demons, stigma, pills

I. the couple afar
you must admit, you do not
possibly know of
the tyrannical screaming
that has brought their walls to sand.

II. and you still persist
in these monologues, postgrads
bringing you to shame
for causes you can’t place one
thumb upon; likely, a sketch.

III. girl from that first job,
the one who dated your first,
a reed-like ideal
you had long sought to fulfill
with Vitamin C tablets.

IV. an odd fixation
your friend attributes to the
per-pin-dick-you-lar
cycles of rage, blind rainstorms
emergency lights shone through.

V. he has left you, then
so surely the effort was
a waste in methods,
years snuck away, and never
did you grace Vogue’s bold pages.

VI. medias rojas.
I wear these to look pretty.
my mother slaps me
though unlike Claudio, she
peddles my song, not my rose.

VII. fantastic Lauren
has been the blessed, to earn
four years of study
while Mother will always break
what liberal arts relieves.

VIII. my shaking, my throat
the pipe where toads so madly
screech, an anthem to
critics and teachers alike,
tests I could fail for decades.

IX. gardenias fly,
reminders of your placid
ambitions asleep,
a vegetative movie
lacking captions to explain.

X. I rid myself of
mediums that aggravate,
infect this bandaged
open wound where gangrene speaks
slowly, nothing true to say.

XI. he turns to face me
and asks with authority,
“What if all you’ve told
yourself are Benjamins, fake?”
well, I guess I won’t spend them.

XII. but the illusion,
I suppose, can tempt young girls
into keeping them.
fragilities, in the end,
moan cautiously—dreams unchanged.

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.

Looking Closer – 1962’s David and Lisa

 

Another praised work, the 1962 independent film David and Lisa, tells of two teenagers’ experiences in a mental health facility. David, ostensibly intelligent and precise in his mannerisms, is brought to by his overprotective mother. Lisa, a girl lacking comparable support, seems to show symptoms of disorganized schizophrenia. However, a closer look at patterns in her behavior suggests a different diagnosis. Though lacking insight into psychiatric treatments of the time, as well as providing an unrealistic, romanticized solution to the disorders concerned (i.e. “Love cures all”), the film, at best, adequately portrays symptoms most resembling obsessive compulsive personality disorder and dissociative identity disorder. For the purposes of this entry, DSM-IV criteria will strictly concern these conditions.

David, the son of unhappy, demanding parents, comes to the facility fraught with paranoia and anxiety. When approached and touched by another young man, David’s hands begin to shake. He screams repeatedly, “You touched me, you want to kill me!” This extreme reaction reveals the lack of social openness and rigid rules of social interaction typical of obsessive compulsive personality disorder. When others approach his room, David grows very worried that they will barge into his personal space. David’s painstakingly inflexible grip on personalized, irrational codes of conduct also manifests upon his refusal to engage in physical activity, claiming, “Exercise is for idiots.” These behaviors fall in line with criterion 4 of the DSM-IV-TR, summarized as holding rigid views of what actions are considered moral and ethical.

We see more of David’s dysfunctional personality in his interactions with Dr. John, the facility psychiatrist. Seeing an upset Lisa, David tells the doctor that he is authoritarian in his practice, and that dealing with Lisa in a permissive fashion would be more suitable for her recovery. He dedicates his time to studying, primarily focusing on clocks. This behavior meets DSM criterion 3 as David’s preoccupation keeps him from engaging in other activities. He is obsessed with the image of a ticking clock, a focal point in dreams. In slumber, David repeatedly pulls the hour hand of the clock to behead certain individuals 12 times.

Through dreaming and visualizing this punitive clock, David takes control as he pretends to rid himself of those who touch or distress him emotionally. We see this when Lisa, who touches David, becomes a victim of the clock. David’s preoccupation with details and order, as seen in his obsession with a clock that systematically kills those who upset him, meets DSM criterion 1 for obsessive compulsive personality disorder. Criterion 8, which concerns stubbornness, manifests itself in David’s objections to Dr. John’s questioning methods, refusing to comply and telling the doctor to “Don’t play Dr. Freud.” As David meets 4 of the 8 DSM criteria for obsessive compulsive personality disorder, this may be a suitable diagnosis. It is also important to note that David does not exhibit the ritualistic behaviors endemic to obsessive compulsive disorder.

Lisa, whose behavior primarily consists of clanging, is labeled by facility staff as an “adolescent schizophrenic.” Hints to her actual condition emerge when David confronts Lisa about her peculiar speech, claiming she speaks in rhymes to be “Lisa.” There are instances when Lisa does not speak at all, instead communicating with others through writing. We see this when she writes “PLAY WIT ME” on a piece of paper in order to catch David’s attention. Towards the end of the film, Lisa draws a circle with the words “MURIEL X LISA.” Outside of the circle are the words “ME.” When she adopts the persona of “Lisa,” she speaks in rhyme. However, as “Muriel,” she is unable to speak and can only convey her thoughts and requests through writing. Lisa is unable to be “ME,” her true self whose behavior is free of peculiarities. She expresses confusion regarding her true identity, repeatedly questioning David as to what kind of girl she is.

Earlier in the film, she shows difficulty in even identifying as female and exhibits two personalities, her identity as “LISA” the predominant persona. She experiences enough altered or dissociated states to receive a diagnosis of dissociative identity disorder (formerly identified as multiple personality disorder). The two personalities repeatedly dictate her actions, remembering her identity and current locale are difficult to impossible feats, and neither external medical illnesses nor mind-altering substances adequately explain her mannerisms. That being said, Lisa fits the necessary criteria for a diagnosis of dissociative identity disorder, rather than any type of schizophrenia the staff believes her to have.

David and Lisa, though overly sentimental and idealistic regarding the prognosis of serious psychological disorders, provides solid examples behaviors definitive of obsessive compulsive personality disorder and dissociative identity disorder. While David’s diagnosis is more easily determined, his behavior and mannerisms distinct and indicative of fixations on order and control, Lisa’s symptoms are frustratingly misleading. It is only when acknowledging her lack of hallucinations, her repeated questions of what kind of girl she is, and the diagram she draws that a more accurate assessment may be made. Viewers’ merely assuming that Lisa has schizophrenia would indicate a failure to look beneath the surface of her behavior, taking comments and stereotypes engrained in the film for granted. Mental illness in cinema, old or new, deserves close observation, and even a brief referral to outside sources for sound evaluation and hopefully, understanding that overrides stigma.