direct-to- consumer pharmaceutical marketing. Journal of Medical Internet Research, 24(3), e29422. https://doi.org/10.2196/29422 Willis, E., Friedel, K., Heisten. M., Pickett, M., & Bhowmick, A. (2023). Communicating health literacy on prescription medications on social media: In-depth interviews with “patient influencers”. Journal of Medical Internet Research, 25, e41867. https://doi.org/10.2196/41867 MAPPING FEMTECH: SITUATIONAL ANALYSIS AS THEORY- METHODS PACKAGE TO EXPLORE REPRODUCTIVE HEALTH, EMPOWERMENT AND SOCIAL MEDIA Beatrice Tylstedt Uppsala University FemTech – technologies, wearables, and software that address female health and wellness – have billions of users worldwide. FemTech products for reproductive health comes primarily in the shape of apps directed at menstrual, fertility, and pregnancy tracking. Together they offer new digital tools for managing reproductive health while claiming to empower users. In our work we address the FemTech industry and these apps in two stages. In the first stage, we use the feminist cartographic approach Situational Analysis (Clarke, 2003; 2005) to map FemTech and the various technological, human, nonhuman, discursive, symbolic cultural, and historical elements that together comprise FemTech. We put forward a series of maps of the FemTech ecosystem and provide an overview of FemTech that we, as researchers of FemTech, have been missing in the literature. In the second stage of our work, we draw on the main discourse revealed during the mapping: the discourse of empowerment. FemTech apps and products are often marketed in terms of empowerment (Hendl & Jansky, 2022), and indeed, previous research has highlighted the potential of FemTech apps in helping users keep track of their cycles, become pregnant, and getting to know their bodies, as well as in navigating thoughts, behaviors, and emotions related to the cycle (Epstein et al., 2017; Karlsson, 2019; Fox et al., 2020). However, FemTech has at the same time been heavily criticized for e.g., lacking privacy (Fox et al., 2019; Mehrnezhad & Almeida, 2021; Paul, 2022), enforcing normative ideals on users (Lupton, 2015; Fox & Epstein, 2020), and of turning users into objects of surveillance, discipline, and commodification (Lupton, 2015; 2016; Ajana 2017; Roetman, 2020; Healy, 2021)–issues that could contradict claims of empowerment. We address the notion of empowerment in relation to FemTech using Nicola Gavey’s (2012) suggestion that we should not focus on questions of whether individuals or their actions are empowered, but instead engage in political analysis of the “sociocultural terrain in which individuals are crafting their lives” (p. 719). In discussing empowerment in relation to girl’s sexuality, Gavey suggests to move away from questions of whether or not individuals and their actions are empowered, to instead look at “cultural conditions of possibility for girl’s sexuality, embodiment and relationships” (Gavey, 2011,  p. 719). In our work we do not intend to make a judgement about whether users are empowered or disempowered by FemTech, but instead apply Gavey’s reasoning to explore the sociocultural terrain of FemTech, in order to begin to consider FemTech’s role in women’s reproductive health. Thus, in our work we aim to explore FemTech and its role in women’s reproductive health through the lens of empowerment, and we begin this exploration with mapping and situating FemTech socially, materially, historically, discursively, organizationally and institutionally (Clarke, 2003). In doing so, we ask; What technological, human, nonhuman, discursive, symbolic cultural, and historical elements comprise FemTech? To answer this question, we use the theory-methods package Situational Analysis developed by Adele Clarke in the early 2000s (2003; 2005). Situational Analysis developed as an extension of Grounded Theory, and in outlining it, Clarke resituates Grounded Theory around the postmodern turn by implementing postmodern emphasis on localities, positionalities, situatedness, complexities and fragmentation. Situational Analysis has the situation being studied as its primary focus. That includes all elements in the situation, and the relations between those elements. While traditional social science often talks about the context of the research phenomenon, the basic premise of Situational Analysis is that the phenomenon and the context are inseparable. The basis of Situational Analysis is a continuous process of mapping and memo-writing during the course of the research. The mapping consists of making four kinds of maps: messy and ordered situational maps, relational maps, social-worlds/arenas maps, and positional maps. The idea of the maps is to identify all the elements of the research situation: human, nonhuman, discursive, historical, symbolic cultural, political and other elements, and the relations between those. Questions to ask when mapping are ”Who and what are in this situation? Who and what matters in this situation? What elements ’make a difference’ in this situation?” (Clarke, 2003, p. 561). This also involves paying attention to the sites of silence in the data and ask; ”What seems present but unarticulated?” (Clarke, 2003, p. 561). Clarke also suggests that the researcher should add themselves to the map, in order to acknowledge the embodiment and situatedness of the researcher, but also because when we do research on a situation, we become part of it–we influence it and it influences us (Clarke, Washburn & Friese, 2022). In our mapping, we use a data set of 35 FemTech newsletters from eight different sources, 105 social media posts from three prolific FemTech companies, and 2 mapping workshops with FemTech researchers. We use newsletters as they are a key form of industry communication in FemTech, and social media as this is a key site of interaction between FemTech app companies and users of the apps. From this data, we create a series of maps that we put forward as representing the FemTech ecosystem. For the presentation of our work at AoIR2024, we specifically elaborate on the social media of FemTech. We argue that social media, as a space where girls, women, and people with uteruses spend time ‘crafting their lives’ both by sharing and consuming content, ought to be taken seriously as a sociocultural site where understandings of reproductive health are crafted. We stress that social media is an important, yet understudied site of research in relation to FemTech, and discuss the potential contribution of principles from Situational Analysis for studying social media. References Ajana, B. (2017). Digital health and the biopolitics of the quantified self. Digital Health, 3. Clarke, A. E. (2003). Situational Analyses: Grounded Theory Mapping After the Postmodern Turn. Symbolic Interaction, 26(4), 553–576. Clarke, A. E. (2005). Situational analysis: Grounded theory after the postmodern turn. Sage Publications. Clarke, A. E., Washburn, R., & Friese, C. (2022). Situational Analysis in Practice: Mapping Relationalities Across Disciplines. Routledge. Epstein, D. A., Lee, N. B., Kang, J. H., Agapie, E., Schroeder, J., Pina, L. R., Fogarty, J., Kientz, J. A., & Munson, S. (2017). Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems, 6876–6888. Fox, S., Howell, N., Wong, R., & Spektor, F. (2019). Vivewell: Speculating Near-Future Menstrual Tracking through Current Data Practices. Proceedings of the 2019 on Designing Interactive Systems Conference, 541–552. Fox, S. E., Menking, A., Eschler, J., & Backonja, U. (2020). Multiples over models: interrogating the past and collectively reimagining the future of menstrual sensemaking. ACM Trans. Compututer Human Interaction 27, 22–24. Fox, S., & Epstein, D. (2020). “Monitoring menses: design-based investigations of menstrual tracking applications,” in The Palgrave Handbook of Critical Menstruation Studies, Bobel, C. Winkler, I. T., Fahs, B. & Hasson, K. A. (Ed.) (Singapore: Springer Nature), 733–750. Gavey, N. (2012). Beyond “Empowerment”? Sexuality in a Sexist World. Sex Roles, 66(11–12), 718–724. Healy, R. L. (2021). Zuckerberg, get out of my uterus! An examination of fertility apps, data-sharing and remaking the female body as a digitalized reproductive subject. Journal of Gender Studies, 30(4), 406–416. Hendl, T., & Jansky, B. (2022). Tales of self-empowerment through digital health technologies: A closer look at ‘Femtech’. Review of Social Economy, 80(1), 29–57. Karlsson, A. (2019). Den kønnede datakrop: en socioteknisk undersøgelse af menstruation, self-tracking og apps. [Doctoral dissertation, Aarhus Universitet]. Lupton, D. (2015). Quantified sex: A critical analysis of sexual and reproductive self- tracking using apps. Culture, Health & Sexuality, 17(4), 440-453. Lupton, D. (2016). Digitized health promotion: Risk and personal responsibility for health and illness in the web 2.0 era. In Joseph E. Davis, & Ana Marta González (Eds.), To fix or to heal (p. 152-176). NYU Press. Mehrnezhad, M., & Almeida, T. (2021). Caring for Intimate Data in Fertility Technologies. Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems, 1–11. Paul, K. (2022). How Private is Your Period-Tracking App? Not Very, Study Reveals. The Guardian. Available online at: https://www.theguardian.com/world/2022/aug/17/pregnancy-period-tracking-apps- privacy (accessed December 6, 2023). Roetman, S. (2020). SELF-TRACKING ‘FEMTECH’: COMMODIFYING & DISCIPLINING THE FERTILE FEMALE BODY. AoIR Selected Papers of Internet Research. REFRAMING CONTRACEPTIVE HEALTH: HOW THE FEMTECH INDUSTRY USES INFLUENCER ADVERTISING Hannah L. Westwood Coventry University The use of influencers to promote makeup, skincare and clothing lines across social media has been well recorded (e.g. Duffy & Hund, 2015; Baker & Rojek, 2020; Hund, 2023; Leaver et al., 2020). However, among more obscure promotions including cars and vacuum cleaners, a trend of influencers promoting the non-hormonal digital contraceptive app Natural Cycles has arisen. The role of influencers in promoting health products and services is a growing area of research that warrants further investigation, and social media is an understudied site of research in relation to FemTech (Willis & Delbaere, 2022). Part of the FemTech – or feminine technologies industry – Natural Cycles is a digital contraceptive app popular among millennial women that is primarily advertised through social media, especially Instagram and TikTok. It works by asking users to measure their basal body temperature (BBT) on a daily basis using the Natural Cycles Bluetooth thermometer. The proprietary algorithm uses this BBT data to determine when ovulation takes place, thus confirming fertility status. The app presents this as an output of either red (fertile) or green (not fertile) each day. Natural Cycles also has a reverse product that assists users who are aiming to conceive. In this paper, I present the findings of a close reading of Natural Cycles influencer advertisements on Instagram, taking into account both visual and textual elements of the posts. I find that the posts feature a narrative that I am terming the ‘contraceptive journey’, which typically describes the previous use and dislike of hormonal contraceptives followed by an emphasis on the moment of discovery of Natural Cycles. This narrative promotes the superiority of non-hormonal contraceptives and aims to convince the reader to make the change to Natural Cycles. Furthermore, the image presents a version of the internet figure ‘that girl’, emphasising the relevance of Natural Cycles to the clean girl aesthetic, and implying that the product fits seamlessly into the morning routines of this aspirational lifestyle (Sweeney-Romero, 2022). Thus, this paper contends that Natural Cycles’ use of influencer advertisements upholds specific expectations of the ideal user and conceals the barriers to accessing the product. This paper aims to contribute to the growing area of research focused on the role and ethics of influencers in promoting health products on social media (Willis & Delbaere, 2022). It is important that the role of influencers in advertising medical products such as contraceptives - that would typically require a consultation with a nurse or doctor - is studied in a way that takes into account the ethical implications of such advertisements. The paper blends methods from social media analysis and advertising analysis to present a comprehensive reading of Natural Cycles Instagram influencer advertisements that form part of a multi-influencer campaign used by Natural Cycles, in which a group of select influencers promote the same product over a specific time period (Leaver et al., 2020, pp.115-127). Specifically, a close reading of the captions and images of each advertisement is conducted, added to comment analysis to present an overall inquiry into the discourses surrounding the promotion of these products. The paper studies several similar advertisements that feature a reality television star-turned- influencer posing on a bed, holding a Natural Cycles-branded thermometer, with an accompanying caption (Mecklenburgh, 2021; Attwood, 2021; Power, 2021). I first present a close reading of the captions, including discussing the main messages in each, and comparing similarities and differences between them. I show that the advertisements construct the ‘contraceptive journey’. This is formulated through a narrative that emphasises previous experience with using one or more hormonal contraceptive methods, but disliking them, often citing specific negative side effects (Mecklenburgh, 2021; Attwood, 2021; Power, 2021). The narrative continues by explaining the switch to Natural Cycles, which is presented as superior to previously tried methods, forefronting hormone-free discourses. The moment of discovery of Natural Cycles is particularly emphasised in the captions to spark strong emotion is the user. This ‘contraceptive journey’ is featured in all of the captions analysed for this paper, showing the importance and cohesion of this message in Natural Cycles marketing. In tandem with the caption analysis, a reading of the image of the advertisement is conducted that focuses on how the product is presented. Featuring influencers holding their Natural Cycles-branded thermometer, I consider the signification of the specific influencers chosen to advertise the product (Williamson, 2005). Using visual cues such as the casual, yet made-up aesthetic of the matching loungewear and styled hair, I contend that the images of the advertisements suggest that the influencers are ‘that girl’, an internet trend that refers to young and typically slim white girls who film their morning routines (Sweeney-Romero, 2022). Such routines often feature getting up early to complete elaborate skincare routines, workouts and clean eating before the working day begins (Sweeney-Romero, 2022). Synthesising the analysis of the caption and image, this paper contends that the advertisements imply that users can complete their own ‘contraceptive journey’ to discover Natural Cycles, a product that is not only superior to hormonal contraception, but one that is necessary to become the aspirational, neoliberal figure of ‘that girl’ (Sweeney-Romero, 2022). This paper also includes a limited comment analysis that allows for a consideration of whether and how users engage and interact with these specific influencer advertisements on Instagram. In particular, I find three categories of interaction: positive, negative and resisting. I focus specifically on the comments that resist the advertisement, for example asking an influencer what brand of clothing they are wearing, refusing to engage with what the post is specifically advertising, and instead treating it as if it were a standard grid post. Following the close reading of the posts and their comments, the paper critically engages with the main message of the ‘contraceptive journey’ that users must complete in order to become ‘that girl’. The way the advertisement is constructed implies that the product is suitable and accessible for everyone, concealing how users may be excluded for reasons including the prohibitive financial cost, the requirement for regular sleep and regular menstrual cycles or the intense amount of labour involved to use the app ‘properly’. Furthermore, while Natural Cycles has regulatory approval as a contraceptive across many parts of the world, the nature of its advertising conceals the need to make an informed decision about one’s method of contraception, which may involve a consultation with a doctor or nurse (National Institute for Health and Care Excellence, 2021). This research forms part of a larger project investigating the accessibility, equity and safety of the FemTech - or feminine technologies - industry. This industry broadly focuses on health solutions for women and non-binary people, with a specific aim to address areas of women’s health that have previously been underfunded. The project uses Natural Cycles as a case study, conducting an in-depth walkthrough of the app and drawing on social media advertisements (Light et al., 2018). The social media influencer advertisements contribute to an overall comparison of how the product is advertised versus how it actually operates for users. It considers the ethical implications of using influencers to advertise Natural Cycles, and health and medical products more generally, and how this can conceal important suitability and access barriers to the product. References Attwood, O. J. [@oliviajade_attwood] (2021, June 10). Whenever I do a Q&A I always get asked what contraception I use [Image]. Instagram. https://www.instagram.com/p/CP9BObOBglU/ Baker, S. A., Rojek, C. (2020). Lifestyle Gurus: Construction Authority and Influence Online. Polity. Duffy, B. & Hund, E. (2015). “Having it all” on social media: entrepreneurial femininity and self-branding among fashion bloggers. Social Media + Society 1(2): 1–11. Hund, E. (2023). The Influencer Industry: The Quest for Authenticity on Social Media. Princeton University Press. Leaver, T., Highfield, T., & Abidin, C. (2020). Instagram: Visual Social Media Cultures. Polity. Light, B., Burgess, J., & Duguay, S. (2018). The walkthrough method: An approach to the study of apps. New Media & Society, 20(3), 881-900. https://doi.org/10.1177/1461444816675438 Mecklenburgh, L. [@lucymeck1] (2021, April 18). AD I use my platform to share open & honest elements of my life [Image]. Instagram. https://www.instagram.com/p/CNzre5MDlYI/ National Institute for Health and Care Excellence. (2021). Medtech innovation briefing: Natural Cycles for monitoring fertility. https://www.nice.org.uk/advice/mib244 Power, J. [@jessika_power] (2021, June 6). as a girl, I know how hard it can be to find a birth control that suits your body [Image]. Instagram. https://www.instagram.com/p/CPxXkGXHyYU/ Sweeney-Romero, K. M. (2022). Wellness TikTok: Morning routines, eating well, and getting ready to be “that girl”. In T. Boffone (Ed.), TikTok Cultures in the United States (pp. 108-116). Routledge. Williamson, J. (2005). Decoding Advertisements: Ideology and Meaning in Advertising (15th impression). Marion Boyars. Willis, E., & Delbaere, M. (2022). Patient influencers: The next frontier in direct-to- consumer pharmaceutical marketing. Journal of Medical Internet Research, 24(3), e29422. https://doi.org/10.2196/29422 EXPANDING DEFINITIONS OF ADHD AND THE MEDICALIZATION OF EVERYDAY NEOLIBERAL EXPERIENCES ON INSTAGRAM AND TIKTOK Deanna Holroyd The Ohio State University Attention-Deficit/Hyperactivity Disorder (ADHD) is an increasingly prevalent disorder (Smith, 2012), with around 10% of American children diagnosed with ADHD (Li et al., 2023) and around 366 million adults worldwide experiencing symptomatic ADHD (Song et al., 2021). This rise in diagnoses, and ADHD-related discourse, is mirrored in the increase in ADHD-related social media content; Instagram has 4.2 million posts with ‘#adhd’, and ‘#ADHDTiktok’ has almost 8 billion views on TikTok. Medical anthropologists attribute this rise in ADHD discourse to increased medicalization (Aronowitz, 1998; Castel et al., 1982; Conrad, 2007; Illich, 1974; Smith, 2012; Starr, 1984), arguing that new technological interventions exemplify the commodification and institutionalisation of the healthcare industry (Gordon, 2013; Sismondo, 2018). Digital media scholars, on the other hand, either understand online health discourse as sites of patient activism, that resist the hegemony of healthcare institutions (Conrad et al. 2016; Epstein and Timmermans, 2021; Gerbaudo, 2022; Parr and Davidson, 2008; Radin, 2006), or are concerned with the prevalence of online health-related mis-/dis-information (Yeung et al. 2022). While these perspectives highlight important issues connected to healthcare institutionalisation, medicalization, and online community formation, they overlook how media technologies, as persuasive socio-technological actants (Latour, 1996; Fogg, 2003), actively shape knowledge production about health and illness. Indeed, rather than dismissing this ADHD-related content as a frivolous trend, I instead understand these videos as meaningful, cultural products that have important consequences on socio-cultural phenomena (Ask and Abidin, 2018; Shifman, 2014). With this in mind, my conference paper asks: 1) how exactly is ADHD presented on social media?; and 2) what consequences does this online, digital ADHD-related discourse have on broader understandings of ADHD, the ADHD healthcare industry, and official industry-standard diagnostic criteria? To answer these research questions, my paper presents the findings of an 18-month-long digital ethnographic study (Hine, 2015; Pink et al., 2015) on online ADHD content. My study consisted of exploring ADHD-related short-form video content on TikTok and Instagram, and conducting a multi-modal analysis (Machin and Mayr, 2023) and critical techno-cultural discourse analysis (Brock, 2018) of the discursive, memetic, aural, and visual aspects of the videos, paying close attention to the symptoms that are listed. The results of this digital ethnographic study show that social media ADHD content tends to follow one of two formats – 1) educational, myth-busting content, or 2) trending content. Educational, myth-busting videos tend to be formatted as short, entertaining, situational skits, aiming to inform viewers about the societal misconceptions and judgements that neurodivergents must face, as well as the lived experiences and struggles of the ADHD mind. Although much of this content humorously engages with the difficulties of having the disorder, these videos also frequently aim to reposition ADHD, not as a debilitating disorder, but as a neurological ‘superpower’. There are therefore strong activist undertones to this content insofar as creators aim to both raise awareness about the disorder, and also reshape popular conceptions of ADHD as something that can be empowering rather than inherently debilitating. However, the second type of popular content reoccurring in these social media spaces is far less concerned with educating viewers and empowering ADHD users, and instead takes inspiration from trending content and memes across social media platforms, such as the ‘put a finger down ADHD edition’, ‘nobody has all 5’ trend or ‘POV You have ADHD’. These videos use these various trending soundbites and editing techniques to present the content creator’s embodied experiences of living with ADHD, and often list supposed symptoms associated with the disorder. Several of the ADHD experiences that are frequently mentioned include: leaving cupboard doors open; being untidy; struggling to tune out neighbouring conversations; poor time management; dehydration; frequent fidgeting; lacking motivation to cook a proper meal; being unable to make a decision or complete an arduous task; hyperfocus; zoning out; forgetfulness; sitting with your knee up; misplacing things; caffeine addiction; and having more than 1000 unread emails. These ADHD experiences presented in the videos on TikTok and Instagram differ dramatically from the official symptoms and diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) used within the mental healthcare industry. Rather, these symptoms can be better understood as quotidian lived experiences of our neoliberal socio-cultural context. As neoliberal critics have argued, neoliberalism has created a society in which ideologies of meritocracy, expectations of constant self-improvement, fast-paced daily living, and an increasing focus on the individual, have become key elements of our everyday reality (Cvetkovich, 2012; Lauren Berlant, 2011; Gershon, 2011; Harvey, 2005). By connecting these everyday experiences of our busy, overstimulating, neoliberal reality to ADHD, the common difficulties that viewers encounter as neoliberal subjects become reconfigured as medicalized symptoms of a disorder – creating an environment in which almost anyone can recognize their everyday experiences as symptoms of ADHD. These two types of social media ADHD-related content therefore demonstrate how vernacular understandings and definitions of ADHD have expanded beyond official medical diagnostic criteria, to encompass everyday neoliberal experiences that become reframed as medical symptoms. By medicalizing everyday experiences as ADHD symptoms and presenting ADHD as a neurological ‘superpower’, this ADHD social media content masks the socio-political causes of these experiences and places the responsibility of managing them onto the individual. At the same time, this content turns the disorder into an alluring identity marker, as it provides a medical framework through which to understand neoliberal struggles, and explain people’s inability to meet neoliberal norms and expectations – “it’s not my fault I’m addicted to coffee and have 1000 unread emails, it’s because I have ADHD”. This paper therefore argues that contrary to previous research on online health discourse, ADHD social media content is not simply a source of advocacy, awareness, and activism. Rather, the content both medicalizes and glorifies everyday struggles, presenting them as ADHD symptoms, and consequently expanding vernacular definitions of what it means to have ADHD in the 21st century. This creates an environment in which almost anyone can understand themselves to be neuro-divergent, and ADHD is thus reduced to an online trend and personality trait that ultimately contributes to the delegitimization of the disorder. As such, this vernacular embodied ADHD knowledge on TikTok is not only actively changing widespread conceptions of what ADHD is, but is also challenging official medical definitions of what it means to have a healthy brain and be neuro-normative. In this way, this ADHD-related short-form video content on TikTok and Instagram has become a key actor in generating alternative knowledge regarding mental health that exists external to the traditional American ADHD healthcare industry. With this in mind, this paper makes several significant contributions to the fields of medical humanities, science and technology studies, and qualitative social media studies. Firstly, it highlights how the socio-political context of neoliberalism impacts what behaviour becomes medicalized and what can be considered normative and disordered behaviour. Secondly, the paper illuminates how social media content shapes understandings of mental health and symptoms of disorders, creating digital spaces where medical symptomology and diagnostic criteria are in a state of constant flux and negotiation. 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