Hazel sits in my office for our first appointment. The 16-year-old adjusts her red glasses, her brown eyes looking intently at me.
Then she starts to talk: about her ‘anxiety and depression’, her ‘emotional dysregulation’, the ‘trauma’ from growing up with parents who are ‘codependent’, the stress she feels having to ‘mask’ just to get through the day.
Sometimes she feels so frustrated with her family she feels she’s going to have a ‘full-on panic attack’ at the dinner table, she tells me.
Then there’s Violet, a 17-year-old with a messy blonde ponytail. ‘I guess I should tell you about my OCD,’ she sighs, just after walking through my door. ‘And my PMDD [premenstrual dysphoric disorder, causing debilitating emotional and physical symptoms before a period], and my ADHD,’ before adding wearily: ‘And my depression.’
I am a psychiatrist who specialises in helping teenage girls, young women and their parents at my own private practice in New York.
Since I began my medical training just over two decades ago, I’ve noticed a big change in the patients I see, something that’s also being reflected in the UK.
Once, people used to dread being told that there was something ‘wrong’ with them. But today, young women announce their diagnoses almost before telling me their names.
Cascades of medical problems and psychiatric buzzwords tumble out of my young patients’ mouths – but no matter how much they talk, with each acronym I often feel like I know less and less about them.
Gen Z prioritise their ‘mental health’, and believe it is something they should ‘achieve’. But somehow normalcy seems more elusive than ever: the Royal College of Paediatrics and Child Health now estimates that around 20 per cent of eight to 16-year-olds have a formal mental health diagnosis (picture posed by models)
All these girls tell me about psychiatric symptoms and conditions I know how to treat. I can use medication; I can teach ‘coping’ strategies. But all of this will only help up to a point.
Because part of the problem is in the very language – ‘therapy speak’ – these girls are using to describe themselves and the world around them.
Indeed, this generation of teenage girls is soaked in therapy speak, and use it constantly.
As well as being entirely au fait with psychiatric diagnoses, they talk about ‘trauma’ and their ‘issues’. They know if they have ‘attachment difficulties’ or their ‘inner critic’ is too loud.
Of course, being mindful of one’s mental health and that of others can be a positive thing. But what my colleagues and I are seeing is something rather different. The rise of ‘therapy speak’ has landed us in a very strange place – where many girls define themselves not by their favourite music or by their hobbies, but by their psychiatric profiles.
Not only this, but they are also pathologising normal feelings associated with growing up – low self-esteem, sadness, worry, distractibility – into full-blown mental health conditions, such as depression, OCD and ADHD. Young women I meet are truly convinced that they must have something ‘wrong’ with them, that they are ‘a bit broken’.
This can have profoundly negative consequences.
The main psychological task of adolescence is forming your identity – who you are.
And although identifying with a mental illness can encourage someone to seek help, and the use of therapy speak can increase understanding, it has also been shown to have an ‘engulfing’ effect, obliterating other aspects of identity and making someone worse.
For example, a 2025 study in the Journal of Social and Clinical Psychology found that those who hold anxiety disorders as central to their sense of self believe they are less capable than others with the same symptoms who don’t label themselves with a disorder.
Meanwhile, research from 2014 in the publication Behaviour Research and Therapy found people with depression have been shown to feel more hopeless and pessimistic if they think of their symptoms as a medical condition, especially if they believe it’s caused by a ‘chemical imbalance’, rather than, say, an understandable life event, such as your parents splitting up or having problems at school. The language teenagers use feeds into this. If a single night’s missed sleep is described as causing ‘dysregulation’, for example, or not being allowed to go out late is ‘traumatising’, it can lead to a disconnect.
How would one cope with actual trauma – a death, for example, or serious illness – when you use the word on such a regular basis that it loses its real meaning?
What’s more, ‘therapy speak’ is exhibiting itself at a critical developmental period, in adolescence when one’s identity is taking hold in the brain.
The words a girl uses during this time – whether ‘crazy’, ‘toxic’ or ‘ADHD’ – play a big role in shaping what she will view as the enduring truth of who she is.
At this time, the teenage brain is laying down myelin, a sheath around frequently used neurons (nerve cells in the brain) to make the pathways through which they communicate thousands of times more efficient. Neurons receiving less traffic are pruned away.
It means if you keep thinking something at this age, such as you are ‘crazy’, it’s likely to stick for a while.
Another contributory factor is that the adolescent frontal lobe – the part of the brain which controls planning and problem solving, among other things – isn’t yet fully formed, meaning teenagers lack self-regulation. Compared to adults, teenagers also have more neurons and fewer myelin pathways.
This means teenage brains are highly active but not integrated – and so the rational, ‘thinking’ parts of the brain cannot yet ‘talk’ to the deeper regions that are busy freaking out.
But why are girls in particular so prone to therapy speak?
Girls develop brain cells earlier than boys in the areas where language and social experiences are integrated: they tend more often to acknowledge what others are saying and to build on it, generating intimacy through consensus.
Styles of speech can travel quickly between young women – even resulting in teenage girls prioritising social intimacy with others: taught to overpathologise human feelings – thanks to therapy speak – they are losing the ability to name and tolerate their own real emotions.
Gen Z prioritise their ‘mental health’, and believe it is something they should ‘achieve’. But somehow normalcy seems more elusive than ever: the Royal College of Paediatrics and Child Health now estimates around 20 per cent of eight to 16-year-olds have a formal mental health diagnosis. We, in psychiatry, are partly to blame, thanks to becoming over-reliant on diagnosing through an official ticklist of external symptoms, rather than seeing people on a continuum reflecting the broad spectrum of human feeling.
Dr Suzanne Garfinkle-Crowell is a US psychiatrist who specialises in helping teenage girls, young women and their parents at her own private practice in New York
And yes, mental health awareness initiatives which started in the 1990s helped de-stigmatise mental illness – but they also injected psychiatric language into the mainstream without much context. All this contributed to today’s therapy culture.
Teenage girls – under more pressure than ever before; to be empowered, to succeed, and to simultaneously post an enviable bikini selfie on social media – are the all-too-willing consumers of this therapy culture.
In a society which often shames or commodifies them, teenage girls have found that any emotional pain or hurt is only considered valid if it’s presented as a disease.
Basically, ‘you can’t ignore me if I have a medical diagnosis’.
But while a diagnosis can bring power and attention to a young woman’s pain, it also allows her to avoid the reality of her true feelings.
I saw this in my patient, Violet, with her alphabet soup of diagnoses. Like so many young women I treat these days, who either receive multiple labels from doctors elsewhere or identify them independently off the internet and apply them to themselves, by the time Violet got to me, her labels had grown quite sticky.
But psychiatric conditions are not as clear-cut as medical illnesses. We have no brain scans or blood tests to diagnose them, and most professionals would agree they are complex – products of the interaction between biology, psychology and culture.
If I had immediately confirmed Violet’s diagnoses and followed evidence-based practice for treating them, she would have needed a cocktail of medications. This would have included a high-dose antidepressant for her OCD and a medicine for ADHD, likely a stimulant, which could make her anxiety symptoms worse and might affect her sleep, which would, in turn, worsen her psychiatric issues across the board.
I don’t like to medicate teenagers for sleep, but if she’s helped by the stimulant, one could argue, why not just treat the sleep, too?
Contraceptives would also probably help with the PMDD. And that’s just the meds.
In addition, her diagnoses would also need a range of therapies. But where could Violet find the time for this?
It became apparent to me that Violet’s diagnoses had become something therapists call ‘transitional objects’. When a young child transitions from the safety of home into the outside world, they often rely on a concrete symbol of their loved ones – a teddy bear on the first day of preschool, for example – before their brains can keep this comfort inside.
In adolescence, a psychiatric diagnosis can function like a transitional object. When a teenager clings to a diagnosis, she’s sometimes moving from a childhood where she knew who she was to an adult world where she is not sure who she can be. The diagnosis is a signal to this new world: Take care of me.
After months of sessions, and one confrontation where I told her I didn’t think she was depressed, which ended in her tearfully walking out, Violet confessed her real feelings: her insecurities about her parents’ at-times upsetting attitudes towards her, and her problems with feeling socially awkward around friends. Common teenage feelings, in other words. Not medical diagnoses.
When we as medical professionals or caregivers allow girls to believe they are ‘sick’ and ‘crazy’ when they may not be, we impede their progress.
Adapted from Girlhood, Translated by Suzanne Garfinkle-Crowell (Simon & Schuster, £22), to be published on Thursday. © Suzanne Garfinkle-Crowell 2026. To order a copy for £19.80 (offer valid until September 20; UK P&P free on orders over £25), go to mailshop.co.uk/books or call 020 3176 2937.
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