The mental health of American young people has been in trouble for decades. Yet, in recent Centers for Disease Control (CDC) survey data, there have been some late improvements. Between 2023 and 2025, several key indicators improved as fewer high school students reported mental health crises and a reduction in suicide attempts. However, important discrepancies between boys and girls remain. While 16 percent of male high schoolers reported poor mental health in 2025, the figure was 31 percent among high school girls.
Researchers recognize that there is a distinct nature to diagnosing diseases of the mind in young men and women. Despite genuine efforts among practitioners and parents to see their children take hold of sound minds, the economic incentives that drive decisions in the psychiatry industry, state-sponsored education, and the online world may lead therapists and even the patients themselves to overdiagnose mental illness. As it turns out, these problems are concentrated among young females.
The Wall Street Journal’s Emma Camp’s book review of Garfinkle-Crowell’s Girlhood, Translated: Understanding Young Women in the Age of Therapy Speak and Self-Diagnosis provides an even-handed analysis of the book’s contents and, what’s more important, eavesdrops on how mental health diagnostics are being dispensed to young women. While defending responsible clinicians, the book’s author explains the incentives facing both patients and therapists.
To begin with, Garfinkle-Crowell’s anonymous accounts provide three essential archetypal young women. Per Camp’s description,
There’s the girl who explains every difficulty with a battery of diagnoses ranging from social anxiety to obsessive-compulsive disorder, the young woman who desperately wants an ADHD diagnosis to explain her underperformance at work, and the quiet, wilting “people pleaser.”
Crucially, there’s an evident belief among these young women that the validation of these self-diagnostics is to earn sympathy. Camp continues,
A depression diagnosis helps a young woman convince her friends and family to be more accommodating of her post-breakup heartbreak, and a gregarious teen girl might find her reserved parents more patient when her intense personality is justified with an ADHD label.
Garfinkle-Crowell further explains,
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.
The economic understanding of these actions is that some portion of young women (and undoubtedly young men) view such diagnoses as means to achieve psychic profits, whether they are relational and educational in their nature. While genuine mental health diseases are a dire concern, those who obtain false-positives obtain clout, influence, and sympathy. These are indeed powerful tools in acquiring social status and, perhaps most treasured, a lack of accountability for actions and their consequences. These psychiatric power plays are on full display in government-run schools, with federal statutes paving the way for a tsunami of funding to match the rise in a generation that has learned to self-diagnose through TikTok reels.
Since 1988, Congress has been continually tinkering with how schools receive additional funding via the health care system. In 1988, the Medicare Catastrophic Coverage Act permitted Medicaid to reimburse schools for health services rendered to children. While this initial intervention required that services were a part of a child’s special education plan, the door was opened for a ratchet effect through this mechanism.
That caveat held until December of 2014 when states were permitted to bill for any service delivered to any Medicaid-enrolled student, regardless of whether they qualified for special education. Further expansions of the program came in the form of the Bipartisan Safer Communities Act, passed in the wake of the Uvalde school shooting. This legislation further “streamlined” the process of billing. The result is that school-based Medicaid now amounts to about $6 billion per year.
While Medicaid funding funneled directly to schools was expanding, the surge in the number of children receiving it due to their household circumstances also grew to cover roughly 37 million kids who are now enrolled in Medicaid and the Child Health Care Program (CHIP). The growth of the welfare state has led to an expansion of school funding, all setting the stage for a tsunami of children who are now self-diagnosing and demanding that therapists fill out the paperwork and that schools comply with their recommendations.
The federal authorities aren’t the only ones creating the groundwork for more diagnoses and greater expenditures. In July of 2025, Illinois governor J. B. Pritzker signed Senate Bill 1560. It made the “land of Lincoln” the first in the nation to require its public schools to perform annual mental health screening on every single student in grades 3 through 12. The state itself will determine the tools used for the assessments, but the diagnoses aren’t strictly up to the mental health professionals. In fact, students will have the option to “self-report.” Apparently, Illinois’ answer to children who are self-diagnosing on the internet is to make that practice profitable for both themselves, through Medicaid funding injections, and for the children themselves who wind up with a lighter academic burden. Let the reader beware any state that wields the power to diagnose mental illness.
For those who genuinely need mental health services or accommodations, 504 plans may provide a narrow path for academic improvement. But, the most powerful incentive at play for schools is the avoidance of complaints filed with the Office of Civil Rights, who oversees 504 plan enforcement on the grounds of non-discrimination. School culture is fundamentally transformed from a place where children are challenged to grow intellectually into one where the adults get greater funding to provide legal cover for kids to downgrade their academic performance. This set of perverse incentives takes hold through centralized planning.
As I’ve argued elsewhere, the state-sponsored culture produces young people who are fundamentally incapable of accountability and therefore of living as free citizens. Recently, Philipp Bagus has identified this as the “state culture,” explaining the litany of injustices that occur in such an order. Subject to statism, individuals who can access state power to extract labor or wealth from their neighbors proliferate. Such is the case with obtaining a mental health diagnosis. It allows young people and their parents to extract resources from school districts and mental health professionals. Further, these therapists are themselves the beneficiaries of increased demand that they are able to write the script for.
All of these parties find a willing accomplice in the extractionary state who can bilk taxpayers for ever-increasing revenues, funneled into school district budgets through the continual expansion of the Medicaid program. Meanwhile, students in genuine need may be underserved, and those without genuine need, overserved. Rather than schools that drive toward merit, state-sponsored schools, combined with a behemoth welfare state, combine to teach families, children, medical professionals, and school officials to look to the government to acquire benefits at the expense of their sometimes more needy classmates and the taxpayers at large. In the end, feigning madness is rewarded, and nowhere is it more evident than in young women’s penchant to desire mental health diagnoses as a means of personal gain.
