The Borders Between Sanity and Insanity As Experienced by Susanna Kaysen in Girl, Interrupted

In this post, you will find my literary analysis essay of Girl, Interrupted by Susanna Kaysen.

“It’s easy to slip into a parallel universe”, Susanna Kaysen’s 1993 memoir begins with an explicit certainty that there’s a very thin line between the world of the sane and insane, and anyone is a step away from crossing this border. This point of view is a peek at the subject’s state of mind which is as ambiguous as it was certain. In “Girl Interrupted”, the narrator’s inside perspective reveals the author’s mental health crisis and her borderline personality disorder through her recounts of an uneven sense of identity and reality.

The memoir retells Susanna's experiences as an 18-year-old patient to the mental institution, McLean Hospital in 1967. Her retelling occurs in a non-chronological manner, and throughout her narration, she seemingly convinces the reader that she was misdiagnosed because there’s a blurred distinction between insanity and sanity. In her own words, her diagnosis was “accurate but not profound” and she was even “tempted to refute it”. Moreso, she claims that some of the basis of her diagnosis, which is uneven self-identity, inability to make choices, and promiscuity, are common among adolescents; and that diagnosis of mental illnesses go and change with trends.

In this analysis, the aspects behind the character’s nature of mind would be brought to the surface using a psychoanalytic lens, particularly, Otto Kernberg’s Object Relations Theory (1976) on Borderline Personality Disorders. But prior to diving deep into her psyche, it’s worth noting the memoir’s introduction which begins with the statement, “What I tell them is, “it’s easy”. It’s easy to slip into a parallel universe.” This is what Susanna replies to people who asks her about how she was admitted to a mental facility. Immediately, the narrator frames the story of someone ‘othered’, and situates herself as an insider to a ‘parallel universe’.

Towards the end of the first chapter, Topography to a Parallel Universe, the sentence, “Every window of Alcatraz has a view of San Francisco'', introduces the themes of perception vs. reality and sane vs. sanity as experienced by its main character. Alcatraz is situated in San Francisco bay, which naturally, would have a view of San Francisco. But the two contradictory places serve as symbols of normalcy and alienation. Alcatraz equates to a mental illness, which can feel imprisoning. It can also be likened to a completely different world—those of the criminals or metaphorically, the world of the insane. It equates to Susanna’s current state of being locked up in the mental health facility. The view of San Francisco connotes that in every insanity is a view of being sane and the two are almost inseparable. Having been able to say this statement says a lot about the character’s state of mind, which will be further elaborated.

Much of Girl, Interrupted revolves around Susanna’s conflicting perceptions and realities which were evident in her conscious hallucinations and inability to form interpersonal relationships. When she looks at things, she sees other representations within them—-such as seeing a forest or her class picture on a rug. She had constant glimpses and misrepresentations of things, and she is all aware of it. Hence, she wasn’t hallucinating or slipping away from reality. She also claims that when she sees a face, she takes it as a peculiar item "squishy, pointy, with air vents and wet spots" and instead of seeing too much meaning, she doesn’t see any meaning which hinders her from forming connections with other people. Susanna notes that for her, "reality was getting too dense", although she was aware of it and even points out that it was either her misfortune or salvation “to be at all times conscious of my misperceptions of reality."

Her confusion of reality and perception is in itself a manifestation of a borderline personality disorder. This mental illness is confusion between ‘normal’ neurotics and psychosis (Kernberg et.al, 2009). When Susanna was experiencing things outside normalcy such as seeing patterns on things but was completely aware of it, she was experiencing neurosis and not psychosis. According to Medindia, neurosis is a mild mental disorder, in comparison to psychosis which is a break from reality. As Susanna dwells on her peculiarity, she wonders whether “insanity is just a matter of dropping the act”, and even contemplates in the chapter, Etiology, whether she is “sane in an insane world”. Her conscious distinction of herself from insanity is an implication of her mental disturbance due to her personality disorder. This contemplation goes on as far as questioning her diagnosis. Because she was somewhere between normal and insane, she continually questioned whether the distinction between the two is accurate. This is evident in her contrasting statements, “I have to admit though, I knew I wasn’t mad”, but in a later chapter, “Was I crazy or not? It was a hard question in 1967, even twenty-five years later, it was still a hard question to answer.” Hence, it is arguable that the persona’s uncertainty about perception and reality, insanity and sanity, is in itself a product of her deranged state of mind–to which she was unaware of.

Susanna consequently lures the reader into believing that there was a poor distinction between sanity and insanity and this is her unconscious attempt to prove herself misdiagnosed. This is a form of denial, disturbance of personality function, and variability of moods, which again are symptoms of borderline personality disorder (Millon, 1996, p. 645). In her accounts, she presents her medical records and consequently comments on them. Her way of questioning her diagnosis was evident in the statement, "What does borderline personality mean anyhow? It's what they call people whose lifestyles bother them." The symptoms of her condition, “uncertain about several life issues”, she also counters in the statements, “I still have that uncertainty. How many would constitute more than my share? Fewer than somebody else–somebody who has never been called a borderline personality?”; “Instability of self-image? Isn’t this a good description of adolescence?”. While she has a point in these statements, she goes on to contradict herself by admitting to self-mutilating behavior. The exemplified self-mutilating behavior of wrist-banging in her diagnosis surprises her because it was too accurate. She even admits that she has never told anyone about hurting herself. In addition to this, Susanna also tries to ‘downplay’ her suicide attempt in complete disregard of its severity (Jones, 2012).

Throughout her accounts, it was obvious that she contradicts herself, and again, this is just an outward look to her psychology. Patients who suffer from BPD have externally or internally contradict concepts of themselves (Kernberg, 1975 cited by Christopher et.al, 2009). Admission to a suicide attempt and self-mutilating behavior themselves are in no way normal, hence, her claims towards the end can easily be deceptive. While the mental health field in the account’s milieu and even in the present has its discrepancies, the narrator’s passive contradiction of her diagnosis was in itself a manifestation of her mental health crisis.

Much of her behavior is also a manifestation of a borderline personality disorder despite her being in denial or unaware of it. There was one instance where Susanna describes having a perception about her perception of thoughts. “An avalanche of synthetic thoughts” attacks her either slowly or quickly, and she goes on saying that whether which of the two is worse, she could hardly care because “I never had to choose”, and that “one or the other would assert itself”. Such experience of identity disturbance in the form of paranoid thoughts is a facet of BPD (Millon, 1996). A worse byproduct of her paranoia also led her to feel like she had no bones in her hand. In an alarming instance, she felt like her hand looked like a monkey’s, and she had to chomp on it until it bled only to prove that she indeed has human bones. What happened to her in this scene was a total disassociation which according to Millon (1996) is a severe symptom of BPD.

Similarly, BPD is associated with suicidal attempts and extreme depression, impulsivity, instability of self-image, and strong desires for intimacy (Christopher et.al, 2009) which Susanna herself has suffered from. In her account after her suicide attempt, she wonders whether she could do it again, and goes on saying “It felt good. I wasn’t dead but a part of me was”. This is understandable knowing that she was extremely depressed and wanted to kill the sadness within her. Her suicidal attempt was also a craving for the attention of her parents who do nothing but admit her to a mental facility. Further, Susanna manifests strong desires for intimacy and impulsivity in instances she had an affair with her high school professor, and her unusual fondness towards one of the patients in Mclean, Lisa. Another instance also revealed her poor self-image, whereby she links her feelings of emptiness to her “incapacities, which were many”. This instability of self-image is another aspect of BPD that can root in biological or developmental problems. In Susanna’s case, her feelings of inadequacy certainly rooted in her family coming from a line of academics, and her being a drop-out.

The reason for Susanna’s disorder is rooted in her early childhood, and to understand her psychology as presented by the memoir is to better understand her life experiences. According to the psychoanalyst, Otto Kernber’s Object Relations Theory (1976), there are two developmental tasks that a person has to go through, and failure to do so can lead to a borderline personality disorder. The first is psychic clarification of the self and the other. This is being able to distinguish one's self from others, and the internal world from the external world. Failure to do so leads to a distorted sense of reality---common in schizophrenic and psychotic patients. The second developmental stage is overcoming splitting. Following the first task of distinguishing self from the other (meaning self from other people and external world), the next stage is to distinguish them through different affects. In this stage, the self and the other are often segregated as good and bad. Meaning, an individual differentiates the two through positive and negative feelings. Hence, the self and other can only be good or bad. But the goal is to know that both can be good and bad at the same time. Failure to do so can lead to borderline pathology.

Childhood plays a crucial role in these two developmental stages. It is then arguable that this instance in Susanna’s life may have greatly influenced the development of her disorder. According to Millon (1996), child neglect, together with child abuse tops the probable causes of borderline personality disorders. Kernberg and Michels (2009) also argue that unempathetic parental care and a poor mother-child match were among the common etiologies of this condition.

Susanna has experienced neglect in her childhood and a poor mother-daughter relationship which is evident in her latest quasi-autobiography, Cambridge (2014). Born from privileged and academic parents, Susanna had long experienced neglect and insignificance. Her father, Dr. Carl Kaysen was an economics professor at Harvard and a Deputy National Security Adviser to President John F. Kennedy. Due to his job postings, Susanna’s family moved from her home, Cambridge, Massachusetts to England, to Italy, and Greece. These marvelous and historic travels made Susanna feel a longing for home and a sense of unworthiness, she notes in Cambridge (2014) that Greece was a “long lesson to her insignificance”. She also craves and celebrates even the slightest attention from her mother. When the latter gives up trying to teach her piano, Susanna recounts that a part of her feels rejected but a part of her would be “gleeful and amazed”. Apart from this, the young Susanna is resentful towards her mother who was always right and which she considers “manipulative and phony”.

In her latest memoir, it was proven that Susanna had indeed failed the second developmental stage of Kernberg (1976), which was overcoming splitting. She had difficulty differentiating the good from the bad. In her recount, she admits to knowing that she tests the patience of the people around her, and in her words, she possesses within her “an indigestible nastiness”. She was up “against the impotence of being a child” and as a grade-schooler was passive-aggressive. According to her, her rebellion began at the time she refused to learn multiplication or to take a bath and was seemingly unreprimanded for it. These childhood experiences, together with genetics (although it was undisclosed, but could be a contributing factor) led to Susanna’s development of borderline personality disorder, as evidenced in her accounts in Girl, Interrupted. She even affirms this in her latest interview with Goodreads where she said that being admitted to Mclean didn’t surprise her because she came from an academic family, but she didn’t go to college, and that for her and everyone else was difficult—passively implicating that her family background and upbringing was indeed a factor to her condition.

Through her memoir, Susanna blurs the line between sanity and insanity and this may have falsely insinuated that anyone could be a borderline personality, but this very notion of the author is a reflection of her state of mind—which is unknowing of her dangerous tendencies, tainted by her condition. Towards the ending of her memoir, Susanna reencounters the painting of Johannes Vermeer, Girl, Interrupted, and experiences a sudden emotional outburst because she resonates deeply with its subject. True enough, her memoir was a retelling of her interrupted years marked by periods of uncertainty between reality and perception. She was a girl interrupted by the years she spent traversing on the borders of the sane and the insane.

REFERENCES

Christopher, J, Bickhard, M, & Lambeth, G Otto kernberg’s object relations theory: A metapsychological critique. Theory & Psychology, Retrieved May 20, 2009, from http://tap. sagepub. com/cgi/reprint/11/5/687.

Jones A, Smith J, Ott C. Girl, Interrupted: Two Perspectives. Ment Health Clin[Internet]. 2012;1(9):235. Available from: http://dx.doi.org/10.9740/mhc.n99719

Kernberg, O.F. (1976). Object Relations Theory and Clinical Psychoanalysis. New York: Jason Aronson.

Kernberg, O. F., & Michels, R. (2009). Borderline Personality Disorder. American Journal of Psychiatry, 166(5), 505–508. https://doi.org/10.1176/appi.ajp.2009.09020263

Mcalpin, Heller (2014) Before She Was 'Girl, Interrupted' She Was A Girl From Cambridge https://www.npr.org/2014/05/24/300255361/before-she-was-girl-interrupted-she-was-a-girl-from-cambridge

Millon, T. (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons.