Understanding Borderline Personalities | Susanna Kayson in “Girl, Interrupted.” (2024)

Borderline Personality Disorder (BPD) is a complex psychological illness that is difficult for even professionals in the mental health field to grasp. Yet, as the illness becomes more present in our society, research and patience towards understanding its origin and development are gradually improving. Due to my fascination with the “disorder” myself, I feel one way to communicate and identify the symptoms and lifelong struggles these individuals experience is to choose great characters in existing literature and pop culture, and walk the reader through my analysis of what is occurring internally with these special individuals who deserve nurturing and understanding.

After watching the film, Girl, Interrupted, I was very intrigued by the protagonist, Susanna Kayson’s mental illness case and how she struggles with Borderline Personality Disorder (BPD). Her experience at the psychiatric ward, Claymore, effectively shows how she relates with other characters in the story, and how her interactions display complex ways in which people perceive their world and respond to survival.

The presenting problem with Susanna is that she is admitted to Claymore after attempting suicide (Criterion 5). She denies this and based on the way she describes her altered sense of reality and time at the moment it happened, it appears she was experiencing a helpless episode of depersonalization (Criterion 9) and took vodka and an overdose of aspirin to stop the strange visions, such as losing bones. It also appears even after getting admitted to Claymore, she displays signs of depression and wants some rest (Criterion 7). As soon as she accepts going she is instantly hesitant towards the outlook of her future staying at the ward. After seeing several patients, she instantly feels she is more normal than other characters because she is not entirely in touch yet with her symptoms and continues to be in denial. During her stay, she cannot seem to turn off memories that burden her, and any subtle thing, such as a song or phrase, can get her back to another moment in time. The journey with Susanna is not linear, which effectively shows how the mind of a person with BPD is tortured by memories and thoughts that strengthen guilt, loneliness, and feelings of hopelessness.

In terms of Susanna’s family history, little is known about it, but it is suggested by her therapist, Dr. Melvin Potts that the condition is five times more likely to be passed down genetically from a borderline parent (American Psychiatric Association, 2013, p. 665). It is uncertain which parent might have the diagnosis, but it is suggested to be the mother. Both parents have negative reactions towards her diagnosis, especially when Susanna inquires whether BPD is genetic. As a result, it appears Susanna was brought up in a more conventional atmosphere where mental illness is not discussed.

When viewing Susanna’s flashbacks we learn that she is socially withdrawn and struggles to conform to societal expectations. For example, she decides not to attend college and wants to be a writer. Throughout the film, it appears she does not receive validation for her career aspirations outside of Claymore. She also seems disinterested in the hippy culture of her time. As a result, she does not identify with either her family’s conventional lifestyle or that of the extreme cultural shift that occurred in the 60s (Kreisman & Strauss 2010, p. 78). She has an unstable self-concept and has difficulty identifying her female role as well (Criterion 3). She does not want to be like her mother — a perfectionist and housewife — and is aware that the women who go to college and pursue a career will not likely have the choices they aspire to.

An additional issue with being a woman is her supposed struggle with promiscuity or sexuality (Criterion 4). Susanna denies her impulsivity with men, and questions whether it is another expectation for women to repress their sexuality. Impulsiveness, such as sexual promiscuity is common for people with BPD. It is a coping mechanism for feeling lonely or depressed (Criterion 1). Susanna displays this way to cope by having a sexual relationship with a married man and spending the night with an orderly right after she breaks up with her boyfriend. Susanna has not committed crimes, but she does not have a sense of following rules and is averse to control and authoritative individuals.

Although common in BPD, there is no evidence in Susanna’s history of climactic trauma or abuse. However, there are some subtle signs of neglect or lack of understanding of how to meet her needs as she has developed to young adulthood. Environmental factors in her upbringing and the drastic changes in the 60s could have contributed to her illness (Watson, 2011). Her struggle to obtain identity in a divided society is quite relatable to the issues of today (Kriesman & Strauss, 2010, p. 82). And a lack of consistency is overall damaging to all. It could also be that Susanna’s brain responds differently and the environmental factors have affected her ability to develop like the “average” person (Lo, n.d.).

Various significant events stood out to me. The first is Suanna’s overall relationship with Toby. She cares deeply about him and they have a passionate relationship. However, she struggles to feel validated by him. In one scene she talks about her suicidal ideations (which is a call for help). His responses appear unsympathetic, yet he deeply cares about her. Additionally, when he picks her up to take her to Canada with him and run away, he is insensitive or lacks the understanding towards her illness and connection with the other patients, which leaves her uncertain about going with him. As a result, they break up. The anxiety around the discussion also leaves her self mutilating as they are talking. Once he leaves, she gets impulsive and sleeps with the orderly on the same night. Susanna had an opportunity to be with someone who loved her, however, when opportunities come, people with BPD tend to regress due to lack of trust and they question the intentions of people (American Psychiatric Association, 2013, p. 665).

Another significant event is at the end of the film when Susanna and Lisa finally show differences in their illness. On the day they run away and witness Daisy’s suicide, Susanna connects more with Daisy’s helplessness and displays compassion towards her suffering. Lisa runs away without any show of remorse. The contrast shows a difference between having an antisocial personality disorder and BPD. People with BPD can be caring and show concern towards people. Susanna has been drawn to Lisa because of their polarities in character. Lisa also has charisma and is manipulative. Even some nurses at the ward cannot resist the need to be liked by her. Lisa liking Susanna has given her a sense of empowerment — that having BPD is a superpower to see the truth. People with BPD tend to believe that they do not have a problem — that the world is an unsafe and evil place (MacKenzie, 2019). This has affected Susanna’s progress in treatment. Due to Lisa’s influence of being hostile towards people who are trying to help in the facility, Susanna also feels the staff is controlling her rather than treating her. Recognizing and understanding her symptoms after Daisy’s suicide has her stop embracing her illness and work to get better. At the end of the film when Lisa and Susanna have their fight, Susanna views Lisa as the evil character after idolizing her (Criterion 2). She models Lisa as a villain in her journal. Her confrontation with Lisa is another emotional breakthrough where she recognizes that she has to work to participate in the world and create boundaries with people like Lisa. Her compassion towards Lisa, in the end, is very moving. This shows she is working to accept people for who they are and avoid splitting good versus evil. “People with BPD do not need cheerleaders or another ‘favorite person.’ They need professionals who truly get it, non-judgmentally to hold them accountable for their behavior, help them learn to unconditionally forgive that behavior, while at the same time challenging them to change it” (MacKenzie, 2019, p. 122).

My emotional reaction throughout the film is irritation towards the women in Susanna’s life outside of the psychiatric facility. I felt upset about how women like her teacher respond to her aspirations of being a writer. This displays hypocrisy towards expectations generally set upon women. Women’s rights was a strong movement like today in the 60s. The modern women’s response to the choices she has are limited and Susanna understands that. “The civil rights and antiwar movements politicized and radicalized a growing number of women bombarded with contradictory expectations and images about work and family” (Walsh, 2010). A woman going to college is considered a step-up to choosing a career instead of marriage, however, Susanna understands that these opportunities do not help in accomplishing career advancement or equal salary. The irony with BPD is that people with the illness are extremely self-aware and perceptive (Fertuck et.al, 2014), yet they focus on the negative aspects of life and that becomes their reality (Lo, n.d.).

Scenes I found moving are the relationships Susanna builds with the Registered Nurse, Valerie Owens, and Psychologist, Dr. Wick. Both confront Susanna in very different ways, but in powerful and effective ways. Valerie confronts Susanna’s cruel outbursts with her genuine blunt remarks (Criterion 8). She is also extremely warm and does not allow her limitations as an African-American woman to dominate her professionalism as a Registered Nurse. Her dedication, pragmatism, and connection to reality are exactly what Susanna needs. Dr. Wick is more of a typical Psychologist who has had more privilege than Valerie to be at the position she is in. Her confrontation towards Susanna is more about intellectualizing and analyzing Susanna’s behavior. She understands Susanna’s intelligence and is using that to help Susanna see the big picture and connect her feelings with her maladaptive behaviors. She also displays a warm genuine interest towards Susanna, and the relationship between the two is moving to watch as it develops positively.

Throughout the film, in terms of Susanna’s relationship with her symptoms, is feeling ambivalent — “Am I sane or am I crazy?” The staff at Claymore notice that she is special and encourage her to pursue what she wants. Once she begins to write in her journal she feels more free and open to connecting and understanding her illness. Although Susanna is very perceptive about social injustice as well as hypocrisy, she learns that her illness is more a struggle of adapting to change and knowing where to place her unique, artistic self in the picture. Her response to feeling alone with her uniqueness causes her to feel misunderstood and abandoned, so she succumbs to the following symptoms of BPD: having an unstable self-image, feeling empty, having unstable relationships and not knowing who to trust, feeling out of touch with reality, having temper outbursts, and engaging in self harm.

When observing how Susanna is treated at the hospital, Claymore is considered, according to Valerie, a 5-star hotel. In the 60s, psychiatric wards were still “full of an anti-psychiatry attitude, blaming psychiatry for being repressive, coercive and more damaging than helpful to patients” (Rössler, 2016). This could also be a reason for Susanna’s hesitance towards trusting and receiving treatment, as well as the continued stigma towards mental illness. However, in comparison to other psychiatric institutions, Claymore, or McLean Hospital (the actual hospital Susanna went to in real life), has a good reputation. It is private and has a record of admitting famous patients. The space in the film is clean and has overall responsible professionals. People came in at will, but once Susanna signed the contract she had to remain for eighteen months to be released. Lisa was there for eight years because she refused to respond to treatment. We do not know if she is a voluntary patient like Susanna.

“Starting in 1954 and gaining popularity in the 1960s, antipsychotic medications were introduced,” and throughout the movie, patients had to take medication each day (“Mental Health Treatment,” n.d.). Throughout the film, you notice how the dependency on using medication has affected the patients. Some were against using them, and others became too dependent on them, which caused trading unwanted medications and overdosing. Susanna at one point overdoses when she is separated from Lisa and her friend Daisy is dependent on Valium and Laxatives. It appears patients had no choice in what medication to take, showing the lack of knowledge at the time of the possible side-effects after taking a drug. Despite the irregular use and perhaps irrational dependency on medication, programs like art and dancing classes show that the hospital engages in “moral treatment” (D’Antonio, n.d.). Overall, each patient was treated like a human being and experienced no abuse — at least in the eyes of Susanna.