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Mental Disorders

by Susanna Kaysen
Vintage Books, 1993
Review by Christian Perring, Ph.D. on Nov 30th 1999

Girl, InterruptedGirl, Interrupted leaves you wondering what exactly Susanna Kaysen makes of her past. Clearly she looks back on it with a sense of surprise, almost wondering whether her memories really belong to her. Her memoir is a series of recollections and reflections on her time in mental hospital. She considers how she got there, and whether she belonged there. Each short chapter focuses on an aspect of her experience, and these are arranged in kind of chronological order, so as to tell her story of the people she met and the treatment she received.

Kaysen's memoir was originally published in 1993, but it portrays events from 1967 to 1969. She signed herself into McLean Hospital at the age of 18, and stayed for nearly two years. Over 20 years after, she hired a lawyer to get access to the medical records giving her diagnosis, and some of these are published in the book.  She questions whether she received appropriate treatment, but her answer to her own question is not clear--she certainly does not come out swinging the battle-ax of antipsychiatry. When her memoir was first published, she said in interview that she probably did need some time away from the rest of her life. But she also suspects there was sexism in the judgments made about her, especially about her "promiscuity." She suggests that the confusion she felt at that time in her life was not so unusual or unreasonable.

Kaysen quotes at length the description of Borderline Personality Disorder from DSM-III-R (1987). This is the diagnosis on the admission form, dated April 27, 1967, and also on the discharge form, dated January 3, 1969, although there is also says "recovered." But we do not learn much about why she received this diagnosis.   Furthermore, she does not mention that the Diagnostic Manual in use at the time of her entry into hospital was DSM-I, published in 1952. 

What was going wrong with her life?  She tells us she decided she did not want to go onto college, and she slept with her high school English teacher. A couple of years earlier, she took an overdose and had to have her stomach pumped. But apart from that we learn almost nothing about her family, friends, or her past. She mentions that one boy liked her so much that he remained in contact with her even while she was in hospital; on one of her visits to him on leave from the hospital, he proposed to her, and she accepted. This comes as a total surprise to the reader. She mentions that the marriage did not last, and that she has since had a number of lovers. She decided to have no children. She wanted to be a writer, and she succeeded.

This memoir conveys a sense of detached bemusement. It is not that Kaysen is particularly angry about what happened to her. She describes the other people she as if they were characters in a story, and she doesn't seem particularly concerned about their unhappiness or even their suicides. These events don't amuse or entertain her either. She simply goes along with them. Eventually she gets out, because she is going to be married, but she doesn't even express much relief about regaining her freedom. Yet while she was there, she was clearly going through troubles, and yet the seriousness of them still seems to escape her.

8/24/67 PROGRESS NOTE: The patient suffered an episode of depersonalization on Saturday for about six hours at which time she felt that she wasn't a real person, nothing but skin. She talked about wanting to cut herself to see whether she would bleed to prove to herself that she was real person. She mentioned she would like to see an X-ray of herself to see if she has any bones or anything inside.

It was at this time that she  bit into her hand, chomping down to the bone.  Her friends stopped her before she did any more damage.  I am no psychiatrist, but maybe the diagnosis of Borderline Personality Disorder was not so far off the mark, and maybe her treatment helped her.  I am quite sure that today Kaysen's Health Maintenance Organization would not pay for her to spend over 18 months in hospital. Spending so long on a psychiatric ward was probably damaging in many ways, even if it was also therapeutic.  So maybe we should be glad that patients such as Kaysen these days rarely spend more than a few weeks, and more often just a few days, in a psychiatric ward.   While her time on the ward was no fun, it's not clear what lessons for us now there are to learn from Kaysen's experience over thirty years ago.   Even Kaysen doesn't seem to have come to a definite conclusion about it.

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