Borderline Personality Disorder - Girl, Interrupted - Book Report/Review Example

Human Sexuality - Girl, Interrupted 1. Key Terms. The topic chosen for discussion in relation to the film Girl, Interrupted (Mangold, 1999) is mental illness, since the story revolves around a group of women who all spend time in a hospital for the mentally ill. Four terms are selected for closer analysis: the condition known as “borderline personality disorder” which is suffered by the main character and narrator of the film, Susanna Kaysen, sociopath which is what the character Lisa is said to be, and two symptoms of mental illness : affective instability, and micropsychotic phenomena. Borderline personality disorder is an inexact term which describes a long term instability in a person’s sense of self. Originally doctors thought it was a border between neurotic and psychotic illness. It is characterized by quick mood changes and chaotic personal relationships. People who have borderline personality disorder are usually impulsive and engage in activities which are high risk and can cause harm to themselves or to others. Sociopath is a term used for a person who suffers from antisocial personality disorder. This is a serious personality disorder which shows many of the same symptoms as borderline and other personality disorders, but usually in a more extreme form and with a marked disregard for the feelings of other people. The person lacks a sense of right and wrong and often resorts to criminal activity. Affective instability is a term used to describe the swiftly changing emotional state of someone suffering from some personality disorders. Sufferers and their families undergo a “rollercoaster” of extreme emotions, often lasting only a few hours at a time. Micropsychotic phenomena are short lived delusions, hallucinations or thoughts which result in odd behaviour but the patient does have insight of them, unlike schizophrenic delusions, of which the patient has no real understanding or awareness. 2. Film content. The film is narrated by a young woman of about 18 years old called Susanna Kayson, played by Winona Ryder, and it opens with her admission to hospital following an overdose of both alcohol and over the counter drugs. The film is set in the 1960’s and so it is to be expected that some of the issues are being presented with a historical perspective. Treatment options, and the layout and strict organization of the hospital, for example, appear old-fashioned, and it is likely that many aspects of mental health theory and practice have changed in America in the last thirty or forty years. From the start there is a question in the narrator’s, and also in the viewer’s mind regarding just how ill this person is. The film shows Susanna’s introduction to the daily routine of the hospital which includes meetings with various doctors who try some version of “talking cure,” the issuing of sedative drugs, and frequent interactions with a down-to-earth nurse played by Whoopi Goldberg who thinks that Susanna is not mad, but just “a lazy, self-indulgent little girl who is driving herself crazy.” At first Susanna is bewildered by all that happens to her, and it seems from her flippant answers to the doctors regarding the overdose episode that she does not want to face up to what she has done, or why, or what this means now and in the future.. Susanna is drawn to the other young women who are enclosed in the hospital ward alongside her. The range of disorders represented here is fairly broad, including the character of Daisy, who has a eating disorder as a result of being sexually abused, a young woman who has been badly burned, and another who is a lesbian, which reflects the prejudices of the 1960s. Susanna makes friends with a young woman called Lisa who seems proud of the fact that she has been diagnosed as a sociopath. At first Susanna does not have a clear diagnosis, but it is clear in the film that there is a very great range in the severity of illness that patients are suffering from. Lisa is an extremely difficult and aggressive woman, who stirs up trouble, and preys on the weaker members of the group, driving them to tears or even in one case, to suicide. Her problems are much more severe than Susanna’s and yet the two woman bond instantly and become close friends. Lisa is like an older, long term prisoner, and in fact refers to herself as a “lifer” at one point, and she takes upon herself the role of mentor and guide to the newcomer Susanna. When Susanna’s boyfriend visits and encourages her to come out of the hospital and go away with him, Susanna responds with an expression of loyalty to her new environment and her new friends. Toby, the boyfriend, ridicules them saying that these girls are “eating grapes off the wallpaper, they’re crazy” but Susanna replies calmly “If they are, then I am.” (Mangold, 1999) This is a theme which recurs in the film. Mental illness is presented as something which we are all potentially susceptible to, and sympathy is created for those who are stigmatized by generic terms like “mad” or “crazy.” Through talking with a wise older woman called Dr Wick, played by Vanessa Redgrave, Susanna learns to understand more about her own mental “ambivalence.” She also learns to discern the difference between Lisa’s destructive influence on the one hand, and the possibility of choosing to leave the hospital and face up to life outside again. Dr Wick’s suggestion that being ill, and being well are actions which some people can choose, is a more modern approach to mental illness, which returns a large part of the responsibility for healing back to the patient herself. Although she displays some extreme behaviors such as sexual promiscuity, self-harming and the suicide attempt, and hallucinating when she says that the bones in her hands disappear and reappear, Susanna is intelligent, capable of learning, and able to regain control of her life and move on from her adolescent mental problems. She is discharged from the hospital, and says good-bye to Lisa, who will more than likely never be released. The initial question about how ill, if at all, she actually is or was, is left open. 3. Information from Textbook (Myers) The section entitled “Personality Disorders” in Myers’ textbook on Psychology (pp. 653-655) defines the term “personality disorders” as “inflexible and enduring patterns of behaviour that impair one’s social functioning.” Often they check for delusions and other symptoms that indicate these serious conditions like schizophrenia and bipolar disorder, and if they find no such symptoms, then the diagnosis by default is a personality disorder. It is very striking that doctors still argue about how to classify personality disorders, and there seems to be no exact and clear differentiation between each one. Myers writes about “clusters” including avoidant personality disorder, which is characterized by anxiety, and schizoid personality disorder which is characterized by eccentric behaviour coupled with social disengagement. The most relevant category for the film Girl, Interrupted is the third cluster, which “exhibits dramatic or impulsive behaviors.” (Myers, 2003, p. 653) It is surprising that Myers focuses most attention on the sociopath variety, which is incidentally in the same cluster as the borderline personality disorder, and draws out particularly the tendency towards criminality that can occur in this case. The graphs and illustrations show both a physical component to the sociopath disorder, in terms of brain scans showing frontal lobe cognitive deficits, and a social component, since studies have shown that patients who suffer particular combinations of risk factors like childhood poverty and obstetrical complications are much more likely to have the severe sociopath disorder than those who have no risk factor, or only one of them. Myer notes that nature and nurture interact to create maladaptive patterns in sufferers and that impaired function escalates into criminal behaviour in the case of sociopaths. In other situations these same genetic tendencies that can be spotted in children as young as 3-6 years old “may lead to courageous heroism, or star-level athleticism.” (Myers, 2003, p. 654) 4. Summary of article on Cost-effectiveness of two types of treatment for borderline personality disorder. (Van Asselt et al., 2008) This article takes a look at different ways of treating borderline personality disorder, and considers not only the effectiveness of different treatments, but also their cost-effectiveness in a modern setting where hospitals and health providers are constantly under pressure to treat more patients with limited amounts of funding. In the case of borderline personality disorder, patients often have treatments lasting many years, with little hope of a cure, but definite possibility of containing and improving symptoms, and so it makes sense to look at cost effectiveness as one of the factors in deciding which treatment to offer. The context is out patient treatment, which reflects current trends in the Netherlands, where the study was based. A total of 86 patients attending a total of four health centers were surveyed over a four year period. About half were undergoing schema focused therapy, (SFT) and half transference focused psychotherapy (TFP). It was recognized from the outset that SFT was the cheaper option, but the authors wanted to check whether it was more or less effective than the more expensive option TFP. Care was taken to adjust for geographical and social variations between the different patient groups, and an attempt was made to estimate both the costs to the health providers and the costs to wider society in dealing with those patients. One finding was that “the societal costs in the SFT group were lower and the recovery rate was higher compared with the TFP group.” (Van Asselt et all 2009, p. 452) Items such as “psychotherapy, treatment centre care, general practitioner, medication” were included but also some non-health services like social work assistance or addiction counseling, lost production estimates for those who were in work, and “out of pocket main costs” such as alcohol and drugs. A large party of the care for patients with borderline personality disorder was given outside the healthcare sector, which is cited as a reason for looking very widely into society at large to trace where the burden of costs actually lies. Graphs are provided to show numeric comparisons. Some limitations were admitted in this study, including a decision to “impute assessments” by carrying forward data from one session to another if some assessments were missed. Another qualifying factor is that the authors relied on patient views for some data, and this may have been flawed at times, since patients do not always accurately report what is and what is not related to their disorder. It was a ground-breaking approach, and so the authors are reluctant to claim too much, and their work does not compare well with existing studies which use very different methods and measures. The conclusion does, however, recommend continuing long term SFT care for this group of patients and looking for new ways to measure costs and benefits of treatment. References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Association, 1994. King, Bruce, M. Human Sexuality Today. 6th edition, Upper Saddle River, NJ: Prentice Hall, 2008. Mangold, James (Dir.). Girl, Interrupted. Starring Winona Ryder, Angelina Jolie, Vanessa Redgrave and Whoopi Goldberg. Columbia Pictures, 1999. Film. Myers, David G. Psychology. New York: Worth Publishers, 2003. Van Asselt, A.D.I, Dirksen, C. D., Arntz, A. et al. “Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused pscychotherapy.” British Journal of Psychiatry 192 (2008), pp. 450-457. Available online at: http://bjp.rcpsych.org/cgi/reprint/192/6/450 Read More