SINGAPORE: About ten years ago the psychiatrist Dr Suzanne Garfinkle-Crowell noticed something new about the teenage girls arriving at her Manhattan office for their first session. “Patients used to dread being told there was something, as they saw it, wrong with them,” she says. “But now these women were announcing their diagnoses almost before telling me their names.”
Others had become aware of something similar. One college professor, she says, told her, “Students used to introduce themselves to me as ‘I’m from Colorado, and I speak Spanish and play tennis’. Now they say, ‘I have a history of PTSD and depression.’”
“It’s not that those things aren’t possibly all true,” says Garfinkle-Crowell, the 47-year-old mother of two children and stepmother of two more. “But people are leading with it now as the thing that is most important about them.”
Last week a landmark government review stated that among young people cases of autism had risen fortyfold since 2000, while ADHD had increased fifteenfold over the same period. It warned a “tipping point” had been reached and children were at risk of lifelong harm due to misdiagnosis and overdiagnosis. In July, a House of Commons research briefing noted the reporting of common health disorders was higher in women than men in every age category — and among those aged 17 to 19 it was twice as high in young women (31.6 per cent) as in young men (15.4 per cent).
Girls, Garfinkle-Crowell says, are much more likely than boys to seek psychiatric frameworks to try to wrangle their issues. Before even receiving a diagnosis, she adds, her young patients will volunteer that they have conditions they have learnt about on TikTok — and frequently demand medication.
She points out wryly that young women are far more likely to seek “socially acceptable” diagnoses such an autism, “because there’s so much more compassion for that. No one wants to say they have a psychotic disorder or narcissism.”
In 2019, 7,700 women in the UK took an online ADHD test. By 2021, this number had risen by 3,203 per cent to 254,400.
“ADHD is very popular, there’s a lot of obsessive compulsive disorder, anxiety and depression. Attachment issues is the one everyone’s talking about right now. For some, but not for all, it’s almost fun — like a dark party game, to say you have these things.”
The situation, she says, has been exacerbated by many seeking therapy via AI chatbots, which unquestioningly validate users and grant diagnoses without probing for vital context. “AI can’t know anything other than what you tell it, so it’s creating a lot of self-fulfilling prophecies.” Teenagers reel off to ChatGPT approved symptoms from the psychiatric bible The Diagnostic and Statistical Manual of Mental Disorders or DSM. Garfinkle-Crowell recently heard from a woman whose 13-year-old daughter had asked for a copy of the DSM for Christmas. “It’s terrifying,” she says.
Girls being overdramatic about their state of mind isn’t new. Back in the 1980s my school friends and I would declare ourselves “depressed” if it was raining or a nail broke. Since then, however, mental health awareness has exploded. A whole new lexicon, formerly only applied to the most severe situations, is now in everyday parlance. “Toxic” (ie a bit annoying), “trauma” (a detention) and “abuse” (being asked to wash up) are all self-righteously, and often aggressively, employed about anything that displeases the speaker, their actual meanings blurred to the point of obliteration.
Meanwhile, social media overflows with videos exalting ADHD as a “superpower”, and adverts for gadgets, courses and supplements to ease anxiety proliferate and almost every teenager will know someone in therapy for, say, feeling sad because their dog died, a condition that used to be considered a normal part of human life. “There’s been a concept creep where milder forms of illness have pushed into and expanded the category of more serious illnesses,” Garfinkle-Crowell says. “Even a lot of doctors consider mild depression a thing, which sends a really confusing message to teenagers — ‘Do I have mild depression or am I just having a bad week?’”
The resulting confusion is, as she puts it, “not good for anyone — not for the healthy people who are surely overpathologising themselves, and not for the sick people whose labels [are] losing their meaning. Mental illness is real and people suffer but there’s this huge middle ground.”
Garfinkle-Crowell has now written a book on the subject, Girlhood, Translated: Understanding Young Women in the Age of Therapy Speak and Self-Diagnosis. She isn’t the first mental health professional to address these issues recently. In the past month alone the Times columnist and clinical psychologist Dr Tanya Byron has published her own book, You Are Not a Diagnosis, while the former president of the Royal College of General Practitioners Dr Iona Heath courted controversy when she announced that ADHD was not — as the NHS states — a medical condition. She added such labels “stop us paying attention to people as individuals… they have no sensitivity to nuance. Psychiatry is in a terrible mess.”
Garfinkle-Crowell is at pains to stress that the mental health struggles of young people should not be diminished. “I see the backlash and feel there’s a level of blaming of kids for this and feel very protective of them,” she says. “Adults are naturally befuddled and frustrated and it’s an understandable impulse to dismiss it all and say this is just normal teenage stuff, but really it doesn’t help us out of the mess. Kids are struggling for old and new reasons. Maybe the words they use aren’t always the exact right words, or there’s a bit too much pathologising. But there’s always something there that is trying to get expressed. I say take this language seriously, but not always literally.
“Girls are the main group looking up health information online, talking about their feelings and relationships and seeking labels for what’s wrong. They are also the demographic with the worst mental health profile. I think the association with young women, a group so often dismissed as frivolous, is a big part of why therapy speak is regarded as a sign of weakness and self-indulgence.”
Indeed, she notes, young women often employ therapy speak believing their problems will only be taken seriously “if they’re medical”.
“It feels empowering to reach for a diagnosis. Girls are used to feeling they have to make themselves smaller and less burdensome to others, so having this feels like, ‘Wait a minute, my suffering is important and someone needs to listen to me.’ But what they may not realise is it’s also disempowering in that it plays into the age-old belief that women are just crazy.”
After all, mental illness has long been used to dismiss women who deviated from social expectations of being meek and biddable. The ancient Greeks and Egyptians viewed menstruating teenagers who were still virgins as susceptible to acute insanity, owing to their “wandering womb”. Victorians declared women deemed — understandably — frustrated and angry about their limited horizons as “hysterical”.
At the same time, our culture has packaged the potentially disturbing reality of a woman in the throes of real mental illness — unwashed, stuck in her bedroom surrounded by empty Pot Noodles — into something more aesthetically pleasing and palatable. Take the 1999 film Girl, Interrupted, set in a psychiatric ward and starring Angelina Jolie playing a diagnosed sociopath who happens to be astonishingly charismatic and beautiful. Early social media websites such as Tumblr glamourised the “internet sad girl” with its beautiful troubled-woman aesthetic. “[The singer] Lana Del Rey is the patron saint. It’s really understandable that this identity would be so appealing and communities formed around it,” Garfinkle-Crowell says.
Psychiatry has been complicit in the situation. Originally the field was viewed in psychoanalytic terms, with shrinks taking pains to familiarise themselves with patients’ history. But as more and more medications were introduced, time allotted for face-to-face contact was reduced. “If a kid has behaviour problems, the father just lost his job, and the family is struggling financially, and the marriage is strained, it’s a complex situation. But nobody has the time or the bandwidth to really get to know this family, to help the parents with their parenting patterns, or figure out how they’re going to get their act together financially. What we do have time for is the diagnosis of something like ADHD and a pill.”
From a patient’s perspective it is often easier to blame a medical condition than explore painful and complex situations in which they find themselves. Garfinkle-Crowell gives an example of one patient claiming she had anxiety, when what she was really experiencing were completely normal but challenging new emotions about her boyfriend’s friendship with her best friend. She adds: “I think it’s better for people to assume they are not crazy, that what they’re going through is understandable, and not to necessarily put a mental health label on it. The longer we stay away from the label, and the more curiosity and patience with ourselves we have, the more likely we are to get people better.”
Despite the challenges, Garfinkle-Crowell insists that our world now is better than the old one, where mental illness was taboo. “If I had to pick I would always choose a world where everybody had a mental health struggle and people were defining themselves way too much by their trauma than an unaccepting world where no one could be open or have vulnerabilities.”
Empathy is key. “Teenagers have much more rapidly cycling and stronger emotions than adults. Adults often forget that,” she says. “It’s one of the reasons it’s hard to be a kid: you feel things so much more intensely than the people around you, and you don’t know what’s normal yet.”