Girl, Interrupted by Susanna Kaysen - Book Report/Review Example

Girl, Interrupted by Susanna Kaysen Summary Girl, interrupted is a memoir in which Susanna Kaysen tells her story as a young girl diagnosed with personality disorder. In 1967, when she was just aged 18, Kaysen was sent to McLean Hospital after having a session with a psychiatrist in Boston, a session that lasted only twenty minutes. She was to be treated for depression at the hospital. Initially, she was supposed to spend a few weeks at the hospital, but she ended up spending close two years at the facility. During her time at the facility, Kaysen received a variety of treatments including drugs and therapy. While at the hospital, she met other patients suffering from various conditions, some of whom became her friends. Through this book, Kaysen tells the stories of these patients. For example, she describes Polly, a girl who had self-inflicted injuries to her body. These injuries left her disfigured. Some of the other patients described include Georgina, Daisy and Lisa. The book also has sections derived from the medical records at the hospital. These records give additional information about Kaysen and the hospital. For example, through these records, Kaysen shows that the psychiatrist at Boston referred her to the hospital because he thought she would kill herself. Kaysen also gives some biographical information about a number of the health workers at the facility. As she recovers, she starts to look for a job outside McLean hospital. She realizes that people who have at one time suffered from mental illnesses are treated unfairly by the society. After leaving hospital, Kaysen enters into a relationship she had started before being taken to hospital. A couple of years after leaving hospital, Kaysen met some of her friends she had met at the hospital. Girl, Interrupted highlights the society’s perception about mental illnesses and how such patients are treated. By reading the book, one can get a clear picture of what psychiatric hospitals looked like in the 1960s. Diagnosis of main character and other characters Throughout the book, most of the characters exhibit different mental disorders. This section gives the diagnoses two of the major characters in the book based on the five axes of the DSM-IV. Susanna Kaysen Axis I: None Axis II: 301.83. Borderline Personality Disorder Axis III: None Axis IV: Severity of Psychosocial Stressors criteria -socialization issues; unemployed Axis V: 34-40: she has problems in thinking, socialization and making sound judgments. For this patient, Axis II: (301.83. Borderline Personality Disorder) diagnosis was given because she exhibits symptoms such as inconsistent moods, poor relationships, negative perception about herself and highly impulsive. For example, she has a poor relationship with her parents and most of her friends. Her impulsiveness is evidenced by the fact that she has already had a relationship with her school English teacher. Lisa Axis I: None identified Axis II: 301.7. Anti-social Personality Disorder Axis III: addicted to smoking (Nicotine) Axis IV: always on the wrong side of the law, unemployed, poor social support Axis V: 35-40 The Axis II was given to this character because she fails to conform to the set rules and regulations at the hospital. She is constantly breaking the law and making life uncomfortable for others, including the staff workers at the hospital. She engages in complicated and dangerous pranks while at the hospital. For example, in one conversation with Kaysen, it is clear that she was planning to escape from hospital. Borderline Personality Disorder The main character, Susanna Kaysen, suffers from this disorder. Borderline Personality Disorder (BPD) is a type of chronic psychiatric disorder that is mainly characterized by mood instability, impulsiveness and poor interpersonal relationships. In addition, this is also characterized by suicidal behavior (Paris, 2005). Due to these characteristics, patients suffering from this disorder are sometimes challenging to treat, and this is a major challenge to health care providers. BPD is a wrecking mental disorder not only to the patient but also to the people around the person. Studies have revealed that the prevalence of this condition in adults is at about 1%, and most of the patients receiving treatment for this condition are mainly women (Paris, 2005). Like many other personality disorders, patients suffering from BPD are likely to have had poor upbringing, of lower social status and have no or limited education. Causes and Risk Factors of BPD A number of studies have been conducted to identify the causes of this disorder. However, these causes have not been fully understood, and further studies are currently being undertaken to understand its causes (Paris, 2005). Generally, the causes of this disorder are classified into three main groups: social, biological and psychological. First, the biological causes are associated with the heritable traits one is born with which manifest in adulthood. Two major characteristics have been observed to be hereditary: impulsiveness and poor interpersonal relationships (Paris, 2005). In addition, it has been observed that a family history studies reveal that first degree relatives of people with impulsive disorders are likely to exhibit the same in adulthood. Neurologists have also observed that impulsive characteristics or traits are linked to the deficits in the central serotonergic functioning (Paris, 2005). However, the contribution of these biological factors to this disorder is still not well established. Secondly, when it comes to the psychological factors, research as shown that many of the patients suffering from this disorder are adolescents (Paris, 2005). Such patients report a number of risk factors such as family dysfunction and abuse. In particular, most of the patients report sexual abuse during childhood, while almost a third of the patients report harsh treatment or abuse. In general, such difficult life events have been shown to contribute to the development of this disorder for vulnerable populations. Finally, there has been indirect evidence to suggest that social factors contribute to the prevalence of this disorder. The most common factor identified is poor parenting, and this is mainly due to the separation of the parents or unsupportive care (Paris, 2005). This extent to the type of family comes from, where, for instance, a child may be exposed to violence by other members of the family. Generally, studies have suggested that societies that are undergoing rapid change are likely to contribute to this disorder compared to traditional families. However, the contribution of these social factors is not clear, and this remains a subject of further research. Effects of BPD As mentioned, BPD does not only affect the person with the disorder but also everyone around that person. First, this disorder causes stress and discomfort in the family. In many cases, persons suffering from this disorder engage in self destructing behaviors and activities, and this leaves friends and family members with a feeling of helplessness (Paris, 2005). Furthermore, people with BPD are likely to injure themselves and/or commit suicide. Secondly, the management of this condition is not only a costly affair but also time consuming. In many cases, healthcare providers demand that the family members help in the management of this disorder, and this may also require the involvement of multiple care providers (Paris, 2005). This leads to higher costs of management. For the patient, this can be stressing, and this limits the ability of an individual engaging in productive activities. Thirdly, due to the poor relationship behaviors exhibited by such patients, it becomes difficult for them to maintain stable relationships. This affects their social life, and this may extend to their marriage life. Furthermore, the inability to maintain proper relationships makes it harder for the patient to get assistance in managing the condition. Symptoms BPD patients exhibit a number of symptoms that can help to distinguish them from patients suffering from other disorders. However, most of the symptoms shown by BPD patients are common to other disorders as well. The first symptom is depression where the patient has a lowered mood that is generally short-lived (Paris, 2005). As a result, such people change their moods rapidly. The patient will thus change from depression to anger, and this usually lasts for a very short time. Secondly, such people exhibit cognitive dysfunction. This is shown through auditory hallucinations related to stress. This may also involve dissociative symptoms where one feels isolated from the rest and generally looses touch with reality (Paris, 2005). Thirdly, such patients have recurring suicidal behaviors or engraining in activities that case bodily harm such as stabbing and cutting. Fourth, such patients may exhibit rough or stormy relationships with family members and friends. These relationships are intense and range from real love and closeness to anger and dislike. Finally, such people many engage in erratic and impulsive social behaviors such as overspending, too much sex, drug abuse, speeding and excess eating. Treatment There are a number of ways of treating BPD, although most of these treatments take time. The first treatment option is through dialectical behavior therapy, which is based on the idea that BPD is as a result of deficits in self-regulatory and interpersonal skills. Therefore, this treatment approach attempts to teach these skills to the BPD patients (Winston, 2000). This involves weekly group and individual therapy sessions where patients are trained on various skills. In addition, this may involve telephone contact between the therapist and the patient. Secondly, the psychoanalytic psychotherapy approach may also be used. This is one of the oldest treatment methods, although it has not been subjected to clinical trials (Winston, 2000). A modernized form of this therapy focuses on the present experiences as opposed to the past in which the therapists are actively involved in the treatment process. Thirdly, the cognitive-analytic therapy (CAT) may be used where a collaborative strategy between the patient and the therapist is used (Winston, 2000). This approach is used in order to identify self-states. During this therapy, the BPD patient is helped in making connections between past experiences and the current behavior exhibited. This helps the patient to change and adopt only the positive behaviors. Fourth, there is also the schema-focused cognitive therapy where concentration is given on the identification and the modification of the ‘early maladaptive schemas’ that are believed to be behind the BPD (Winston, 2000). Schemas in this case refer to the feelings one has about himself and his/her relationships with the people around. These behaviors are usually developed during childhood and manifested in adulthood. Therefore, during therapy, the core schemas are activated, which are then discussed. Finally, the treatment of this disorder also involves medications. Some studies have shown that medications can be combined with psychotherapy in order to better the outcomes, although there are no specific medications that cure this disorder on their own (Paris, 2005). Research has shown that some medications help in managing certain symptoms associated with BPD. For instance, some medications may be used to reduce behaviors such as depression, anxiety and aggression. Generally, the medications used in treating one patient may not be used to treat another patient (Paris, 2005). Furthermore, some of these medications may have varied side-effects to the user. Therefore, it is usually important for clinicians and patients to understand that these medications do not cure the disorder but only help in containing it. Defense mechanisms When the ego is threatened or has a difficult time in making a decision, it employs a number of defense mechanisms. The main character in the book, Susanna Kaysen, employs some of these mechanisms in an attempt to deal with her problem. The first defense mechanism employed by this character is denial. With this defense mechanism, an individual refuses to perceive the facts as they are. In Girl, Interrupted, Kaysen employs this mechanism to run away from her problem. For example, although there were signs of hallucinations, she states in the book that “I never ‘believed’ anything I saw or thought I saw” (Kaysen, 1993). In addition, after having been released from hospital, she continues to deny her condition. For instance, she responds to this by claiming that “…instability of self image…mood” are descriptions of an adolescent (Kaysen, 1993). For her, the condition was imposed to her by the doctors. This is pure denial. Secondly, this character uses rationalization as a way of justifying her behaviors and actions. This defense mechanism involves one giving logical or rational reasons instead of focusing on the real reasons. For example, when she was ordered to go to hospital by the doctor, she claims that this was done in order to protect her from the mean and cruel world she has been living. To her, there was nothing wrong with her, and there was no need to be taken to hospital. Another example of rationalization is clear when she attempts to explain the reasons for wanting to commit suicide. She says that she wanted to do away with a “certain aspect of my character” (Kaysen, 1993). To her, every action she took had a justification. Susanna’s Behavior Human behavior can be explained through a number of theoretical perspectives. This section attempts to explain Susanna Kaysen’s behavior based on the psychodynamic perspective and the social behavioral perspective. First, the social behavioral perspective is based on the idea that human behavior is learned as people interact with others and their environment (Hutchison & Charlesworth, 2010). For Susanna, her behavior was mainly shaped by the people she interacted with, both outside and within hospital. For example, it shown in the book that she had a negative perception towards the teachers and the parents. In fact, she ended up abandoning school. This behavior can be attributed to the fact that her interaction with the parents and teachers made her develop a negative perception towards them. For example, she states that the parents and teachers did not share her self-image and did not put value on her. As a result, she did not obey the teachers’ instructions. She answered them rudely. As illustrated by the cognitive social learning theory, behaviors are shaped nu beliefs and expectations. For Susanna, the expectations of her parents and teachers of her did not favor her, hence the negative reception. In addition, the role played by the environment in shaping her behavior is well illustrated by her explanation for wanting to commit suicide. For her, she wanted to commit suicide because she did not want to writer her history paper. She was tired of offering explanations. In this case, the society had taught her that suicide is the best option of running away from personal problems. Coupled with the pressure on her by the people around her, she started to develop the suicidal thoughts and behavior. The second perspective in explaining human behavior is the psychodynamic perspective. According to this perspective, human needs, desires and emotions shape behavior (Hutchison & Charlesworth, 2010). The need to satisfy one’s desires and demands plays a great role in shaping behavior. For instance, unlike many other students in her class, Susanna wanted a future without a job, husband etc. She notes that when her classmates talked about “their fantasies for the future: lawyer, ethnobotanist…” she knew that was not what she wanted. This not only helps to explain her negative attitude towards teachers and college, but also her overindulgence in sexual activities and lawlessness. To her, writing and having multiple boyfriends is all that mattered. Another illustration is her unwillingness to take up other jobs in order to satisfy her smoking needs. For example, she states that one of the reasons why she decided to become a writer was to “be able to smoke in peace” (Kaysen, 1993). Furthermore, curiosity, which is one of the internal processes, greatly influenced her behavior. Most of her actions were motivated by her need to uncover or reveal something to satisfy her curiosity. For example, while at the hospital, she poked her arm just to find out whether the arm has bones or tendons. She states that she continued to poke deeper “to feel the bones” (Kaysen, 1993). Such behavior was simply born out of curiosity. Susanna’s ambitions and desires in life made her do crazy things that went against the wishes of parents, teachers and friends. To her, this was the only way to achieve happiness in life. Susanna’s Treatment Susanna was hospitalized for almost two years at McLean hospital. At the hospital, she and other patients were subjected to strict daily routines where nurses performed checks and periodic appraisals in order to understand the activities of the patients. In her memoir, Susanna describes the treatment she received at the hospital as talk therapist where she was asked the same two questions by the therapist: “‘Yes?’ and ‘Could you say more about that’” (Kaysen, 1993). In addition, drugs were also used to in treating her and other patients. For instance, she says that the therapists doped them on “Thorazine, Stelazine, Mellaril, and Librium” (Kaysen, 1993). Therefore, her treatment involved therapy sessions and medications. However, I do not entirely agree with the treatment approach used in managing Susanna’s mental problem. The fact that the therapists asked almost similar questions during every session makes the approach somewhat inadequate. This did not encourage an open two way communication channel. It appears that the therapist was not interested on gathering as much information as possible from the patient. It is important that the therapist cultivates an open dialogue with the client in order to understand the client’s fears and emotions. Furthermore, while Susanna was confined at the facility, the therapists did not interact with her parents and other people close to her. In order for a therapy to be effective, it is important that the patient’s family is involved on order to gain a deeper understanding of the victim’s behavior and actions. Involving the family makes the treatment process more effective. Furthermore, Susanna notes that the therapists doped with various drugs as a routine. Although drugs play an important role in managing some of the behaviors associated with BPD, it is important that such drugs are administered in a controlled manner due to the side effects associated with them. Conclusion Girl, Interrupted helps highlight to the readers the treatment given to patients with mental illness and the attitudes of the society towards them during the 1960s. Susanna’s behavior and reactions are a clear reflection of what persons with psychological problems go through. Her reactions and defense mechanisms are common to many people with similar problems today. Therefore, by reading this book and understanding Susanna’s behavior, readers are in a position to understand the behaviors exhibited by BPD patients. In addition, this is a good read for therapists as it helps highlight some of the strategies that can be used to manage patients with psychological problems. This assignment has facilitated my understanding of the DSM-IV and how it can be used in diagnosing patients with mental/psychological problems. In addition, this assignment has enabled for deeper research on the Borderline Personality Disorder (BPD) thereby enhancing my understanding of the symptoms, effects and treatment approaches related to this disorder. References AllPsych (2011). Ego Defense Mechanisms. Retrieved on 28 March 2014 from http://allpsych.com/psychology101/defenses.html American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM). Retrieved on 28 March 2013 from http://www.psychiatry.org/practice/dsm Hutchison, E and Charlesworth, L (2010). Theoretical Perspectives on Human Behavior. In Dimensions of Human Behavior: Person and Environment, pp. 34-69. SAGE. Kaysen, S (1993).Girl, Interrupted. New York: Random House. Paris, J (2005). Borderline Personality Disorder. Canadian Medical Association Journal, 172 (12), pp. 1579-1583. Winston, A.P (2000). Recent developments in borderline personality disorder. Advances in Psychiatric Treatment, vol. 6, pp. 211–218 Read More