GIRL, INTERRUPTED

Girl, Interrupted is Susanna Kaysen’s memoir. In this book she writes about her experience as a psychiatric patient in the 1960s. Susanna was an 18-year-old female admitted to McLean Hospital, in Belmont, Massachusetts, after making a suicide attempt. Susanna was born and raised in Cambridge, Massachusetts. She attended high school at the Commonwealth School in Boston and Cambridge School. She was a daughter of the economist Carl Kaysen, a professor at MIT and former advisor to President John F. Kennedy. Her mother was sister of architect Richard Neutra. Susanna also had a sister.

Susanna was about to finish high school when she had a sexual relationship with her high school English teacher and ran away with him to New York. After returning, Susanna woke up one morning with the decision to commit suicide. “It was my task: my job for the day. I lined them up on my desk and took them one by one, counting” (Kaysen, 1993, p.17). Altogether, she took 50 aspirin, but beforehand, she called her (same-age) boyfriend and told him she was going to kill herself. When she went out to get some milk, realizing the attempt was a mistake, the police arrived at her home (the boyfriend had alerted them). She collapsed at the store, and was taken to the emergency room.

The doctor who forcefully advocated her committal to a mental hospital interviewed Susanna for only twenty minutes. He sent a letter to McLean Hospital stating that his evaluation was three hours long. He described her as having the following symptoms: immersion in fantasies; a chaotic lifestyle with no plans for the future; decompensation; sleep problems; depression; suicidality; immersion in fantasy; and progressive withdrawal and isolation. At the hospital, she was assessed as profoundly depressed, suicidal, and promiscuous, with no direction to her life.

During her stay at the hospital, Susanna described the difficulty she had making visual sense of patterns in objects like Oriental rugs, tile floors, and print curtains. Supermarkets were especially bad, because of the long, hypnotic checkerboard aisles. When she looked at these patterns, she saw other things within them. She adamantly denied that she hallucinated. She knew she was “looking at a floor or a curtain. But all the patterns seemed to contain potential representations, which in a dizzying array would flicker briefly to life.”

She also had some perceptual challenges with people’s faces. She stated “once you start parsing a face, it’s peculiar item: squishy, pointy, with lots of air vent and wet spots. This was the reverse of my problem with patterns. Instead of seeing too much meaning, I didn’t see any meaning” (Kaysen, 1993, p. 40).
Furthermore, she stated, “The world, whether dense or hollow, provoked only my negations. When I was supposed to be awake, I was asleep; when I was supposed to speak, I was silent; when a pleasure offered itself to me, I avoided it. My hunger, my thirst, my loneliness and boredom and fear were all weapons aimed at my enemy, the world” (Kaysen, 1993, p. 42).

During her two-year stay at the hospital, she experienced one, six-hour episode of depersonalization, where she bit open the flesh of her hand after becoming terrified that she had "lost her bones.” She talked about wanting to cut herself to see whether she would bleed to prove to herself that she was a real person. She mentioned she would like to see an x-ray of herself to see if she had any bones or anything else inside.

Throughout her stay, she had periods of depression and believed her parents did not understand what she was going through. They communicated little to her, and she felt as if they weren’t to be trusted. Susanna received psychoanalysis at the hospital but didn’t appear to get much out of work with her therapist. She talked about the “us against them” mentality of the residents and the nurses, but Susanna described as being close to one of the nurses. Her closest – and longest-lasting – relationships were with her fellow residents.

Question: If you have seen the movie or already read the book, do you remember the diagnosis she was given? Did this seem appropriate?

If you don't have familiarity with this memoir, what other information might you need to provide an appropriate DSM diagnosis? What diagnosis would you lean toward?