It's always been my opinion that anonymity makes people more aggressive and more willing to partake in antisocial behavior. A person in a car could have their trip extended by 2 seconds before someone else decides to endanger their lives because they see "slow car" instead of "real family on a road trip".
For stalkers, just have an option to lock down the account. Like, block the stalker and make your account inaccessible to those who aren't already your friend/follow you. With anonymous accounts, there's nothing stopping bypassing any moderation attempts by creating another account unless you do an IP ban, which can also be bypassed. Moderation and especially auto-moderation can be subject to silencing topics and voices the parent company of the social media platform deems shouldn't be talked about.
But if your real name is attached to any number of sensitive topics, getting doxed suddenly becomes a major issue. If Reddit is half full of psyops campaigns, political campaigns, marketing campaigns, what's stopping the people who use these sort of tactics from doxing and threatening you directly to prevent dissent directly from the source? I can only imagine what happens to all those people who have basic walkthroughs for Nintendo emulation only to have hired mobs show up to their door to break their knees within the week. Or a conservative government find a reason to jail (or worse) someone asking about abortion options.
So if you can't be anonymous and talk about sensitive topics without it resulting in rage and propaganda and you can't have your name attached to sensitive topics without it resulting in a risk of doxing or violence, what's the answer? I honestly have no idea. :/ Maybe it will always be a fact that there will be both anonymous websites in addition to websites attached to people's real names.
I guess the answer depends on the social media format, right? I think the old school PhpBB forums were peak for interacting with random people online (at least for me). An issue I've always had with things like Reddit and things similar to that is that there's no Avatar and signature to identify people in a conversation. And the forums that I was a part of, a moderator would always pop in to tell people to take it to PMs if there was too much back and forth conversation (or arguments) between 2 people if it got too heated, too personal, and started diverging too much from the main topic.
So, as far as "healthy" goes, I think my opinion is that communities should be more personal and much smaller. Lemmy definitely feels better to reddit and that's likely just due to the size difference and the fact that more of a percentage of us are real people and aren't part of some marketing campaign or karma farming bots. That way, there's more of a sense of community and people can remember your name from past posts/comments. If your "home" on the internet is slow and small, you won't feel the need to scroll endlessly since you can catch up to content.
As far as format goes, I like the idea of a feed (no text limit) where you can see generally what people are up to recently, but there's also topics people can follow that function more like forums. So then the question becomes should communities have artificially limited user counts and see everything (like Path was)? Or should there be a friends list so you only see things your friends are saying and the comments to those posts like facebook? I'm leaning towards artificially limited user counts since it guarantees a small and slow internet "home". And it's gotta be web based, unlike Discord communities.