In my opinion, I think Puppychan's rants stem from constantly being trapped in a cycle they don't know how to get out of--and by extension, a cycle that don't want to exit. There's no denying that many lolcows like Puppychan thrive off internet attention and it's easy to see why. People are very quick to judge on the surface and immediately offer some form of support, even if they don't understand the full context of what's going on. In a sense, it's very easy for coddling to occur with fanbases like Puppychan's because one of the internet's purposes is to bring others together (for better or worse). I don't think some of their followers are ignorant to this fact, but rather, choose to ignore it to make themselves look better in the process or because they genuinely believe Puppychan is a nice person who just needs help. If anything, I think it goes to show how poorly people understand how mental health works and how the internet has kind of perverted that aspect altogether, but I digress.
People might disagree, but due to these constant cycles we see every so often, I don't think Puppychan understands how the internet works. There is such a thing as moderation in terms of what type of content, environments, and online personas you choose to interact with. Most people when dealing with situations like these will usually try to remove themselves from said spaces and find something more productive to do if it's poorly affecting their health long term. However, considering Puppychan seems to never leave sites like Twitter for more than a week, it comes across as extremely unhealthy. I truly think they lack the ability to remove themselves from these spaces for whatever reason.
I think of it as a consequence of being online for so long and being exposed to the internet while they were too young. A lot of kids who grew up like this (and by extension have become lolcows) see social media as their own form of unlicensed therapy. The reason this fails is because random people on the internet can't substitute for clinical help. At some point you have to realize that your followers don't know you as well as they think they do. No matter how much support you get online, that won't stop any mental health issues from happening.