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Girlhood, Translated: Understanding Young Women in the Age of Therapy Speak and Self-Diagnosis
A clear-eyed child psychiatrist reveals how “therapy speak” and the culture of self-diagnosis is reshaping the inner lives of adolescent girls and young women—and what to do about it.
“Suzanne Garfinkle-Crowell takes on the current issue of diagnosis as identity and, with vivid examples, unpacks old problems and new.”—Mary Pipher, author of Reviving Ophelia and Women Rowing North
ADHD. OCD. Toxic. Unwell. Over the past decade, psychiatrist Suzanne Garfinkle-Crowell noticed that girls were coming to her office with an increasingly long list of psychiatric diagnoses, often pulled from the internet and social media. It seemed like it was becoming impossible for young women to talk about their feelings without using "therapy speak" or connecting them to mental illnesses. At the same time, she saw parents responding to this jargon with either alarm or dismissiveness, both of which only broadened the communication gap with their daughters.
In Girlhood, Translated, Dr. Garfinkle-Crowell explores how ‘therapy speak’ is fundamentally reshaping the identities of girls and young women. While some terms (“emotional labor,” “weaponized incompetence,” and even "gaslighting") have helped girls name problems and find common ground, many inadvertently play into the age-old cliché that teenage girls are “hysterical” and “crazy.” Girls are—rightly, desperately—asking for healing and connection, but in a language that often does not get them either.
Through vibrant, moving stories from the therapy room, Dr. Garfinkle-Crowell helps us see why girls have been driven to rely on this lexicon in order to be heard--and teaches us to listen better. Girlhood, Translated shows us how a girl can evolve from damaged object to empowered subject. This book will change the conversation about mental health to one that promotes agency and connection, urging girls not only to heal, but to thrive.
“Suzanne Garfinkle-Crowell takes on the current issue of diagnosis as identity and, with vivid examples, unpacks old problems and new.”—Mary Pipher, author of Reviving Ophelia and Women Rowing North
ADHD. OCD. Toxic. Unwell. Over the past decade, psychiatrist Suzanne Garfinkle-Crowell noticed that girls were coming to her office with an increasingly long list of psychiatric diagnoses, often pulled from the internet and social media. It seemed like it was becoming impossible for young women to talk about their feelings without using "therapy speak" or connecting them to mental illnesses. At the same time, she saw parents responding to this jargon with either alarm or dismissiveness, both of which only broadened the communication gap with their daughters.
In Girlhood, Translated, Dr. Garfinkle-Crowell explores how ‘therapy speak’ is fundamentally reshaping the identities of girls and young women. While some terms (“emotional labor,” “weaponized incompetence,” and even "gaslighting") have helped girls name problems and find common ground, many inadvertently play into the age-old cliché that teenage girls are “hysterical” and “crazy.” Girls are—rightly, desperately—asking for healing and connection, but in a language that often does not get them either.
Through vibrant, moving stories from the therapy room, Dr. Garfinkle-Crowell helps us see why girls have been driven to rely on this lexicon in order to be heard--and teaches us to listen better. Girlhood, Translated shows us how a girl can evolve from damaged object to empowered subject. This book will change the conversation about mental health to one that promotes agency and connection, urging girls not only to heal, but to thrive.
368 pages, Hardcover
Published September 8, 2026
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Displaying 1 - 8 of 8 reviews
September 21, 2026
As a mom of a teen girl I found this book to be very helpful and interesting. The author presents the ideas in a way that is accessible for the average person. I listened to the audiobook, which was an enjoyable listen. The author uses typical patient interactions (with fake patients) to teach us something, and the audio format made that aspect extra enjoyable. She speaks to many of the concerns I have had as I hear my daughter and her friends using therapy speak somewhat flippantly. I thought the author provided a good balance of needing to take mental health seriously and sometimes needing to use meds as a part of that process, while also recognizing that society has gotten to a point that we are often pathologizing any type of natural discomfort/anxiety or difficulty meeting others' expectations. I also really enjoyed the sections that reviewed the history of the therapy/psych field and how the devaluing of the feminine has been entrenched in its practices.
September 25, 2026
i’d love to give this book a good review but i think the entirety of it - a book about mental health, about the way people perceive themselves at the hands of society, the harm that can be caused by placing people into boxes and attempting to narrow them down to a few buzzwords - is completely underminded by including a quote by adichie, an incredibly vocal and active transphobe.
if your feminism is not intersectional, it is not feminism.
if your feminism is not intersectional, it is not feminism.
Review of advance copy received from Publisher
Girlhood, Translated is a thoughtful and timely exploration of how young women are using the language of therapy and self-diagnosis to make sense of their emotions and experiences. Suzanne Garfinkle-Crowell brings her perspective as a child psychiatrist to the conversation, sharing stories from her work with girls while examining terms like “toxic,” “ADHD,” “OCD,” and “trauma” that have become part of everyday vocabulary. I appreciated that she didn’t dismiss the struggles behind these words, but instead looked at why girls have turned to this language in the first place.
What stood out most was the compassion behind the book. The message isn’t that young women are “wrong” for seeking answers, but that there can be a difference between understanding yourself and letting a label define you. Garfinkle-Crowell does a great job encouraging better conversations between generations and reminding readers that there is more to a person than a diagnosis. It’s a thoughtful read for anyone who wants to better understand the mental health conversations shaping young women today.
What stood out most was the compassion behind the book. The message isn’t that young women are “wrong” for seeking answers, but that there can be a difference between understanding yourself and letting a label define you. Garfinkle-Crowell does a great job encouraging better conversations between generations and reminding readers that there is more to a person than a diagnosis. It’s a thoughtful read for anyone who wants to better understand the mental health conversations shaping young women today.
September 29, 2026
This book examines the growing tendency to understand girls’ emotional lives through the language of therapy, diagnosis and mental illness. The author is not arguing that psychiatric disorders are unreal or that diagnosis cannot be useful. Instead, she asks what happens when ordinary but painful experiences such as anxiety, heartbreak, anger, insecurity and adolescent instability are increasingly translated into medical categories. As she writes, psychiatric conditions are not always as clear-cut as physical illnesses, but rather “complex entities - products of the interaction between biology, psychology and culture.”
One of the book’s strongest ideas is the contradiction at the heart of therapeutic language. Labels can validate suffering, especially for girls whose emotions have historically been dismissed, but they can also create distance from those emotions. The author describes this as learning “to dramatise and minimise their emotions at the same time.” A diagnosis can therefore give pain legitimacy while also allowing someone to avoid asking what the pain actually means: “A diagnosis can bring power and attention to her pain while allowing her to keep avoiding it.”
The book places this within a much longer history of how female emotion has been understood and controlled. Girls and women have repeatedly been characterised as irrational, hysterical or unstable, while the language used to explain this has shifted from religion to medicine to psychiatry. At the same time, the book acknowledges the emancipatory side of psychology and therapy. Psychoanalysis, for example, created a space in which women were encouraged to speak and tell their own stories, while modern therapeutic terms such as “gaslighting” have helped people recognise manipulation and demand better treatment.
A major concern throughout the book is what happens when diagnoses move from describing distress to becoming identities. The author is particularly interested in anxiety, pointing out how often girls say they “have” anxiety rather than that they “feel” anxious. This distinction matters because anxiety is also a normal physical and emotional response. The book argues that treating every uncomfortable feeling as evidence of dysregulation can encourage avoidance rather than emotional understanding. One line captures this particularly well: “When we use 'dysregulation' to describe feeling on edge after a poor night of sleep or a tense day at work, we have crossed into over-pathologising.”
This becomes especially interesting in the discussion of adolescence. The book combines psychology, neuroscience and social conditioning to explain why girls may experience intense anxiety and emotion during puberty, while also stressing that intensity itself is not necessarily pathology. It discusses brain development, the stress response, temperament and family relationships alongside cultural expectations placed on girls. One of my favourite formulations is: “A 'handful' is defined by the hands doing the holding.” What counts as a difficult personality is therefore partly relational rather than simply something defective within the child.
The later sections move into anger, ADHD, neurodiversity, splitting, interpersonal conflict and defence mechanisms. Again, the emphasis is on making distinctions that contemporary therapeutic language can sometimes flatten. Feeling angry is not the same as behaving destructively because of anger. Harm is not automatically abuse. Emotional conflict does not automatically make one person a Victim and another a Perpetrator. The line “Treat distress, not difference” is perhaps one of the clearest expressions of the book’s overall philosophy. The author repeatedly tries to return complexity to experiences that online psychological language can turn into rigid categories.
What I found most compelling is that the book does not simply reject therapy culture. It recognises that having language for an experience can be genuinely liberating, while asking what gets lost when that language becomes too dominant. The central question is not whether girls' suffering is real, but whether immediately interpreting that suffering as illness actually gives girls more power. As the author puts it, “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 towards equality.”
One thing I really disliked, however, was the decision to quote Chimamanda Ngozi Adichie on page 248. Given Adichie’s controversial statements about trans women, her inclusion jarred with me and undermined some of the open and inclusive language that I appreciated throughout the rest of the book. It felt especially strange in a book that is otherwise so attentive to the consequences of labels, exclusion and the ways cultural narratives shape how people understand themselves.
Overall, this is a nuanced critique of the medicalisation of girlhood rather than an argument against psychiatry or therapy. Its strongest argument is that emotional pain should be taken seriously without automatically being transformed into pathology. Girls need language for suffering, but they also need permission to experience anger, anxiety, heartbreak, conflict and uncertainty as meaningful human emotions rather than immediate evidence that something is psychologically wrong with them.
Favourite Quotes:
“Labels and organisational systems make human beings feel safe. It can be healing to find a way to describe what's troubling - especially for those in powerless positions. Being young is a form of powerless-ness. So is being female. The ideas of therapy culture have helped girls see and liberate themselves, at times. For example, the elevation of the term 'gaslight' from obscure movie reference to common par-lance, while easy to mock, has helped millions of women recognise and resist manipulative behaviour, and has raised the bar for how they expect to be treated.”
“In the cases I describe, you will see how medicalising one's pain helps girls do something else they've been conditioned to do: to dramatise and minimise their emotions at the same time.”
“When a person can't name or express her painful feelings, they get worse. And when others don't take that pain seriously - because of her difficulty describing it, or their own issues responding to it, or both - she has to scream it louder. A diagnosis allows a girl to convey how very serious the pain is - how much she wants comfort and care - without having to know what she feels. A diagnosis can bring power and attention to her pain while allowing her to keep avoiding it.”
“Whether or not the broken bowl was my fault, it is my problem...For me, therapy is not about blame. It's about recognising a person's experience.”
“In asking to reframe her predicament as a mental illness - not heartbreak- Hazel is unwittingly writing herself into the latest chapter of another longer and more troubling story. For millennia, girls have been told they are irrational, hysterical and crazy. The labels have evolved over the ages, and in modern times have been largely supplied by the field of psychiatry.”
“In the Middle Ages, experts started to think very differently about human suffering. Maybe it wasn't the body, but the devil - not physically driven illness, but a sign of being possessed by evil. This change occurred in large part because medicine had proven unable to contain the bubonic plague, and increasing paranoia elevated priests as the new authorities on human mysteries. In other words, the answer changed again, from sick to bad.”
“Psychoanalysis allowed and invited women to speak: for all of Freud's oft-bemoaned limitations understanding women, it was he and his colleagues who reversed much of the pathologising and mistreatment of young women in emotional pain. He pioneered the idea that it was therapeutic for his patients, most of whom were women, to tell their own stories.”
“The Talking Cure began to redefine what it meant to be mentally healthy: instead of living life solely by society's rigid moral structure, true emotional wellness depended on friendly relations between the body and mind, a private honesty about the full range of one's own true feelings - even the unacceptable ones.”
“People are serious and private about their actual problems, but often simultaneously public and casual about their issues. Problems demand direct attention; issues call for a more laissez-faire ap-proach: 'anger issues, 'trust issues, "boundary issues.”
“As the Sad Girls on Tumblr multiplied, the messages grew layered, and confusing. No line was drawn between mental illness and mental suffering. Was a Sad Girl just someone having a bad day, seeking support, making a statement, or clinically depressed?”
1980s DSM-1: “Therapy underwent a dramatic transformation, shifting emphasis from an individual's subjective experience to objective signs and symptoms.”
“Increased public discussion of mental illness leads people to notice and privilege symptoms that may be ordinary or normal; knowledge of others with mental health conditions leads young women to see signs of illness in themselves.”
“This concreteness - also known as 'neuroessentialism' - can lead people to believe they are more stuck in their diagnoses than they are.”
“Whether the rise in anxiety diagnoses reflects actual disorders or not, I've observed girls refer to anxiety almost universally as something they 'have'.
This language has struck me, because it is different from how girls describe other feelings. One would not 'have' anger, sadness or fear; one would 'feel' them.”
“Anxiety is a physical experience. An anxious state includes uncomfortable body sensations ranging from muscle tension, shortness of breath and a fast heartbeat to stomachaches and headaches, and even to experiences deep in the nervous system like vision changes, blurring of thoughts, and dissociation. These experiences drive people further away from their anxiety-producing feelings, perpetuating a vicious cycle. When it comes to anxiety, the body does not just keep the score: it also plays the game.
Even when anxiety is normal and useful, it can feel incredibly un-comfortable. So when we feel anxious, we must regulate ourselves.”
“Overreliance on anxiety as an identity, however, can be harmful. Although anxiety disorders can be validating and can provide relief, research also shows that labelling anxiety as an illness can actually make anxiety worse. As I mentioned earlier, people who hold anxiety disorders as central to their identity believe they are less capable and can become more fearful and avoidant compared to others with the same symptoms who don't label it as a disorder or an identity.”
“When little girls get hurt, they are likely to receive coddling and hugs (whereas boys are taught to push through). Parents, especially fathers, have been found to be more nurturing and attentive to little girls when they show 'submissive emotions like sadness and anxiety.
The 'little girl' part of teenagers and young women turns out to be something many wish to reclaim.”
“One reason for this is the timing of the development of the amyg-dala, a structure involved in fear processing. The amygdala is a kind of anxiety relay centre in the brain. When it gets input suggesting a danger, it triggers the fight-or-flight response, telling the body's stress system (the hypothalamic-pituitary-adrenal, or HPA, axis) to release stress hormones: adrenaline and cortisol. During adoles-cence, the amygdala undergoes significant development. It matures in parallel with puberty, which happens in girls on average eighteen months earlier than in boys. The onslaught of ostrogen during puberty also potentiates the stress response system, which may explain why the HPA axis (featuring the 'stress hormone' cortisol) is more reactive in teens than in adults and especially in females.
It's not just the amygdala, though, Zach says, moving on to the other major brain area relevant to this discussion: the frontal lobe, the last part of the brain to develop. Adolescents are filled with thoughts and feelings and impulses, but as a result of incomplete frontal lobe development, they lack a full set of self-regulation
skills.”
“Stress is classically thought to produce a fight or flight' response, but in women, it has also been found to trigger a tend and betriend' response, mediated by oxyton, the love hormone'. It stands to reason that these mutual caring practices provide a kind of treatment to the anxious brains of girls and their friends.”
“Sloane is displaying idealisation, a defence mechanism that can indicate deeper problems, depending on a person's age and how often their mind functions that way. On the other side of idealisation is always total devaluation,”
“When we use 'dysregulation' to describe feeling on edge after a poor night of sleep or a tense day at work, we have crossed into over-pathologising. And yet, the concept is now so prevalent that according to a national survey, Gen Z's top goal in life is to achieve a 'calm nervous system'. Its popularisation has, alas, led us to pathologise the experience and expression of any strong feeling. Or even any mild-to-moderate feeling. Possibly any feeling at all.”
“What does it mean to have a 'good' temperament? That answer largely depends on the match between caregiver and child. What's obnoxious to one parent is delightful to the next. What's cosy to one parent might be dull to another. A 'handful' is defined by the hands doing the holding.
This concept is so important, I'm giving it its own line. It's called goodness of fit'.
When the fit between parent and child is good enough, parents can tune in to the needs of their child, and can signal to the child that they are good enough and will get what they need.”
“When someone yells and screams, throws things, slams doors and spews invective, those behaviours can be functions of feeling anxious. about being angry and needing to get rid of the feeling. The problem. in that case would be the anxiety they feel experiencing anger, not the
anger itself.”
“‘But you know it's not hatred that sent her storming out of that room.'..”’People storm out because they're overwhelmed with anxiety.'”
“As rates of diagnosis have grown exponentially in the past decade, especially in adolescent girls and young women, a debate has emerged about whether more girls are actually developing ADHD, whether they seek mental health treatment disproportionately (referral bias), or whether they are influenced by the wide availability of ADHD content on the internet (information bias) and as a result focus on evidence that confirms what they already suspected (confir-mation bias).”
“this adage that I picked up from the neurodiversity community: Treat distress, not difference.'”
“In a sense, that's what defines the dominant culture, right?" I say.
When all the other narratives feel impractical and exhausting.’”
“For example, teenagers can get heated in their feelings and be driven to black-and-white thinking ('Everyone in my class is stupid,
'Only losers don't have Snapchat', 'Boys suck'). These may be micro examples of splitting, producing a cognitive style that relies on overgeneralisation, idealisation and devaluation.”
“Anger is an alarm that something needs to be corrected, but its goal is resolution of a conflict. Rage, on the other hand, means someone needs to burn in hell. To feel that way, we have to see that person as pretty much all bad in that moment. If someone relies heavily on splitting as a coping mechanism, her existence will be marked by a lot of emotional chaos and drama.”
“When Maeve is hit by a wave of complex feelings - hurt, anger, sadness, vulnerability - she panics. She tries to get rid of the feeling as fast as possible, and if Lanie is all bad, Maeve's mind can throw her out like a bag of trash and not have to deal with any of her own feelings.”
“feeling angry and 'getting angry are not the same. The former is a private experience of thoughts and physical sensations; it's productive and im-portant. The latter describes actions between people and is often destructive.”
“A Victim' will feel helpless and enraged at a Perpetrator and believe she desperately needs a Saviour. A 'Perpetrator' will feel worthlessness and crushing guilt. A 'Saviour' will feel numb to their own needs. But in therapy, we invite people to recognise when they are putting themselves or others in these roles. Almost no one is only a Victim, Saviour, or Perpetrator. People are complex entities, and relationships are dynamic. Often, just helping a person recognise these roles is enough to get her to try stepping out of whichever one she's in.”
“Abuse is not the same as harm. It's a very specific kind of harm inflicted by a more powerful person on a less powerful person. It's an ‘ab-use', or a misuse, of power.”
“Each person's constellation of defence mechanisms gives shape to their personality. Some of them, like intellectualisation, humour, altruism and sublimation, help us transform our impulses into positive human enterprise. Others, like projection and denial, can interfere with our grip on reality. Still others, like minimisation, distractibil-ity, vagueness and rumination, can be either helpful or harmful, depending on how and when they are used.
Sigmund Freud developed the notion of defence mechanisms and his daughter, Anna Freud, elaborated and refined it. Without de-fences, people would be roiling lava pits of feeling and impulse: we need them. In fact, sometimes therapists think of them as 'protec-tors', because they are doing a job. They are just not always doing that job very well.”
One of the book’s strongest ideas is the contradiction at the heart of therapeutic language. Labels can validate suffering, especially for girls whose emotions have historically been dismissed, but they can also create distance from those emotions. The author describes this as learning “to dramatise and minimise their emotions at the same time.” A diagnosis can therefore give pain legitimacy while also allowing someone to avoid asking what the pain actually means: “A diagnosis can bring power and attention to her pain while allowing her to keep avoiding it.”
The book places this within a much longer history of how female emotion has been understood and controlled. Girls and women have repeatedly been characterised as irrational, hysterical or unstable, while the language used to explain this has shifted from religion to medicine to psychiatry. At the same time, the book acknowledges the emancipatory side of psychology and therapy. Psychoanalysis, for example, created a space in which women were encouraged to speak and tell their own stories, while modern therapeutic terms such as “gaslighting” have helped people recognise manipulation and demand better treatment.
A major concern throughout the book is what happens when diagnoses move from describing distress to becoming identities. The author is particularly interested in anxiety, pointing out how often girls say they “have” anxiety rather than that they “feel” anxious. This distinction matters because anxiety is also a normal physical and emotional response. The book argues that treating every uncomfortable feeling as evidence of dysregulation can encourage avoidance rather than emotional understanding. One line captures this particularly well: “When we use 'dysregulation' to describe feeling on edge after a poor night of sleep or a tense day at work, we have crossed into over-pathologising.”
This becomes especially interesting in the discussion of adolescence. The book combines psychology, neuroscience and social conditioning to explain why girls may experience intense anxiety and emotion during puberty, while also stressing that intensity itself is not necessarily pathology. It discusses brain development, the stress response, temperament and family relationships alongside cultural expectations placed on girls. One of my favourite formulations is: “A 'handful' is defined by the hands doing the holding.” What counts as a difficult personality is therefore partly relational rather than simply something defective within the child.
The later sections move into anger, ADHD, neurodiversity, splitting, interpersonal conflict and defence mechanisms. Again, the emphasis is on making distinctions that contemporary therapeutic language can sometimes flatten. Feeling angry is not the same as behaving destructively because of anger. Harm is not automatically abuse. Emotional conflict does not automatically make one person a Victim and another a Perpetrator. The line “Treat distress, not difference” is perhaps one of the clearest expressions of the book’s overall philosophy. The author repeatedly tries to return complexity to experiences that online psychological language can turn into rigid categories.
What I found most compelling is that the book does not simply reject therapy culture. It recognises that having language for an experience can be genuinely liberating, while asking what gets lost when that language becomes too dominant. The central question is not whether girls' suffering is real, but whether immediately interpreting that suffering as illness actually gives girls more power. As the author puts it, “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 towards equality.”
One thing I really disliked, however, was the decision to quote Chimamanda Ngozi Adichie on page 248. Given Adichie’s controversial statements about trans women, her inclusion jarred with me and undermined some of the open and inclusive language that I appreciated throughout the rest of the book. It felt especially strange in a book that is otherwise so attentive to the consequences of labels, exclusion and the ways cultural narratives shape how people understand themselves.
Overall, this is a nuanced critique of the medicalisation of girlhood rather than an argument against psychiatry or therapy. Its strongest argument is that emotional pain should be taken seriously without automatically being transformed into pathology. Girls need language for suffering, but they also need permission to experience anger, anxiety, heartbreak, conflict and uncertainty as meaningful human emotions rather than immediate evidence that something is psychologically wrong with them.
Favourite Quotes:
“Labels and organisational systems make human beings feel safe. It can be healing to find a way to describe what's troubling - especially for those in powerless positions. Being young is a form of powerless-ness. So is being female. The ideas of therapy culture have helped girls see and liberate themselves, at times. For example, the elevation of the term 'gaslight' from obscure movie reference to common par-lance, while easy to mock, has helped millions of women recognise and resist manipulative behaviour, and has raised the bar for how they expect to be treated.”
“In the cases I describe, you will see how medicalising one's pain helps girls do something else they've been conditioned to do: to dramatise and minimise their emotions at the same time.”
“When a person can't name or express her painful feelings, they get worse. And when others don't take that pain seriously - because of her difficulty describing it, or their own issues responding to it, or both - she has to scream it louder. A diagnosis allows a girl to convey how very serious the pain is - how much she wants comfort and care - without having to know what she feels. A diagnosis can bring power and attention to her pain while allowing her to keep avoiding it.”
“Whether or not the broken bowl was my fault, it is my problem...For me, therapy is not about blame. It's about recognising a person's experience.”
“In asking to reframe her predicament as a mental illness - not heartbreak- Hazel is unwittingly writing herself into the latest chapter of another longer and more troubling story. For millennia, girls have been told they are irrational, hysterical and crazy. The labels have evolved over the ages, and in modern times have been largely supplied by the field of psychiatry.”
“In the Middle Ages, experts started to think very differently about human suffering. Maybe it wasn't the body, but the devil - not physically driven illness, but a sign of being possessed by evil. This change occurred in large part because medicine had proven unable to contain the bubonic plague, and increasing paranoia elevated priests as the new authorities on human mysteries. In other words, the answer changed again, from sick to bad.”
“Psychoanalysis allowed and invited women to speak: for all of Freud's oft-bemoaned limitations understanding women, it was he and his colleagues who reversed much of the pathologising and mistreatment of young women in emotional pain. He pioneered the idea that it was therapeutic for his patients, most of whom were women, to tell their own stories.”
“The Talking Cure began to redefine what it meant to be mentally healthy: instead of living life solely by society's rigid moral structure, true emotional wellness depended on friendly relations between the body and mind, a private honesty about the full range of one's own true feelings - even the unacceptable ones.”
“People are serious and private about their actual problems, but often simultaneously public and casual about their issues. Problems demand direct attention; issues call for a more laissez-faire ap-proach: 'anger issues, 'trust issues, "boundary issues.”
“As the Sad Girls on Tumblr multiplied, the messages grew layered, and confusing. No line was drawn between mental illness and mental suffering. Was a Sad Girl just someone having a bad day, seeking support, making a statement, or clinically depressed?”
1980s DSM-1: “Therapy underwent a dramatic transformation, shifting emphasis from an individual's subjective experience to objective signs and symptoms.”
“Increased public discussion of mental illness leads people to notice and privilege symptoms that may be ordinary or normal; knowledge of others with mental health conditions leads young women to see signs of illness in themselves.”
“This concreteness - also known as 'neuroessentialism' - can lead people to believe they are more stuck in their diagnoses than they are.”
“Whether the rise in anxiety diagnoses reflects actual disorders or not, I've observed girls refer to anxiety almost universally as something they 'have'.
This language has struck me, because it is different from how girls describe other feelings. One would not 'have' anger, sadness or fear; one would 'feel' them.”
“Anxiety is a physical experience. An anxious state includes uncomfortable body sensations ranging from muscle tension, shortness of breath and a fast heartbeat to stomachaches and headaches, and even to experiences deep in the nervous system like vision changes, blurring of thoughts, and dissociation. These experiences drive people further away from their anxiety-producing feelings, perpetuating a vicious cycle. When it comes to anxiety, the body does not just keep the score: it also plays the game.
Even when anxiety is normal and useful, it can feel incredibly un-comfortable. So when we feel anxious, we must regulate ourselves.”
“Overreliance on anxiety as an identity, however, can be harmful. Although anxiety disorders can be validating and can provide relief, research also shows that labelling anxiety as an illness can actually make anxiety worse. As I mentioned earlier, people who hold anxiety disorders as central to their identity believe they are less capable and can become more fearful and avoidant compared to others with the same symptoms who don't label it as a disorder or an identity.”
“When little girls get hurt, they are likely to receive coddling and hugs (whereas boys are taught to push through). Parents, especially fathers, have been found to be more nurturing and attentive to little girls when they show 'submissive emotions like sadness and anxiety.
The 'little girl' part of teenagers and young women turns out to be something many wish to reclaim.”
“One reason for this is the timing of the development of the amyg-dala, a structure involved in fear processing. The amygdala is a kind of anxiety relay centre in the brain. When it gets input suggesting a danger, it triggers the fight-or-flight response, telling the body's stress system (the hypothalamic-pituitary-adrenal, or HPA, axis) to release stress hormones: adrenaline and cortisol. During adoles-cence, the amygdala undergoes significant development. It matures in parallel with puberty, which happens in girls on average eighteen months earlier than in boys. The onslaught of ostrogen during puberty also potentiates the stress response system, which may explain why the HPA axis (featuring the 'stress hormone' cortisol) is more reactive in teens than in adults and especially in females.
It's not just the amygdala, though, Zach says, moving on to the other major brain area relevant to this discussion: the frontal lobe, the last part of the brain to develop. Adolescents are filled with thoughts and feelings and impulses, but as a result of incomplete frontal lobe development, they lack a full set of self-regulation
skills.”
“Stress is classically thought to produce a fight or flight' response, but in women, it has also been found to trigger a tend and betriend' response, mediated by oxyton, the love hormone'. It stands to reason that these mutual caring practices provide a kind of treatment to the anxious brains of girls and their friends.”
“Sloane is displaying idealisation, a defence mechanism that can indicate deeper problems, depending on a person's age and how often their mind functions that way. On the other side of idealisation is always total devaluation,”
“When we use 'dysregulation' to describe feeling on edge after a poor night of sleep or a tense day at work, we have crossed into over-pathologising. And yet, the concept is now so prevalent that according to a national survey, Gen Z's top goal in life is to achieve a 'calm nervous system'. Its popularisation has, alas, led us to pathologise the experience and expression of any strong feeling. Or even any mild-to-moderate feeling. Possibly any feeling at all.”
“What does it mean to have a 'good' temperament? That answer largely depends on the match between caregiver and child. What's obnoxious to one parent is delightful to the next. What's cosy to one parent might be dull to another. A 'handful' is defined by the hands doing the holding.
This concept is so important, I'm giving it its own line. It's called goodness of fit'.
When the fit between parent and child is good enough, parents can tune in to the needs of their child, and can signal to the child that they are good enough and will get what they need.”
“When someone yells and screams, throws things, slams doors and spews invective, those behaviours can be functions of feeling anxious. about being angry and needing to get rid of the feeling. The problem. in that case would be the anxiety they feel experiencing anger, not the
anger itself.”
“‘But you know it's not hatred that sent her storming out of that room.'..”’People storm out because they're overwhelmed with anxiety.'”
“As rates of diagnosis have grown exponentially in the past decade, especially in adolescent girls and young women, a debate has emerged about whether more girls are actually developing ADHD, whether they seek mental health treatment disproportionately (referral bias), or whether they are influenced by the wide availability of ADHD content on the internet (information bias) and as a result focus on evidence that confirms what they already suspected (confir-mation bias).”
“this adage that I picked up from the neurodiversity community: Treat distress, not difference.'”
“In a sense, that's what defines the dominant culture, right?" I say.
When all the other narratives feel impractical and exhausting.’”
“For example, teenagers can get heated in their feelings and be driven to black-and-white thinking ('Everyone in my class is stupid,
'Only losers don't have Snapchat', 'Boys suck'). These may be micro examples of splitting, producing a cognitive style that relies on overgeneralisation, idealisation and devaluation.”
“Anger is an alarm that something needs to be corrected, but its goal is resolution of a conflict. Rage, on the other hand, means someone needs to burn in hell. To feel that way, we have to see that person as pretty much all bad in that moment. If someone relies heavily on splitting as a coping mechanism, her existence will be marked by a lot of emotional chaos and drama.”
“When Maeve is hit by a wave of complex feelings - hurt, anger, sadness, vulnerability - she panics. She tries to get rid of the feeling as fast as possible, and if Lanie is all bad, Maeve's mind can throw her out like a bag of trash and not have to deal with any of her own feelings.”
“feeling angry and 'getting angry are not the same. The former is a private experience of thoughts and physical sensations; it's productive and im-portant. The latter describes actions between people and is often destructive.”
“A Victim' will feel helpless and enraged at a Perpetrator and believe she desperately needs a Saviour. A 'Perpetrator' will feel worthlessness and crushing guilt. A 'Saviour' will feel numb to their own needs. But in therapy, we invite people to recognise when they are putting themselves or others in these roles. Almost no one is only a Victim, Saviour, or Perpetrator. People are complex entities, and relationships are dynamic. Often, just helping a person recognise these roles is enough to get her to try stepping out of whichever one she's in.”
“Abuse is not the same as harm. It's a very specific kind of harm inflicted by a more powerful person on a less powerful person. It's an ‘ab-use', or a misuse, of power.”
“Each person's constellation of defence mechanisms gives shape to their personality. Some of them, like intellectualisation, humour, altruism and sublimation, help us transform our impulses into positive human enterprise. Others, like projection and denial, can interfere with our grip on reality. Still others, like minimisation, distractibil-ity, vagueness and rumination, can be either helpful or harmful, depending on how and when they are used.
Sigmund Freud developed the notion of defence mechanisms and his daughter, Anna Freud, elaborated and refined it. Without de-fences, people would be roiling lava pits of feeling and impulse: we need them. In fact, sometimes therapists think of them as 'protec-tors', because they are doing a job. They are just not always doing that job very well.”
September 29, 2026
This book really resonated with me as I raise a teenage girl myself. There are many helpful real world examples that feel relevant and applicable. Great read and enormously grateful for the professional insight!
September 14, 2026
This book is essential reading for psychiatrists, women, and mothers. The wisdom in this book distills and beautifully articulates concepts that I am seeing in my practice, online, and among friends and family. Dr. Garfinkle conveys MUCH-NEEDED nuance in the field of psychiatry away from reducing women and girls to diagnoses, toward understanding the FEELINGS and EXPERIENCES behind the labels. This book feels like a validation of my practice and supplements my training with much-needed discourse to meet the girls of the 21st century and help them understand themselves and the context in which we are all living.
September 8, 2026
Every time I talk about this book, people's eyes light up!! This is SO needed in this day and age for teen girls!
October 12, 2026
I've helped raise three generations of girls, and I think she nailed it.
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