Crazy is as Crazy Does

Girl, Interrupted is a 1993 memoir written by Susanna Kaysen in which she recounts her stay at the McLean Hospital from 1967 to 1969 at the age of 18. Susanna was admitted to McLean directly after an incredibly brief encounter with a psychiatrist she had never seen before after a suicide attempt with some aspirin. Right away this makes you question psychological diagnosis and the implications of treatment. Her stay was originally intended to be for a short rest and only around two weeks long, but Susanna ultimately ends up being a patient at McLean Hospital for going on two years. During her stay, Susanna is housed in a ward with other teenage girls she ultimately befriends, including her roommate Georgina, as well as the resident sociopath, Lisa, who seems to socially run the place. Daisy, the seasonal visitor, comes to stay mostly around the holiday, and Polly, a burn victim by her own hand, seems childlike and sweet. Susanna's temporary home is a ward full of many other interesting characters she tells about, reflecting on the girls’ diagnoses and idiosyncrasies, the staff and hospital procedures, and all of the happenings of this “parallel universe” as she calls it, in a poignant, nonlinear fashion that leaves us questioning the protocols of mental health treatment. She dedicates each chapter to certain characters or stories that involve them, instead of telling her story in chronological order, also including documents and progress reports from her records at McLean throughout the book, which is a much more interesting way to convey the thing.  

All of the girls in the ward have different diagnoses and could even be seen symbolically as different personalities within the human collective. Susanna is seemingly the sanest one there and is somewhat treated as such by her therapist, Melvin, who tries out analytical therapy on her. Lisa seems the most insane of the bunch, diagnosed as a sociopath. She runs away periodically only to be returned again and seems to be a long-term patient. Contrastingly, Daisy is released to live on her own in an apartment, making enough supposed progress to be considered cured enough to do so, only to die by suicide. In the end, Susanna, who does show signs of borderline personality disorder, is released because she receives a proposal and becomes engaged, not because of making progress. She remains in contact with her roommate for a while, until Georgina moves out of state, and then ends up running into Lisa at the end of the book as well. Lisa, who seemed to be committed to the lifestyle of McLean, ends up with a child and in contact with her parents again. Overall, the book is rather anticlimactic, and the patients seem almost a group of misfits and victims of bad parenting rather than occupants of a mental hospital. They form a sort of family and grow accustomed to each other. McLean shelters them from real life, allowing them to live in a paused liminal space. This seems like a waste of precious time, given their tender ages while also occurring alongside the final years of the 1960s, which was such a culturally important time. Time is a precious thing. Time is but a fleeting, grouping of moments, all that we have in life and Susanna seems rather obsessed with being able to account for this time, becoming upset when she is put under by the dentist at one point and unable to track how much time she has lost. She spends a bit of time explaining how she can't fully recall how much time she was in the office of the psychiatrist who sent her to McLean in the first place. It's funny that she is so concerned with this time and seemingly less upset that she is missing out on the tail end of one of the biggest decades in history as well as the initial years of her adult life.   

We must remember, also, that McLean is an expensive facility and none of these girls would be here if their parents or benefactors could not afford to pay for their care, and aside from Daisy’s dad who was having a majorly inappropriate relationship with his daughter that ultimately leads to her death, no parents visit the ward. Susanna is visited by a boyfriend, but her parents never visit during her stay. She makes a point to note how none of the other girls’ parents visit them either and they seem to have a somewhat similar view of their families of origin. In the book, one of her progress reports from the hospital states how she became upset and had an episode thinking about her parents and their lack of communication and caring. How many of these girls had similar experiences with their parents, I wonder. Even Lisa, despite her obvious imbalances, seems almost like a rich kid acting out more than a sociopath in a psych ward. She struggles with addiction, which research shows is related to adverse childhood experiences, but her antics, like stealing all of the lightbulbs, seem somewhat impishly harmless. She also seems relatively sane when Susanna runs into her and her son at the end of the book, albeit still rather quirky, showing Kaysen her excess skin. The fact that all of these girls come from families that wish to utilize McLean Hospital to mitigate the social shame that their black sheep family members bring home to them speaks volumes. Honestly, through my own personal studies, I’ve come to believe that most conditions stem from some sort of attachment trauma or childhood traumas in general. Afterall, psychology is merely based on the generalization of patterns of disruptive behaviors found in the population, generalizations, mind you, that a group of men at one point in time merely agreed on, labeled and ultimately included in a manual. Sometimes, we need to call a thing a thing to wrap our heads around it. Other times, however, connecting it so tightly to a label can enable unwanted associations, and we have to focus less on ourselves as a specific thing in order to get it out of our heads. There is a time and place for everything. 

The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, as it is
known, is essentially a tome of labels and labels can be helpful for categorizing and generalizing treatment, but they can also hinder progress when they stick, especially when they are accurate, but even more so when inaccurate, as they can become self-fulfilled prophesies. One of the questions this book brings up is should a patient know their diagnosis? Girl, Interrupted was written years after Kaysen's stay, after she had researched her diagnosis and gathered her records, most likely using journals she kept from the time. In the book, Susanna never knows she is being treated for borderline personality disorder, while in the movie, the girls break into the head doctor’s office and find their files, reading all of their diagnoses and sharing amongst themselves, in one of the most interesting scenes in the film. How triggering and derailing would this have been if experienced in real life? If someone receives a diagnosis that is very stigmatized it could very well derail their progress. Statistically, BPD is more often diagnosed in women. Is this because it actually occurs more often in women, or because it presents differently in the sexes, as with many things? Borderline personality disorder already is commonly misdiagnosed as other conditions and has many similarities between Complex-PTSD. It also has several different "faces" or subtypes, even, which gets even more complicated. Was Susanna's diagnosis even accurate? How would Kaysen have fared if she had been aware of her diagnosis, or label, during her stay? In the movie she reads the criteria and states that it's "so me" but in real life, we can’t very well say, but the movie somewhat tries to answer this question for us.   

There are a striking number of differences between this book and the movie adaptation. The movie, instead of having Kaysen be her own villain, paints Lisa, who is played perfectly by Angelina Jolie, as a sort of villain of the ward. She is much more combative in the film, and it’s ultimately her verbal assault that sends

Daisy, played by Brittany Murphy

Daisy over the edge, whereas in the book, Susanna and Lisa never escape and go to Daisy’s apartment, and she organically ends herself all on her own without a push to do so. Daisy is one of my favorite characters and plays a truly memorable role in the book as well as the film. People seem to want a villain on screen, though. It translates better to film, maybe, having a battle being between two external forces, rather than an internal, invisible force playing the antagonistic role. Lisa becomes an external symbol to Susanna, of her potential for downfall and ruin. While I do enjoy Jolie's interpretation of this character, she is made out to be more like Nancy from The Craft, only she then reconciles in a final scene that includes toenail painting as Susanna says her goodbyes, instead of her being isolated in a straightjacket. Susanna is easy to forgive for something that was downright terrifying, in the film. This is somewhat strange, but forgiveness is essential in any form of mental progress. It's very big of her, but also, everyone at the hospital seems to understand that the crazy sometimes just grips you, and you can't always take it personally. 

Girl, Interrupted is, at its heart, a coming-of-age story, set mostly inside of a mental hospital, which seems oddly fitting given the gravity of the task of coming-of-age, whatever that fully means anyway. That kind of story traditionally is in the form of youth and a crazy time in their lives a la Stand By Me, Now and Then, even The Goonies and Monster Squad. There is usually some common antagonist the group of young protagonists engage against. They are also usually more-so feel-good comedies. Girl, Interrupted is full of comedy, but it makes us question things as much as it makes us laugh, and like most adaptations, the book is very different from the screen version. Girl, Interrupted is more of a feel bad comedy of sorts and is made to make us laugh and think, all while questioning the trustworthiness of the narrator, mostly due to the stigma of her diagnosis. Is it an honest voice? Can we trust her judgements and perceptions at all if she is retelling a chapter of her life filled with meds and psychotherapy? Can we trust anyone telling us stories? Can we trust anyone? 

It is true that Susanna Kaysen, as with many writers before her, romanticizes the idea of mental illness. This is obvious when she opens by stating all of the famous people that have been admitted to McLean, almost insinuating that it's somewhat of a rite of passage as a writer. She uses it to her advantage that we only have her point of view throughout the whole tale, as well. We are at her mercy, much as she was at the mercy of the staff of McLean as a young woman. It also states right on the back of the book that McLean is an expensive hospital. Wynona

Ryder, who plays Susanna in the film and actually bought the movie rights to the book, having an integral part in the movie’s creation, even calls Kaysen a “rich girl that goes to a hospital" in her recount of the book in interviews. I think that this matters, because McLean was a very different experience for Kaysen than a state run hospital of the same era would have been. Kaysen received what was considered privileged care during her stay. She also enjoyed privileges that she somewhat keeps on the downlow throughout the book, finally revealing her holding of a job during her stay as a patient and even having enough evenings free from the place to basically date and become engaged, thus calling for her release. It was a little under two full years, as well, that she was at McLean, so she somewhat embellishes in the beginning as to the conditions of her confinement and the amount of time that she was in there. This successfully keeps you questioning her reliability as a narrator. 

The movie alternately paints her as somewhat of a personal hero, overcoming herself and doing the mental work required of her in order to be released, being fully aware of her diagnosis. In the book, however, Kaysen never learns her diagnosis during her stay, and she does not go through her transition into aggressive self-work that Susanna steps into after witnessing Daisy’s demise like she does in the film. In the film, the girls' escape is a pivotal point where Lisa pushes Daisy to suicide, and Susanna returns to McLean, afterward, with the realization that Lisa is not anyone to emulate, and she could either be like her and drop anchor at McLean, or she could do the self-examination required to be released. She gets a little help from Whoopi Goldberg, who plays Valerie the nurse, in the movie, who dunks her into a tub of cold water and tells her "You are a lazy, self-indulgent, little girl who's driving herself crazy.” Her release ultimately has the feel of a mental graduation into adulthood. In the book, Kaysen basically is released simply because she gets engaged, because it’s the 1960s and that’s what was important for women back then, to paraphrase. There is no hero doctor, there isn’t really even an overcoming of the self, there is just a release with almost a sense of confusion as to why she was even there in the first place, which possibly explains why the book has her seeming to question her own sanity much more than she does in the movie. She has an episode of depersonalization that isn’t exactly reflected in the movie. In fact, she seems less mentally ill in the movie than she does in the book, with her whole bone talk and hand incident. I personally feel as though it is her captivity in McLean itself that ultimately pushes her into this episode. It's said that you become like the people you hang out with the most, so it could stand to reason that if you hang out with people you consider crazy, eventually you may become crazy yourself. This is akin to Nietzsche's warning: "Battle not with monsters, lest ye become a monster, and if you gaze into the abyss, the abyss gazes into you."

McLean is symbolically a state of limbo that the girls are lingering in between childhood and adulthood. It holds them during this transition into adulthood and ultimately protects them while simultaneously keeping them from acquiring some of the life skills that they would need to survive on the outside. "This fucking place!" Lisa repeats throughout the book. The movie depicts this more as an idea of self-choice, highlighting Susanna’s realizations and progress with the scene from The Wizard of Oz where Glinda utters the famous line “You always had the power, my dear, you just had to learn it for yourself!” Not that I disagree, I believe that ultimately, we are the masters of our fate and the creators of our lives and hold all the power for change, and that's possibly what L. Frank Baum meant, but that isn’t exactly what happened in the book or in real life. Is it okay to portray someone’s memoir more brightly than it originally appeared? To add fiction to a nonfiction account? They do it all the time, I guess. This may be up for debate but in Hollywood anything goes. It makes for better entertainment, as the book had no real climax and lacked the quality of self-realization that Kaysen experiences in the movie. Kaysen actually left a lot of autobiographical details out of the writing and the account is somewhat observational. It also lacked a villain or any real conflict of character versus character. While Kaysen, herself, would have been basically the villain at times, being character versus self, or McLean, for imprisoning her, character versus society or institution, in the end it was somewhat ambivalent. Who is the real conflict with here? In the book, I would say most of the conflict was with society and self. The movie, however, depicts Lisa Rowe, who is a diagnosed sociopath, as more of a psychopath towards the end, culminating in a scene where she takes Susanna’s journal down into the tunnels, reading it aloud to the other patients, and ultimately chases Susanna in a suspenseful scene where you aren’t sure if she’s in real danger or not. In the book, Lisa was more so a fellow victim, of her parents, a victim of McLean, and a victim of herself, she was a patient, after all. She still showed sociopathic tendencies but seemed overall more like a rebellious teenager, as with her lightbulb shenanigans. She definitely didn't seem as scary as she was portrayed by Angelina Jolie. I think it’s a more enjoyable character, though, the way she is played in the movie, but it is somewhat different. This is one case where I think the movie is actually better than the book. Yep, I said it!

This book begs the question: What's in a diagnosis? Are diagnoses always accurate? Of course not. It's all just guesswork in white coats, as a friend of mine said of the medical world, in general. You're better off trying to understand yourself than relying on a professional to tell you who or what you are, no matter how trained, certified, licensed, or knowledgeable they are. That being said, labels and diagnoses are often necessary in order to generate the acceptance needed to open you up to your own healing. Sometimes you need to call a thing a thing in order to own it. This isn't to knock therapists or psychotherapy, both are absolutely necessary when needed and psychology is a special interest of mine, but you know more about yourself than anyone else ever will...if you allow yourself to see it. This road to understanding and self-realization often times begins with submitting to some form of treatment or care, though. The work of knowing yourself also takes a lifetime, and most people are not geared towards questioning their behaviors or idiosyncrasies as much as one is required to when going on this journey. You are the work of your life but be careful in there. The abyss is scary, not many people like to gaze into that. The trouble with diagnosis, though, is that everybody, no matter how generalizable they may be, is still an individual. Borderline personality disorder is named such because it was originally believed to exist on the borderline between neurosis and psychosis. Neurosis being defined as a mental condition that involves symptoms of stress including depression, anxiety, obsessive behavior, or hypochondria, but does not include a radical loss of touch with reality. Psychosis, on the other hand, is defined as having lost contact with external reality and often includes hallucinations and delusions. BPD was thought to float in the liminal space between the two, teetering on the line. Borderline---it's not just a hit song by Madonna. This book makes you think about what it means to be a normal teenager and what it means to experience reality in general, but the world of psychology forces you to question: What is reality, anyway? Kaysen discusses this in the chapter titled "Mind vs. Brain" and she hits on some very solid truths about reality and the nature of mental illness. There are multiple parts in us, interacting and having a dialogue at all times. "The point is, the brain talks to itself, and by talking to itself changes its perceptions." (pg. 138) She describes this as Interpreter One and Interpreter Two but admits it's more nuanced than that. "Why stop at two?" she says. Thinking and thinking about thinking isn't the same thing. It all depends on perspective and whether you are identifying with your thoughts or observing them. Isn't reality somewhat subjective? Isn't society filled with silly rules of conduct that some people just can't seem to hack? We seem to have a social consensus on what reality is, but even people detached from this reality are surely attached to some form of reality, however alternate it may be. Neuroscientists and analysts can't understand psychotics, though, so they don't understand where they are coming from. They are making observations on mind and brain and assuming they are one and the same. Our collective experience is what we deem reality and honestly, sometimes it's enough to drive you mad. 

The diagnostic criteria for borderline personality disorder, as per the DSM, are described as thus:

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. 
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). 
5. Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.(Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright © 2000 American Psychiatric Association.)

What is the self? Isn’t it selfish, in and of itself, to develop the Self, while it yet remains a cornerstone of self-actualization? Kaysen did not publish her story until years after she was confined to McLean from 1967-1969. Much of the work happening in the psychology world during this time was experimental, even more so than today. In one of the deleted scenes from the movie, Susanna is talking to Melvin about how everything they do is basically an experiment anyway. They're still learning about her diagnosis, he admits, and patients, receiving analysis, meds, and experimental shock treatments, were all just a big study and practice. In the book and movie, Susanna recounts her time as a guinea pig like a true writer. There is a similarity between her voice and the narrative in traditional coming-of-age stories, the mature narrator later in life giving the account of their youth, but there is also a reliving of the experience, through the retelling, almost as if she is coming-of-age through the retelling of the story. She does also seem somewhat disconnected from emotions and practically scientific in her observations. It still highlights the struggles of coming to terms with life in general and what it means to grow up in this world. It may not be as exciting as many other tales; Kaysen just happens to deal with the monsters within herself instead of externalized monsters in graveyards or deep woods. In a way, Kaysen gives us a more esoteric view of the coming-of-age story. I highly recommend both the book and the movie. I'd most likely give the movie 4 stars, whereas I would give the book a solid 3 to 3.5. In my opinion, the book wasn't better, this time around, although it was still a good read.

McLean Hospital has admitted the likes of James Taylor, Ray Charles and even Sylvia Plath. This book is Kaysen's write-of-passage, of sorts. It hints at the idea that creatives are a little disturbed, but also touches on how we are all a little disturbed, in our own ways. Aren't our individual idiosyncrasies often times our own specific neuroses? Every experience in our lives has determined the structure of our individual personality. Borderline is considered a personality disorder. A disorder is defined as a disruption in normal functioning, but what the hell is normal, anyway? Couldn't many of the symptoms that Kaysen was presenting with be considered normal reactions to certain abnormal conditions? If this is true, then it's not a disorder, per se, it's the structure of her personality. Carl Jung, the father of analytical psychology, stated: "In all chaos, there is a cosmos, in all

disorder, a secret order." What seems out of sorts by a certain set of standards and rules, may be perfectly sound by a set of others. We indeed have a common thread within our psyches as humans that can be generalized and studied by others, but ultimately, our personal experiences and environments leave the constructs of our personality very unique, and viewing life through our own particular lens is a truly individual experience and that's absolutely something to write about. As the Ancient Greek aphorism goes: Know thyself!