Borderline Personality Disorder in Girl Interrupted - Movie Review Example

Borderline Personality Disorder Introduction Mental illness and personality disorders have become prevalent today, and this remains an area of interest in the field of health. There are different types of mental disorders that affect individuals. These have negative health and psychological consequences on the individuals, as well as those in their immediate environment. Borderline personality disorder (BPD) is one of the mental disorders that affect a significant part of the population today. There is need to understand this disorder in order to ensure that people, including mental health professionals, BPD patients, and other people in society, deal with it in the most appropriate manner. This essay focuses on the borderline personality disorder and draws from the 1999 film “Girl Interrupted,” which has borderline personality disorder as its main theme. Summary of the Movie (Girl Interrupted, 1999) The movie “Girl Interrupted” is based on a book written by Susan Kaysen. The film stars Winona Ryder as Susanna Kaysen, a woman searching for the meaning of her life and the struggles she goes through to find it in a mental hospital. Susanna attempts to commit suicide with pills and vodka, and this gets her to Claymore mental hospital, where she is diagnosed with borderline personality disorder and stays here for one year. While at the hospital, Susanna meets and befriends Lisa Rowe, a woman who is highly obsessive and manipulative. They develop a deep and dangerous relationship. Susanna rebels against the nurses and psychiatrists. However, Susanna finally finds her way and copes with her diagnosis of borderline personality disorder after breaking free from Lisa and other friends, and returns to the world and to a sense of reality. Borderline Personality Disorder Borderline personality disorder is a serious and complex mental disorder that involves a number of symptoms and maladaptive behavior. This is named borderline because this disorder lies between or on the border of psychotic and neurotic mental disorders. Borderline personality is mainly characterized by problems with relationships, perceived abandonment, control of emotions and behaviors, the identity of the sense of self and mortality by suicide (National Institute of Mental Health, n.d). People with this disorder may also suffer from other personality disorders and mental illnesses. Nevertheless, today, there are different treatments for the borderline personality disorder that are considered effective. Primary Diagnosis Personality disorders such as borderline personality disorder are usually diagnosed by a mental medical professional that is well trained. This may be a psychiatrist or a psychologist. Family physicians and general medical practitioners are not trained to make this type of psychological diagnosis; neither are they well-equipped to undertake this diagnosis. Therefore, if one consults their physician about this problem, it is expected that the physician refers them to a mental health professional for diagnosis and treatment. Unlike other biological diseases, the diagnosis of borderline personality disorder does not involve laboratory, blood or genetic tests (Gunderson, 2009). In many cases, it is rare for an individual suffering from the borderline personality disorder or other mental illnesses and personality disorders to seek medical attention. Usually, most of such individuals will wait until the personality disorder has advanced and is in its later stages, whereby it interferes with their life significantly, for them to seek medical attention. This mostly occurs when the affected individual has exhausted their coping resources, hence finding it challenging to deal with stress and other life events (National Institute of Mental Health, n.d). In making a diagnosis of borderline personality disorder, a trained mental health professional will compare the symptoms of the affected individual with their life history. This, therefore, involves a thorough interview with the mental health provider. The mental health professional will also conduct a psychological evaluation of the individual, and obtain a complete clinical history of the individual (Gunderson, 2009). This will, therefore, help the mental health professional to determine whether or not the symptoms of the individual meet the criteria necessary for the diagnosis of borderline personality disorder. In order to be diagnosed with borderline disorder, an individual must meet the criteria spelt out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published and updated by American Psychiatric Association, and is utilised by mental health professionals to diagnose mental conditions (National Institute of Mental Health, n.d). In the movie “Girl Interrupted,” the main character “Susanna” is diagnosed with borderline personality disorder. When she is rushed to the hospital after her attempted suicide, she holds a conversation with a psychiatrist. Susanna reveals to the psychiatrist that she has been having some delusions. She also reveals that she had been having an affair with the husband of her parents’ friend. The psychiatrist concludes that Susanna had attempted suicide when she took a bottle of aspirin and a bottle of vodka. Nonetheless, having known that Susanna suffered from the borderline personality disorder, the psychiatrist recommended that Susanna rests at the Claymore mental hospital for a given period. Susanna exhibited most of the symptoms of borderline personality disorder, hence her admission to the mental facility. Signs and Symptoms The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines different symptoms, among which an individual should exhibit at least five in order to be considered as having the borderline personality disorder. These among others include extreme reactions, stormy relationships with family and friends, distorted self-image, impulsive behaviors, chronic feelings of emptiness, recurrent suicidal behaviors, paranoid thoughts, emotional instability, and anger problems (National Institute of Mental Health, n.d). In more detail, people with borderline personality disorder experience frantic efforts to avoid imagined abandonment or rejection. This causes their self-image, thinking, emotion, and behavior to change. These will, therefore, be very sensitive to things happening around them. The fear of abandonment makes them experience inappropriate temper when they are faced with real separation (Cutler, 2014). The abandonment fears of people with borderline personality disorder are a reflection of their intolerance of being alone. To avoid abandonment, these people might engage in impulsive actions such as suicide and self-mutilation. People with borderline personality disorder are considered to switch rapidly from idealizing other people to devaluing them. They develop feelings that the other person does not care enough, does not give enough, and hence is not good enough. People with this disorder will only empathize with other people with the expectation that those people will also be available for them when they need them to meet their demands. There is, therefore, a rapid shift between beneficent support and as cruelly punitive. This shift is a result of disillusionment with other people whom they have idealized or whose abandonment is foreseen. This idealization and perceived abandonment can be seen in the movie, whereby Susanna was at first close to the staff at the hospital, but she later changed and become rude and stubborn to them (Chapman & Gratz, 2007). On the other hand, people with the borderline personality disorder may experience sudden shifts in self-image, exhibited by changes in opinions and plans about career, values, and types of friends, and sexual identity, among others. These individuals might at one time play the role of the needy supplicant for help and others, a righteous avenger of past unfair treatment. The self-image of individuals with the borderline personality disorder is based on being bad or evil. However, at times, these might feel like they are non-existent (National Institute of Mental Health, n.d). In the movie, it is quite clear that Susanna Kaysen was suffering from depressive symptoms and was experiencing a type of mental illness. She admits to experiencing feelings of emptiness and boredom. These are based on her perceived incapacities that were based on what was socially acceptable at that given time. Susanna also admits that she sometimes has self-injurious behaviors including face scratching and wrist banging. Furthermore, Susanna experienced suicide thoughts, one of the symptoms of a person with the borderline personality disorder. Susanna had attempted to commit suicide by taking a bottle of pills and vodka. Prevalence Borderline personality disorder is more prevalent in females, as compared to males. 75 percent of all the diagnoses made are in females. It is also considered that this personality disorder affects between 1.6 and 5.9 percent of the population in a given year. Borderline personality disorder, like other personality disorders, becomes less severe with age. For this reason, individuals that are aged from the 40s or 50s will experience only a few of the most severe symptoms of this disorder (National Institute of Mental Health, n.d). Treatment Modalities The treatment of borderline personality disorder involves the use of psychotherapy, or “talk” therapy. In some cases, the mental health professional may recommend medications to treat different symptoms of the disorder. There continues to be a research on treatment of borderline personality, therefore, the most effective treatment for borderline personality disorder has not yet been determined. Nonetheless, the first treatment of people with the borderline personality disorder is psychotherapy. Research today points out that psychotherapy has the potential of relieving some symptoms of the disorder (Clarkin Levy, Lenzenwenger & Kernberg, 2007). However, there is no clear understanding on how psychotherapy works. There are different types of psychotherapy that are used to treat borderline personality disorder. The first type is the cognitive behavioral therapy (CBT). This involves the identification and changing of core beliefs and behaviors of affected individuals that make them have inaccurate perceptions of themselves and problems interacting with others (National Institute of Mental Health, n.d). This acts to reduce moods and anxiety symptoms as well as a number of suicidal and self-injuring behaviors. Second, the dialectical behavior therapy focuses on mindfulness. This teaches the affected individual how to control strong emotions, reduce self-injuring behaviors, and enhance their relationships with others. Unlike CBT, this therapy works by balancing between changing and accepting beliefs and behaviors (Paris, 2008). The third type of psychotherapy is the schema-focused therapy. This therapy based on the notion that a distorted self-image is the root of borderline personality disorder. A distorted image may have been brought about by negative experiences in childhood, which affect the reactions of people to their environment, relationships with others, and coping mechanisms. A mental health professional may provide therapy either one-on-one with an individual patient or in a group setting (Mondimore & Kelly, 2013). Apart from these three major therapies, there are other therapies that mental health professionals may use on individuals with borderline personality disorder. Treatment of this disorder may be effective for some symptoms. However, other symptoms such as mood change, impulsiveness and anger tend to be more persistent (Paris, 2008). Psychosocial Issues BPD is characterized by different psychosocial issues. This disorder is known to have significant effects on relationships, hence causing them to be in turmoil. An individual living with BPD will, therefore, have love-hate relationships with other people (Mondimore & Kelly, 2013). This is mainly it is hard for the individuals to accept gray areas, as they only view things in black or white. In addition, identity diffusion is a major issue that a person with BPD experiences. This is usually considered to result in frequent changes in jobs, friendships, values, and goals. This also results in the self-harming behaviors that are linked to the disorder. Labelling and Discrimination People with mental illness face a considerable level of discrimination. Thornicroft, Rose & Kassam (2007) argue that most mentally ill patients receive poor quality physical healthcare. They, however, attribute this to mental health illiteracy and negative attitudes towards people with mental illness. According to Chapman & Gratz (2007), the stigma associated with BPD is strong as compared to other mental disorders. These also note that the cause of stigma for BPD people includes the television and film media, lack of knowledge on the causes of BPD, and some of the behaviors that go along with BPD, which hit a nerve on people in society. Beck, Butler, Brown et al Dahlsgaard (2001) also found out that specific sets of dysfunctional beliefs held by people contribute to the discrimination of people with personality disorders. According to Veysey (2014), the diagnosis of BPD attracts significant stigma. Individuals suffering from BPD are labeled as being attention-seekers, untreatable, and manipulative. Veysey (2014) interviewed eight BPD patients in New Zealand, who faced discriminatory experiences from healthcare professionals. One of the effects of discrimination of BPD patients was found to include negative self-image as a result of negative comments. In another study by Rivera-Segarra, Rivera, Lopez-Soto, Crespo-Ramos, & Marques-Reyes (2014) to explore stigmatization of BPD individuals in Puerto Rico, results showed that people living with BPD experienced a high attributed personal responsibility, discrimination, lack of social support, and social exclusion. BPD was found to be the mental illness with more complex stigmatization. Overall, people with BPD continue to be discriminated against. This has an adverse impact on their coping ability, hence does not promote their well-being. Appropriate measures, therefore, need to be instituted to address the issue of discrimination against people with BPD in society. Ethical Issues There are different ethical issues that psychiatrists should consider when treating patients with borderline personality disorder. The first issue involves telling the patients about their diagnosis of borderline personality disorder. In the past, psychiatrists feared to share the diagnosis of BPD with patients. However, it is considered important today to share this information with patients, as this is a sign of respect, and in return, it is expected that BPD patients will cope well and build trust with the psychiatrist (Magnavita, Critchfield, Levy & Lebow, 2010). Discussing the increased risk of suicide is another ethical issue for psychiatrists. Psychiatrists are required to discuss realistic expectations with their patients. Since BPD patients are more likely to attempt suicide, it becomes challenging to know whether the psychiatrist should share this possibility with the patient. Ethically, disclosing risks to a patient exhibits respect for the patient hence might increase the trust of the patient in the psychiatrist (Howe, 2013). On the contrast, this might harmful to the patient. This, therefore, brings in the controversy of anti-suicide contracts. Nonetheless, it is ethical for a psychiatrist to share this risk, as they can face this together until the risk diminishes with time (Howe, 2013). The involuntary hospitalization of patients with BPD is yet another ethical issue in this case. Most psychiatrists hospitalize BPD patients involuntarily. However, research has shown that suicidal patients are more likely to cope well if not hospitalized. Therefore, psychiatrists should discuss the possibility of hospitalization with their patients in open early on the treatment process (Magnavita, Critchfield, Levy & Lebow, 2010). Another ethical issue regards how psychiatrists should act when patients attempt suicide and failed. Ethically, psychiatrists should discuss with patients early on the treatment on what they would do if the patient attempted suicide. When the psychiatrist assures a BPD patient that they will continue with treatment, this helps to dispel some of the abandonment fears of the BPD patient (Howe, 2013). Recommendations Borderline personality disorder remains one of the most dangerous personality disorders. Therefore, for the general good of society, there is need to ensure that people are protected from this disorder and those that already have it are provided effective care and treatment. To achieve this, first, all parents should embrace responsible parenting. This is the major reason that negative childhood experiences play a major role in the development of BPD in individuals. By protecting their children from different negative childhood experiences, parents will have played an important role in the prevention of this disorder. Creating awareness among people on BPD including its symptoms and effects is important in ensuring that more people visit mental health professionals for diagnosis. Currently, it is considered that many people with BPD do not seek medical attention until later when this disorder starts to take a toll on their life. Awareness will encourage early treatment, which is more effective. Finally, it is also important for the government in collaboration with different health bodies to educate the masses on BPD including its causes, symptoms, and effects. This will go a long way in reducing discrimination and labeling of people with BPD in society. Discrimination of these individuals reduces their ability to cope and might increase their likelihood of attempting suicide. Therefore, an educated population will understand these individuals and co-exist with them, hence contributing to their healing process. Overall, an understanding of BPD is important, as this might help to promote positive interaction with affected individuals. References Beck, A., Butler, A., Brown, G., Dahlsgaard, K., Newman, C. & Beck, J. (2001). Dysfunctional beliefs discriminate personality disorders. Behaviour Research and Therapy 39: 1213–1225. Chapman, A. & Gratz, K. (2007). The Borderline Personality Disorder Survival Guide. New York: New Harbinger Publications. Clarkin, J., Levy, K., Lenzenwenger, M. & Kernberg, O. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. American Journal of Psychiatry, 164: 922-928. Cutler, J. (2014). Psychatry. London: Oxford University Press. Gunderson, J. (2009). Borderline Personality Disorder: Ontogeny of a Diagnosis. American Journal of Psychiatry, 166: 530–539. Howe, E. (2013). Five Ethical and Clinical Challenges Psychiatrists May Face When Treating Patients with Borderline Personality Disorder Who Are or May Become Suicidal. Innovations in Clinical Neuroscience. 10(1): 14–19. Magnavita, J., Critchfield, K., Levy, K. & Lebow, J. (2010). Ethical Considerations in Treatment of Personality Dysfunction: Using Evidence, Principles, and Clinical Judgment. Professional Psychology: Research and Practice, 2010, Vol. 41, No. 1, 64–74. Mondimore, F. & Kelly, P. (2013). Borderline Personality Disorder. New York: JHU Press. National Institute of Mental Health (n.d). Borderline Personality Disorder. Retrieved from http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/borderline_personality_disorder_508.pdf Paris, J. (2008). Treatment of Borderline Personality Disorder. New York: Guilford Press Rivera-Segarra, E., Rivera, G., Lopez-Soto, R., Crespo-Ramos, G., & Marques-Reyes, D. (2014). Stigmatization Experiences among People Living with Borderline Personality Disorder in Puerto Rico. The Qualitative Report 2014 Volume 19, Article 30, 1-18. Thornicroft, G., Rose, D. & Kassam, A. (2007). Discrimination in health care against people with mental illness. International Review of Psychiatry, 19(2): 113–122. Veysey, S. (2014). People with a borderline personality disorder diagnosis describe discriminatory experiences. Kōtuitui: New Zealand Journal of Social Sciences Online, 9:1,20-35. Read More