How “therapy talks” has created a generation of girls who think they are broken, sick and crazy: I have been a psychiatrist for 20 years helping young women. This is how alarmingly my patients have changed

Hazel is sitting in my office for our first meeting. The 16-year-old girl adjusts her red glasses, her brown eyes staring at me.

She then starts talking about: her “anxiety and depression,” her “emotional dysregulation,” the “trauma” of growing up with “codependent” parents, the stress she feels when she has to “mask” to get through the day.

Sometimes she gets so frustrated with her family that she feels like she’ll have a “real panic attack” at the dinner table, she tells me.

There’s also Violet, a 17-year-old girl with a wild blonde ponytail. “I think I should tell you about my OCD,” she sighs as she walks straight through my door. “And my PMDD [premenstrual dysphoric disorder, causing debilitating emotional and physical symptoms before a period]and my ADHD,” before wearily adding, “And my depression.”

I am a psychiatrist specializing in helping adolescent girls, young women, and their parents in my private practice in New York City.

Since I began my medical training just over two decades ago, I have noticed a big change in the patients I see, and this is also reflected in the UK.

Once upon a time, people were afraid when they were told that there was something “wrong” with them. But today, young women announce their diagnoses almost before they tell me their names.

Cascades of medical problems and psychiatric buzzwords pour out of the mouths of my young patients—but no matter how much they talk, with each acronym I often feel like I know less and less about them.

Generation Z prioritizes their “mental health” and believes it is something they should “achieve.” But somehow normalcy seems more elusive than ever: the Royal College of Paediatrics and Child Health estimates that around 20 per cent of children aged 8 to 16 have a formal mental health diagnosis (photo courtesy of models).

All these girls tell me about psychiatric symptoms and conditions that I know how to treat. I can use medications; I can teach coping strategies. But all this will only help up to a certain point.

Because part of the problem lies in the very language—“talk therapy”—that these girls use to describe themselves and the world around them.

Indeed, the current generation of teenage girls is saturated with talk therapy and uses it constantly.

Not only are they fully aware of psychiatric diagnoses, but they also talk about “trauma” and their “problems.” They know if they have “attachment difficulties” or if their “inner critic” is too loud.

Of course, taking care of your mental health and the mental health of others can be a positive thing. But what my colleagues and I see is completely different. The rise of “talk therapy” has taken us to a very strange place – where many girls define themselves not by their favorite music or hobbies, but by their psychiatric profile.

Not only that, but they also turn normal feelings associated with growing up – low self-esteem, sadness, anxiety, distractibility – into full-blown mental disorders such as depression, OCD and ADHD. The young women I meet are genuinely convinced that there is something “wrong” with them, that they are “a little broken.”

This can have profoundly negative consequences.

The main psychological task of adolescence is the formation of your personality – who you are.

And while identification with a mental illness can motivate someone to seek help, and the use of therapeutic language can improve understanding, it has also been shown to have a “consuming” effect, erasing other aspects of identity and worsening the person’s condition.

For example, a 2025 study published in the Journal of Social and Clinical Psychology found that those who consider anxiety disorders central to their sense of self believe that they are less capable than others with the same symptoms who do not self-identify as a disorder.

Meanwhile, a 2014 study published in Behavior Research and Therapy found that people with depression feel more hopeless and pessimistic if they think of their symptoms as an illness, especially if they believe it is caused by a “chemical imbalance” rather than, say, an understandable life event such as a parental separation or problems at school. The language teenagers use contributes to this. If, for example, missing a night’s sleep is described as causing “dysregulation” or if not being able to leave the house late is “traumatic”, this may lead to shutdown.

How can you cope with real trauma—like death or serious illness—if you use the word so regularly that it loses its true meaning?

Moreover, “talk therapy” occurs during a critical period of development, adolescence, when a person’s personality is cemented in the brain.

The words a girl uses during this time—whether it’s “crazy,” “toxic,” or “ADHD”—play a big role in shaping what she will consider to be the enduring truth of who she is.

During this time, the teen’s brain forms 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 cut off.

This means that if you continue to think about something at this age, such as being “crazy,” it will likely stick for a while.

Another contributing factor is that adolescents’ frontal lobe—the part of the brain that controls planning and problem-solving, among other things—is not yet fully developed, meaning teens lack self-regulation. Compared to adults, adolescents also have more neurons and fewer myelin tracts.

This means that the teenage brain is very active, but not integrated – and therefore the rational, “thinking” parts of the brain cannot yet “talk” to the deeper areas that are busy worrying.

But why exactly are girls so inclined to talk therapy?

Girls develop brain cells earlier than boys in areas where language and social experience are integrated: they tend to be more likely to acknowledge what others say and build on it, creating intimacy through consensus.

Speech styles can change rapidly between young women—even resulting in adolescent girls prioritizing social intimacy with others: taught to overpathologize human feelings—through therapeutic speech—they lose the ability to name and tolerate their own real emotions.

Generation Z prioritizes their “mental health” and believes it is something they should “achieve.” But somehow normalcy seems more elusive than ever: the Royal College of Paediatrics and Child Health estimates that around 20 per cent of children aged 8 to 16 have a formal mental health diagnosis. We psychiatrists are partly to blame because we have become overly reliant on diagnosing by a formal list of external symptoms rather than seeing people on a continuum that reflects the broad range of human feelings.

Dr. Suzanne Garfinkle-Crowell is an American psychiatrist who specializes in helping adolescent girls, young women, and their parents in her private practice in New York City.

And yes, mental health awareness initiatives that began in the 1990s helped destigmatize mental illness, but they also brought psychiatric language into the mainstream without much context. All of this contributed to the development of today’s therapeutic culture.

Teenage girls are under more pressure than ever before; empowerment, success, and simultaneously posting an enviable bikini selfie on social media are the most willing consumers of this therapeutic culture.

In a society that often shames or commodifies them, teenage girls have found that any emotional pain or hurt is only valid if it is framed as an illness.

Essentially, “you can’t ignore me if I have a medical diagnosis.”

But while a diagnosis can give power and attention to a young woman’s pain, it also allows her to escape the reality of her true feelings.

I saw this with my patient Violet and her alphabet array of diagnoses. Like many of the young women I treat these days, who either get a lot of labels from doctors elsewhere or self-identify them online and apply them to themselves, by the time Violet got to me, her labels had become quite sticky.

But psychiatric conditions are not as clear-cut as somatic diseases. We don’t have brain scans or blood tests to diagnose them, and most professionals would agree that they are complex and the product of the interaction of biology, psychology and culture.

If I had immediately confirmed Violet’s diagnosis and followed evidence-based practices in their treatment, she would have needed a cocktail of medications. This would include high doses of an antidepressant for OCD and an ADHD medication, likely a stimulant, which could worsen her anxiety symptoms and affect her sleep, which in turn would worsen her psychiatric problems across the board.

I don’t like giving teenagers sleep medications, but if a stimulant helps her, you could argue why not just treat sleep as well?

Birth control is also likely to help with PMDD. And those are just the medications.

Additionally, her diagnosis will also require a number of treatments. But where could Violet find the time for this?

It became apparent to me that Violet’s diagnoses had become what therapists call “transitional objects.” When a young child transitions from the safety of home into the outside world, he often relies on a concrete symbol of his loved ones—like a teddy bear on the first day of preschool—before his brain can hold that comfort inside.

During adolescence, a psychiatric diagnosis may function as a transitional object. When a teenager clings to a diagnosis, she sometimes moves from childhood, where she knew who she was, to an adult world where she is not sure who she might be. The diagnosis is a signal to this new world: take care of me.

After several months of sessions and one confrontation in which I told her I didn’t think she was depressed, which ended with her tearfully leaving, Violet confessed her real feelings: her insecurities about her parents’ sometimes upsetting attitude towards her and her problems with feeling socially awkward among friends. In other words, normal teenage feelings. Not medical diagnoses.

When we as health professionals or caregivers allow girls to believe that they are “sick” and “crazy” when in fact they are not, we hinder their progress.

Adapted from Childhood, 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 20 September; UK P&P free on orders over £25), visit mailshop.co.uk/books or call 020 3176 2937.