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

The study, conducted by Azélie Maurice of the Department of Anthropology at Southern Methodist University in Dallas, employed a qualitative design built around five semi-structured interviews with advocates recruited through nonprofit organizations. Rather than evaluating specific programs or prevention campaigns, as much of the earlier literature has done, the research set out to understand the roots and practices of eating disorder advocacy itself. The interviews were analyzed using reflexive thematic analysis, a flexible qualitative method in which themes are developed through the researcher’s active engagement with the data rather than through rigid, pre-set coding frameworks. To sharpen the interpretation, Maurice framed the analysis through two conceptual lenses: medicalization, which describes how conditions come to be defined and treated as medical problems, and neo-pluralist interest group theory, which examines how organized groups compete to influence policy within systems where power is unevenly distributed.

Three major themes emerged from the analysis, and together they sketch both the promise and the paradox of eating disorder advocacy. The first theme, stigma as both barrier and motivator, captures a central tension in advocates’ accounts. Stigma surrounding eating disorders, the participants explained, is not merely an unpleasant social attitude; it actively shapes who gets diagnosed, who gets treated, and whose suffering is taken seriously. Stereotypes that eating disorders affect only young, thin, white, affluent women continue to exclude men, people of color, older adults, and people in larger bodies from recognition and care. Advocates reported drawing directly on their own lived experience to challenge these stereotypes, using personal narratives to humanize the illness and push for more inclusive approaches to treatment. In this sense, stigma functioned paradoxically: it was the very obstacle that fueled their commitment, transforming personal pain into public purpose.

The second theme, navigating structural constraints, shifts the focus from social attitudes to institutional architecture. Participants described in striking detail how fragmented and uneven insurance systems restrict access to eating disorder treatment. In the United States, coverage for eating disorder care varies dramatically between insurers, between states, and even between individual policies. Advocates described patients being denied residential or intensive outpatient care, being discharged before recovery because benefits ran out, and being forced into financial ruin to continue treatment. These accounts align with longstanding critiques of managed care, in which utilization review and cost-containment mechanisms can override clinical judgment about the level of care a patient needs. For eating disorders, where early and sustained intervention strongly predicts recovery, such barriers are not merely inconvenient; they can be life-threatening.

The third theme, strategic repertoires, documents the practical toolkit that advocates have developed to work within and around these constraints. Participants described deploying personal storytelling as their most powerful instrument, since narratives of lived experience can shift public opinion in ways that statistics rarely do. Alongside storytelling, advocates reported using cost-based arguments, framing eating disorders not only as a humanitarian crisis but as an economic one, in which untreated illness generates far greater downstream costs than timely treatment. Education formed a third pillar, with advocates working to inform clinicians, schools, families, and policymakers about the realities of these illnesses. Finally, coalition-building emerged as a key strategy: by forming alliances with other advocacy organizations, professional bodies, and policymakers, advocates amplify voices that would otherwise be too small to be heard in the crowded arena of health policy.

Taken together, these themes reveal what Maurice describes as a fundamental paradox at the heart of eating disorder advocacy. The movement exists to challenge stigma and promote inclusion, yet it must operate inside a healthcare system shaped by profit-driven logics and chronic resource scarcity. Advocates are simultaneously critics of the system and participants in it, pressing for reform while negotiating with insurers, providers, and institutions whose incentives may run counter to comprehensive, long-term care. This paradox, the study suggests, is not a sign of failure but a structural condition of advocacy in the American context, where movements for health justice must often fight the system using the system’s own language of cost, evidence, and market logic.

One of the study’s most compelling insights concerns the dual role of lived experience. For advocates, personal history with an eating disorder serves simultaneously as a source of personal healing and as a form of political leverage. Telling one’s story publicly can consolidate recovery, give meaning to suffering, and connect the advocate to a community of others who understand. At the same time, that same story becomes a strategic asset in meetings with legislators, insurance companies, and media outlets, where the authenticity of lived experience can accomplish what clinical data alone cannot. This dual function, however, carries its own risks, including emotional exhaustion and the pressure to repeatedly perform one’s most vulnerable moments for institutional gain, a dynamic familiar from studies of advocacy in HIV/AIDS and breast cancer movements.

The comparison with those earlier movements is instructive. Advocacy for HIV/AIDS and breast cancer has received sustained scholarly attention and is widely credited with transforming research funding, drug approval pathways, and public awareness. Eating disorder advocacy, by contrast, has rarely been studied beyond program evaluation or prevention campaigns, leaving the field without a clear account of its own history, strategies, and internal tensions. By situating eating disorder advocacy within the broader landscape of health social movements, the new research helps correct that gap and provides a framework that future scholars can extend. The findings point to patterns that likely resonate internationally, even as they emphasize how distinctly the U.S. healthcare system and political environment shape what advocates can realistically achieve.

The study also opens several avenues for future research. Maurice suggests examining the relationships between advocates and healthcare practitioners, a dynamic that can range from productive partnership to friction over treatment philosophy and resource allocation. Another promising direction is the transition from patient to advocate, a process through which individuals convert recovery into activism and renegotiate their relationship with the illness. Finally, the evolving role of social media in shaping advocacy strategies deserves close attention, as digital platforms have lowered the barriers to storytelling and coalition-building while introducing new risks around misinformation, harassment, and the commercialization of recovery narratives.

For clinicians, policymakers, and the public, the message of this research is clear. Eating disorder advocacy is not a peripheral activity but a central force in the struggle for fair and effective care, and its effectiveness depends on conditions that society controls: insurance parity, inclusive diagnostic practices, and genuine recognition of who these illnesses affect. The advocates interviewed in this study demonstrate that lived experience, when organized and amplified, can contest stigma and demand accountability from powerful institutions. But their accounts also show that individual courage cannot substitute for structural change. As eating disorders continue to rise as a public health concern in the United States, the voices documented here offer both a roadmap and a warning: progress is possible, but only if the systems that ration care are themselves made the subject of reform.

Subject of Research: A qualitative reflexive thematic analysis of the motivations, strategies, and structural challenges of eating disorder advocacy in the United States.

Article Title: Contesting care, navigating paradoxes: a thematic reflexive analysis of eating disorders advocates voices

Article References: Maurice, A. (2026). Contesting care, navigating paradoxes: a thematic reflexive analysis of eating disorders advocates voices. Journal of Eating Disorders. https://doi.org/10.1186/s40337-025-01521-6

Image Credits: AI Generated

DOI: 10.1186/s40337-025-01521-6

Keywords: eating disorders, advocacy, lived experience, stigma, insurance barriers, reflexive thematic analysis, medicalization, health policy, mental health, qualitative research, nonprofit organizations, United States healthcare