“Girl, Interrupted”: Mental

Illness Analysis
Introduction
James Mangold’s film “The Girl, Interrupted” was based on the
autobiographical book by Susanna Kaysen, who spent two years in a
psychiatric hospital. This is the story of a fifteen-year-old girl who
spent one year in a psychiatric hospital after trying to commit suicide.
The film takes place in the 60s in America during the time of the
aggravation of socio-political conflicts, which resulted in mass
disillusionment and youth riots. Susanna Kaysen is not a child of her
time: she is lonely, depressed, disappointed in the values and
aspirations of her surroundings. Half of her peers get married and have
a couple of offspring by the age of twenty. The other half runs away to
San Francisco and lives in hippie communes in an eternal LSD frenzy.
At this time, she is torn by the inability to understand what she wants.
Susanna had just graduated from high school, and she is the only one
of the graduates who refused to study further. This fact caused
misunderstanding, surprise, and discontent among teachers and
friends. Then a young, anxious, physically, and emotionally fragile
Susanna ends up in a psychiatric hospital. After a failed suicide
attempt, she is sent to the Claymore Psychiatric Clinic.
She signs consent for treatment there, not suspecting that two weeks
of “rest” can turn into a whole year. Susanna Kaysen is played by
Winona Ryder; the actress gave her all, vividly showing her heroine’s
feelings, emotions, and deep and suppressed pain. The film’s shooting
took place in an actual psychiatric clinic located in Harrisburg,
Pennsylvania. The development of conflict and characters, the play of
actors, the atmosphere of a psychiatric clinic, camerawork, and even
the transitions between scenes are made according to the best
American standards.

Borderline Personality Disorder in

DSM-5
The diagnosis with which Susanna is put in a psychiatric hospital first
appeared in the American Diagnostic and Statistical Manual of Mental
Disorders (DSM) in 1980 (American Psychiatric Association, 2013). It
belongs to the category of “Personality disorders” — it is a borderline
personality disorder. Susanna feels depressed and empty; she
experiences intense feelings of nervousness, often arising in response
to interpersonal stress and anxiety about negative feelings of past
unpleasant experiences and possible future events. The patient has a
sense of fear, timidity, threats from uncertainty.
Another criterion observed in a girl is a significant decrease in interest
or pleasure in almost all activities, loss of desires, and taste for life.
Also, Susanna has such a symptom of borderline personality disorder
as fatigue and loss of energy. Her activity has dropped to zero; she can
not start doing something, and there is no motivation.
The heroine feels useless; she has developed an inflated sense of guilt.
Communication with Lisa can be associated with another criterion of
borderline disorder: poorly developed, unstable self-image. This is due
to self-criticism, a chronic feeling of emptiness, and dissociative states
under stress. As with most patients with borderline personality
disorder, the girl has decreased ability to concentrate; her attention is
disturbed. In addition, she also has such an important symptoms
(because of which Susanna was admitted to the hospital), as repeated
thoughts about death, plans to commit suicide, and suicide attempts.
Thus, the patient has most of the symptoms of borderline personality
disorder indicated in the DSM-5.

The Accuracy of The Depiction

The main character Susanna is in a borderline state and has depression
with exogenous causes; the image of the disease can be considered
quite realistic. As she remembers herself, “all her life she was like this”:
taciturn, not cheerful, she never smiled. Susanna tried to commit
suicide by washing down an aspirin with vodka, but she does not admit
that she wanted to end her life. Emotional instability associated with
endocrine restructuring and vegetative instability is a frequent
companion of adolescence.
The emotions are highly intense; teenagers quickly move from joy to
sadness and vice versa. Future adults tend to fixate on negative
experiences, which makes feelings long-lasting, and emotional
impulses tense. Susanna, a girl who made a suicidal attempt, describes
her condition that preceded this episode in such terms: “Feel my hand,
there are no bones in it.” She said: “Something bad was happening with
my perception of people. When I looked at someone’s face, I often
couldn’t read it in any way”. Susanna also claimed: “Instead of seeing a
lot of feelings in faces, I didn’t see anything in them” (Mangold, 1999).
From these self-reports, it can be seen that the girl faced violations of
perception of the surrounding reality and herself, corresponding to
depersonalization-derealization disorders. Other experiences are more
consistent with the description of the symptoms of negativism: “My
whole world, filled or empty, only provoked the denial. When I had to
get up, I stayed in bed; when I had to talk, I was silent; when some
pleasure was waiting for me – I avoided it” (Mangold, 1999). Outwardly,
Susanna looks depressed; her facial expressions are frozen, and she is
fenced off from the surrounding reality; she manages to fall asleep right
during the solemn graduation ceremony at school. This clinical picture
does correspond to the characteristics of a depressive episode to
consider the image of a mental illness realistic.

Psychopathology in Parents
Symptoms of psychopathology can be traced not only to Susanna but
also to her parents. Susanna’s father works in economics, he is a
careerist and is often on the road. Her mother is a housewife whose
suspiciousness and emotional lability do not allow her to get closer to
her daughter. Susanna’s mother is more concerned about the opinions
of others than the feelings of her own daughter. Often, she does not
understand that her actions offend or hurt her daughter. At her father’s
birthday party, Susanne’s mother pushes her to say hello to a friend
and at the same time hisses in her ear: “What are you wearing?!”
(Mangold, 1999). She couldn’t even take her daughter to the clinic but
only watched her from afar and cried.
The relationship between the main character and her parents is
strained and devoid of mutual understanding. Communication with
them causes negative emotions; Susanna’s parents instill a constant
sense of guilt in her. They devalue the girl, criticizing her desire to
write, her studies, and her achievements. Their comments lower her
self-esteem and present everything as if the girl and all her actions are
worth nothing. There are no scenes in the film where the mother or
father tries to talk to her or somehow establish contact. Strangers do it
for them: a family friend, medical staff at the clinic, etc. Thus, the
parents of the main character also have psychopathologies: for
example, the excessive concerns of the mother are a signal of her own
borderline state (Comer, 2010). Her chronic pathological fear may
indicate the presence of an anxiety disorder in a woman.

Risk Factors
The main risk factor was undoubtedly Susannah’s childhood; the
viewer learns that after Susanna fell from the crib and broke her leg,
her mother began to tie her up. The parents tied the girl to the furniture
as a child so that would not fall and hurt herself. When a child is in a
forced immobile position for quite a long time, develops a passive
attitude to life, which may have caused depression. In addition, it can
be assumed that such elements of education, coupled with increased
maternal anxiety, could negatively affect the future fate of Susanna.
Anxious parents raise anxious children, and they are constantly
depressed; such children are passive, constrained, timid, unsure of
themselves, and feel guilt due to frequent reproaches. They have
difficulties interacting with the surrounding world, which seems hostile
and frightening: life, according to Susanna, consists of “pitfalls, ghosts,
quicksand” (Mangold, 1999).
The next risk factor is the constant manipulation of Susanna with the
help of guilt. Even a family friend tells her: “Susanna, you constantly
cause pain to your loved ones” (Mangold, 1999). Guilt is a powerful
destructive feeling; if a person is taught from childhood that they are
the source of all troubles, they subconsciously begin to look for
punishment. In adulthood, self-punishment occurs through various
ways of self-destruction (mutilation, drug addiction, alcoholism,
promiscuous sexual relations, suicide). Against the background of her
peers trying to enter universities, Susanna seems even more worthless
and hopeless. In addition to everything, there is a threat of exposing a
sexual relationship with a family friend; as a result, she decides to
commit suicide.

Protective Factors
Susanna’s mental disorder developed due to a complex interaction of
social, psychological, and biological factors. Such events in the girl’s
life as graduation from school, not meeting the expectations of
teachers and parents, and an affair with a married man contributed to
the activation of protective factors. In numerous memoirs of Susanna,
one can trace the neglect of her parents, for whom it was essential to
save face in front of colleagues and neighbors. She experienced the
dissatisfaction of teachers when she decided not to continue her
studies, the harassment of a friend of her father, and painful
procedures after an attempted poisoning.
However, throughout history, it is impossible to separate the girl’s
successes or any joyful moments. The triggered protection factor
erased everything that Susanna could rely on to restore her identity.
The same protection factors also affected the girl’s bodily sensations,
dulling them; according to Videler, Hutsebaut, Schulkens, Sobczak, and
Alphen (2019), this made it possible to harm her body. At the beginning
of the story, Susanna says that she has no bones in her hand.
The mental disorder prompted the activation of such a protective
factor as isolation, which in the case of Susanna did not allow sharing
her experiences with relatives and doctors. This factor makes the girl
deny the suicide attempt to the last, and does not make the
seriousness of the situation clear to her, which significantly
complicates the course of treatment. Also, Susanna has activated such
a protection factor as an “unsuccessful attempt to run.” To escape from
her unpleasant experiences, Susanna enters into casual relationships
with men, uses drugs, and attempts suicide.

Therapeutic Orientation
Susanna’s condition was called borderline; the therapy for it included
hospitalization, taking medications, attending a course of
psychotherapy, and writing a book (journaling). In the treatment
course, the girl processes childhood insults, and harmful parental
attitudes, learns to control herself, and accepts herself as she is. The
therapy aimed to create the primary underlying deficiency in a person
with a borderline disorder which is a stable secure relationship with
clear boundaries. Feelings that have not found a way out in the client’s
childhood are turned to the psychologist as a substitute for the parent
figure. In addition, an important aspect was working with guilt; the
borderline client had a lot of toxic shame imposed on her by her
parents.
According to Chanen, Nicol, Betts, and Thompson (2020), any
interpretation of her behavior involuntarily caused guilt and a desire to
defend herself. Initially, Susanna devalued what is happening in
therapy, the therapist himself, and the results achieved; she did this
because of the specifics of her violation. However, the treatment has
achieved its main task to create and maintain stable boundaries,
discuss the difficulties of following the rules in therapy, and gradually
create trust in the relationship. The treatment began to benefit the girl;
in addition, Susanna begins to write a diary about everything that
happens to her, which also helps her to get better.

Expected Outcome
Susanna began to go to a therapist actively; every day, she was getting
better and better. At the end of the film, she returned home and
became “normal” – active and cheerful. The turning point in Susanna’s
relationship with the disorder, which increased her chances of
recovery, was a combination of different factors. They were the kind
attitude of the senior nurse, medical treatment, friendship with other
patients, and small joys from communicating with a Lisa.
Taking care of the cat gave a new meaning to the girl’s life, and keeping
a diary was an outlet for pain and frustration, and recorded written
evidence of small successes. According to Fonagy, Luyten, Allison, and
Campbell (2017), it is impossible to single out the only factor
contributing to recovery, but all of them together gave a result. The
ability to record her experiences and analyze relationships with other
patients during therapy helped the girl significantly.
Although Susanna’s recovery was slow and sometimes there were
steps back, it happened steadily. At first, she admitted that she tried to
commit suicide; then she got rid of the feeling of guilt and learned to
say “no” to the desires of others. After facing the real death of her
friend, she realized that there is nothing attractive about death. At the
final medical examination, she said that she got a job in a store, but she
does not give up her dream of becoming a writer. This means that she
has learned not only to coexist with the surrounding reality but is also
ready to realize her true desires.

Conclusion
The film not only allows reflecting on the psychopathological picture of
depression with a predominance of depersonalization and derealization
symptoms. It also focuses on the problem of long-term residence of
young people in a psychiatric hospital (in the film, during a period of
one year). In addition to the actual emotional experiences and
disorders, the main character faces existential problems in a private
psychiatric clinic. She deals with a total lack of freedom, supervision,
loss of privacy of life and personal space, isolation, loneliness, and fear
of death. Not every parent will have the funds that the heroine talks
about ($60 a day) to provide an opportunity for their child to receive
help in the private clinic (Mangold, 1999). Even these privileged
conditions are considered by the heroine as a permanent freedom
restriction.
This view should be considered when providing psychiatric care at the
inpatient stage, especially in relation to children and adolescents with
mental disorders. The necessary control and safety measures should
be carried out, taking into account a respectful and careful attitude to
the patient’s personality. The child or teenager should be able to
integrate the experience of hospitalization into his life path and not
treat it exclusively as negative, critical, and unfavorable. One of the
methods that can help in this issue in specialized adolescent
departments is creating conditions for the realization of the innate
need for initiation. The creation of a system of fines and rewards for
behavior during hospitalization will contribute to the transition of a
teenager to a new social and personal status.

References
American Psychiatric Association. (2013). Diagnostic and Statistical
Manual of Mental Disorders: DSM V. Washington, DC: American
Psychiatric Publishers.
Chanen, A. M., Nicol, K., Betts, J.K., & Thompson, K. N. (2020).
Diagnosis and treatment of borderline personality disorder in young
people. Current Psychiatry Reports, 22(25), 114-135.
Comer, J.R. (2010). Abnormal Psychology. New York: Worth Publishers.
Fonagy, A. J., Luyten, R., Allison, E., & Campbell, C. (2017). What we
have changed our minds about: Part 2. Borderline personality disorder,
epistemic trust and the developmental significance of social
communication. Borderline Personality Disorder and Emotion
Dysregulation, 4(9), 140-147.
Mangold, J. (Director). (1999). Girl, Interrupted. Web.
Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Alphen,
S.P. (2019). A life span perspective on borderline personality disorder.
Current Psychiatry Reports, 21(51), 119-128.