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What “counts” as a mental illness–related image matters. Most research attention has focused on distressing or recognizable mental illness–related visual practices, yet this offers partial insight into youth mental health. Using visibility and practice theories, I share an in-depth case study exploring the social media practices of four young women, aged 14–17 years, engaged with an Australian adolescent psychiatric service. They describe how being visible to others on social media potentially produces anxiety and burdens them to respond to others’ questions or unhelpful support. In response, they engage in practices of control to manage the vulnerability of mental illness and burdensome sociality. Their mental illness–related media practices are often invisible; they rework mental illness through ambiguous, supportive or humorous practices or, through imagined intimacy, engage with images that feel relatable to them even if the images do not depict recognizable mental illness content or employ recognizable hashtags or titles. These insights complicate “what counts” as mental illness–related content or practices on social media and challenge researchers and practitioners to consider the sociotechnical contexts that shape young people’s mental health.

Young Women’s Mental Illness and (In-)visible Social Media Practices of Control and Emotional Recognition