Diagnoses Shape How Young Women Make Sense of Mental Distress

A new qualitative study from Sweden reveals that psychiatric diagnoses have become far more than clinical labels for adolescent girls and young women—they function as compasses for navigating life, sources of moral relief, and, paradoxically, forces that shrink the very space young women have to simply be normal. The research, published in SSM – Mental Health by Hanna Ljungvall of Uppsala University, explores how girls and young women aged 16 to 23 make sense of mental health in a culture where diagnostic categories increasingly organize everyday experience.

The backdrop to the study is stark. The World Health Organization estimates that one in five children and adolescents worldwide suffers from mental illness, and suicide ranks as the second leading cause of death among young adults. In Sweden, young women between 16 and 29 report worse mental health than their male peers—the highest levels of distress and the lowest levels of wellbeing. Intriguingly, more gender-equal countries show larger gender gaps in adolescent mental health across all outcomes, a paradox researchers attribute to the complex interplay of biological, cognitive, and sociocultural gendered risks, including normative ideals that shape expectations of how girls should behave.

Scholars remain divided over whether the reported rise in mental health problems reflects a genuine crisis or a redefinition of mental illness, in which ordinary life suffering is progressively pathologized. Women’s distress has historically been disproportionately medicalized, and critics argue that the neoliberal emphasis on individual optimization encourages people to frame existential struggles as disorders. The new study suggests the truth may combine both: increasing biopsychosocial stressors and a cultural shift in how young people interpret and narrate their own suffering.

Ljungvall interviewed 29 participants, 14 aged 16 to 18 and 15 aged 21 to 23, all of whom identified as cisgender girls or women. Recruitment ran from March to December 2024 through social media advertisements, posters, and snowball sampling, drawing 97 applicants of whom 42 were invited and 29 accepted. Fifteen participants reported more than one psychiatric diagnosis, including depression, PTSD, anxiety disorders, ADHD, eating disorders, bipolar disorder, OCD, and autism, while ten reported none. In-depth interviews lasting from 42 minutes to nearly two and a half hours began with a single open question: tell me about yourself and your life related to experiences of mental health.

Theoretically, the study integrates cultural psychology with critical phenomenology, treating mental health as a situated bio-cultural phenomenon enacted through interactions between person and environment. Building on Svend Brinkmann’s account of diagnostic cultures, and on Ian Hacking’s concept of

The interviews themselves reveal how deeply diagnostic language has penetrated everyday self-understanding among young Swedish women. Participants did not merely report symptoms; they narrated their lives through the vocabulary of disorders, often introducing themselves by their diagnoses or explaining their personalities, relationships, and futures in diagnostic terms. This reflects what the study describes as a diagnostic culture, in which psychiatric categories have become the dominant framework through which individual behavior, emotional states, and even character are interpreted. The author notes that this dominance persists despite longstanding critiques of diagnostic validity, since there are no independent criteria that can verify a clinician’s assessment of a mental disorder. For the young women in the study, however, the question of scientific validity was often less pressing than the practical and existential work that a diagnosis could accomplish in their lives.

One of the most striking findings concerns the sense of relief that diagnosis can provide. Far from experiencing a diagnostic label as an imposition of insanity, many participants described it as a validation of sanity—a confirmation that they were not, in the words of the study’s title, simply crazy. In a social environment saturated with gendered expectations about how girls should feel, behave, and present themselves, a diagnosis could function as an explanation that lifted blame from the individual. It offered a legitimate reason for struggling, a way of communicating distress to family, friends, schools, and employers that could not be dismissed as laziness, drama, or moral failure. This dynamic echoes a broader countermovement in which patient organizations and advocates have reinterpreted labeling practices into an emancipatory ownership of diagnosis, embracing difference and building new identities aligned with their conditions.

At the same time, the study documents a darker counterpart to this emancipatory potential. Diagnostic interpretations of lived experience tended to reframe disorientation and distress as personal deficits, individualizing both the cause of suffering and its solution. When the origins of distress are located within the individual’s neurology or psychology, the social conditions that shaped that distress—unequal power arrangements, exposure to violence, normative ideals of femininity, performance pressures—recede from view. The young women in the study described how understanding themselves through diagnostic categories could narrow their sense of what was possible for them, encouraging them to see their struggles as permanent features of who they are rather than as responses to circumstances that might change. In this way, the diagnosis simultaneously liberated and constrained.

To capture these dynamics, the author extends Svend Brinkmann’s well-known triad of having a diagnosis, doing a diagnosis, and being a diagnosis. Having a diagnosis refers to the possession of a label and the practical entitlements it unlocks, since in Sweden and many other countries a psychiatric diagnosis is often a prerequisite for accessing psychological treatment, welfare benefits, and accommodations at school or work. Doing a diagnosis concerns the practices and performances associated with a condition—the ways people adjust their behavior to fit or manage their classification. Being a diagnosis describes the deeper existential state in which the category colonizes identity, so that the person understands herself primarily through the lens of the disorder. The study’s empirical material, however, revealed something the original framework did not fully capture: the process of moving toward a diagnosis—the waiting, the assessment, the uncertainty, the pursuit of recognition—is itself constitutive of how young women inhabit the world. For this reason, the author proposes the additional concept of being diagnosed, a liminal and often prolonged state that shapes self-understanding and agency even before any label is conferred.

This extension matters because the diagnostic journey in contemporary mental health care can stretch over months or years, particularly for conditions affecting women. During this period, young women may organize their lives around the anticipated diagnosis, researching symptoms, rehearsing narratives for clinicians, and reinterpreting their pasts through the categories they hope will be confirmed. The process provides space for reorientation—a chance to rewrite one’s life story in ways that make suffering intelligible—but it also entrenches the diagnostic frame as the primary mode of self-knowledge. The study suggests that clinicians and policymakers should attend not only to the consequences of receiving a diagnosis but to how the pursuit of one reshapes identity and expectations along the way.

Gender emerges as a critical dimension throughout the analysis. The author shows that diagnostic discourse does not operate on young women in the same way it does on other groups, because women’s mental distress has historically been disproportionately medicalized and dismissed. The phrase captured in the study’s title—people just think she’s crazy—points to a long tradition of trivializing women’s suffering, and it is precisely against this backdrop that a diagnosis acquires its validating power. Yet the same gendered norms that make diagnosis feel like vindication also ensure that the label carries gendered meanings. What counts as normal is shaped by contemporary expectations about how people, and especially girls, ought to feel and behave, and these normative judgments determine who is deemed healthy, ill, or deviant. Normality, in this account, is not a statistical description but a mental structure people use to make sense of reality in a particular historical period, constituted through broader social and gendered norms.

The study also engages Ian Hacking’s concept of the looping effect, which describes how people classified in a certain way tend to conform to those descriptions, while simultaneously evolving in their own ways and thereby forcing constant revision of the classifications themselves. Classifications, in Hacking’s famous phrase, make up people. The young women in this study illustrate the looping effect vividly: some embraced their diagnoses and built communities and identities around them, while others resisted the categories, describing experiences that exceeded or contradicted their labels. This constant negotiation between classification and self-definition means that diagnostic categories are not static containers but dynamic forces that both shape and are shaped by the people they name.

Methodologically, the study’s strength lies in its openness. By beginning each interview with a single open question about the participant’s life and experiences of mental health, the design allowed diagnostic categories to emerge—or not emerge—naturally from the participants’ own sense-making. The heterogeneity of the sample, including young women with multiple diagnoses and those with none, made it possible to compare how diagnostic status shaped self-understanding. The interdisciplinary framework, which refuses to reduce mental health to either biology or culture, treats it instead as a bio-cultural phenomenon enacted through complex interactions between the person and her environment, integrating phenomenological concerns with perception of self, stigma, meaning-making, morality, orientation, and agency.

The implications extend beyond Sweden. If diagnoses guide the interpretation of behavior and emotion across Westernized societies, then the narrowing of normality documented here is likely a broader phenomenon. The study calls for greater ethical and moral vigilance in diagnosing children and adolescents, given the imprecision of psychiatric categories and their normative construction. It also suggests that supporting young women’s mental health requires attending to the structural and gendered conditions of their distress, not only to individual symptoms. Recognizing the dual function of diagnosis—its genuine capacity to relieve and empower, and its tendency to individualize problems that are socially produced—may help clinicians, educators, and families offer young women both recognition and room to define themselves beyond the label.

Subject of Research: How adolescent girls and young women in Sweden make sense of mental health and psychiatric diagnosis in a diagnostic culture

Article Title: “People just think she's crazy” – Adolescent girls' and young women's sense-making of mental health in a diagnostic culture

Article References: Ljungvall, H. (2026). “People just think she's crazy” – Adolescent girls' and young women's sense-making of mental health in a diagnostic culture. SSM – Mental Health, 10, Article 100704. https://doi.org/10.1016/j.ssmmh.2026.100704

Image Credits: AI Generated

DOI: 10.1016/j.ssmmh.2026.100704

Keywords: mental health, psychiatric diagnosis, adolescent girls, young women, medicalization, diagnostic culture, gender norms, Sweden, qualitative research, phenomenology, ADHD, social media