Mental Illness, Treatment, and Stigma in Girl, Interrupted

The Memoir, not the Movie with Winona Ryder and Angelina Jolie

Girl, Interrupted, an account of a young woman’s long-term stay at the famous McLean Hospital, provides a look into the institutionalized lives of women suffering with severe mental illness. Several treatments of the time were administered to ameliorate their symptoms, though the efficacy of such treatments was often debatable. Though brief, the memoir opens dialogue regarding misdiagnoses, the perception of nonconforming individuals as “crazy,” and the stigmatization of those receiving a mental health diagnosis.

Schizophrenic symptoms were common among McLean’s patients. Polly, left disfigured with burns after a suicide attempt, is void of emotion. Not happy, unhappy, or agitated, Polly’s emotional responses indicate a flat affect. She rarely speaks, even in stressful situations. For Polly, negative symptoms take hold. The indifferent viewers of the television set sit catatonic without response. Even when Lisa covers the couch with toilet paper, the catatonics remain still in their seats. The girl who claimed to be an alien’s girlfriend, as well as a proud penis owner, beams delusions of grandeur, calling ice cream vulgar names that all rhyme together. Wade, Georgina’s boyfriend, is a bit paranoid, and claims he was persecuted by two friends of his father, who he falsely reported to do dangerous work for the CIA. He is indifferent to Georgina’s burns.

Susanna Kaysen, admitted to the hospital for mental exhaustion and a suicide attempt, is diagnosed with borderline personality disorder. She is impulsive, her interactions jarred by routine splitting behaviors. It’s mainly black and white in Susanna’s world. She cries in front of a painting she finds relatable, much to the annoyance of a boyfriend. Frustrated, he remarks on her self-centered way of perceiving things. Susanna faces conflict within, perceiving herself as a terrible person to later identify as the venerated Angel of Death. She scratches her hands, desperately wanting to know if there’s still bone beneath. Banging her wrists on a butterfly chair, regardless of vein damage all can see, is how she bears the numbness. Scratches mark her face. As Susanna showed at least 5 of the criteria for borderline personality disorder, as listed in the DSM-IV-TR—(1) Tumultuous relationships where splitting is common, (2) An ever-changing self-image, (3) Impulsive behavior, (4) Frequent episodes of self-harm, and (5) Dissociative episodes spurred on by distress—it is reasonable to conclude that her diagnosis was valid.

Lisa, on the other hand, is diagnosed with antisocial personality disorder. Cold and insensitive, Lisa cares not for the feelings of others. She jeers at the catatonics sitting around the television set, even turns it off despite the possibility that someone may really like the show that’s played. Lisa does away with rules, scheming to escape Mclean. Even in exclusion, Lisa expresses no remorse for her bad behavior, continuing to plot other escapes and even the escapes of others. Of course, these plans lack authentic concern. Self-interest dictates her behavior. She wants to be liked among the girls, and indeed, she has an appealing sense of humor that brings color to a dull environment. However, while Lisa doesn’t struggle in making friendships, she doesn’t give them value. Stable relationships are impossibilities. Towards the end of the Kaysen’s memoir, Lisa raises her son, whose father she disowns.

Aggressive and provoked by perceived threats to popularity, Lisa takes measures to derail rivals. Her continuous bullying of Lisa Cody, a diagnosed sociopath who seems to only emulate Lisa’s behavior, only fuels the latter’s self-indulgence. Blame is the name of Lisa’s game. Various times, she bemoans her lack of rights, using her attorney to bully the hospital staff when her requests were ignored or unfulfilled. I’m sure we’ve encountered these sorts, in college, doctors’ offices, and popular tourist attractions. While at least 3 criteria in section A of the DSM IV-TR must be met to receive a diagnosis of antisocial personality disorder, Lisa meets 6, such as (1) Failure to adhere to social norms relating to lawful behaviors, (2) Deception in the name of self-interest, (3) Aggressiveness and frequent irritability, (4) Pervasive disregard for the wellbeing of others, (5) Repeated irresponsibility, as evidenced by a failure to fulfill her daily obligations, and (6) Lack of remorse for her cruelty towards others.

Reflections on Treatment

The drug treatments mentioned throughout the memoir had an inhibiting effect on the patients. Thorazine was a common resort for those with highly unstable behavior, such as the trembling Torey or Susanna, who experienced an episode of extreme agitation upon scratching her hand. Feeling heavier than usual, the patients would calm down and their agitation would cease. Other antipsychotic drugs, such as Stelazine and Mellaril, seemed to calm those with schizophrenia, although their movements grew more sluggish, as evidenced by Polly’s way of walking and the odd suspension of her hands. Periods of sleepiness may have been influenced by benzodiazepines such as Librium and Valium. The depressed woman, Cynthia, received electro-convulsive shock therapy once a week, with therapy twice a week. Her memory was noticeably impaired, with her speech disorganized after initial treatment. Daily, most patients were required to see three specialists. Sessions with doctors were uninformative and short, as were sessions with residents concerned with medication and the granting of privileges. Therapy was also described as unhelpful, with therapists expressing a lack of sympathy, refusing to discuss life in the hospital yet determining whether patients were to have increases in medication. This three-part regimen seemed more systematic and impersonal than helpful to the individual needs of each patient. Susanna, deemed capable of undergoing “analysis,” recalled the treatment as ineffective. It seemed that the treatment did little to benefit her, the specialists’ repetitive questions irritating her so much that she would simply fabricate answers to placate them.

Is She Crazy? 

Susanna explicitly questioned her diagnosis during her hospitalization. She felt that what others perceived as inappropriate, tiring behavior were hallmark characteristics of young adulthood. She criticized the DSM as a vague collection of generalizations, often subjectively applied to those who do not conform to social norms. The only person in her affluent high school to not attend college, Susanna was the black sheep of the family, defying expectations to attend a prestigious college and unable to handle the duties of simple jobs. Perhaps the shame her family experienced impacted their willingness to pay for her costly hospitalization for almost two years. They may have wished to maintain normalcy without directly dealing with her chaotic behavior. I feel that her inability to maintain her typing job may have related to sexist attitudes of the time. All the supervisors were men, while the typists were women. Strict regulations were placed on their behavior and dress. This could have been agitating for Susanna, who defied such rules. Although her behavior was erratic, “crazy” is not an accurate word to describe her.

Considering the aforementioned behaviors, it’s reasonable to say that Susanna showed striking characteristics of borderline personality disorder. The episodes of self-harm, the persisting interpersonal conflicts, and emotional instability indicate that psychologically, she just wasn’t healthy. However, these behaviors may have been byproducts of growing up in an environment with rigid, highly demanding expectations. Ultimately, “troubled” may be a more fitting description, as it does not dehumanize nor stigmatize, but emphasizes that Susanna is a person who at the time needed guidance and empathy.

Ultimately, Girl, Interrupted (the memoir, not the movie) gave me a glimpse of the impersonal and rushed nature of psychiatric care in these facilities, given the amount of patients who have to be treated. I observed how sexist attitudes of the time period may have influenced perceptions of women already struggling with a mental illness. Susanna was expected to be sexually modest, emotionally stable, and uncomplaining. The scorn she received, made salient in a doctor’s writing that she “might sell self or get pregnant” (11) shed light on the stigma imposed on women who rebelled against norms of conservatism. The title, inspired by the poignant painting Susanna saw at the Vermeer, is more than an allusion. It is a description of Susanna’s destabilizing experience—a long term hospitalization, a stigmatized diagnosis, and a lost sense of self—that prevented her from enjoying life in the way that most young women do. It was only after this hiatus that she could continue living, hopefully with a greater sense of stability.

Dispelling Conventional Perceptions of Intelligence

I remember a boy in the second grade by the name of Joel. Friendless, a burden to our impatient teacher, and a playground pariah, Joel was often ridiculed for three things: flapping his hands in frenzy when excited or distressed, banging his head against his desk when things did not go his way, and when his turn came to read out loud, he would turn a story into an awkward song, singing the lyrics in some rigid, broken melody. Other than participating in class readings, and screaming at the top of his lungs when a classmate picked on him, Joel never really talked. Unfortunately, news of his strange behavior reached several parents, who demanded that their children be taken out of an “unsafe and disruptive learning environment.” I recall my mother pulling me from him when she volunteered at a school event, scolding me for befriending “that strange, abnormal kid.” Years later, reading about Joel’s distinctive behaviors, I learned about autism.

For a long time, I didn’t really have a solid understanding of autism, nor the thought processes of individuals with it. In past psychology courses, the condition was simply glossed over, either in text or during class lectures. However, I was taught that the majority of people diagnosed with autism also display a degree of mental retardation, capable of little to no speech. Wretches and Jabberers depicts the story of two men, Tracy and Larry, who dismantle a large misconception that people with autism are incapable of intelligible communication. Through the use of a keyboard, they learn to communicate their thoughts with others, and indeed, I was surprised and impressed with the eloquent messages conveyed to observers, whether such messages were simple questions regarding where to eat in Japan, or references to Buddhist philosophy when discussing personal experiences. Observing these men use technology to pose inquiries, express needs, and convey opinions that were silenced for so many years in the absence of advanced technology was not only heartwarming, but eye-opening. This is a documentary that allows viewers to take a closer glimpse into the lives of individuals who, at the outset, appear so alien in their appearance and behaviors, but really possess a comparable depth in emotion and capacity for communication as those without autism.

Recalling the opening facts presented at the beginning of the documentary, that in previous years, many children in the United States diagnosed with autism were institutionalized and cast away as mentally retarded, I thought of how liberating it must be for Tracy and Larry to finally convey to the world that they are more than just “disabled.” Provided with an avenue to convey their thoughts articulately and cogently, they clearly develop a greater sense of confidence, dispelling stereotypes the public may have about individuals with autism and similar conditions. One may opine that these men possess an intelligence that is not only markedly different, but perhaps more dynamic than that of verbal communicators. To maneuver around autism’s problematic symptoms—the tics, peculiar speech patterns, and impaired interaction—and be able to relay their thoughts in such depth, is an impressive feat, a daily challenge which I myself cannot imagine having to tackle. It saddens me that Tracy, Larry, and Joel from second grade have to deal with constant discrimination and meager confidence in their abilities. However, Wretches and Jabberers provides hope that such individuals can defy negative expectations, delivering the message that one’s intelligence manifests in alternative ways, not simply defined within the confines of disabilities often so heavily stigmatized.