Introduction
The movie Girl, Interrupted is a psychological drama exploring the relationship between two main characters with different mental health disorders. The primary focus of the given analysis will be on Susanna Kaysen, an 18-year-old woman with borderline personality disorder or BPD. The plot begins with Susanna overdosing on pills, which results in her relocation to a psychiatric hospital called Claymoore. Throughout the story, she interacts with various patients at the hospital, with the most prominent one being Lisa Rowe, played by Angelina Jolie. The latter is a sociopath who regularly escapes the center and refuses to undergo treatment procedures. Susanna’s past background is revealed to be filled with inappropriate and questionable sexual interactions with her professor and a young man named Toby.
Lisa and Susanna build a complex and intricate bond with each other, which results in them escaping the hospital together. Lisa’s lack of empathy leads to the main characters’ friend’s death due to suicide, after which they split their ways, where Susanna returns to the center and undergoes all of the necessary treatments and therapies (Mangold, 1999). Subsequently, Lisa is caught and brought back to the center, where the two have a confrontation in the tunnels, and Susanna reveals Lisa’s emotional dependence on the hospital. The latter is profoundly affected by her friend’s statement, which makes her contemplative about suicide (Mangold, 1999). However, other characters are able to prevent Lisa from committing suicide, and Lisa and Susanna reconcile on the latter’s last day at the hospital.
Susanna Kaysen
It is important to note that the given analysis will primarily focus on Susanna Kaysen, although Lisa also offers an interesting example for an investigation. Susanna is a person with a major self-image problem alongside her instability and impulsivity throughout the movie. In addition, these factors are accompanied by an aimlessness in life, and her sexual relationships with the professor and boyfriend, usually on the same day. Susanna engages in substance abuse through pills in order to inflict self-harm. Lastly, she can easily become inappropriately and intensely angry while interacting with others, such as the head nurse.
Diagnosis: Borderline Personality Disorder
The diagnosis of borderline personality disorder is evident because it is revealed by Susanna’s therapist in the movie and through up-close observations of her behavior and actions. It is stated that “BPD is found in ∼1.7% of the general population but in 15–28% of patients in psychiatric clinics or hospitals and in a large proportion of individuals seeking help for psychological problems in general health facilities” (Gunderson et al., 2018, p. 1). In other words, the illness impacts a rather small percentage of the total population, but a quarter of patients in psychiatric centers indicate the severity of BPD. In general, “BPD is characterized by extreme sensitivity to perceived interpersonal slights, an unstable sense of self, intense and volatile emotionality, and impulsive behaviors that are often self-destructive” (Gunderson et al., 2018, p. 1). Therefore, instability in one’s behaviors, emotions, and thoughts is the key indicator of the condition.
In order to properly diagnose the disease, it is critical to consult the DSM-V manual. Borderline personality disorder’s code number is 301.83 (F60.3), and the diagnosis is conducted only after a patient has at least five or more of nine symptomatic descriptions (APA, 2013). DSM-V states that BPD is “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 five (or more) of the following” (APA, 2013, p. 663). The five relevant criteria will be presented in order to focus on Susanna’s case with a higher degree of precision.
Firstly, a person needs to exhibit a clear pattern of alternations between devaluation and idealization within a framework of unstable and intense interpersonal relationships. Susanna demonstrates such behavior in regard to both Lisa and her boyfriend. Both relationships are highly unstable and intense, and while Lisa has her own contribution to the pattern, the boyfriend can be considered normal. For example, Susanna initially perceives Lisa in an idealized frame, where the latter is willing to follow the former even during the escape. However, by the end of the film, Susanna destroys Lisa’s personality and self-worth to the point that the sociopath contemplates suicide. Secondly, DSM-V states that there needs to be “impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)” (APA, 2013, p. 663). Susanna shows the given symptoms in regard to sex and substance abuse within the film. For instance, the protagonist engages in self-harming sex with both her boyfriend and professor on the same day, and she also abuses pills to inflict harm on herself.
Thirdly, one of the indicators of BPD is a chronic feeling of aimlessness and emptiness. The given condition is demonstrated by Susanna in her pessimistic view of the world for the most part of the film. Chronic feeling of aimlessness and emptiness commonly occurs between her anger outbursts and self-damaging behaviors. It is also confirmed by the character herself after she learns about her condition and reads about its symptoms to her friends. Fourthly, DSM-V states a patient needs to show “inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)” (APA, 2013, p. 663). The given criterion becomes evident during Susanna’s interactions with her therapist or head nurse, where she speaks with an angry tone and raises her voice without a clearly appropriate reason. Fifthly, the “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” is present in a milder form in Susanna, with a higher emphasis on self-mutilation rather than suicide attempts (APA, 2013, p. 663). Although the film begins with a suicide attempt, the protagonist denies it, making the event either a case of self-harm or suicide.
Treatment
When it comes to the treatment process of borderline personality disorder, two main approaches can be highlighted. One is the use of medications, and two is the integration of psychotherapy. The drugs might include mood-stabilizing drugs, antipsychotics, or antidepressants, which are mainly used to treat impulsiveness, anxiety, or depression (Whitbourne, 2020). The applicable and varyingly effective psychotherapy treatment options include dialectical behavior therapy, mentalization-based therapy, schema-focused therapy, good psychiatric management, and transference-focused psychotherapy. It is stated that “randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy)” (Guilé et al., 2018, p. 199). Therefore, both methods of treatment of BPD can be considered effective, but it is possible to combine them in order to achieve a greater effect.
The treatment plan should involve dialectic behavioral therapy or DBT for three main reasons. Firstly, DBT is best suited for adolescents or young adults, which is preferred since Susanna is 18 years old in the film (Guilé et al., 2018). Secondly, it is stated that DBT can include “individual psychotherapy, multifamily skills training groups, family meetings, telephone coaching for patients and family members, and supervision for therapists” (Guilé et al., 2018, p. 206). Thus, considering the fact that Susanna has both parents actively involved and interested in their daughter’s recovery, such flexibility between individual and family-centered approaches can prove to be useful for the patient. Thirdly, DBT is “associated with a greater long-term reduction in self-mutilating behaviors, suicidal ideation, and depressive and borderline symptoms” (Guilé et al., 2018, p. 207). In other words, the evidenced improvements are observed in the areas and symptoms which are of prime interest to Susanna, who also suffers from the described issues.
Susanna should be enrolled in a one-year program focused on both individual and family therapies to ensure that multifamily skills are acquired under professional supervision. Shorter duration DBT versions are also possible, as short as 19 weeks (Guilé et al., 2018). Involving the family members is critical since Susanna has no one else to rely on in case of hardships in life. The meetings should be conducted three times per week, either on Mondays, Wednesdays, and Fridays, or Tuesdays, Thursdays, and Saturdays (Guilé et al., 2018). After the 19-week treatment is completed, Susanna should have a follow-up assessment of either six months or one year with minimal invasiveness from the professional’s side. In addition, the patient should be given prescriptions for mood-stabilizing drugs and antipsychotics with no need for antidepressants unless explicitly requested and depressive symptoms are observed.
Dialectical behavioral therapy is designed to be a mindfulness-based method. DBT is designed to prevent suicidal behavior in patients with borderline personality disorder. It is distinguished by a detailed study of the therapy process. The year-long course of DBT includes weekly individual and group therapy sessions, phone consultations, and mandatory weekly meetings of participating psychotherapists to discuss the treatment process. The main goal of therapy is to change suicidal, pathological patterns of behavior, emotional response, and thinking based on their study. Therapeutic tasks are subdivided into groups of problem-oriented and complementary skills. As a behavior requiring correction, they are considered a borderline personality disorder. This includes impairments to interpersonal interaction, affectivity, self-perception, behavior, and cognition. It is important to include the skills of interpersonal communication, regulation of the emotional state, and coping with stress, as well as the skills of completeness of awareness, among the skills necessary for mastering. In addition, it is necessary that the patient develop skills that promote the growth of personal integrity and are identified as fundamental to the entire process of psychotherapy.
DBT is used to treat patients with borderline personality disorder, suicidal behavior and substance abuse. The use of DPT for the treatment of depression, including those that has arisen in people suffering from a borderline personality disorder and for patients with substance abuse behavior disorders, has been described. Patients who received DPT, the year of therapy, and the year of follow-up were half as likely to commit suicide attempts, were less likely to be hospitalized due to suicidal thoughts, and the severity of suicide attempts and self-harm was less than in the comparison group (Whitbourne, 2020). Patients treated with DBT were less likely to withdraw from treatment and were less likely to seek inpatient and emergency medical care due to mental health conditions. In DBT, unlike other techniques, it is assumed that the acquired skills of the fullness of awareness are maintained throughout life, which excludes constant reinforcement through meditation.
Movie Discussion
It should be noted that the movie affected me profoundly because of two major reasons. Firstly, the film is based on a true story since the protagonist, Susanna, existed in real life and experienced the hardships shown in the plotline. In other words, there is a sense of authenticity despite the artistic interpretation elements, which make the depicted story believable and relevant for my field of study. Secondly, both Winona Ryder and Angelina Jolie played their respective roles phenomenally, properly showing the key symptoms as realistically as possible. The combination of these two factors created a movie, which is not only enjoyable as a source of entertainment but also as a professional curiosity of looking inside a clinical setting of a psychiatric hospital. Many not evident challenges of psychiatric care and patient management are revealed within the scenes, such as the head nurse Valerie trying to protect the characters from harm.
Conclusion
In conclusion, Susanna, in the film Girl, Interrupted, is diagnosed with borderline personality disorder. The major symptoms include alternations between devaluation and idealization in interpersonal relationships, impulsivity in sex and substance abuse, and a chronic feeling of aimlessness and emptiness. In addition, Susanna regularly becomes intensely and inappropriately angry and contemplates suicidality and self-mutilation. These five factors fit the diagnostic criteria in accordance with DSM-V for borderline personality disorder. The treatment plan should involve a combination of psychotherapy and medications.
References
APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Guilé, J. M., Boissel, L., Alaux-Cantin, S., & Garny de La Rivière, S. (2018). Borderline personality disorder in adolescents: Prevalence, diagnosis, and treatment strategies. Adolescent Health, Medicine and Therapeutics, 9, 199–210.
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018). Borderline personality disorder. Nature Reviews Disease Primers, 4(18029), 1-20.
Mangold, J. (1999). Girl, interrupted [Film]. Columbia Pictures.
Whitbourne, S. K. (2020). Abnormal psychology: Clinical perspectives on psychological disorders. McGraw-Hill Education.