Podcast Summary:
Something Was Wrong – S24 Ep9: Adolescent Mental Health with Dr. Stephanie Hartselle, MD
Host: Tiffany Reese/Broken Cycle Media
Guest: Dr. Stephanie Hartselle, MD
Date: August 21, 2025
Episode Overview
This episode dives deeply into the realities, myths, and current challenges of adolescent mental health, with a focus on the dangers of unregulated “wilderness therapy” programs. Dr. Stephanie Hartselle—a board-certified psychiatrist in both pediatric and adult psychiatry, as well as an educator and advocate—shares expertise about warning signs of mental distress in youth, the systemic issues in mental health care, and guidance for caregivers seeking safe treatment. They also discuss how media, culture, and new research are impacting diagnoses and support for neurodivergent youth, with an eye toward actionable resources for families.
Key Discussion Points & Insights
1. Dr. Hartselle’s Background and Exposure to “Wilderness Programs”
[01:45–03:46]
- Dr. Hartselle describes early work as an EMT in Oregon, witnessing the aftermath of unregulated wilderness therapy programs (e.g., seeing kids with injuries, trauma, and being forcibly taken from home).
- Medical professionals noted the cycle: programs shut down and re-emerge under new names.
- Dr. Hartselle’s career focus includes media advocacy for accurate portrayals of mental health and deep critique of unregulated treatment models.
“These kids coming out who’ve been kidnapped out of their beds in the middle of the night and taken to these programs... It’s a horrifying aspect of unregulated things that are called mental health treatment that are not.”
—Dr. Hartselle [02:33]
2. Expert Consensus and Red Flags About Wilderness Therapy
[03:46–04:56]
- Mainstream, trauma-informed professionals are highly skeptical of wilderness therapy:
"When we hear about wilderness programs, all of our internal anxiety flags go way up... the vast majority can be incredibly damaging.”
—Dr. Hartselle [04:09] - Rarely are these programs safely run; many lack regulation and oversight.
Why Are Licensed Professionals Sometimes Involved?
[04:56–05:57]
- New professionals can get “brainwashed” by echo chambers within these organizations; group dynamics make it difficult to speak out or leave.
- Religious ideologies can create an “echo chamber” effect and foster environments where dissent or trauma is silenced.
3. Understanding Warning Signs and Parental Responses
[06:32–07:53]
- Typical versus concerning teen behaviors:
- Dramatic changes in social engagement
- Complete withdrawal vs. normal individuation
- Sudden shifts in friends or interests
- Depression in boys can emerge as anger or opposition
- Shame as a Parental Tool: Never helpful; curiosity and gentle inquiry are much better.
"Shame never works." —Dr. Hartselle [07:23]
Navigating Mental Health Care as a Parent
[08:23–09:28]
- Use trusted, evidence-based resources and clinicians.
- Pediatricians are often the best first stop—they are frontline providers in recognizing and managing children’s mental health.
4. Misconceptions About Psychiatry and Neurodiversity
[11:01–13:12]
- The brain is an organ like any other: Willpower is not a cure for mental illness.
- Many parents believe children can “just try harder”; instead should treat mental symptoms as they would asthma or other illnesses.
Missed Diagnoses in Girls & Women
[12:46–15:23]
- ADHD and autism are underdiagnosed in women and girls, partly due to gendered presentation and outdated stereotypes.
“Boys and men are diagnosed at four times the rate that women are... But I don’t believe that to be true. I think many, many women are missed.” —Dr. Hartselle [13:12]
- Empathy paralysis and unique traits may manifest in girls with autism, leading to missed identification.
5. The Impact of Systemic Barriers
[15:23–16:45]
- US healthcare is fragmented, dividing medical and psychiatric care, and insurance access is a huge barrier.
- Dr. Hartselle is candidly critical of the insurance industry:
“I am enraged by our insurance system... I think there’s a policy to hope for attrition so that they don’t have to pay out.” [15:45]
6. Deciphering Legitimate Care from Dangerous Programs
[16:46–19:21]
- Resources like Cereal for Dinner and the American Academy of Child and Adolescent Psychiatry provide credible guides to finding vetted, affordable care.
- Red Flags in Programs:
- Lack of pre-admission assessment by a licensed clinician
- Family can’t visit the program
- Forced signing over of custody/parental rights
- Prevention of child-parent communication
- No licensed professionals on-site
- High-pressure tactics; secrecy; religious or inflexible values
- Parental intuition (“gut”) is essential.
“If a child is forbidden from calling home or being able to communicate with the family for any period of time, absolutely not.”
—Dr. Hartselle [18:33]
7. The Impact of Shame and Trauma in Youth
[19:21–20:41]
- Abusive programs reinforce trauma circuits with shame, deprivation, and punishment; this loops into long-term adult impairment and persistent fear responses.
“Putting them into a situation where that circuit of trauma... is being reinforced by shame, by punishment, by deprivation... continues to add to these circuits that will continue to loop.”
—Dr. Hartselle [19:36]
8. Cultural & Historical Context: Synanon, “Tough Love,” and Policy
[21:55–24:32]
- The surge in attack therapy and the “scared straight” approach stemmed in part from 1980s moral panic and militaristic ideas about behavior change.
“There were programs and news features on these kids were terrible. And look at them now. We’re scaring them straight... There are cultural waves that initiate things.”
—Dr. Hartselle [22:22] - These methods are not evidence-based, do not improve long-term outcomes, and would not be used in other systems if effective.
9. Training Future Mental Health Professionals
[24:50–26:40]
- Focus on empathy, non-shame-based communication, and healthy boundaries.
“Don’t shame them with their face. Don’t shame them with your tone of voice... Patients are already ashamed.”
—Dr. Hartselle [25:41] - Structure, boundaries, and love—not punishment or chaos—enable youth safety and self-regulation.
10. The Role of Media & Positive Representation
[26:40–29:52]
- Positive media (e.g., Paris Hilton’s documentary) validates survivors and sparks societal dialogue.
- Media connects isolated survivors, especially those in remote areas, and brings hidden experiences to light.
- Boys’ mental health and the impacts of competition, emotional isolation, and toxic masculinity merit new attention and research.
“We need to also now focus our attention on the boys who’ve been left behind... Their entire world is competition and feeling often like they are failing.”
—Dr. Hartselle [28:46] - Dr. Hartselle is involved in “Facts for Families,” providing free, practical mental health guides for caregivers.
11. Advice for the Uninsured or Unhoused
[30:34–32:40]
- Emergency hospital systems (e.g., Bellevue in NY, Emanuel in Portland) take all in crisis.
- The 988 hotline can connect people to crisis and resource services nationwide.
- Even small steps—community online, positive digital connections—can help counter the isolation.
“This generation of children and teens... have such an impressive amount of empathy for each other... I do have hope that this generation... is going to be so different.”
—Dr. Hartselle [32:28]
12. Resources and Closing Guidance
[33:12–33:32]
- Key resource: American Academy of Child and Adolescent Psychiatry – has medication guides, treatment resource centers, and key questions to ask potential programs.
Notable Quotes & Moments (with Timestamps)
- "When we hear about wilderness programs, all of our internal anxiety flags go way up... the vast majority can be incredibly damaging." —Dr. Hartselle [04:09]
- "Shame never works." —Dr. Hartselle [07:23]
- "If a child is forbidden from calling home... absolutely not." —Dr. Hartselle [18:33]
- "Don’t shame them... Patients are already ashamed." —Dr. Hartselle [25:41]
- "We need to also now focus our attention on the boys who’ve been left behind... Their entire world is competition and feeling often like they are failing." —Dr. Hartselle [28:46]
- "I do have hope that this generation... is going to be so different." —Dr. Hartselle [32:28]
Timestamps for Important Segments
- [01:45] Dr. Hartselle’s background; direct exposure to wilderness therapy fallout.
- [04:09] Dangers and skepticism about wilderness programs.
- [06:43] Recognizing warning signs in adolescents.
- [12:46] Challenges with neurodivergence diagnosis in women/girls.
- [16:50] How to find vetted, affordable mental health resources.
- [17:41] Red flags for unregulated or dangerous programs.
- [19:35] How shame and punishment cause lasting trauma.
- [24:32] “Tough love,” Synanon, and the rise of dangerous therapeutic approaches.
- [26:40] Positives of survivor-led and broader media advocacy.
- [30:48] Access for unhoused/uninsured—practical crisis resources.
- [33:12] Where to go for more resources and treatment guidance.
Resources Mentioned
- American Academy of Child and Adolescent Psychiatry: aacap.org
- Facts for Families: Free downloadable guides for caregivers
- Cereal for Dinner: Peer-supported site for vetted mental health resources
- 988 Hotline: National mental health crisis and resource line
Tone & Final Thoughts
The episode was forthright, compassionate, and action-oriented, combining Dr. Hartselle’s clinical expertise with an empathetic understanding of the trauma too often perpetuated by unregulated institutions. Listeners are left with hope—buoyed by media awareness, generational shifts in empathy, and a push for more accessible, evidence-based care.
“Your gut means a lot as a parent. You know things the best. You’ve known your child forever.”
—Dr. Hartselle [19:10]